Care Home: Gorsefield Residential Home

What the care home does well Staff have good awareness of health care needs with swift referrals to Health Care professionals if there are any concerns about peoples health. The home have a good record of providing quality End of Life care with support from the District Nursing Service. There have been several examples of this, one person was cared for in bed for 3 years and the home received accolades from the Nursing Service. The relative of another person with deteriorating health made pleas on the last inspection for her to remain at Gorsefield. She died recently in the home and the relatives recorded in writing their thanks for the "excellent care" provided for her at the end of her life. We saw a well presented environment with good standards of hygiene and infection control and good odour management. These are the ongoing standards for this home. This is a small home where positive relationships are easily established between people using the service, staff and visitors. There is a very relaxed atmosphere, visitors reported they are welcomed and feel comfortable in the home. What has improved since the last inspection? At the time of the key inspection in August re found that the new Acting Manager did not have sufficient supernumerary time to adjust to her new role and undertake effective management of the home. This had improved at the time of the random inspection in December 2009. We found on this key inspection visit that the Acting Manager was spending 3 or 4 days each week supernumerary and able to carry out the required changes to care plans, documentation, care and practice that were needed. She has made considerable progress - all care plans have been revised/re-written and related documentation also revised and updated. Care plans now provide clear current instructions to staff enabling them to meet peoples needs. She is determined to make further progress and is presently taking the necessary steps to make application to us to become the Registered Manager of the service. A health care record giving a chronological account of interventions by health professionals is now in place for all people using the service. The quality of daily notes has improved since the last key inspection. Particular progress has been made in the night care records where previously poor recording had been evident. This is vastly improved. We inspected a sample of staff files and found that recruitment procedures had improved with appropriate checks and references obtained prior to employment of new staff. Information is now readily available in the home. The Complaints procedure is posted in the home and available to all. The Statement of Purpose and Service Users Guide have been updated to reflect the level of current service. It was pleasing to see that more general information is also now available, this includes information about the home and also services available to people outside the home. We made a recommendation at the time of the last report to provide clear instructions to ensure prescribed creams were administered correctly. This has been done - care plans record the reason the product is prescribed and how, where and when it should be applied. The home has a poor record of providing activities for people. This has improved both during the summer and winter months but further improvements are needed. All the lounge chairs have been replaced with comfortable, appropriate high quality ones. This has improved comfort and presentation of those areas. What the care home could do better: We recommended at the last key inspection that an ongoing cumulative count of medication was required to ensure that all medication could be accounted for and audited. This has been addressed in part, but unless the amount of each item of medication in stock at the start of the medication cycle is recorded, it is still not possible to audit the system. It is important to continue to extend the range of activities both internally and externally to meet the needs of people using the service. It is important that we are notified under Regulation 37 of all accidents and significant events affecting the lives of people using the service. We were able to clarify during the inspection, the circumstances under which these notifications are needed. Plans to submit an application for approval of a Registered Manager to run the home must continue. Key inspection report Care homes for older people Name: Address: Gorsefield Residential Home 306 High Lane Burslem Stoke on Trent Staffordshire ST6 7EA     The quality rating for this care home is:   one star adequate 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: Peter Dawson     Date: 0 9 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Gorsefield Residential Home 306 High Lane Burslem Stoke on Trent Staffordshire ST6 7EA 01782577237 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs C Bhalla,Mrs Janet Hood,Mr David John Hood care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 17 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 (OP) 17 Physical disability - over 65 years of age (PD(E)) 5 Dementia - over 65 years of age (DE(E)) 8 Date of last inspection Brief description of the care home Gorsefield is situated on the main road in High Lane, close to Burslem and directly on a bus route allowing easy access for visitors. The home is a large detached property which has been extended and provides good spacious accommodation. The building and location are quite impressive, well presented and well maintained. There are Care Homes for Older People Page 4 of 28 0 0 0 Over 65 8 17 5 Brief description of the care home attractive gardens to the front and rear with good parking facilities. Accommodation for residents is on 2 floors with shaft lift access to the first floor. On the ground floor there are 2 lounges, separate dining room, kitchen and 5 single bedrooms, there is an assisted bathing facility also on this floor. On the first floor there are 10 bedrooms, 2 are shared rooms and have en-suite facilities, some with shower. On this floor there are 2 bathrooms, one has an assisted facility. There are separate toilets, office and storage facilities. There is a small lounge/recessed area with kitchenette, allowing space to receive visitors. The home has registration to provide accommodation for up to 17 older people 5 of whom may have a physical disability and 8 may have dementia care needs. There is presently no registration for people with mental health needs. Current weekly fees can be obtained by contacting the service direct. Care Homes for Older People Page 5 of 28 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was on 24th August 2009 when the quality rating was changed to 0 Star - Poor. This was because we were not satisfied with the interim management arrangements in the home following the resignation,for personal reasons, of the previous Registered Manager. Following the August inspection we carried out an unannounced Random Inspection of the service on 2nd December 2009 to monitor progress being made overall and in relation to the management of the home. We found that progress had been made in many areas. This unannounced key inspection was carried out on 15th February 2010 by one inspector on one day from 08:30 - 15:00. The National Minumum Standards for Older People we used as the basis of the Care Homes for Older People Page 6 of 28 assessment of the service. During the inspection most people were seen and many spoken with separately and together as a small group. We were able to speak to 2 visiting relatives who expressed positive views about the service. Comments from people using the service were positive and no complaints or concerns were expressed. We also spoke with a visiting District Nurse. We spoke with staff on duty throughout the day. All showed a positive committment to people using the service. We were able to visit the communal areas and spoke with people in depth sitting in the two lounge areas. We saw a small sample of bedrooms. We inspected records including Care plans, risk assessments, daily notes, medication records, staffing rosters and staff records. All records were readily available in the home for inspection. We carried out the inspection with the Acting Manager and also spoke with the provider in the later stages of the inspection. We were able to feed back to the Acting Manager and Provider the outcomes at the end of the inspection. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? At the time of the key inspection in August re found that the new Acting Manager did not have sufficient supernumerary time to adjust to her new role and undertake effective management of the home. This had improved at the time of the random inspection in December 2009. We found on this key inspection visit that the Acting Manager was spending 3 or 4 days each week supernumerary and able to carry out the required changes to care plans, documentation, care and practice that were needed. She has made considerable progress - all care plans have been revised/re-written and related documentation also revised and updated. Care plans now provide clear current instructions to staff enabling them to meet peoples needs. She is determined to make further progress and is presently taking the necessary steps to make application to us to become the Registered Manager of the service. A health care record giving a chronological account of interventions by health professionals is now in place for all people using the service. The quality of daily notes has improved since the last key inspection. Particular progress has been made in the night care records where previously poor recording had been evident. This is vastly improved. We inspected a sample of staff files and found that recruitment procedures had improved with appropriate checks and references obtained prior to employment of new staff. Information is now readily available in the home. The Complaints procedure is posted in the home and available to all. The Statement of Purpose and Service Users Guide have been updated to reflect the level of current service. It was pleasing to see that Care Homes for Older People Page 8 of 28 more general information is also now available, this includes information about the home and also services available to people outside the home. We made a recommendation at the time of the last report to provide clear instructions to ensure prescribed creams were administered correctly. This has been done - care plans record the reason the product is prescribed and how, where and when it should be applied. The home has a poor record of providing activities for people. This has improved both during the summer and winter months but further improvements are needed. All the lounge chairs have been replaced with comfortable, appropriate high quality ones. This has improved comfort and presentation of those areas. 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 28 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 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission assessments are carried out and adequate information is available to ensure appropriate admissions and successful placements Evidence: The Statement of Purpose and Service Users Guide has been updated since the last key inspection and provides current information about the home. The information is sufficient to inform people considering admission to Gorsefield about the services that the home can offer and the facilities available. People have told us previously that they have visited the home prior to admission allowing them to make a judgment, without pressure, about the suitability of the home for them. People are assessed prior to admission by the home and multi-agency assessments Care Homes for Older People Page 11 of 28 Evidence: obtained from social workers. The home has a satisfactory assessment tool to make a judgment as to whether assessed needs can be met. Care Homes for Older People Page 12 of 28 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. Updated care plans ensure that peoples health and personal care needs are known and met Evidence: At the time of the last key inspection on 24.8.09 we made 5 recommendations relating to this outcome area. These were: Update care plans with clear instructions for staff to meet peoples needs. Make urgent request for re assessment for person whose needs could not be met. Provide a chronological record of interventions by Health care professionals. Provide cumulative account of medication allowing audit of the medication system and Provide clear instructions for the application of prescribed creams. Care plans have all been updated providing current information about peoples needs. We saw in relation to a person with deteriorating health that her needs had constantly been revised/reviewed and the care plan did provide an accurate account of her changed but current needs. Care Homes for Older People Page 13 of 28 Evidence: A request for urgent re-assessment of a persons needs that could not be met was made following the last inspection and following re-assessment the person was transferred for nursing care. The home now has a health care record for each person giving a chronological record of interventions by all health care professionals. This provides an over-view of interventions providing easily identified interventions in the event of urgent situations or reviews by health care professionals. The ongoing cumulative count of medication has only been addressed in part. The home are recording on MAR (Medication Administration Records) the monthly medication supplied by the pharmacy but not recording the amount in stock at the start of the period. Until this is done it is not possible to audit the system and account for all medication used. The home were advised to contact the pharmacy who usually record the medication supplied in each instance on the MAR sheets. Clear instructions are now provided for staff in relation to prescribed creams. Care plans now record the reason for the cream and how, where and when it is to be applied. Virtually all the recommendations have been acted upon since the last inspection. We saw several care plans that had been updated and checked aspects of health and personal care. There are no instances of pressure damage in the home at this time. District Nurses visiting only for routine checks. The medication system was inspected and apart from the issue of a cumulative count of medication motioned above other aspects of the medication system had been carried out correctly, ensuring a safe system was in place. The only exception was one missing signature on a MAR sheet, clearly an isolated omission. All staff administering medication have had external training in medication. We looked at the recording in daily notes and the amount of information has improved. Records of night care were previously poor in quantity and quality but we noted improvements also in that area of recording. The home have a good record of providing end of life care with support from the nursing service, there have examples of this in the past. At the time of the key inspection we spoke with the son of a person who had been at Gorsefield for a few years and was rapidly deteriorating. The son told us that he had confidence that Care Homes for Older People Page 14 of 28 Evidence: Gorsefield could continue to meet her needs and had requested and agreed that she would not be transferred to hospital or nursing care if that was at all possible. We saw a letter from the son addressed to the home following his mother dying at Gorsefield in January 2010 it stated My mother has had exception care at Gorsefield in the 4 years she has been there and she has been very comfortable during those years. Staff certainly went beyond the call of duty in the last days of mums life. They ensured that she was not alone in her final days. We want to thank Gorsefield for the excellent care they provided to her. Care Homes for Older People Page 15 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements in the provision of activities have improved the options available to people. Further progress will further improve quality of life for people in the home. Evidence: Activities in this home have been poor in the past and recommendations made to improve the range of activities available. People have told us during previous inspections that they have been bored. Few, if any activities were provided in the past. There are 2 staff on duty throughout the day and staff have felt there was insufficient time for them to engage with people in activities. At the time of the last key inspection on 24.8.09 some improvements had been made. During the summer people spent more time in the private garden area, new garden furniture bought and some large garden-type games purchased. People told us that this was an improvement. The intention was to provide activities in the home during the winter months and craft and other materials purchased for that purpose. At the time of this inspection, craft material had not been used although some activities had been provided. Large games such as hoops and giant darts previously bought for the garden area have been used indoors, but there was evidence of more Care Homes for Older People Page 16 of 28 Evidence: individual engagement with people using reminiscence, nail cosmetics or individual 1:1 talking with people to provide some stimulation and occupation. Whilst some improvements have been made in this area, there is still some way to go. The home are aware of this and the Acting Manager intends to make further progress in this area. No external visits within the community have been made over the past year. External visits should be considered by the home. A residents meeting has been held since the last inspection. People had told us that they wished to discuss issues concerning food at that meeting. Unfortunately minutes were not made to record discussion and outcomes but we were told that as a result, some changes had been made to the ongoing menus and that peoples likes/dislikes were now more widely known and acted upon. Further meetings are intended and we look forward to further progress in this area too. Visitors were seen during the inspection and people said that they were welcomed into the home and felt comfortable whilst visiting. Contacts with family and friends are considered important for people. Some people do go out with relatives, some regularly. Whilst some people did have some reservations about food provision, some said that there had been improvements and the staff are keen to make changes in response to suggestions. Care Homes for Older People Page 17 of 28 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. Information about complaints and safeguarding are now readily available in the home. People can be confident that their interests are protected. Evidence: The complaints procedure was not readily available in the home at the time of the last key inspection. The procedure has been updated and is now readily available in the reception area of the home for people using the service and visitors. The procedure is clear and concise and residents we spoke with were aware of the procedures for reporting complaints. No complaints have been received by the home since the last inspection. A compliment has been received about the end of life care for a person, mentioned earlier in this report. No complaints have been received in relation to this home by us in recent years. No referrals have been since the last inspection in relation to Safeguarding Vulnerable Adults. Following a recommendation of the last report the home have obtained a current copy of the Safeguarding Adults Procedures for Stoke on Trent and Staffordshire. These are now posted in the reception area of the home. It was pleasing to see that a wealth of information has been provided in the reception area of the home including Safeguarding, introduction to the home, infection control, Care Homes for Older People Page 18 of 28 Evidence: fire safety and a range of information about external services, benefits and organisations offering advice. Dated information has been replaced with current information. This is readily available to people in the home and visitors. Care Homes for Older People Page 19 of 28 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 live in a safe, comfortable, well maintained environment and enjoy the good facilities provided. Evidence: Ongoing improvements have been made to the home by the providers over recent years. Maintenance and redecoration has been part of the ongoing improvements providing a good standard environment. Providers have been compliant with any requirements or recommendations made. The home is comfortably furnished and has a homely appeal. Much of the original character of the home has been retained, such as original fireplaces giving a pleasant, authentic feel to the home. All the lounge chairs in both lounge areas have been replaced since the last inspection, providing particularly comfortable and well presented areas. There are two assisted bathrooms, one on each floor. The providers are currently considering replacing the first floor bathroom that is unused with a walk-in shower facility, providing an alternative bathing option for people. We found during this inspection that the door in the smaller lounge that opens onto the garden area was extremely draughty with a 1 gap when the door is closed. It is Care Homes for Older People Page 20 of 28 Evidence: too cold for people to sit in the area near to this door and this needs to be rectified swiftly during the current cold weather. We drew this to the attention of the provider during the inspection and he will take steps to resolve the matter. The garden area is well established and well maintained, providing a pleasant, private area that people can enjoy in the summer months. A sample of bedrooms seen during this inspection were well furnished and personalised reflecting individuality. They were clean, with quality furnishings and fittings and well maintained. At the start of this inspection we found that radiators were cooling on this cold day. The Manager immediately called a heating engineer who visited and made an immediate adjustment. The provider is aware of a potential defect in the system and negotiating to repair or replace. Care Homes for Older People Page 21 of 28 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. Further staff training and improved recruitment procedures mean that people are supported by trained staff and protected with good recruitment procedures. Evidence: The home is staffed to the minimum level with 2 Carers on duty throughout the day and one waking night carer and someone sleeping in and on call in the building. There is pressure upon staff in providing care at peak times, staff busy answering telephone calls, receiving visitors and engaging with health care professionals. This leaves little time for staff to engage individually with people in a meaningful way that is not taskcentered. The staff group is small with low turnover but a high degree of commitment to people using the service. We observed good engagement and sensitive interventions by staff when dealing with people needing support and reassurance. Staff training has continued over the past year. Since the last key inspection there has been training for staff in Fire Training, medication and dementia care. A recommendation was made at the time of the last inspection to provide training for staff in the Mental Capacity Act and Deprivation of Liberty Safeguarding - 8 out of 14 staff have now undertaken this training and this will be arranged for remaining staff soon. Care Homes for Older People Page 22 of 28 Evidence: It is difficult to extract training information for each person from the many training records and a staff training a matrix is recommended for easy monitoring of training needs. Staff files inspected at the last inspection showed some shortfalls in obtaining Protection of Vulnerable Adults checks prior to employment and ensuring two written references were always obtained. One person has been appointed since the last inspection. The file showed that appropriate checks and references had been obtained prior to the person commencing duties. We also found that in relation to a file seen on the last inspection further information has been obtained to check a gap in employment. There is an indication of improved recruitment procedures. Care Homes for Older People Page 23 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Interim management arrangements have improved and the appointment of a Registered Manager will ensure the health, safety and welfare of people using the service. Evidence: The Registered Manager left the home in May 2009. At the time of the Key Inspection on 24.8.09 a Senior Carer had taken on the Acting Manager role. At that time she was trying to acquaint herself with the procedures and information necessary for her to continue to manage the home effectively in the interim period. Unfortunately she was still mainly on the staffing rota with little time to study, update and review the information systems in the home. She needed specific allocated time each week in a supernumerary role to take on the additional management responsibilities. It was not clear whether she would eventually be proposed as the Registered Manager. Clear, knowledgeable and confident management is a requirement of all homes and we made a requirement that: A person must be appointed to manage the home and interim management arrangements should ensure the Acting Manager had the necessary Care Homes for Older People Page 24 of 28 Evidence: time, skill and resources to effectively manage the home. Over the past months the Acting Manager has developed her skills and made progress in many areas. She has been allocated time specifically for management duties usually 3 days each week. She has reviewed all the care plans and some of the information systems in the home. It has been a steep learning curve for her but she is determined to do what is necessary to manage the home effectively. She has made progress in several areas. The provider and Acting Manager told us during this inspection that she is to seek a CRB for the purposes of completing an application to us to become the Registered Manager at Gorsefield. We are satisfied with the interim management arrangements for the home pending a Registered Manager being appointed. Staff supervision has not been in place at this home, the Acting Manager is aware of the need to provide this on a regular basis for all staff and is one of her objectives. Staff meetings have not taken place although there is constant daily dialogue with staff. The Acting Manager is aware of the need to have formal staff meetings that are minuted. She is now working in the office area of the home 3 days each week she says that this has provided her with the opportunity for individual discussions with staff members. It was clear from records seen and from discussions that we have not been notified under Regulation 37 of all accidents. We discussed the circumstances under which we need to be informed of accidents and other events affecting the lives of people using the service. Care Homes for Older People Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 It is important to ensure that a count of medication on MAR sheets include the amount of medication in stock and brought forward to the current sheets. This will ensure the system can be audited providing evidence of the amount of all medication in the home at any time. Continue to extend the range of activities, both internally and externally to meet the needs of people using the service. The extreme draught from the door in the smaller lounge area that opens onto the garden area must be eliminated as soon as possible. Application must now be made to appoint a Registered Manager to run the home. Regular staff meetings and individual supervision of staff must be introduced. 2 12 3 19 4 5 31 31 Care Homes for Older People Page 27 of 28 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 28 of 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!