Care Home: Goldenley

What the care home does well Prospective people wishing to live at Goldenley are assessed prior to admission so that the management and staff team are able to meet the individual`s needs. Staff working at the home, have a good rapport with individual people and demonstrated a good knowledge and understanding of peoples care needs. Visitors to the home are made to feel welcome and staff morale at the home is good. Many members of staff have been employed at Goldenley for some considerable time, providing stability and continuity of care to the people who live there. The quality of meals provided at the home for residents is good and people`s comments in relation to meals provided were positive and are recorded within the main text of the report. People live in a home which is comfortable, safe and homely for their needs. The home was observed to be clean, tidy and odour free at the time of the site visit. There is a quality assurance system in place so as to seek the views of residents and their representatives, staff and other stakeholders about the services and facilities provided at the home. A good range of social activities is provided for people and caters for the varying needs of people in the home. People are assured that any complaints or areas of concern are taken seriously by the management team of the home and acted upon. Where safeguarding alerts are raised and initiated, there is evidence to show that the management and staff team of the home are proactive so as to ensure positive outcomes for people and that they are protected from possible harm and/or abuse. What has improved since the last inspection? Care planning and risk assessment processes have improved so as to ensure there is a plan of care in place which is detailed and records clearly the person`s care needs, guidance for staff as to how these are to be met and highlights risk areas that require on-going monitoring. Records also showed that where the care needs of individual people had changed, the plan of care was reviewed and updated to reflect the new information. Where appropriate there was evidence to show that appropriate healthcare professionals had been contacted for advice and intervention at the earliest opportunity so as to ensure people`s health and welfare. Medication storage systems are appropriate with medication stored securely. Where medicines are prescribed on a "when required" basis there are now appropriate guidelines in place for their use. The majority of staff who work at the home have received specific training to deal with people who exhibit challenging behaviour. In addition much emphasis has been placed on ensuing that staff`s training in core subject areas is up to date. The deployment of staff within the home is much improved so as to ensure that people who live at Goldenley receive the right care and in a timely manner. Records for a 4 week period showed that there have been sufficient numbers of staff on duty. Staff now receive regular formal supervision. People who live at the home receive regular drinks throughout the day and are given a choice. What the care home could do better: Ensure that associated care documentation e.g. turn charts, are completed consistently and evidence actual care provided by staff in line with people`s care plans and care needs. Ensure that the temperature of the room where medication is stored is monitored so as to ensure medication is of a suitable quality and remains effective for people`s use and where this is close to the maximum temperature, appropriate action is taken in a timely manner to remedy this. In addition where it is noted that the temperature of the fridge that is used to keep medication that requires cold storage is above the recommended temperature, ensure that appropriate action is taken to rectify this. Ensure that staff receive appropriate training for those conditions associated with the needs of older people. Key inspection report Care homes for older people Name: Address: Goldenley 11-15 Richmond Avenue South Benfleet Essex SS7 5HE     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: Michelle Love     Date: 2 2 1 2 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 32 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 32 Information about the care home Name of care home: Address: Goldenley 11-15 Richmond Avenue South Benfleet Essex SS7 5HE 01268758487 01268758176 christine.webster@excelcareholdings.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Goldenley Healthcare Ltd care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 38 The registered person may provide the following category of service only: Care Home only - Code 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 - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Goldenley is a purpose built home providing accommodation for up to 38 older people. The Registration category permits the home to provide care to older people and a number of these may have dementia. The layout of the premises consists of two separate lounges. One is a very large lounge and the other is smaller. There are also a few small areas scattered around the home with one or two chairs for residents use. None of the bedrooms have ensuite facilities. Goldenley is situated close to the local shopping area of South Benfleet. There is good bus and train links to the area. There is limited parking to the side of the property, but two public car parks are very close if Care Homes for Older People Page 4 of 32 1 8 0 2 2 0 0 9 38 0 Over 65 0 38 Brief description of the care home needed. The weekly fees for residents range from 366.66 to 433.37. Additional costs are incurred by people living at the care home in relation to hairdressing, chiropody, magazines/newspapers and other items of personal shopping. Care Homes for Older People Page 5 of 32 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 was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 10 hours, with all key standards inspected. Additionally progress against previous requirements and recommendations from the last key inspection were also inspected. Prior to this inspection, the registered manager had submitted an Annual Quality Assurance Assessment (AQAA). This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the site visit, surveys for Care Homes for Older People Page 6 of 32 people who live at the home, staff, relatives and healthcare professionals were requested to be sent to the home for distribution. The response was positive and we received 6 completed surveys from staff, 14 completed surveys from people who live at the home, 2 from healthcare professionals and 5 from residents relatives and/or representatives. Where comments have been recorded these have been incorporated into the main body of the report. The manager, team leader, senior carer and other members of the staff team assisted the inspector on the day of the site visit. Feedback on the inspection findings were given to the manager and senior manager. The opportunity for discussion and/or clarification was given. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? Care planning and risk assessment processes have improved so as to ensure there is a plan of care in place which is detailed and records clearly the persons care needs, guidance for staff as to how these are to be met and highlights risk areas that require on-going monitoring. Records also showed that where the care needs of individual people had changed, the plan of care was reviewed and updated to reflect the new information. Where appropriate there was evidence to show that appropriate healthcare professionals had been contacted for advice and intervention at the earliest opportunity so as to ensure peoples health and welfare. Medication storage systems are appropriate with medication stored securely. Where medicines are prescribed on a when required basis there are now appropriate guidelines in place for their use. The majority of staff who work at the home have received specific training to deal with people who exhibit challenging behaviour. In addition much emphasis has been placed on ensuing that staffs training in core subject areas is up to date. The deployment of staff within the home is much improved so as to ensure that people Care Homes for Older People Page 8 of 32 who live at Goldenley receive the right care and in a timely manner. Records for a 4 week period showed that there have been sufficient numbers of staff on duty. Staff now receive regular formal supervision. People who live at the home receive regular drinks throughout the day and are given a choice. 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 32 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 32 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 use the service are assessed and assured that their needs can be met. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff and management team are able to meet the prospective persons needs. Admissions are not made to the home until a full needs assessment has been undertaken. In addition where appropriate, supplementary information is provided by the persons Placing Authority or Primary Care Trust. Out of 6 staff surveys returned to us, 5 confirmed that staff are provided with up to date information about the needs of the people they are to support and/or provide a service for. On inspection of the care files for the two newest people admitted to Goldenley, records showed that a pre admission assessment had been completed for each person by the manager or team leader and prior to their admission to the home. There was evidence to show that the information recorded was informative and detailed. In Care Homes for Older People Page 11 of 32 Evidence: addition the pre admission assessment for both people recorded the rationale for their admission and records showed that arrangements and opportunity were given for the prospective person and/or their representative to visit the home prior to admission. A letter from the manager was on each persons care file confirming that the home could meet their needs. A Customer Satisfaction Survey for Goldenley was conducted in September 2009. The results showed that prospective people wanting to live at Goldenley are given sufficient information about the homes services and facilities, that prospective residents and their representatives are welcomed by members of the staff team and staff are helpful in answering any queries or questions. A record was maintained as part of the pre admission process confirming that a copy of the homes Statement of Purpose and Service Users Guide had been provided to the prospective resident and/or their representative. The home does not provide intermediate care. Care Homes for Older People Page 12 of 32 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 assured that they will have a plan of care and that their care needs will be met so as to ensure positive outcomes. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual people and to specify how these are to be met by staff who work in the home. In addition to the care plan, formal assessments are completed in relation to manual handling, nutrition, pressure area care and dependency levels. Of those people case tracked, each person was observed to have a plan of care and these were devised from information undertaken as part of the pre admission assessment and from other associated information provided by other stakeholders. As part of the inspection process we looked at 4 peoples care files (2 in full and 2 in relation to specific healthcare needs). Records showed that since the last key inspection to the service in February 2009, positive steps have been taken by the manager and other members of the management team to address previous identified shortfalls relating to care planning, Care Homes for Older People Page 13 of 32 Evidence: risk assessing and delivery of care by staff. The care needs of individual people are now clearly recorded and provide a good level of detail of the actions and interventions required by care staff to ensure that all aspects of their health, personal, emotional and social care needs are met. Each care plan was seen to be written in plain language and was easy to understand. Care plans examined were observed to be person centred and individualised. For example the care plan for one person pertaining to their personal hygiene recorded the number of staff required to provide support and assistance, the persons personal preference for either a bath or shower, the persons personal preferences relating to the choice of clothes worn and their choice as to whether they prefer a male or female carer. Another plan of care clearly recorded the persons strengths and abilities in relation to maintaining independence with some aspects of their personal care e.g. washing their face with a flannel and/or putting soap on the flannel. Another persons care plan made reference to them being resistant to care by staff and displaying inappropriate challenging behaviours towards staff and others who live at Goldenley. The plan of care relating to this was seen to be detailed and there was evidence to show that information had been cross-referenced in both their personal hygiene care plan and the record relating to their mental health state. The care plan for two people randomly sampled recorded them as being diabetic. While each plan of care included specific actions e.g. medication to be administered, diabetic diet to be followed, regular snacks to be given and for care staff to observe for any signs of ill-being, there was no information recorded as to the specific blood sugar levels experienced by the individual person. In addition the care plan recorded that should any symptoms occur request blood sugars to be monitored by the District Nurse. This potentially means that any changes in the persons blood glucose levels are not being detected at the earliest opportunity and staff are being reactive rather than providing a proactive service. From discussions with the manager it was unclear as to why staff who work at the home are not trained by an appropriate healthcare professional to undertake blood glucose monitoring. Of 4 care files sampled there was good evidence to show that the care plan had been regularly reviewed and updated to reflect changes to peoples care needs. Risk assessments were compiled for the majority of identified risks however care must be taken to ensure that they are devised for all areas. No risk assessment was completed for one person who is resistant to care and who exhibits challenging behaviour towards both staff and others who live at Goldenley. On inspection of the persons behavioural assessment records and their daily diary, records showed that there were regular incidents whereby staff and others were physically assaulted and/or Care Homes for Older People Page 14 of 32 Evidence: threatened. Care must also be taken in relation to the completion of associated documentation e.g. turn charts. Records showed that these were completed each day however there were some occasions whereby the frequency of recording was not in line with the persons actual care requirements or instruction as detailed within their plan of care. Records continue to show that people have access to a range of healthcare professionals and services e.g. Chiropodist, GP, Dentist, Optician, District Nurse Services as and when required. The manager confirmed there is a good relationship with the local GP surgery and other healthcare professional services. Of those peoples care records case tracked, there was evidence to show there is an audit trail detailing healthcare interventions provided and outcomes. The care file for one person showed in recent months that the persons physical condition had deteriorated significantly however there was evidence that appropriate action had been taken by the management team of the home to ensure the persons comfort and wellbeing and where appropriate healthcare professional advice and interventions had been sought. Staff interactions with people who live at the home were observed to be much improved and positive. Where support and assistance was provided by staff in relation to individuals personal care, this was conducted with respect and sensitivity. In addition staff presence within the lounge areas was more prevalent so as to provide support and assistance in a timely manner. Out of 6 staff surveys returned to us, all confirmed that they were meeting the needs of current people in the home and providing a good standard of care. Out of 14 resident surveys returned to us, 9 confirmed that they always receive the care and support they need and 5 recorded usually. Comments recorded within the resident surveys included Generally Im looked after very well. Good respect from the staff, but sometimes perhaps too busy to spend as much time with me as I would like, Ive got no faults, good care and They understand the needs of the residents. Staff all seem to know individuals quirks and requirements. Comments recorded within relatives surveys returned to us recorded peoples satisfaction with the level of care provided at the home. Comments included They take care of my relatives needs, staff are very efficient and friendly. They give all the residents love and care that they require and They are excellent at dementia care. My relative is treated as an individual and with respect, care and kindness. They are always clean and tidy. They always keep me informed of my relatives healthcare needs or if there is any change or treatment required. I am so glad I chose Goldenley for my relatives care. Practices and procedures for the safe storage, handling and recording of medication were examined as part of this inspection. A Medication Identification Sheet was Care Homes for Older People Page 15 of 32 Evidence: completed for each person and this included their photograph, name, date of birth, name of GP and known allergies. In addition PRN (as and when required medication) protocols were in place. The team leader was advised that where pain relief medication is prescribed as PRN, the protocol should clearly detail as to whether or not the resident is able to express pain and if not what non-verbal cues are known. A random sample of 16 peoples Medication Administration Records (MAR) were examined. Records showed that these were in good order with no discrepancies and/or unexplained gaps. All packets and bottles of medication were signed and dated when opened. We examined the records for people who are prescribed Controlled Drug medication and found that the stock balance and record keeping was in good order providing a clear audit trail. Medication is stored securely for the protection of people in the home. The temperature of the cupboard used to store medicines is checked and recorded each day to ensure that medication remains effective. Records showed from October 2009 to December 2009 there were many occasions whereby the temperature of the cupboard had reached the maximum level that medication should be stored. This was discussed with the manager at the time of the site visit and appropriate action was taken with immediate effect to rectify the issue. We also examined the dedicated fridge temperatures where medication that requires cold storage is kept. Records showed on several occasions between September 2009 and December 2009 that the fridge temperature was above the maximum level that medication should be stored however there was no evidence to show that action had been taken to address this. A copy of the staff training matrix was provided to us at the time of the site visit but examined following the inspection. It was unclear from the records as who of the senior staff have up to date medication training. Care Homes for Older People Page 16 of 32 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. People who use the service can be assured that their social care needs will be met and that they will receive a varied diet. Evidence: An activities co-ordinator is employed at Goldenley for 36 hours per week Monday to Friday, however the hours are flexible to cover special events held during the evenings and at weekends and for fund-raising. From discussions with the activity co-ordinator it is evident that they are committed and enthusiastic to their role. They advised that their aim is to provide an activity service that provides a diverse range of meaningful and therapeutic activities tailored to suit the specific needs of individual people and so as to maintain and improve peoples mental and physical wellbeing. The activities coordinator advised that regular meetings with residents are undertaken so as to discuss planned and future activities and to seek the views of people in the home. The minutes of the last meeting recorded a number of suggestions from residents about future activities e.g. story-telling, poetry readings, visiting harpist etc. Comments from residents included we are very lucky, the entertainment is very good and having all these things to do keeps your mind occupied. Care Homes for Older People Page 17 of 32 Evidence: An activities file is completed for each person and this includes a welcome sheet, life history (profile) of the person, information relating to past hobbies and interests, a personalised activity plan and social activities log detailing activities undertaken on any given day. A rolling 12 week activity programme is in place and on inspection of this showed that people who live at Goldenley continue to be given the opportunity to participate in a varied programme of activities. Activities include gentle exercises, relaxation, sensory stimulation, reminiscence, word association, current affairs, arts and crafts, manicures, music appreciation, ball games, scrabble, religious observance, bingo , karioke, memory boxes and visits by external entertainers. A copy of the weekly activity programme is displayed in the corridor on a notice board and in the dining areas. At Goldenley there is the Friends of Goldenley. These are a team of committed and dedicated people who work together to help raise funds for the residents. We were advised that the Friends of Goldenley meet up 3 times a year to discuss and plan fundraising events. We were advised by the activities co-ordinator that in 2009 through charity auctions and buffets, Christmas raffle, sponsored fun run/walk, charity meal, table top sale and a mystic evening fundraiser, new wheelchairs have been purchased, a garden project has been completed, several games e.g. large Connect 4, Boomerang Skittles, magnetic darts board have been purchased and also some of the money goes to pay for the resident cat (Lucky) vet fees. There is an open visiting policy at the home whereby visitors can see their member of family and/or friend at any reasonable time. There was evidence to show that people living at the home are actively encouraged and supported to maintain friendships and relationships. Relatives spoken with confirmed they can visit the home at any time and are always made to feel welcome when they visit. Relatives visiting the home were observed to have a good relationship with staff and members of the management team. People spoken with who live at the home confirmed they are enabled to maintain friendships with others and to see members of their family when they choose. The menu for the day was written on a white board in both dining rooms and showed 2 choices of main meal at lunchtime with vegetables and a choice of 2 desserts and choices available at the teatime meal. Meals provided to people were observed to be plentiful and looked appetising and where people require a pureed/soft diet this was seen to be portioned separately. Where people require assistance from staff to eat their meal this was undertaken with due care, respect and dignity. Comments from people in the home about the quality of meals provided were positive and included oh yes the food is good, I have no complaints and yes its fine. Since the previous Care Homes for Older People Page 18 of 32 Evidence: key inspection to the home in February 2009, changes have been made to ensure that residents now receive a choice of hot and cold drinks throughout the day. Care Homes for Older People Page 19 of 32 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. People who use the service are able to raise concerns and are protected from abuse. Evidence: Information relating to how people can make a complaint or raise concerns was observed to be displayed in the homes visitors room. In addition a copy of the complaints policy was noted in the reception area of the home. This identifies to who any compliments or complaints should be referred to and the timescale within which any complaints received would be responded to following investigation. We advised the manager that this needs to be amended as it makes reference to the wrong Care Quality Commission office address and other offices which are no longer operational. People who live at the confirmed they know who to complain too and are confident that any issued raised will be dealt with appropriately. Of 5 relatives surveys completed and returned to us, all confirmed they knew how to raise issues should the need arise. The complaints log shows that since the last key inspection there have been 4 complaints relating to poor care practices, medication for one person found in their room, inadequate cleanliness of one persons room, a resident not accompanied to the local hospital and one resident did not like the way a member of staff spoke to them. A record of the specific complaint, investigation and outcome was recorded for each of the complaints. The outcome was that all complaints were upheld however it was unclear from the records that the complainant was satisfied with the outcome of the Care Homes for Older People Page 20 of 32 Evidence: investigation and the actions taken by the management team of the home. A record of compliments was readily available and comments included we have just been sitting with our relative watching the activities co-ordinator doing gentle exercises with everyone in Priory Room, it was excellent and everyone joined in. Our relative looked well groomed and alert. Thank you, I started to fill in the customer satisfaction survey and decided to write and tell you that we are very happy with the care they receive at Goldenley and We are very happy with the care that our relative is receiving from Goldenley. They provide all of our relatives care and go that bit further. A copy of Southend, Essex and Thurrock safeguarding adults staff handbook was readily available within the home. Prior to the site visit we were made aware by the management team of the home that within the past 11 months there have been 3 safeguarding alerts made. These have related to challenging behaviour exhibited by one resident towards another person who lives at the home, concerns relating to one residents finances and alleged abuse by a member of staff towards a resident. Records showed that the management team of the home have acted appropriately by instigating safeguarding procedures and liaising with the Local Authority. Care Homes for Older People Page 21 of 32 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. People who use the service live in a safe, well maintained and comfortable environment which meets their needs. Evidence: A partial tour of the premises was undertaken by us throughout the day of the site visit. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home environment continues to be maintained, decorated and furnished to a good standard and is both homely and comfortable. Furnishings and fittings were domestic in nature and were of a good quality and were in keeping with the environment. There is sufficient communal space and this refers specifically to one large lounge/dining area, one smaller lounge/dining area and another small lounge area. There are sufficient bathing and communal toileting facilities available which enable immediate access and these are fitted with appropriate aids and adaptations. On the day of the site visit the premises were seen to be clean, tidy and odour free and no health and safety issues were noted. A random sample of individual peoples bedrooms were inspected and these were seen to be personalised and individualised. Since the last key inspection to the service in February 2009, 4 peoples bedrooms have been newly decorated and fitted with ensuite facilities and new furniture and soft furnishings have been purchased and fitted. Care Homes for Older People Page 22 of 32 Evidence: The AQAA confirms that since the last key inspection a sensory room and activities room has been newly developed and a second visitors lounge and training room for staff created. The AQAA details that over the next 12 months it is hoped that the rolling programme of redecoration and refurbishment will continue and better signage to be placed within the home so as to ensure that people who live at Goldenley are able to orientate themselves within the home environment. A random sample of maintenance records and certificates were examined in relation to fire drill records, emergency lighting, fire alarms, fire equipment and fire risk assessments. Records showed that regular fire drills are conducted, the homes emergency lighting and fire alarms are tested each week to ensure they remain fully operational, the homes fire extinguishers were serviced in July 2009. On inspection of the training matrix this shows that the only training completed by the homes maintenance person is fire safety awareness. There was no evidence to show they have undertaken training relating to manual handling, health and safety, COSHH (Control of Substances Hazardous to Health), infection control or safeguarding. Care Homes for Older People Page 23 of 32 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. People can expect to be supported by caring staff that are safely recruited and who have the skills and competence to meet peoples specific care needs. Evidence: We were advised by both the manager and team leader that staffing levels at Goldenley remain at 5-6 care staff between 07.00/08.00 and 20.00/21.00 and 1 senior and 2 members of care staff between 20.00 and 08.00 each day. In addition to the above there is a senior member of staff between 07.45 and 20.15 and a team leader between 08.00 and 18.00 (hours are flexible). The managers hours are supernumerary to the above, Monday to Friday 09.00 and 17.00. In addition ancillary staff are employed and these include housekeepers, administrator, laundry person, cook and maintenance person. On inspection of 4 weeks staff rosters these evidence staffing levels as detailed above are being maintained. We checked the staff roster on the day of the site visit and this reflected accurately the staff on duty. The deployment of staff on the day of the site visit was observed to be much improved, staff were observed to engage and interact with people in the home more frequently, people were provided with personal care in a timely manner and actions by staff were seen to be positive and not solely based around tasks and/or routines. Care Homes for Older People Page 24 of 32 Evidence: The recruitment files for 3 people newly employed since the previous key inspection to the home were examined. Records showed that recruitment procedures within the home are robust and all records as required by regulation were in place. Records also showed that each person completed general induction training and Common Induction Standards in line with Skills for Care. Training for staff is provided by both external trainers and by accessing E Learning systems. The staff training matrix provided to us by the manager showed that the majority of staff working at the home have up to date training in core subject areas e.g. manual handling, fire safety awareness, health and safety, food and hygiene, infection control, safeguarding and emergency first aid. Some gaps were noted for staff whereby they require refresher training in core subject areas and records showed that no staff have undertaken COSHH training. Since the last key inspection to the service the training matrix showed that other training provided to staff has included the Mental Capacity Act, dealing with challenging behaviour, dementia awareness, care planning awareness, 3 people have received training relating to pressure area care, 5 people have completed training relating to Deprivation of Liberty, 8 people have undertaken training relating to end of life issues and one person has completed advanced care planning training. Further development is required to ensure that staff receive appropriate training for those conditions associated with the needs of older people e.g. Parkinsons, Diabetes awareness, stroke awareness, pain management, nutrition, sensory impairment, effective communication etc. The staff training matrix records that 14 people have attained NVQ Level 2 and 5 people have got NVQ Level 3 (of which 2 people are NVQ assessors). Care Homes for Older People Page 25 of 32 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. The home is well run for the people who live there ensuring provides positive outcomes for people. Evidence: The manager has over 19 years experience within a care field setting and has been manager of Goldenley since 2006. The manager has attained the Registered Managers Award in 2007, NVQ Level 3, D32/D33 Assessors Award and undertaken a variety of training in both core and specialist subject areas. Evidence showed that on a day-to-day basis the home is well run and provides positive outcomes for the people who live at Goldenley. The management team of the home continue to strive to meet previous identified shortfalls by implementing new systems so as to monitor progress, to examine what works well and what requires further improvement. It is positive that since the last key inspection to the service in February 2009, concerns about some aspects of the homes care planning, risk assessing processes and delivery of care have been addressed and improved so as to Care Homes for Older People Page 26 of 32 Evidence: ensure positive outcomes for people in the home. The emphasis of the management team is to ensure that the delivery of care is appropriate to meet the individual persons care needs and that the care planning and risk assessment processes ensure that staff working at the home have the necessary information and guidance available. At this site visit it was evident that previous identified statutory requirements relating to meeting individuals healthcare/care needs, some aspects of medication practices and procedures, staff training deficits, deployment of staff, shortfalls in maintaining staffing levels and staff supervision have now been met to a satisfactory level. On inspection of a random sample of 5 member of staffs supervision records, these showed that people are now receiving regular supervision in line with National Minimum Standards requirements and recommendations. It was positive to note that within the last 11 months the supervision process has been improved and this includes observations of staff members practice. All sections of the AQAA were completed and the document returned to us when requested. Information recorded was seen to be informative and detailed providing evidence as to what the home does well and areas that still require improvement. The management team have a quality assurance programme in place that includes obtaining views from residents, relatives and other professionals and stakeholders. A copy of the most recent satisfaction results of the recent survey carried out at Goldenley in September 2009 were forwarded to us prior to the inspection. A copy of this was noted to be displayed within the home and the manager confirmed from discussions that any comments and/or actions highlighted from the survey are included as part of the homes overall action plan. The areas covered within the survey process included a series of questions relating to new residents, staffing issues, care practices, social care practices, catering, environment and management. It was positive to note that the majority of comments recorded were positive and included care is very good, since I have been the allocated CPN (Community Psychiatric Nurse) for Goldenley, I have been extremely impressed with the standards of care and professionalism of all staff, especially the senior carers and management. More general and negative comments made were in relation to some aspects of the decoration and refurbishment of the home, gaining access to the home during the weekend in particular on Sundays is not always easy and not enough staff on duty. In addition to the quality assurance questionnaire, the organisation monitor the quality of the service through regular monthly visits by a member of the organisation. Records showed these were completed each month, were detailed and informative and included evidence of an action plan and outcomes. There was also evidence of regular staff and resident meetings conducted at the home once monthly wherever possible. Care Homes for Older People Page 27 of 32 Evidence: Corporate health and safety policies and procedures were readily available. On inspection of the staff training matrix this showed that the majority of staff have received health and safety training. No health and safety issues were highlighted and on inspection of a random sample of health and safety certificates, these were found to be satisfactory and in date. A list of health and safety policies which can be found in the home were listed within the AQAA forwarded to us. Care Homes for Older People Page 28 of 32 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 29 of 32 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 9 13 Ensure that the temperature 05/02/2010 of the fridge which is used to keep medication cold does not exceed the recommended temperature. So as to ensure that medication remains effective. 2 30 18 Ensure that staff receive appropriate training specifically for those conditions associated with the needs of older people. So as to ensure that staff have the skills and competence to meet peoples care needs. 01/05/2010 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 8 Ensure that turn charts are completed consistently to show Page 30 of 32 Care Homes for Older People 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 provided by staff. Care Homes for Older People Page 31 of 32 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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