Care Home: Good Companions

What the care home does well Residents were receiving good support from external health professionals. For example, appointments and visits had been arranged with district nurses and doctors so that the residents receive the care and support they needed to ensure their health and welfare. A resident said, “I can see my doctor at any time.” Staff were observed to be respectful in their approach towards the residents. During the visit staff spoke with the residents in a polite and friendly manner and residents appeared comfortable in their company. A resident said, “The staff are always very nice indeed, nothing is too much trouble for them.” There was a pleasant, friendly atmosphere in the home and visitors were seen at various times of the day. This enables the residents to remain in close contact with friends and family, which is important for family life. The home was found to be well maintained and the standard of furnishings, fittings and décor good. Residents had brought in items from their own home to make their room feel special to them. Two lounges provide ample space for residents to sit in comfort and to also enjoy some ‘quiet’ if preferred. One of the lounges has a small library, which a resident said she enjoyed using. Feedback from the residents was positive regarding the meals served. Residents commented on the ample choice available and said they could ask for what they wanted. A resident said, “I enjoy the meals and I have breakfast in bed, which I like.” The majority of residents attended the dining room for lunch and the view of the garden makes this a pleasant room to sit in. The managers carry out a number of checks to make sure the home is run in the best interests of the people accommodated. This has included satisfaction surveys, external quality awards and also looking at various documents used by the staff to ensure residents receive a good reliable service.Good CompanionsDS0000005324.V378144.R01.S.docVersion 5.2 What has improved since the last inspection? Staff had completed a risk assessment for residents who wished to look after their own medicines. This is carried out to ensure the residents can undertake this practice safely. Staff had been recruited safely to ensure the welfare of the people in the home. Recruitment includes police checks and two written references being received prior to appointment. What the care home could do better: Fire extinguishers were subject to an annual safety check, however there was no contract for any other fire prevention equipment, for example, the fire alarms. An engineer was contacted at the time of the inspection regarding this. A date has been planned to ensure this work is carried out as soon as possible. Once a fire prevention certificate has been issued, a copy of this should be forwarded to the Commission for our records. Fire prevention in the home must be monitored with input from external agents to ensure people are safe. The needs of the residents had been recorded in a plan of care with supporting care documents to ensure their health and welfare. Care plans should record more detail with regard to specific care needs. This will help to provide the staff with more information as to the level of support each resident needs and how it is being monitored. The staff had recorded the care they gave the residents. The managers should review how the residents’ daily notes are recorded and consider the use of individualised personal record sheets instead of the current use of a generic diary. This was raised as recommendation in the last key inspection report in October 2008. It is raised again in this report, as there are issues around confidentiality of information held. Staff administer medicines to the residents. They should receive ongoing medicine training and have a written competency assessment with regards to how they administer medicines. This will ensure they have the skills and knowledge to undertake this practice safely. The Department of Health have introduced Deprivation of Liberty Safeguards under the Mental Capacity Act 2005. These safeguards are to help people who cannot make their own decisions about their care or treatment because they do not have the ‘mental capacity’ to do so. A policy has been introduced for the staff regarding this and training should be provided for them to ensure they know how to implement the safeguards. This will help to protect people in their care. There were window restrictors in place. These are so that windows do not open too wide. The maintenance plan should include a review of these, as a smallGood CompanionsDS0000005324.V378144.R01.S.doc Version 5.2 number were found not to work correctly. This will help protect people accommodated in the rooms identified at the time of the inspection Communal towels were in a number of bathrooms. Paper towels should be placed in the bathrooms to ensure good standards of hygiene for hand drying. New staff received an induction when they start employment. The skills for care induction should be implemented for new staff, as this provides a formal introduction into care working. Key inspection report CARE HOMES FOR OLDER PEOPLE Good Companions 113 Roe Lane Southport Merseyside PR9 7PG Lead Inspector Mrs Claire Lee Key Unannounced Inspection 15th October 2009 09:30 DS0000005324.V378144.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Good Companions DS0000005324.V378144.R01.S.doc Version 5.2 Page 2 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 Good Companions DS0000005324.V378144.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Good Companions Address 113 Roe Lane Southport Merseyside PR9 7PG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01704 220450 F/P 01704 220450 Mrs Jennifer Moffatt Mr David Michael Moffatt Mrs Jennifer Moffatt Mr David Michael Moffatt Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Good Companions DS0000005324.V378144.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies 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 The maximum number of service users who can be accommodated is: 23 Date of last inspection 1st October 2008 Brief Description of the Service: Good Companions is a Registered Care Home providing personal care and accommodation for up to 23 older people. The home is owned and managed by Mr and Mrs Moffatt. Mrs Moffatt is the Registered manager. The two deputy managers Ruth Watson and Mhairi Cairns are also actively involved with the day-to-day running of the home. The home is a large, converted Victorian property with an added extension to the rear and side of the building. The home is serviced by a passenger lift and access is available to all floors. All but one of the bedrooms has en-suite facilities. Communal facilities include two lounges, a large pleasant dining area and a hairdressing room. There are two bathrooms that provide assisted baths and one shower unit. There is a large well-maintained rear garden, which the home uses for garden parties and activities. The garden and patio also provide a pleasant area for the service users to sit in the summer months. The front entrance provides an attractive approach to the home and parking for visitors. The home has a minibus, which is used frequently for day trips. The cost for the service is £389.00 per week Good Companions DS0000005324.V378144.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star which means that people who use this service experience good quality outcomes. A site visit took place as part of the inspection and this was carried out over one day for a duration of approximately nine hours by one inspector. Information for this inspection was gathered in a number of different ways. This included the unannounced site visit where time was spent reading service records and looking at different areas of the building. All of the key standards and other standards were inspected and also previous requirements and recommendations from the last inspection were looked at. The manager was present for the inspection however it was conducted with the two care/deputy managers. The deputy managers were also present for the feedback at the end of the inspection. ‘Case tracking’ was used as part of the site visit. This involves looking at the support residents get from the managers and staff including their care plans and other records relating to them. Two residents were case tracked, however this was not carried out to the detriment of other residents who also took part in the inspection process. Time was spent meeting with residents, visitors and staff to gain their opinions of the overall service and to find out what it is like to live at Good Companions. Different areas of the building were also viewed. People accommodated at the home like to be called residents. This term is used in this report to respect their wishes. Satisfaction surveys were sent out to staff and residents prior to the inspection to ask them for their comments regarding the care home. Feedback was positive and a number of comments from interviews and surveys received are included in this report. An AQAA (annual quality assurance assessment) was completed by the management team prior to the site visit. The AQAA comprises of two selfquestionnaires that focus on the outcomes for people. The self-assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service, including staff numbers and training. Some information from the AQAA is recorded within the report. Good Companions DS0000005324.V378144.R01.S.doc Version 5.2 Page 6 What the service does well: Residents were receiving good support from external health professionals. For example, appointments and visits had been arranged with district nurses and doctors so that the residents receive the care and support they needed to ensure their health and welfare. A resident said, “I can see my doctor at any time.” Staff were observed to be respectful in their approach towards the residents. During the visit staff spoke with the residents in a polite and friendly manner and residents appeared comfortable in their company. A resident said, “The staff are always very nice indeed, nothing is too much trouble for them.” There was a pleasant, friendly atmosphere in the home and visitors were seen at various times of the day. This enables the residents to remain in close contact with friends and family, which is important for family life. The home was found to be well maintained and the standard of furnishings, fittings and décor good. Residents had brought in items from their own home to make their room feel special to them. Two lounges provide ample space for residents to sit in comfort and to also enjoy some ‘quiet’ if preferred. One of the lounges has a small library, which a resident said she enjoyed using. Feedback from the residents was positive regarding the meals served. Residents commented on the ample choice available and said they could ask for what they wanted. A resident said, “I enjoy the meals and I have breakfast in bed, which I like.” The majority of residents attended the dining room for lunch and the view of the garden makes this a pleasant room to sit in. The managers carry out a number of checks to make sure the home is run in the best interests of the people accommodated. This has included satisfaction surveys, external quality awards and also looking at various documents used by the staff to ensure residents receive a good reliable service. Good Companions DS0000005324.V378144.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Fire extinguishers were subject to an annual safety check, however there was no contract for any other fire prevention equipment, for example, the fire alarms. An engineer was contacted at the time of the inspection regarding this. A date has been planned to ensure this work is carried out as soon as possible. Once a fire prevention certificate has been issued, a copy of this should be forwarded to the Commission for our records. Fire prevention in the home must be monitored with input from external agents to ensure people are safe. The needs of the residents had been recorded in a plan of care with supporting care documents to ensure their health and welfare. Care plans should record more detail with regard to specific care needs. This will help to provide the staff with more information as to the level of support each resident needs and how it is being monitored. The staff had recorded the care they gave the residents. The managers should review how the residents’ daily notes are recorded and consider the use of individualised personal record sheets instead of the current use of a generic diary. This was raised as recommendation in the last key inspection report in October 2008. It is raised again in this report, as there are issues around confidentiality of information held. Staff administer medicines to the residents. They should receive ongoing medicine training and have a written competency assessment with regards to how they administer medicines. This will ensure they have the skills and knowledge to undertake this practice safely. The Department of Health have introduced Deprivation of Liberty Safeguards under the Mental Capacity Act 2005. These safeguards are to help people who cannot make their own decisions about their care or treatment because they do not have the ‘mental capacity’ to do so. A policy has been introduced for the staff regarding this and training should be provided for them to ensure they know how to implement the safeguards. This will help to protect people in their care. There were window restrictors in place. These are so that windows do not open too wide. The maintenance plan should include a review of these, as a small Good Companions DS0000005324.V378144.R01.S.doc Version 5.2 Page 8 number were found not to work correctly. This will help protect people accommodated in the rooms identified at the time of the inspection Communal towels were in a number of bathrooms. Paper towels should be placed in the bathrooms to ensure good standards of hygiene for hand drying. New staff received an induction when they start employment. The skills for care induction should be implemented for new staff, as this provides a formal introduction into care working. 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. Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 6 (Standard 6 was not assessed as intermediate care is not provided at the home) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their families had information regarding the home to help them decide whether the home could provide the service they wanted. Residents’ needs were assessed to ensure the staff could provide the care and support they needed. EVIDENCE: There was a service user guide and statement of purpose which provided information for the residents living at the home and those who are looking to take up residency. This information forms part of a welcome pack, which also includes a welcome letter, details of terms and conditions of residency and a local bus timetable. The documents are being updated with the latest contact details for the Commission. Surveys received and talking with residents indicated that they received enough information to help them to choose Good Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 11 Companions as their home. A resident commented that they were happy with the arrangements made and that he was ‘settling in’ well. Residents have their care and social needs assessed prior to admission to the home. An assessment seen recorded details in areas such as, eating and drinking, communication, medicines, past medical history and walking. This helps to ensure the staff have the information they need to meet residents’ individual needs and to provide the right levels of support. Prospective residents are invited to the home to spend some time with residents accommodated and to meet the staff. This helps to make the admission process less daunting for them. Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ health and personal care needs were being met by staff who respected their privacy and dignity. EVIDENCE: Residents had an individual care file with care documents relating to the care and support they needed to ensure their health and welfare. Care plans recorded information in areas such as, help with walking, meals, washing and dressing. The information had been reviewed regularly to ensure it was accurate and to reflect any change in the person’s care and treatment. It is recommended however, that further detail be recorded in a care plan when a resident has specific care needs, for example a poor diet. This will help to provide the staff with more information as to the level of support each resident needs and how it is being monitored. Residents were receiving person centred care however the records did not always reflect this. Ways of implementing changes to the care plans were discussed with the deputy managers at the time of the key inspection. Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 13 Records seen showed that staff were prompt in seeking medical advice when needed. For example, care records evidenced visits from district nurses and doctors. A resident confirmed that they could see their doctor at any time and the staff would arrange an appointment on their behalf. A chiropodist also visits the home on a regular basis to help maintain good foot care. Comments made by the residents were positive regarding the standard of care received. They included, “I think they do everything they can”, “I am quite happy here”, “The girls take look after me very well” and “They care for me.” Likewise, a relative said, “Everything is fine.” Risk assessments were in place for the residents to assess day to day activities. For example, walking, bathing and assessing independence. The assessments recorded the level of support needed by the staff to help minimise the risks and keep the resident safe. Care documents seen showed that residents had been weighed and where staff had concerns about a resident’s diet then they had contacted a dietician and district nurse for advice. The treatment and advice given had been implemented and staff interviewed were aware of the care the resident was receiving. The implementation of a nutritional assessment would also help staff assess factors that affect a resident’s health and diet and provide further information for the plan of care. The AQAA recorded information relating to the quality checks of the care records as part of the external awards the staff have achieved. This helps to maintain good standards of care for the residents. Staff had recorded daily notes regarding the care they gave. At the last key inspection it was recommended that the deputy managers review how daily notes are recorded for individual residents. The deputy managers were asked to consider the use of individualised personal record sheets instead of the current use of a generic diary. This is raised again in this report, as there are issues around confidentiality of information held. Daily care notes are still not stored in individual files. It is also more difficult for staff to make reference to care plans while writing these notes as the care plans are maintained separately (in a resident’s individual care file). When staff come on duty they receive a verbal handover with information regarding the residents. A number of staff hold a key worker role and this gives them extra responsibilities for a number of residents to enable them to get to know them better. This provides evidence of good communication. A contract is in place with a local chemist to supply medicines to the home each month. The majority of medicines were being administered from a dosage system called a blister pack. A number of medicine charts were looked at and these showed that the staff had signed for the prescribed medicines they had given. Staff had completed risk assessments for residents who were Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 14 administering their own medicines. This is to ensure they are able to undertake this practice safely. A risk assessment seen recorded an action plan detailing the support the resident needed. Staff have received medicine training in the past and the deputy managers stated that they observe staff giving out the medicines to ensure this is carried out in accordance with the home’s medicine policy and procedure. A written check should be completed as part of assessing whether staff are competent to give out the medicines. They should also receive ongoing medicine training to ensure they have the skills and knowledge to undertake this practice safely. The deputy managers said the chemist will be supplying work books for the staff to complete as part of their medicine training. This has yet to commence. Residents interviewed said the staff were polite, kind and helpful. Staff were observed to be friendly and respectful in their approach and took time to help residents with different activities during the day. Staff knocked on bedroom doors before entering and addressed each resident with their preferred name and title as a mark of respect. Residents said, “The staff are always polite”, “They always speak to me correctly” and “Everything is OK.” Likewise a staff member said, “Personal dignity is ensured and residents are given the best care possible.” Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive the support they need to live their chosen lifestyle. EVIDENCE: The home had a pleasant, relaxed atmosphere and visitors were seen at various times of the day. Residents were able to meet them in their own room or in the two lounges if preferred. A relative commented on the warm welcome they always received. Residents appeared comfortable with the staff and there was plenty of laughter amongst everyone. A number of residents go out independently from the home or with their family members. A resident said she enjoyed the freedom offered to her by the staff. Residents’ spiritual needs had been recorded and Holy Communion arranged in the home so that residents have the opportunity to continue with their chosen faith. A hairdresser visits regularly and this service is offered in the hairdressing salon on the lower ground floor. Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 16 Social interests and activities are arranged according to the wishes of the residents. The AQAA reported that activities are ‘resident led’. Therefore the residents can choose what they would like to take part in or would like arranged. There is a minibus for outings and trips include, pub lunches, shopping, narrow boat events and the Christmas pantomime. A Christmas fete is planned, which the residents are being encouraged to help with the arrangements. There is no formal plan for activities, however residents spoken with were happy with what was going on. A resident said she enjoyed the exercise game played during the afternoon of the inspection. An electronic menu board displays the menu of the day and residents interviewed said they enjoyed the ‘home cooked’ meals. Residents’ dietary preferences were recorded so that they received meals they enjoyed. The menu offered a good choice of food through out the day and food stores were plentiful. This included fresh fruit and vegetables, which residents said they received. Their comments included, “The food is very good”, “You are given a choice,” “You have homemade soups at tea time”, “I cannot complain about the meals.” Food hygiene records were found to be up to date, however food placed in the fridge was covered but not dated. This was raised as a good practice recommendation in an environmental health report dated February 2009. Food should be dated when placed in the fridge so that good standards of food hygiene control are maintained. Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are procedures in place so that people who live in the home are able to express concerns, be listened to and their rights are protected to safeguard from abuse. EVIDENCE: There is a complaint policy and procedure and this has information on how to make a complaint. Details of this were found in the service user guide and also on display in the home for residents and visitors to access. The complaint policy is currently being updated with the new contact details for the Commission. Interviews with residents and surveys received confirmed that people knew how to make a formal complaint. No complaints were raised at the time of the inspection and a resident said they would ‘speak up’ if unhappy. The AQAA reported that three complaints had been received ‘in house’ and these were not upheld following investigation. A complaint log evidenced the nature of the complaint and how the staff had investigated the issues raised. The Commission received two complaints and this included a safeguarding referral. Following investigation these were also not upheld. A staff member said, “The residents are very happy and if they are not, or have a problem, it is soon rectified.” Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 18 Policies and procedures were in place to help safeguard people. This included local guidelines and protocols for reporting an alleged incident. The correct procedures were followed for the referral received by the Commission and other safeguarding agencies. Staff have received training in dealing with an alleged incident and a staff member interviewed was aware of the reporting procedures and what constitutes abuse. The Department of Health have introduced Deprivation of Liberty Safeguards under the Mental Capacity Act 2005. These safeguards are to help people who cannot make their own decisions about their care or treatment because they do not have the ‘mental capacity’ to do so. A policy has been introduced for the staff regarding this and training should be provided for them to ensure they know how to implement the safeguards. This will help to protect people in their care. No safeguards have been made to date. The necessary recruitment checks were being carried out for new staff to ensure they were employed safely. This is discussed under Standard 29 of this report. Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,20,21,22,24,25 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in safe, clean and comfortable accommodation. EVIDENCE: The home is a large, three storey converted building. A passenger lift provides access to all three floors and the home is accessible via steps and a ramp. The AQAA reported that the home is subject to general maintenance and a number of bedrooms have been re-decorated, new curtains provided and new flooring laid in two bathrooms. A tour of the building confirmed a good standard of maintenance, decoration and furniture. A selection of bedrooms were viewed and residents had brought personal possessions from their own home to make their room feel special to them. Residents had the use of a call bell when assistance is needed from the staff. Residents spoken with said they were happy with their rooms. Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 20 Bathrooms had equipment to help the residents bathe safely and in comfort. For example, bath hoists and walk in shower room. The bathroom and toilets are appropriately placed enabling easy access for the residents. All but one bedroom has an ensuite facility. The bathrooms were clean and hand gel was available for hand washing. Communal towels were in a number of bathrooms. Paper towels should be placed in the bathrooms to ensure good standards of hygiene for hand drying. The laundry room was tidy and organised and hand washing facilities were available for the staff. Some cleaning products were being stored in the hairdressing room and these were removed at the time of the inspection to be stored more securely. Residents have the use of two lounges and a dining room. One lounge is the ‘quiet’ lounge and this has a small library for the residents. Both rooms have comfortable armchairs and coffee tables. Residents were observed to use both rooms, reading the papers, watching TV, meeting visitors or taking part in the exercise games in the afternoon. A number of residents preferred to stay in their own room and the staff respected this wish. The dining room is situated on the lower ground floor with easy access to the garden and new patio area which is near completion. New decking area provides a seating area for the residents to enjoy in the warmer weather. Residents enjoy the garden and they help staff to grow summer vegetables. The hot water to the baths was regulated so that the water was at a safe temperature for the residents to use. Records were seen to evidence this. Radiators were covered to minimise the risk of injury to people in the home. Window restrictors were in place. These ensure windows do not open too wide. The maintenance plan should include a review of these, as a small number were found not to work correctly. This will help protect people accommodated in the rooms identified at the time of the inspection. Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements, recruitment and training ensures that people are cared for and supported safely. EVIDENCE: Sufficient staff were on duty at the time of the unannounced visit to meet the needs of the residents. Eighteen residents were accommodated and during the day two deputy managers were on duty with three carers. One carer held a senior position. The owner Mr Moffatt was cooking in the kitchen and the owner and registered manager, Mrs Moffatt was present in the building. There was no domestic on duty as the employee was on annual leave. This work was being undertaken by one of the deputy managers. At night there is one carer on duty and the owners live on the premises and operate an ‘on call system’ to provide support to the night staff and during the day if needed. A staff member confirmed that help was available at all times. The deputy managers stated that resident dependencies were low at present, however should the care needs of the residents increase then staffing numbers would be reviewed. Two files for newly appointed staff were viewed and these showed that staff had been recruited safely. There was evidence of completed job application forms, past employment details, two references and POVA (Protection of Vulnerable Adults) checks prior to commencing employment. CRB (criminal Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 22 record bureau) disclosures were also on file. New staff sign to say they have read the job description in the policy folder and they also receive an induction. Two induction records were looked at and they cover areas such as, health and safety, fire prevention and care practices. The skills for care induction standards should be implemented for the care staff, as this provides a formal introduction into care working. The two new members of staff had an NVQ (National Vocational Qualification) in Care and had held previous care positions. The AQAA reported that twenty permanent staff are employed and twelve had an NVQ at Level 2 or above. Certificates were seen for NVQs in staff files to evidence their qualification. The deputy managers both have NVQ Level 4 in management as part of their managerial role. Staff had received training in safe working practices, for example, moving and handling, infection control, fire prevention and food hygiene. Personal development days for the staff have been introduced to assess training needs and to devote time to assist the staff member with their professional development. Evidence was seen of this on file. Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,32,32,33,35,36,37 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all fire prevention equipment had been serviced to ensure it was working safely. This places people at risk. EVIDENCE: The registered manager and provider/owner for the home is Mrs Moffatt and she shares the day to day running of the home with two deputy managers who supervise all of the care and general running of the home. Mr and Mrs Moffat live on the premises and are therefore in day to day to day contact with everyone. A deputy manager, Ms Ruth Watson, stated at the inspection that she will be applying for the position of registered manager over the next few months as she would like to take on this role. Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 24 The staff have achieved a number of external quality awards which help to monitor the service and to make improvements when needed. One of the audits included satisfactions surveys for the residents and their relatives. The staff had achieved a high overall satisfaction percentage which indicated that residents and relatives were pleased with the overall management. The managers also conduct internal audits and checks of care records and the environment as part of monitoring standards. Discussion with the residents confirmed that they do not wish to attend formal meetings and at present are more than happy with chatting to the owners and staff each day. A resident said, “I cannot think of any where better than here.” Staff meetings are not held regularly however it was evidence that the staff have daily contact with the managers. The staff made the following comments, “The management are always willing to discuss things with you to make both your working environment is comfortable” and “Provides excellent care in a homely environment and they look after the staff well.” Staff had received supervision of their job role and dates of individual supervision sessions were on file. The staff are currently not responsible for personal allowances held on behalf of the residents. Financial records for a resident viewed were current to protect their financial interests. Records held on behalf of the residents and staff were maintained in good order. It is recommended that care records be stored securely as they hold confidential information. This was discussed at the time of the inspection and actioned by the deputy managers. The AQQA reported details of current contracts for services and maintenance of equipment in the home. A spot check for the gas and electric were up to date. Fire extinguishers were subject to an annual safety check, however there was no contract for any other fire prevention equipment, for example, the fire alarms. An engineer was contacted at the time of the inspection regarding this. A date has been planned to ensure this work is carried out as soon as possible. Once a fire prevention certificate has been issued, a copy of this should be forwarded to the Commission for our records. This will show the home are compliant with fire protection. Fire prevention in the home must be monitored with input from external agents to ensure people are safe. Staff have access to a good number of policies and procedures so that they work safely and provide a good standard of care for the residents. Staff had signed to say they had read and understood them. A number of accident records were seen. These gave good detail for each accident, including whether families had been informed of the incident. They Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 25 were stored in accordance with data protection to ensure confidentiality of the information held. Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 2 Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 24 (4) Requirement The registered provider must ensure fire prevention equipment is maintained. This will ensure the ongoing protection of people in the home. Timescale for action 15/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The managers should review how daily notes are recorded for individual residents and consider the use of individualised personal record sheets instead of the current use of a generic diary. Care plans should record more detail with regard to specific care needs. This will help to provide the staff with more information as to the level of support each resident needs and how it is being monitored. 2. OP9 Staff should receive ongoing medicine training and have a written competency assessment with regards to how they DS0000005324.V378144.R01.S.doc Version 5.3 Page 28 Good Companions 3. 4. OP18 OP25 5. OP26 administer medicines. This will ensure they have the skills and knowledge to undertake this practice safely. Staff training should be provided for the Deprivation of Liberty Safeguards so that the staff know how to implement a safeguard. With regards to the environment there were window restrictors in place. The maintenance plan should include a review of these, as a small number were found not to work correctly. Paper towels should be placed in the bathrooms to ensure good standards of hygiene for hand drying rather than the use of communal towels. Skills for care induction should be implemented for new staff as this provides a formal introduction into care working. A copy of the fire prevention certificate should be forwarded to the Commission for our records. This will ensure the home are compliant with fire prevention. 6. 7. OP30 OP38 Good Companions DS0000005324.V378144.R01.S.doc Version 5.3 Page 29 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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