Care Home: Glendale House

What the care home does well There`s a relaxed and homely atmosphere. People say that the care workers are kind and attentive. They also say that they receive the support and assistance they need. There are interesting social things that people can do. People are helped to stay in good health. This includes keeping an eye on how everyone is and then calling doctors as soon as they are needed. People`s medicines are handled safely so that they take them in the right way at the right time Sensible things are done to help prevent people having accidents. People are served with good quality meals. What has improved since the last inspection? When we last completed an inspection visit to the Service we found that things in general were going well. However, we required that two improvements be made. One was about strengthening parts of the systems used to complete security checks on new members of staff. The other involved the need to develop aspects of the training provided for staff. We also recommended that nine developments be made. They were about a range of things. Some of them were to do with aspects of how medicines are administered in the Service. This included the need to have a more secure place to store medication. One was about needing to make sure that the frames around the toilets are secure. We also wanted to make sure that no one was likely to be burnt if they fell against a radiator and that no one was likely open a window too far and then get into difficulties. Another point we made was about the need for the Manager to complete a particular training course. A further point involved the need for the Registered Provider to complete regular monitoring visits to the Service. The Manager says that both of the requirements and all of the recommendations we made have been met. As we go through our report, we`ll mention some of the things we found. They largely support what the Manager`s saying. In more detail, some of the recent improvements are as follows: Seven of the bedrooms have been redecorated and have had new carpets laid. A new table and new chairs have been provided in the garden patio area. In the kitchen there`s a new fridge and dishwasher.A new and more sturdy trolley has been provided for the secure storage of medicines. Members of staff have done various relevant training courses. What the care home could do better: There`s no record kept of the tea time meals that are served. This means that we can`t get a reliable picture of the variety and choice being provided at this meal time. There`s an error in the written complaints procedure. This needs to be put right so that people know about all of their rights. The doorway and the ramp that lead to the patio area aren`t that easy to use for people who have difficulties with getting about. The employment history for one member of staff isn`t detailed enough. This means that the Registered Provider can`t be sure that it has done all of the necessary security checks. There are some gaps in the training records. This means that it`s not clear that all care workers have done all of the training that`s intended for them by the Registered Provider. Parts of the fire safety system need to be strengthened. This is necessary to ensure that the Service continues to provide the high level of fire safety protection that is required. All parts of the electrical installation have not been certified as being safe to use. Key inspection report Care homes for older people Name: Address: Glendale House 32 Boyne Park Tunbridge Wells Kent TN4 8ET     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mark Hemmings     Date: 0 4 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Glendale House 32 Boyne Park Tunbridge Wells Kent TN4 8ET 01892524222 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Chistlehurst Care Ltd care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Up to 20 older people can make their home in Glendale House (the Service). The property is a detached older house thats been adapted and extended for its present use. The accommodation is on the ground floor, first floor and second floor. Theres a passenger lift that gives step free access to all of the floors. Two of the bedrooms can be shared by two people each. In practice, theyre only now used for single occupancy. This means that everyone has their own bedroom. All of the bedrooms have a private wash hand basin. Four of them also have a private toilet. There are two bathrooms. Theres also a wet room thats got a walk-in shower. Theres a call bell system. This has call points in each of the bedrooms, bathrooms and toilets. This means that people Care Homes for Older People Page 4 of 33 Over 65 20 0 Brief description of the care home can ring for assistance should it be needed. Glendale House is a no-smoking Service. This means that people who live in the Service are asked to smoke outside where theres a small covered area. The Service is in a quiet residential street thats about half a mile or so from Tunbridge Wells town centre. At the back, theres a large enclosed garden. Theres a level lawn area where there are seats. To get to it you have to go up a short flight if steps. To the side of the property, theres a sheltered patio area where there is a garden table and chairs. The Service doesnt have its own vehicle. The Registered Provider is a private limited company. The weekly fee for living in the Glendale House runs from £337.15 to £585.00. This fee includes all accommodation costs, meals taken in the Service, laundry and the provision of personal care. It doesnt include things like seeing the hairdresser and having a newspaper delivered. If you want to find out more about the fees you can phone the Service and have a chat with the Manager. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. Since 1 April 2006, weve developed the way we do our inspection of care services. This inspection of the Service was an unannounced Key Inspection. We arrived at the Service at about eight oclock in the morning and we were there for about seven hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with five of the people who live in the Service. We also spoke with the Manager, three care workers and the cook. We walked around parts of the accommodation and we looked at a selection of key records and documents. Care Homes for Older People Page 6 of 33 Before we visited the Service, we asked 10 of the people who live there and 10 members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of Glendale House. Eight people who live there and eight members of staff kindly completed them for us. Later on in our report, well tell you what people are saying in these questionnaires. The Registered Provider has also recently asked the people who live in the Service, their relatives and members of staff to say what they think about the Service. As we go through our report well tell you some of the things that people are saying in their replies. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? When we last completed an inspection visit to the Service we found that things in general were going well. However, we required that two improvements be made. One was about strengthening parts of the systems used to complete security checks on new members of staff. The other involved the need to develop aspects of the training provided for staff. We also recommended that nine developments be made. They were about a range of things. Some of them were to do with aspects of how medicines are administered in the Service. This included the need to have a more secure place to store medication. One was about needing to make sure that the frames around the toilets are secure. We also wanted to make sure that no one was likely to be burnt if they fell against a radiator and that no one was likely open a window too far and then get into difficulties. Another point we made was about the need for the Manager to complete a particular training course. A further point involved the need for the Registered Provider to complete regular monitoring visits to the Service. The Manager says that both of the requirements and all of the recommendations we made have been met. As we go through our report, well mention some of the things we found. They largely support what the Managers saying. In more detail, some of the recent improvements are as follows: Seven of the bedrooms have been redecorated and have had new carpets laid. A new table and new chairs have been provided in the garden patio area. In the kitchen theres a new fridge and dishwasher. Care Homes for Older People Page 8 of 33 A new and more sturdy trolley has been provided for the secure storage of medicines. Members of staff have done various relevant training courses. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods will be helped to go back home. Evidence: The Manager asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving in to Glendale House is the right thing for them. She also talks with family members and with people like care managers (social workers). All of this information is collected so that the Manager can build up a really good picture of how the person can best be supported. After shes got all of this information, she can then decide if Glendale House can meet the persons needs for help. We looked at the information thats been collected for one person whos recently moved into the Service. We wanted to see what sorts of things are being considered. Care Homes for Older People Page 11 of 33 Evidence: Theres lots of useful information. Theres information about practical things such as the help needed in the bathroom and about health care. But there is also other information about quality of life things. Such as the sorts of social activities the person likes to do. The Manager says that when she gets the information she shares it with the care workers. This is done so that care workers know in advance about what support they will need to provide. We asked two care workers about how all of this works out in practice. They say that they are indeed told about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days, while they get to know them better. The Manager recognises that moving into a residential care setting is a big step. She says that she wants to do everything possible to put the persons mind at rest. We agree that this is really important. She says that as part of the introduction process, people are invited whenever possible to visit Glendale House. This is so that they can see what the place is like first hand. During these visits, people can ask any questions they want. There are also some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Manager is quite happy for them to take away a copy if they want to have a look at them at their leisure. One of the care workers says, we find out quite a lot about someone whose moving in so that we know what help they need and the best way to go about this. We want someone to feel at ease as soon as possible and we dont want to have to ask them loads of questions about themselves while theyre still settling in. In our questionnaire we ask people who live in the Service, did you receive enough information about this home before you moved in so you could decide if it was the right place for you? Everyone says that yes they did. One person adds, when I came here the staff were very kind and made me feel welcome. Thats really important because its very stressful to have to leave your home and move somewhere new. They really did their best and I didnt feel rushed about making a decision about whether to stay or not. It felt homely from the start and I liked and like the kind attitude of the staff. Ive not regretted moving in here, this is a kind place to be. Nearly all of the people who move into the Service do so with the intention of making it their longer term home. However, there is the chance that someone will only want to stay for a shorter period. This might be so that someone who cares for them at home can have some time to themselves. Or, someone might move in because theyve been in hospital and arent quite ready to go home yet. When someone moves Care Homes for Older People Page 12 of 33 Evidence: into a residential care setting theres always the risk that their stay might become longer than is necessary. The Managers aware of this. She says that people are helped to make any arrangements that are necessary for them to go home as planned. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the personal and health care they need. Medicines are handled safely. People are treated with kindness and respect. Evidence: The people who live in the Service say that the care workers offer them all the assistance they need. Theres a written individual plan of support for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to care workers so that they know what to do. We looked at two of these plans in some detail. They give a clear account of who needs to do what and why. For example, theres useful information about things such as helping people in the bathroom, about health care and about keeping people safe. In more detail, one person needs special help to promote their continence. Another person wears dentures and likes to have them cleaned over night. Theres also information about quality of life things. For example, about the times that people like to go to bed and about when they want to get up in the morning. Care Homes for Older People Page 14 of 33 Evidence: We asked three care workers about some of these things. We wanted to know what all of this written information means in practice. They know all about it. In our questionnaire for people who live in the Service we ask, do you receive the care and support you need? Everyone says that they always do. The care plans are kept up to date so that theyre accurate. This involves care workers making daily notes about how things are going. There are then monthly and annual reviews. These give the people who live in the Service and their relatives the chance to discuss in more detail how things are going. The Registered Providers questionnaire for people who live in the Service asks, do staff involve you in the planning and delivery of your care? Most people say that yes they are involved. Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, some people are a bit unsteady on their feet. They are accompanied by a care worker so that they dont lose their balance. People are helped to keep healthy. Care workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, people have seen their doctors as and when necessary. There have also been visits by other professionals such as district nurses. We looked at some of the records about how quickly doctors are being called after the need for medical attention is first noted. Its being done straightaway. In our questionnaire for people who live in the Service we ask, do you receive the medical support you need? Everyone says that they always do. People can manage their own medication if they want to and if its safe for them to do it. At the moment, everyone who lives in the Service prefers to have members of staff sorting out their medication for them. Theres a system to check that the correct medicines are received from the chemist. These checks arent being recorded at the moment. The Manager says that they will be from now on. The completion of the checks is helped by the fact that most of the medicines are put in blister packs by the chemist. This means that theres much less chance of medicines getting mixed up. Once in the Service, medicines are stored securely in a sturdy metal trolley thats fixed to the wall when its not being used. Theres a lockable refrigerator that can be used for medicines that require cool storage. The Assessment says that all members of staff who give out medication have been trained so that they know what theyre doing. Theres a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. Theres a photograph of each person thats attached to their individual records to help make sure that there are no mistakes. The records themselves are pre-printed by the Care Homes for Older People Page 15 of 33 Evidence: chemist and they list each of the medicines that someone is supposed to take. Theres a record thats completed on each occasion that a medicine is given. We examined three sets of these records for a period of several recent days. Theyre correctly completed. We looked at three medicines in more detail. This was done to see if the remaining stock matches what should be there. Again, we found things to be in order. People say that the care workers are courteous and attentive. In our questionnaire we ask, do the staff listen and act on what you say? Everyone says yes. When we were in the Service we talked with people a lot about this. They are very positive about the care workers. Two people summarise the general mood in their comments to us. One says, I get treated really well here and the staff really are very kind. Nothing at all is too much trouble for them. They make the place of course and I cant speak too highly of them. The other says, I like my home here, Ive no complaints the staff are really so kind and helpful. I feel quite okay if I need something because I know that theyll help me and do so willingly. The Registered Providers questionnaire also asks about this subject. It says, do you feel that the staff listen to you? Most people say that yes they do. It also asks, are you satisfied with your overall care? Everyone says that yes they are. When people want to use the bathroom, they are helped to leave the lounge without drawing attention to themselves. Then they are helped in the bathroom with the door closed so that they can have privacy. People are helped to wear neat and clean clothes so that they can present themselves how they want. Theyre given their post promptly. Also, theyre helped to deal with it if something is difficult for them. People can use the phone if they want. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some interesting things for people to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: The Manager says that the plan is that at least several times a week theres a social thing that people can do. These events involve various things. Some of them are when outside entertainers come in to play music or to lead gentle exercises. At other times, care workers do things such as games and quizzes. In our questionnaire we ask, are there activities arranged by the Service that you can take part in? Six people say that there always are and two people answer usually. The Registered Providers questionnaire deals with this subject too. It asks, do you feel that there are enough activities in the home? Most people say that yes there are. When we were in the Service we chatted with people about this subject and in general we got positive comments. One person says, theres always something to see even if theres no activity on as such. I do the music and movement and there are the activities that the staff put on to. Theres no need to be bored here, theres normally something to watch or to take part in. Care Homes for Older People Page 17 of 33 Evidence: People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Manager keeps in touch with family members so that they know how things are going. For example, if someone is not well or if they are admitted to hospital. The Registered Providers questionnaire for relatives asks, do you feel that you are kept up to date with your relatives/friends care? Most people say that theyre happy with the present arrangements. The Registered Provider doesnt get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Instead, most people get help from members of their family or from people like solicitors. The Assessment says that people are encouraged to make their bedrooms their own private space. They are asked to bring in things for their own homes so that they can have personal items around them. We saw lots of examples of this. People have their own photographs and ornaments so that their bedrooms feel more like being home. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. One of the questions we ask in our questionnaire for people who live in the Service is, do you like the meals? Four people say that they always do and four people say that they usually do. The Registered Providers questionnaire for people who live in the Service asks about this too. It says, are your meals attractively served and enjoyable? Most people say that yes they are. Theres a choice of dish at each meal time. We looked at the records of the meals provided over a two day period. We wanted to see if different people are actually having different things and they are. The Registered Providers questionnaire for people who live in the Service asks, are you offered a choice of meals? Two people say that yes they are, two people say that sometimes they are and two people say that theyre not sure. We looked at the variety of the lunchtime meals provided over a period of two or three days. Theres a reasonable balance. The dishes include things like shepherds pie and sausages and onions. Unfortunately, we couldnt do the same check for the tea time meal because records arent kept of these. We think that it would be helpful to keep a record of these in the future. We chatted quite a lot with people about the catering when we were in the Service. One person sums up the general tone when they say, the meals are excellent. I always have enough to eat, in fact too much. I tell the girls I only want small portions but they put more on because they say they want me to eat what I can and that if I leave some they know that Ive had a really good meal. Thats how caring they are here. Care Homes for Older People Page 18 of 33 Evidence: Care workers say that people can have drinks and snacks throughout the night. This is important. Otherwise, it can be a long time for some people between the late evening milky drink and breakfast the next day. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Theres a complaints procedure but it needs to be strengthened. There are arrangements to make sure that complaints are dealt with properly. There are arrangements in place that are designed to safeguard people. Evidence: We asked several people about making complaints. They say and show by their relaxed manner they would feel quite okay about raising a complaint should they need to. One person sums up the overall mood when they observe that, I can say what I want and the staff are always helpful and kind. Ive never had anything to complain about but if I did Im sure it would get sorted out straight away. In our questionnaire for people who live in the Service we ask, do you know how to make a complaint? Everyone says that yes they do. The Registered Providers questionnaire asks about this too and gets the same response as does ours. Theres a written complaints procedure. This explains how to go about making a complaint or raising a concern about something. Its the Registered Providers responsibility to sort out complaints. However, people can also tell us about things that are concerning them. This isnt clearly explained in the current procedure. The Managers going to sort this out by 1 August 2009. Its very important that people are confident that theyre safe from being mistreated in some way. The Assessment commits the Registered Provider to ensuring that people who live in the Service are indeed kept safe. In our questionnaire for people Care Homes for Older People Page 20 of 33 Evidence: who live in the Service we ask, is there someone you can speak to informally if you are not happy? Everyone says that yes there is. One person adds that the Service, provides me with a warm, safe friendly place (to live). Its like home from home. The staff are like a big family. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation is comfortable and pleasant. Theres a modern fire safety system. The kitchen is well equipped. Theres a suitable laundry. Evidence: The building is well maintained on the outside. On the inside, the accommodation is well decorated and furnished. Although its quite a large building, the place has a homely, lived-in feeling to it. Having said this, some of the bathrooms and toilets are a bit bare and uninviting. We had the chance to see some of the bedrooms. Theyre well decorated, there are good quality carpets and the furniture is in a good condition. When someone leaves the Service their bedroom is redecorated. We saw one bedroom thats just been prepared in this way. We found it to be presented to a high standard. Our questionnaire for people who live in the Service asks, is the home fresh and clean? Everyone says that it always is. The buildings fitted with an automatic fire detection system. This provides a high level of fire safety protection. We understand that the fire brigade people say that the system meets the national standard. The Registered Provider does a regular fire safety risk assessment. This is where the Manager goes around the place to check out that everythings still working in the right way. We looked at the record of the most recent Care Homes for Older People Page 22 of 33 Evidence: one. It says that the fire safety system remains well organised and safe. The Managers going to update the assessment by 1 August 2009. Once this is done, shes going to send it to the fire brigade people. This is so that they can double check that everything remains okay with the Services fire safety arrangements. The people from the local Department of Environmental Health called to look at the kitchen in 2008. We looked at their report. It gives the Service a Gold Star and says that there is, an excellent standard of food hygiene. We looked in the kitchen too. Its well equipped, clean and well organised. The cook checks to make sure that the fridges and the freezer keep foods cold enough. Theres also a system to make sure that foods are used promptly once theyre opened. The cook checks to make sure that hot foods are properly cooked through before theyre served. She knows about other food hygiene things too. For example, about the need to keep uncooked meats separate from other foods when theyre being prepared. People who need it are helped to get about. Theres a walk in shower. This means that there isnt a shower tray that you have to step into. One of the bathrooms has a bath with a special seat that winds up and down. Theres also a mobile hoist that can be used in the bedrooms. This might be needed if someone cant manage at all to get out of bed. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. More generally, there are banister rails along corridors. There are sturdy frames near to the toilets. People find these very helpful when they are getting down and getting back up again. There are other less obvious things to help people get about. For example, theres a special belt that can be used to give people that extra bit of help they might need when getting up from a chair. Also, there are special sheets that can be used to help people change position in bed. When someone moves into the Service, the Manager makes a note of what assistance they need to get about. She looks at things such as the help someone needs in the bedroom and in the bathroom. We asked care workers about this. They know what theyre doing. The French doors that lead out onto the garden have got quite a large step on the outside. Theres then quite a steep ramp that leads down to the patio area. Both of these things are not that easy to use if someone has difficulty getting about. We think that the Registered Provider should consider putting in a more gentle ramp that does away with the step altogether. We asked people how warm the accommodation is kept. They say that they are Care Homes for Older People Page 23 of 33 Evidence: always comfortable even during the coldest weather. We thought that the lounge was a bit on the cool side when we were sitting in there after lunch. This was because the French doors were open and there was a draught. These doors really need to be kept closed except when its hot outside. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. The hot water taps that are used by the people who live in the Service are temperature controlled. This means that they wont get hot enough to scald someone. We tested a few taps and the temperature seems alright to us. The laundry has two large washing machines. These have an extra cycle for items that need an especially hot wash. Theres a tumble dryer. We looked in the laundry. Its well organised and clean. New rules have been introduced to help make sure that used water doesnt leak back from things like washing machines into the drinking water supply. It looks like the Service already meets these rules. However, just to be on the safe side the Registered Providers going to contact the local water supply company to find out. Its going to do this by 1 August 2009. The Manager says that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. We asked people about this. They say that they do nearly always get their own clothes back from the laundry. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough care workers around. Care workers know what theyre doing. Security checks are completed on new members of staff. Evidence: The Manager says that in addition to herself theres a minimum of two care workers on duty from early in the morning until later in the evening when the night care workers come on duty. Each day there is a cook on duty and each weekday there is also a housekeeper. We looked at the written roster for several recent days to check this out in more detail. It confirms what the Manager says. In our questionnaire we ask people who live in the Service, are the staff available when you need them? Six people say that they always are and two people answer usually. In our questionnaire for members of staff we ask, are there enough staff to meet the individual needs of all the people who use the Service? Three people say that there always are, three people say usually and two people say sometimes. The Registered Providers questionnaire for members of staff asks, do you feel that the residents receive good care? All but one person answers yes. When we were in the Service we kept a look out for things that might give us a clue about how well the place is being staffed in practice. We noticed that two people who asked to be helped to use the toilet were assisted straight away. Another thing was the call bell that sounded twice. On each occasion it was answered in less than one minute. Its very Care Homes for Older People Page 25 of 33 Evidence: important that only honest and trustworthy people are employed as care workers. With this in mind, the Registered Provider completes a number of security checks on new care workers. These include things such as confirming their identity, taking up references and doing a police check. The Manager says that recently she has double checked to make sure that the checks in question have been done. We looked at the records for one recently appointed care worker. Most of the necessary checks have been done. However, the record of the past jobs the person has had isnt detailed enough. This means that the Registered Provider cant be sure that it has obtained all of the necessary references. The Managers going to sort this out by 1 August 2009. The Manager says that new care workers have introductory training before they work on their own. In our questionnaire we ask about this. We say to members of staff, did your introductory training cover everything you needed to know to do the job when you started? Five people say that the training met their needs very well and three say that it mostly did. Theres a checklist of the subjects that new care workers are told about. We looked at one of these checklists. It shows that important things are being covered. For example, new care workers are told about the individual care plans we spoke about earlier. Theyre also told about fire safety things. The Manager says that this initial training is just to get the care workers started. Theres a lot to learn after that. She says that all care workers are expected to do regular training in important subjects. For example, in how to safely support people move about, in basic first aid, in keeping people safe and in infection control. We looked at the records of who has done what courses and when. The records show that care workers are doing quite a lot of training in relevant subjects. In our questionnaire we ask members of staff, are you being given training that is relevant to your role and that keeps you up to date with new ways of working? Everyone answers yes to this question. The Registered Providers questionnaire for members of staff asks, are you given the opportunity to attend training sessions? Nearly everyone says that yes they are. However, there are some gaps in the training records. Its not clear if these are just an administrative error or if they show that some care workers have not had parts of the training that is intended for them. The Managers going to sort this out by assessing the skills and knowledge that each care worker already has. This is so that she can be sure that each person does training in the future that will be of the most benefit to them. Shes going to do this using a new national model that we think is very useful. Care Homes for Older People Page 26 of 33 Evidence: Theres a total of 13 care workers employed in the Service. Of this number, seven of them have completed a National Vocational Qualification (NVQ) in health and personal care. This qualification is a very good idea. This is because it helps care workers to deliver high quality residential care services. The Manager says that all new care workers will be encouraged to work towards the qualification. We spoke with three care workers to find out what they know about particular bits of the support they will need to give people. As we have said earlier in this Report, they know a lot about how each of the people who live in the Service likes to be supported. More generally, they know about helping older people to take care of their skin. They also know about how to respectfully help people who need assistance to manage their continence. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Things are well managed. However, the Manager isnt registered with us yet. People are asked what they think of their home. However, they arent as involved as they might be. People are helped to buy what they want. There are sensible health and safety arrangements. Evidence: The Manager has a good knowledge of how things are going. She has one of the two formal qualifications that are recommended by the Standards. These qualifications are important. This is because theyre designed to help managers ensure that high quality support is reliably provided. The Managers been in her post for several years now. The Registered Provider hasnt asked us to register her. This is now quite overdue and it needs to be sorted out without any further delay. Its important because we need to have an opportunity to discuss with her the plans she has for maintaining and developing the Service. The Manager says that she is about to complete the necessary application to send to us. Care Homes for Older People Page 28 of 33 Evidence: Shes assured us that we will receive it by 1 August 2009 at the latest. The Registered Providers reminded that this is a legal requirement. If we dont receive the application as promised, well take enforcement action. The care workers say that there is good team work between them. There are handover meetings at the beginning and end of each shift. These are held so that care workers can be kept up to date with developments. There are team meetings every couple of months or so. We looked at the records of the sorts of things that are being discussed. Theyre practical and relevant. For example, care workers have recently talked about the need to be careful to make sure that clothes are ironed properly. Theyve also discussed how to support some people to make sure that they can change their clothes as often as they want to. In our questionnaire for members of staff we ask staff, do the ways you pass information about people who use the Service between staff (including the manager) work well? Five people think that they always do, two people answer usually and one person says that they sometimes do. Its really important that the people who live in the Service have a direct say on how things are going. Theyre the experts because they live there. The Assessment says that people who live in the Service are regularly asked what they think about their home as part of everyday life. In addition to this informal thing, there are the questionnaires that weve already mentioned. The Manager does a summary of whats been said. She then prepares an action plan that lists how shes going to respond to any improvements that may have been suggested. However, there isnt really any way for the people who live in the Service to know whats been said about their home or about what improvements are going to be made. We think that this is really important. This is so that people can be actively involved in deciding things about their home if they want to. The Manager says that after the next round of questionnaires, people who live in the Service will be told about whats been said. The Registered Provider has an Area Manager. She calls to the Service about once a month to see how things are going and to support the Manager. She completes a record of these visits. We looked at the most recent one of these. It shows that the Area Managers doing important things such as checking what accidents have occurred and reviewing the individual plans of care. She also talks with the people who live in the Service and with members of staff. The Registered Provider doesnt hold any money for anyone. Instead, it helps some people by paying for things for them and then sending a bill to their families about once a month. The Manager says that each of the people concerned and their relatives have agreed to this in advance. We looked at some of the records for one person. We wanted to see if the amounts claimed to have been spent are reasonable. We also Care Homes for Older People Page 29 of 33 Evidence: wanted to see if the purchases are supported by a receipt to prove that the money in question has been spent. Things are in order. The Manager says that regular checks are completed to ensure that the Services fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells. More detailed checks of the fire safety equipment are completed every now and then by an engineer. There are regular unannounced fire drills. These are also used as opportunities for members of staff to have training in how to operate the Services fire safety procedure. Most but not all, members of staff have recently received fire safety training in this way. This training is very important. This is because the level of fire safety protection largely depends upon members of staff doing the right thing when theres a fire safety emergency. The Managers now going to strengthen the training system. This is so that all members of staff have a period of fire safety training at least once in every six months. Shes going to do this by 1 August 2009. There are up to date reports from engineers about things such as the passenger lift and the gas appliances. They say that everything is in good working order. However, when an engineer last looked at the electrical wiring installation a limited number of improvements were required. Most but not all, of these have been done. The Manager says that the remaining items will be completed by 1 August 2009. We looked at the record of accidents that have occurred in the Service over the past several months. There hasnt been that many. Most have been minor bumps and bruises. The Manager keeps an eye on who has had an accident and what has happened. This is done so that she can do something if theres a particular problem that is causing the accidents. The Manager says that she and the care workers regularly check the accommodation. They do this to make sure that nothing is broken. Also, they want to see that there are no hazards that might cause someone to have an accident. For example, they look to see that there arent any carpets that are loose and that might cause someone to trip over. Another check is making sure that things like bleach are stored securely when theyre not being used. They also check the operation of the windows to make sure that none of them open too wide. The Manager says that no one has noticed anything in particular that needs attention. We kept our eyes open when we were walking around. We didnt notice any particular hazards either. Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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