Care Home: Godolphin House

What the care home does well People who use the service, who we spoke to, said they were happy living in the home. They said staff were caring and supportive. Food provided is to a good standard and there is a choice of main meal and evening tea. There are some organised activities which are available to everyone. Our expert was very positive about the home`s decor, her observations of the care received and by the attitude of the manager. What has improved since the last inspection? The manager has settled into her post and is registered with the commission. This has helped make the home feel more organised, ensure there is a more settled atmosphere, and helped to improve people`s satisfaction with the delivery of the service they have receive. The registered persons have worked hard to address the issues outlined in the last key inspection report. Care planning has improved, medication is generally managed appropriately, there is a satisfactory adult safeguarding policy and most staff have received training regarding adult safeguarding. There is improved ventilation in the kitchen. Quality assurance systems have improved. What the care home could do better: In summary the statutory requirements, which the registered provider must take action include improvement regarding: (1) Pre admission assessment records. (2) The medication system-particularly in regard to staff training in this area. (3) Maintaining previously agreed communal space for people using the service. (4) Ensuring two references are always received for new staff-including one from their previous employer /where they have recently worked in a caring capacity. (5) Complete planned staff training. These matters must be addressed in the timescales set, and the commission will monitor to ensure appropriate action is taken through our assessment processes. Key inspection report Care homes for older people Name: Address: Godolphin House 42 Godolphin Road Helston Cornwall TR13 8QF     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: Ian Wright     Date: 0 6 0 4 2 0 1 0 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 34 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Godolphin House 42 Godolphin Road Helston Cornwall TR13 8QF 01326572609 01326569432 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ablecare (Helston) Ltd Name of registered manager (if applicable) Mrs Ann Marsh Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 31. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP - maximum 31 places Dementia aged 65 years and over on admission - Code DE(E) - maximum 5 places Mental disorder, excluding learning disability or dementia, aged 65 years and over on admission - Code MD(E) - maximum 5 places Date of last inspection 1 1 0 6 2 0 0 9 0 0 0 Over 65 5 5 31 Care Homes for Older People Page 4 of 34 Brief description of the care home Godolphin House is near the centre of the town of Helston. There is a bus which goes past the home to the centre of town. The home provides residential care for up to thirty-one elderly people, five of who may have a dementia or mental illness. The home also provides some day care. Accommodation is over 4 floors with a shaft and stair lift provided. There are two lounges on the upper ground floor and a small lounge on the lower ground floor. The home has three double rooms which can also be used for single occupancy. There is a small garden at the front and parking space at the back of the home. A copy of the inspection report was available in the hallway at the time of the inspection. The range of fees at the time of the inspection is £400 to £625 per week. There are additional charges e.g. for chiropody and newspapers. Care Homes for Older People Page 5 of 34 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: This key inspection took place by one inspector, in eight and three quarter hours in one day.All the key standards were inspected. The methodology used for this inspection was: (1)To case track three people using the service. This included, where possible, meeting and discussing with the people their experiences, and inspecting their records. (2) Discussing care practices with management and people who use the service. (3) Inspecting records and the care environment. (4) Carrying out a postal survey of the views of people who use the service, staff who work in the service, and the relatives of people who use the service. (5) An Expert by Experience accompanied the inspector. This person works for Age Concern/ Help the Aged and has experience of using care services for elderly people. Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), was used to help form the judgements made in the report. Care Homes for Older People Page 6 of 34 Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? 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 8 of 34 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 9 of 34 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. Information provided (e.g. regarding services offered) to people who use the service is to a good standard . For example people who use the service receive a statement of terms and conditions of residency or contract and a copy of the service user guide. This assists them to know their rights and responsibilities. Documentation regarding how people are assessed, before admission is arranged to the home, does need to be improved. This will give us more assurance that people who move into the home are appropriately assessed before admission is arranged to the service. Evidence: The home has a satisfactory statement of purpose and service user guide. We were told that a copy of the service user guide is available in each bedroom. If it is not the case already, it would be useful to place at least one copy of this in each of the communal areas. The persons representative should also be offered a copyparticularly if the person themselves has limited capacity. Care Homes for Older People Page 10 of 34 Evidence: People also receive a copy of the homes brochure when an initial enquiry is made about vacancies. All people using the service, who answered our postal survey stated they had enough information regarding the service, to help them make a decision, before they moved in.The one relative, who answered our survey said they received satisfactory information regarding the service. The registered persons have a satisfactory pre admission assessment policy. We inspected information regarding pre admission information for three people who have been admitted to the service since the last inspection. Although the registered manager was able to describe a satisfactory process (e.g. speaking with relatives, hospital and social services staff), documentation regarding pre assessment information does need improvement so it is clear to us how staff come to a decision regarding arranging admission for someone to the service, and how they determine they can meet someones needs before admission is arranged. Advice regarding what information needs to be obtained and recorded (e.g. as outlined in the national minimum standard), and how to demonstrate this, was given. We viewed the contracts / statement of terms and conditions of residency for the same group of people. Some of these had not been completed as we were told there were still negotiations between the local authority and the registered persons regarding contracts etc. However, other information for other people regarding contracts / statement of terms and conditions of residency was satisfactory. People who are privately funded receive a contract regarding their accommodation and care arrangements. The majority of people using the service, who answered our postal survey said they had a copy of the homes terms and conditions of residency (7), although some (3) said they did not. Care Homes for Older People Page 11 of 34 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 using the service are happy with the personal and health care support they receive. Care planning systems are generally satisfactory. Some improvement is required to the operation of the medication system to give us and other stakeholders assurance that peoples medication is managed and administered to a satisfactory standard. Evidence: An Expert by Experience helped the inspector with this key inspection. She spent her time talking with people using the service and the manager. She said she observed people using the service being treated with respect and dignity; for example how people were spoken to, and also treated when personal care is being given. She said that the people she had spoken to felt safe living in the home and people appeared well cared for. She said staff were observed knocking on peoples doors before entering, and peoples dignity was observed as being respected at all times. People also told the Expert they could have a bath when they wish. We inspected the files of three people who use the service. A care plan was available Care Homes for Older People Page 12 of 34 Evidence: on all files inspected. Care plans are accessible to staff members. Information is satisfactory; although it could be more detailed in some areas. Care plans are reviewed although we pointed out that for one person their deteriorating mobility should have resulted in the manual handling assessment being re-completed. The manager said she would attend to this. From the postal survey we can conclude people are happy with this service. The majority of people using the service (8) said they always receive the support they need, and the remainder (2) said this was usually the case. The majority (7) said they always receive satisfactory support with medical care, although (2) people said this was usually the case. One person raised a concern that they did not receive prompt attention when they needed medical assistance, and they had received conflicting messages from staff regarding the action that was taken. We discussed this situation with the registered manager. One person also said staff should respond to the nurse call bell system more promptly, although we felt this was generally well responded to on the day of the inspection. The one relative who responded to our postal survey said they were happy with the service. In regard to health records kept, these still require some improvement. Although records of when someone sees a GP and / or a district nurse is recorded, it is still difficult for us to determine when people last saw other professionals such as a dentist, chiropodist, or optician. The registered manager said these services were available and are organised, and she keeps some records on her computer (e.g. when a person next needs to see a medical professional). This is a useful system to remind the manager, but clear records of medical input do need to be kept so it is easy to determine when someone last received medical support, and when they need it again e.g. to see the dentist/ optician etc. We inspected the medication system. Medication is stored in a dedicated clinical room. Medication is supplied in a monitored dosage system supplied from a local pharmacist. Storage of general prescribed medication is satisfactory. Some controlled drugs are kept in the home, and administration and recording of these are satisfactory. The operation of the system has improved since the last visit. It seems medication is always given as prescribed, and accurate records are kept. We did note that for one person their medication was not being administered from the correct section of the monitored dosage pack. Although we received a reasonable explanation why this was, we have said that to avoid confusion, medication should be administered from the correct section of the pack. We noted some over supply of a minority of the medication ordered. This should be avoided to minimise the cost to the NHS and also Care Homes for Older People Page 13 of 34 Evidence: to avoid waste through medication having to be returned for disposal. Time limited medication also needs to be labelled when it is opened (e.g. eye drops) so it is disposed of when past its use by date. We did note that there was insufficient records that some staff had received formal training regarding the administration of medication. This needs to be arranged as soon as possible. Care Homes for Older People Page 14 of 34 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. Routines,food and opportunities generally meet the needs of the people living in the home Evidence: People using the service, who the inspector and Expert by Experience spoke to, said they could get up and go to bed when they wished, and said routines in the home are relaxed. We observed throughout the inspection a relaxed and friendly atmosphere in the home. People got up and came downstairs at a leisurely pace and there did not seem a rushed atmosphere despite staff being busy. The Expert by Experience thought the quality of life of people living in the home appears to be excellent, and it really does feel more like a family home than a residential home. She said generally people using he service said they were happy, but several said that they would like more conversation She has suggested staff could spend a little more time sitting with people and encouraging them to talk to each other. The inspector noted that the staff had started work to develop a brief life history for each person, although the manager said it was difficult to obtain information regarding Care Homes for Older People Page 15 of 34 Evidence: some people. The Expert noted that having a brief history of each person would enable the staff to prompt conversations, and would help the people to talk about loved ones they have lost, but to remember the good times they have had-which is very important when living with strangers. This seems a positive suggestion. The Expert noted that although many people were sitting around in the lounge, some were reading magazines or newspapers. The inspector noted that some of these were provided by the home which is excellent, although there are arrangements for people to purchase their own newspapers and magazines should they wish. Music was playing in the lounge, and it is positive that the TV is not left on all of the time. The Expert said the lounge seemed a peaceful setting. The manager said activities are available throughout the week, usually in the afternoon. The Expert suggested there should be a notice board or calender put up somewhere in the communal areas so people could see what was planned each day, and give people something to look forward to. The Expert also suggested there should be some physical exercises being undertaken to help to keep people mobile. This is a good suggestion, and arm chair type exercises or gentle exercise to music can be very enjoyable to people in care homes. Some homes have purchased a Wii console, and there are some exercises-aimed at older people-which can be very useful and fun for people in care homes. A vicar visits the home once a month to provide a Christian service, and some people are taken out to church by friends and relatives. A mobile library visits the home regularly. A hairdresser visits the home twice a week, and a designated room is being developed into a permanent salon where people can have their hair done. The Expert discussed with the manager about involvement of people to do small tasks such as laying tables or clearing up. However the people the expert spoke to were reluctant to participate in jobs in the communal areas. However it is a good idea that people are offered the opportunity so they can feel useful-if that is the wish of individuals living in the home. The inspector assessed the homes records and there seems regular activities provided for example-since January- a reminiscence afternoon, regular bingo sessions, flower arranging, as well as regular outside entertainers visiting to provide music. An external entertainer also provides a tea dance activity for people in the home. On one occasion the owner of the home took out some of the people for lunch which seems a nice thought. On the day of the inspection some people were offered a manicure from the care staff, and there was also a bingo session in the dining room. Care Homes for Older People Page 16 of 34 Evidence: The majority of people who answered our survey said there was enough activities available. Some said this was usually (2) the case, and some (2) said this was only sometimes the case. Some people who answered our survey stated there should be more trips out arranged by the home. The one relative who answered our survey said usually their relative could choose the lifestyle they wanted to live. Some people receive regular visitors, and some people go out with relatives. There is suitable space for people to receive visitors in private. A choice of main meal is always provided. For example on the day of the inspection people had a choice of roast meats, or another option could be provided if they did not want a roast dinner. People could make their mind up at the dinner table so it was not necessary to make a decision in advance. This seems excellent. People are offered a choice of evening tea from a number of options available to them. Regular drinks and biscuits are provided to people throughout the day and evening. The Expert by Experience observed the meal time at the home. She stated the meal looked well cooked, well presented and nutritious. She stated people using the service are given a choice of food at every meal, and people appeared to be enjoying the food at lunchtime. One man said he enjoyed the food and was appreciative that he was offered a second helping. Staff support at the meal time was observed as positive. For example several care staff sat with people using the service, to oversee the meal and to make sure that everyone was managing. Our Expert stated carers appeared to be attentive and caring, and spoke pleasantly to people using the service. The kitchen was inspected. It is generally clean, and well equipped. There was a satisfactory supply of stock. Suitable records of meals are kept. The Food Standards Agency Better Food, Better Business hygiene system is in place. For example there is a cleaning schedule in place and records of food temperatures are kept. Ventilation in the kitchen has now improved, and the kitchen floor surface has been replaced. Regular cleaning of the kitchen window ledge needs to be included on the kitchen staffs cleaning schedule as this was very dirty. Care Homes for Older People Page 17 of 34 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. Complaints and safeguarding procedures are satisfactory, and people who we contacted did not have any concerns about the service. People generally felt listened to if they have any concerns, and know what to do if they wish to express a concern or make a complaint. Some improvement regarding training in safeguarding, mental capacity and deprivation of liberty is necessary although this appears to be underway. Subsequently, people using this service should feel safe, and there are satisfactory procedures in place if people have concerns. Evidence: The registered persons have a satisfactory complaints procedure. A summary of this is contained in the homes statement of purpose and service user guide. The registered persons and the Care Quality Commission have not received any complaints regarding the home. When our Expert by Experience spoke to people in the home she reported that nobody reported any concerns, and people said to her that they had not experienced any swearing, bullying or mistreatment in any way. From our survey people using the service said staff always (3) or usually (5) act / listen to what they say, although one person said this was only sometimes the case. The majority (8) said they knew who they could speak to if they had any concerns, and knew what the complaints procedure was (8). All staff answering our survey said Care Homes for Older People Page 18 of 34 Evidence: they knew what to do if they had concerns about the home. The relative answering the survey also knew what to do if they had a complaint. There is a record of some resident and staff meetings. These should be more regular so people can build up a rapport and confidence in management, should they wish to make suggestions or raise a concern or a complaint. The registered persons have a satisfactory adult safeguarding procedure. There have been no safeguarding concerns regarding this home in the last year. The registered manager said a number of staff have just attended adult safeguarding training. There are still some staff that need to attend this, but they will receive this by the summer. The registered manager then plans to ensure staff attend Deprivation of Liberty and Mental Capacity Act training. The manager is also planning to attend safeguarding training for managers within the next few months. Care Homes for Older People Page 19 of 34 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. Godolphin House is a suitable care facility for people living there. However the registered provider must maintain satisfactory communal space for people using the service where they can spend their time. Evidence: The building was inspected. Godolphin House is a large building, with bedrooms over three floors. The home is a large Victorian house which has been extended. Floors in the main part of the house are connected by stairs with a chair lift which can be used if people have physical disabilities or are unsteady on their feet. The building has been extended, and the extension has three floors connected by a staircase and a shaft lift. The home has a large dining room, and a large lounge. The lounge can be divided in two via a partition. There is also a small quiet lounge. There is talk that this may be converted to a staff room, particularly as people were not using this quiet area. This must not happen as it would reduce the amount of communal space for the use of people using the service. Although it may not be used much now, it may be used more by people using the space in future, particularly if the space is made welcoming. Historically there was a small lounge on one of the other floors of the home, but this space was swapped with what was previously a staff office. The national minimum standards and associated regulations provide clear guidance and regulation that the amount of communal space cannot be reduced. Any further plans to change the layout Care Homes for Older People Page 20 of 34 Evidence: of the building, which could result in less communal space, must be discussed with the commission before any work commences. There are suitable toilets and bathrooms. Some of the bathrooms have assisted baths for example Parker style baths which are specially designed for people with physical disabilities and /or are frail. The registered persons have told us thermostatic valves are fitted to limit the temperature of bath water (essential to minimise the risk of scalding). We have been told records are kept regarding monthly testing to check the thermostatic valves work. All parts of the home are well decorated and maintained. Furnishings and decorations are to a good standard. The toilet seat (in the toilet on the first floor) needs replacing as the covering is very worn and also could present a infection control risk. We raised this matter at the last inspection but it has not been attended to. Bedrooms we inspected were all to a good standard. There are two designated shared bedrooms (currently let as single bedrooms), and twenty seven single bedrooms. Three of the single bedrooms have an en suite toilet and wash hand basin. Decorations, and furnishings in bedrooms are to a good standard. Many of the bedrooms do not have a lock. People using the service should at least have a lockable facility e.g. for personal possessions or valuables, if it is not appropriate for them to have a lockable bedroom door. It should be a default position that all bedrooms have a lockable bedroom door, and people are issued with a key unless they lack capacity. The front door of the home is locked from the inside and people have to ask if they want to go out. This is not really satisfactory as it prevents people from coming and going from the home. If there are some people at the home who are at significant risk of being at danger if they leave the home, the registered persons should look at other means to maintain their safety such as a pressure mat by the front door which would bleep if the door was opened. If there really is no other safe means but to ensure the front door is permanently locked this must be clearly risk assessed, recorded and this assessment regularly reviewed in line with Deprivation of Liberty / health and safety / fire guidelines. People who we spoke to said they were happy with their accommodation. The Expert by Experience said she felt the home was welcoming and homely. She felt it was good there were fresh flowers on each dining room table. She felt the home was clean and there were no unpleasant odours. People using the service said they felt the home was safe. She thought the rooms she visited were tastefully decorated, and very homely with peoples personal items around. All bedrooms were assessed as clean Care Homes for Older People Page 21 of 34 Evidence: and tidy. Our postal survey concluded that the majority of people (8) using the service are thought the home was fresh and clean . Care Homes for Older People Page 22 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are generally satisfactory and meet the needs of people using the service. Recruitment and training provision has improved since the last inspection, although some further development is still required to give us assurance that employment procedures are satisfactory, and the delivery of training meets legal standards. Evidence: On the day of the inspection there were four care staff on duty from 07:00 to 14:00. From 14:00 to 22:30 there were three care staff. There were two waking night staff from 22:30-08:00. There were also managerial staff, and other ancillary staff such as cooks, and cleaners. People using the service all said they were positive about care staff. Our Expert by Experience was able to discuss with people using the service about their views of staff. All the people she spoke to said they were treated well by the staff employed. The Expert by Experience also observed positive interactions between staff and people living in the home. She said staff seemed caring and attentive, and that they carried out their care duties with thought for the individuals concerned, and worked with people in a respectful and dignified manner. She said staff spoke pleasantly to people. The inspector was also positive about his observations of staff practice, and surveys received by us did not raise any concerns. Care Homes for Older People Page 23 of 34 Evidence: From our postal survey, people using the service also gave positive responses regarding staff members. The majority of respondents said they receive the care and support they need. The majority of respondents said staff are only usually available when they are needed (6) although the rest of the respondents (4) said this was always the case. The one relative that responded to our survey said that staff usually met the needs of their relative / provide agreed support and care / and had the right skills and experience. However no narrative comments were given to state how staff could always provide this level of support. The staff responses were positive about team work and no concerns were raised about support given by other colleagues. The staff group said there was usually enough staff (6), although some people (5) said there was always enough people. One person however said there was never enough staff. The majority (6) said there was good information sharing among the staff group, although five people said this was usually the case, and one person said this was only sometimes the case. Personnel records were inspected for nine staff (i.e. care staff on duty during the 24 hour period on the day of the inspection). Personnel records inspected were to generally a satisfactory standard. By law records need to include two references. An Independent Safeguarding Authority (ISA) check, and a Criminal Records Bureau check (CRB) need to be completed. These checks ensure people employed are not on a list which states they are deemed not fit to work with vulnerable people (ISA), or have a criminal record (CRB) which may deem them unsuitable to work in an environment with vulnerable people. Staff must have completed an application form, containing work history, provide evidence of their identity and a self declaration of medical fitness. Most records were satisfactory although it is essential: (1) All staff sign a thorough declaration of medical fitness. This was not available on some files. (2) There are always two references. This was not the case for three staff who commenced employment since April 2009. It is important a reference is always taken up from the previous employer. It is strongly advisable that a reference is taken up if the person has worked previously in a caring capacity, and they have not given this employer as a referee. One member of staff did not have references from the two care homes they worked in prior to working in this home, and only had only one personal reference in total. All staff responding to our survey stated they thought suitable checks had been completed regarding them prior to them commencing employment. From the registered persons Annual Quality Assurance Assessment (AQAA), and from discussion with the manager, there is satisfactory opportunity for staff to obtain a Care Homes for Older People Page 24 of 34 Evidence: National Vocational Qualification in care. 66 (12 out of 18) of staff have an NVQ-at least at level two according to the AQAA. About half of the staff files we assessed had evidence that people had obtained this qualification. We checked records of training staff have received. By law staff require the following training: (1) Regular fire training in accordance with the requirements of the fire authority. (2) There must always be at least one first aider on duty (at appointed person level). (3) All staff must have manual handling training and regular updates of this (e.g. annually). (4) All staff must have basic training in infection control. (5) Staff who handle food receive food hygiene training. (6) All staff must have an induction and there needs to be a record of this. Staff also need to have training to meet the needs of people who use the service such as dementia, mental health needs etc. From the records of the nine staff we inspected, seven staff have a record that they had received an induction. We were told that this was being completed for the other two staff. However these two people started working at the home in September 2009 and February 2010 respectively, and the induction checklists should have been completed by now. It is essential there is satisfactory evidence that induction training is completed, and it is done in a timely manner in order for it to be effective for the staff concerned. From the staff survey that was completed , the majority of staff (8) said induction was competed very well, although some people said this was only mostly (3) or partly (1) the case. In regard to other training this has improved since the last inspection, but some further progress is still required: (1)Manual Handling Training- All staff have received this although one person should have an update as they last received training in their previous employment in 2007. (2)Infection Control Training- One person needs to receive this training-although one person should also receive an update as they last received the training in 2003. (3) Dementia-Records show only three staff had training regarding this area. Significant action needs to occur in this area. (4) Mental Health- We did not see a record of any training regarding this area. Significant action needs to occur in this area. (5) First Aid- Staff on duty in the morning and overnight had satisfactory training, however there were no trained first aiders (apart from the manager) on duty in the afternoon until 8pm. This training needs to be delivered as a matter of urgency to ensure the safety of people using the service. (6) Fire training- There did not appear to be records that two staff had received training in this area, although records were Care Homes for Older People Page 25 of 34 Evidence: satisfactory for all other staff. Staff answering our survey all said training was relevant to their roles, and the majority said the training helped them to understand the needs of people in the home / keep up to date with ways of working / provided them with skills and knowledge regarding medication. Although there are some gaps in training provision, the manager has assured us that all staff training will be up to date by June 2010. This is outside the timescale of the statutory requirement issued at the last key inspection. We would suggest that once staff training is up to date, the manager develops training profiles or a training chart to ensure that all staff training is kept up to date in future. Care Homes for Older People Page 26 of 34 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. Management arrangements have significantly improved since the last inspection although some improvements are still required as outlined in this report. However people using the service should benefit from a generally well managed service. Evidence: The registered provider is Ablecare (Helston) Limited. The manager Ms Ann Marsh has now been registered with the commission. Our Expert by Experience discussed with people, who use the service, their views of the manager of the home. People using the service said the manager was a caring and sensitive person. The Expert by Experience also felt positive about the manager. She said the conversation I had with her was very positive, she is open to suggestions and is continuing to improve the quality of life for the residents. From our postal survey the majority of staff said they received either regularly (7) or occasionally (4) enough support from management. Narrative comments in the Care Homes for Older People Page 27 of 34 Evidence: survey were mixed. Some people said the management were supportive, although others said management and communication could be improved. The inspector noted that there is significant improvements in a number of areas of the service since the last inspection. There was also less concern expressed by staff and people living in the home, and we felt much more assured about the operation of the service on this visit compared to our previous visit. It is clear to us that now the manager has had time to settle into her post, this has had a positive impact on the functioning of the home, and subsequently the satisfaction of people living and working in the home. There is still some further work to do, but we do appreciate this takes time. The registered persons have a Quality Management Policy. This is to a good standard. A survey has been completed regarding the views of people who use the service in June 2009 and December 2009. This concluded people were happy with the service. Regular checks are completed that rooms are kept clean. There are audits of various management systems, and copies of thank you letters and cards are kept. The policy states an Annual Development Plan will be completed, but we did not see evidence this has yet occurred. There is a record of meetings held with people using the service and staff. However these meetings occur only on an irregular basis. It would be helpful for these to be more frequent for the processes to work effectively so stakeholders can air their views, and participate in decision making in the home. An AQAA (Annual Quality Assurance Assessment-an annual return required by the commission which includes a self assessment and data regarding the service) from the registered manager has been received and this was satisfactory. We have received notifications about untoward incidents / accidents and deaths from the registered manager, as required by law, and we did not have any concerns about how these were managed. We assessed arrangements regarding the management of the finances of people who use the service. The registered persons, or staff working in the home, do not act as appointee for peoples monies or financial benefits. Any expenditure on behalf of people using the service is invoiced to them or their representative. Records of all transactions are kept. The registered provider has a health and safety policy. There is also a fire risk assessment which was completed by an external consultant. Staff in the home carry Care Homes for Older People Page 28 of 34 Evidence: out appropriate checks on the fire system and emergency lighting. Suitable checks on the fire system, and regarding fire extinguishers are carried out by external contractors. Portable electrical appliances were last tested in May 2010. There is a certificate to state the electrical circuit has been tested and is deemed satisfactory (20/08/2007). The home has a gas certificate deeming the boiler and appliances safe (5/3/2010). There are health and safety risk assessments in place. There is a policy regarding the prevention of legionella. Regular checks are completed to help ensure the risk of Legionnaires Disease is minimised. The nurse call system has been serviced in March 2010. Assisted baths have been serviced in June 2009. The lift and stair lift have also been serviced in February 2010. As stated in the staffing section, training regarding health and safety issues needs some improvement. A current certificate of insurance was displayed in the home. Care Homes for Older People Page 29 of 34 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 30 of 34 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 1 3 14 The registered persons must ensure processes and information gathered to assess people moving in to the home, and used to determine the decision to admit people to the service, is documented. This will help to demonstrate that satisfactory systems are in place to ensure the registered persons assess they can meet the needs of people planning to use the service, before admission is arranged 01/05/2010 2 9 13 Some improvement is required to the operation of the medication system as is outlined in the body of the report. All staff administering medication must receive formal training before they carry out this task. 01/05/2010 Care Homes for Older People Page 31 of 34 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 People who use the service can then be more assured their medication is more appropriately according to national guidance. 3 20 23 The registered provider 01/05/2010 must continue to provide a satisfactory amount of communal space as outlined in the national minimum standard (20.4). This will ensure people using the service have a variety of communal space to spend their time and meet with their visitors in private. The registered persons must 01/05/2010 ensure two written references (one from the persons previous employer) are obtained for all staff employed from the date of this report. This will help to assure people who use the service that staff who work with them are suitable people to work with the vulnerable. 5 30 18 The registered persons must 01/06/2010 ensure the current training programme is competed, so any outstanding training, as required by the law, and outlined in the body of the 4 29 19 Care Homes for Older People Page 32 of 34 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 report, is received by staff working in the home. This will help people who use the service to be more confident that staff receive training to meet their needs, and according to the law. 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 1 19 Review the permanent locking of the front door in line with relevant legal guidance. Care Homes for Older People Page 33 of 34 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. 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