Care Home: Gracelands

What the care home does well The home has an assessment process which enables the manager to decide whether Gracelands can meet the needs of the individual. The ones we saw on this occasion were completed and were used to inform the care plan. When we spoke with people using the service they told us they were happy with the activities that are available for them. Daily routines in the home were flexible and people who use the service are being encouraged to make choices for themselves and exercise personal autonomy as far as was reasonably possible. People who live at the home were generally positive about the food that the home provided and the condition of the accommodation that they occupied. The home is regularly maintained and is comfortable with pleasant furnishing. Staff have undertaken training in mandatory areas and in caring for people with confusion and management of medication. We saw that new staff had been recruited and that the home had carried out checks to protect people who use the service. New staff have begun induction training in working at the home. Staff are kept up to date in mandatory training. People who use the service are consulted about the home and what they would like whilst they live there. What has improved since the last inspection? The AQAA for the home said that: "A more in depth care plan has been implemented which covers Mental Capacity Assessment and DOLS Risk Assessment. We do regular updates to ensure that we are fully compliant and that we have as much information about our residents as necessary to ensure all needs are met. Residents are encouraged to voice their opinions and tell us when there is something they do not like or want to do. More staff are becoming involved in the implementation of activities rather than just a designated activities co ordinator. We have started a support and volunteer group with relatives and friends of the residents. Our aim is to raise funds for a mini bus which can be used for more regular outings for our residents. Since the registered manager left I have spoken with several relatives to ensure that they feel able to discuss areas of concern with me and that they feel that any issues they do raise will be dealt with accordingly. Feedback from relatives has been encouraging and shows a vast improvement in our service". What the care home could do better: All individuals must have a care plan that is based on their assessed need for support, including risk assessments. Care plans must be reviewed to ensure that the most appropriate support and care is being given. A record must be kept of medication that is prescribed `as required` is given the reason, and outcome for the individual. Where there is a variable dose a record must be kept of what was given, why and the outcome for the individual. All staff must have regular training in fire safety. All fire prevention equipment must be checked following fire safety guidelines. Key inspection report Care homes for older people Name: Address: Gracelands 42-48 Richmond Avenue Bognor Regis West Sussex PO21 2YE     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: Val Sevier     Date: 1 0 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Gracelands 42-48 Richmond Avenue Bognor Regis West Sussex PO21 2YE 01243867707 01243868331 mpch.graceland@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Macleod Pinsent Care Ltd care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 31. The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home Gracelands is a care home registered to provide care and accommodation to thirty-one service users over the age of sixty-five with dementia (DE(E)). The property is situated in Bognor Regis within close proximity of local shops and the seafront. Accommodation is provided on two floors, which are accessible by passenger lift, and consists of twenty-five single rooms and three double rooms. Communal space consists of four lounge areas and a dining room on the ground floor and a garden to the rear of the property. Care Homes for Older People Page 4 of 31 31 0 Over 65 0 31 Brief description of the care home Macleod Pinsent Care Limited privately owns Gracelands. Mr Russell Pinsent is the Responsible Individual on behalf of the organisation. The Registered Manager responsible for the day-to-day running of the home is Mrs. Margaret Anne Kerbey. The current fees being charged by the home are from #400 to #600 per week. Care Homes for Older People Page 5 of 31 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 quality rating for this service 1 star. This means the people that use this service experience adequate quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The visit was carried out on the 10th August 2009 between the hours of 09:50 and 4:35 pm Prior to the visit to the home we reviewed, previous inspection reports and information received from the home since it was last visited in August 2007. The Annual Quality Assurance Assessment (AQAA) was returned to the Commission by the due date before we visited the home. The AQAA is a document that we send to a service once a year, in it they are able to comment on improvements they have made, any barriers to improvement to meeting the standards and how they feel the service is Care Homes for Older People Page 6 of 31 meeting the needs of people who live at the home. We met with the acting manager, area manager, two staff, three visitors and there were three people who use the service involved in the inspection visit. The registered manager has left the home since our last visit. The head of care has been acting manager for the past six months, we discussed with her about applying for registration with the commission, as it is an offence under the Care Standards Act to run a care home without being registered. The area manager who supports all the managers in the Macleod Pinsent Care Limited group is waiting for their position to be confirmed by Mr Pinsent. We looked at three pre admission assessments, four care plans, medication records, staff files and training records and fire prevention testing and training records. We sent out ten surveys to people who use the service, ten staff and five professionals at the time of writing the report we have had ten surveys returned. There were concerns about the care plans at the time of our visit, the home has written to us following our visit to say that they have written a care plan for the individual where there was not one and two others have been updated. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: All individuals must have a care plan that is based on their assessed need for support, including risk assessments. Care plans must be reviewed to ensure that the most appropriate support and care is being given. A record must be kept of medication that is prescribed as required is given the Care Homes for Older People Page 8 of 31 reason, and outcome for the individual. Where there is a variable dose a record must be kept of what was given, why and the outcome for the individual. All staff must have regular training in fire safety. All fire prevention equipment must be checked following fire safety guidelines. 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 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process, which involves other professionals or family as needed. The current assessment record would prove more beneficial to the assessment and care plan process for the individual if the information is used as a basis for the care plan to meet identified needs. Evidence: The AQAA for the home said: Prospective residents and their families are fully supported when moving into to the home to make the transgression as easy and as smooth as possible. Prospective residents are encouraged to visit prior to admission and to spend time meeting their peer group and even joining in an activity and or having a meal with them. Individuals are are fully assessed prior to admission to ensure that we can meet all their relevant needs. At this stage also we assess what family and social contacts they have, whether any specialist equipment is required, Care Homes for Older People Page 11 of 31 Evidence: their cultural and spiritual needs, peer relationships and compatibility, and methods of communication amongst other things. There have been several admission since we last visited in 2007 we looked at three of them from the past six months. We saw that there was information on individual needs based on their present and past medical history for example, communication issues. The assessment offered choices and space for individual issues to be written. For example needs assistance of one person with personal care, able to carry out some tasks such as cleaning teeth, needs prompting. We saw that one assessment had not been signed or dated. It was not clear when people had been admitted to the home, or when the assessment had taken place. Visitors spoken to on the day said they felt they had had enough information when they were looking for a home for their relative. They acknowledged that someone from the home had come to see their relative and they had been able to visit the home. Care Homes for Older People Page 12 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans do not always detail the needs of the individual and support staff are to give. The medication records and administration within the home do not show that this is always carried out in a safe manner to protect the people who use the service. Staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. Evidence: The homes AQAA told us that: Senior staff are being trained to use new care planning techniques and review these on a regular basis with assistance from family, friends ands advocates. Staff have had training in record keeping to ensure mental health needs are reflected. Dignity, respect and privacy is respected by all staff i.e. we always ensure that our residents wear their own clothing, receive Doctors and visitors in private, are able to take phone calls in private if they wish. Staff receive regular training to ensure these standards are being met. Nutritional assessments are in place to identify any residents who may be at risk from malnutrition. Residents are weighed monthly and any major changes in weight are discussed and monitored carefully. We Care Homes for Older People Page 13 of 31 Evidence: monitor and review frequently all documentation regarding falls and every resident has up to date relevant assessments in place. All senior staff have undergone medication training and after completing successful accredited training sessions are deemed competent in administering medication. Some experienced care staff will be trained in medication administering in the event of an emergency or a pandemic i.e Swine Flu outbreak. All residents have access to a local GP, District nurses, Chiropodists, Dentists and Opticians if required. We work in partnership with other professionals to ensure we deliver best practice. The first care plan we saw that the individual had moved to the home permanently in March 2009, following a period of respite. We could not see a photo identifying the person. We saw admission details with the next of kin, GP and social workers contact details. We saw a dependency profile scoring sheet which had been reviewed March, April, May and June 2009. We saw reports on the individuals daily activities including a fall and injury, GP visits, optician appointments, district nurse visits regarding a pressure blister and the community mental health team. There was a chart to record weight on monthly this had been done twice, February and August 2009 where it was seen that the person had lost 7.1 kg. We saw a fire risk assessment and a life history. We asked the acting manager and area manager where the care plan was, to ensure that they did not have any more information anywhere that we had not seen. They said that the care plan had been written and should have been in the folder they had given us to look at and that the risk assessments were also in there. We showed them the file which had no further documentation on how to care for and support the individual. Since the visit the area manager has written to us to say that they have put care plans in place for this person. The next two care plans we saw had care plans and documents associated with the individuals care and support including risk assessments. There was a photo on each care plan. There was a life history in each care plan seen. This gave information about their life, occupation, family and interests. We saw that care plans had last been reviewed in June 2009. The area manager said that these were the older style plans and that they should have been reviewed. Since our visit to the home the area manager has written to us to say that these care plans have been reviewed. The fourth care plan we saw was the new care plan style that the home is introducing. There was a cover page indicating contact details for person and included allergies and potential risks. We saw a profile/ personal history which had not been completed with a post it note asking senior cares to get information. The home had completed a Care Homes for Older People Page 14 of 31 Evidence: daily living activity assessment, which indicated likely abilities and limitations of the individual. The action plan for staff to support the individual following this assessment was not completed with a post it note saying seniors to complete to return to get printed. The area manager said that she and the acting manager had only just completed this care plan and had left areas for other staff to complete. We saw that some areas had been finished for example personal care, personal safety and diet and weight. There was information for staff to support the person for example full assistance two carers to manage personal care show clothing and help make a choice, provide with paper plates, plastic cutlery and cups as has a tendency to throw at staff and other residents. Well balanced soft diet as often refuses to chew food. Often refuses first course but nearly always eats desserts, food should be offered as a soft diet or finger foods offer extra dessert if doesnt eat main meal and if no food taken offer Fortisip. We were able to speak with the kitchen staff who confirmed that they knew about how to provide food for the person and they kept a record of what they offered and what the person had had. We saw risk assessments for bed rails, and stair gates and there were assessments regarding the individuals capacity under the Mental Capacity Act and Deprivation of Liberty. We saw that nutritional, mental health and physical needs assessments had been completed. We saw a post it note on the manual handling assessment which had last been done in April 2009 the note asked for a reassessment to be carried out. We discussed with the area manager that the care plan was not complete and that the previous care plan was not being used during the transitional period. The area manager said that a member of staff had recently completed the manual handlers training course and that they would be reassessing all the people who live at the home for their manual handling needs. We looked at the medication storage and administration records. We saw the medication records for 4th to the 10th August we requested the records for the month prior to our visit, as this was only a small sample to look at. The medication trolley was attached to the wall downstairs by the staff office. The home has Temazepam stored as a controlled medication and this was kept locked in cupboard near the main office. We looked at the Controlled Medication book and saw the total number of tablets written in the book did not match the stock. We saw that a mistake had been made in the Controlled Drug book. We saw that staff could read guidelines and policies on medication administration, errors, household remedies, risk assessments for people who wanted to self medicate, prescription terms, and generic abbreviations. Medication had been booked into the home and there was a record of the amount the Care Homes for Older People Page 15 of 31 Evidence: home had received We saw the medication records been kept by staff there were three gaps where medication was prescribed to be given and there was nothing to indicate if the medication had been offered, refused or destroyed. We saw that where there is a choice of dosage to be given for example one or two Paracetamol, there was not always a record of how many tablets had been given. Where a medication was as required, there was no record of why it had been given and outcome for the individual. We saw that there were examples of medication that were to be given as directed with no directions for staff to follow. There was no indication in the medication records that creams and lotions that had been prescribed for individuals had been administered or applied. We saw for one individual that they had not received one of their medications for four days as it was out of stock, the acting manager told us that there had been some difficulty between the GP practice and the pharmacy before this was resolved. All surveys returned by staff indicated that they are given up to date information about the support they are to give people that live at the home. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. Evidence: The AQAA for the home said that: We have flexible routines which allow our residents more choice and less restrictions in their daily living i.e. residents choose when they get up and go to bed, meals can be provided to suit individual requirements. Residents are consulted about changes and choices on the menu and these have been developed according to their requests for certain dishes. Activities are planned and suited to the client group with input from the residents themselves as to what activities and outings they would like to participate in. Families and friends are encouraged to maintain relationships and be involved in the daily lives of their relatives. Visiting is unrestricted unless advised otherwise by the resident. We encourage our relatives to visit and stay for lunch as frequently as they are able. Some residents go out with their relatives on a frequent basis also. Residents are encouraged to pursue or continue with activities or interests outside the home as well as in it. Residents are encouraged to personalise their rooms and are consulted when Care Homes for Older People Page 17 of 31 Evidence: decorating is being done as to their preferences. Small items of furniture may be brought in if they wish. This is stated in the service user guide. Residents are supported where able to manage their financial affairs. Small personal possessions of value can be held in our safe if required and most of the residents have their personal allowances held there also. We spoke with the staff in the kitchen and they told us what they had prepared for lunch the day of our visit which was homemade lasagna, vegetables, omelets and cheese and onion bake. The cook keeps a list of what people have had. We saw that people have indicated what they would like for breakfast with the home offering a cooked breakfast three times a week; people had chosen to have for example egg sandwiches, egg and bacon, egg on toast. Other breakfast items include fruit, cereals, porridge and toast. Tea on the day of our visit was fishcake tomatoes, sandwiches soup fruit flan, milk jelly and blancmange. We saw that two type of homemade cake were served with afternoon tea. We saw that a record is kept of key worker activity this included people who use the service being taken out for a walk, to the shops or the local to have a drink. Many of the records we saw for these activities had last been completed in May 2009. The area manager showed us some more paperwork which said that on the week the 4th August there had been 14 people who had participated in exercise, 8 had walked in the garden and there had been manicures, and cake and sandwich making. We were able to speak with some relatives on the day of our visit and they felt that the amount of activities offered by the home had declined. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected through the open complaints process and the staffs knowledge and understanding of safeguarding and protection issues. Evidence: The AQAA for the home said: There is a clear and accessible complaints procedure for the residents, their families and employees. We try to resolve concerns at the earliest opportunity before they become complaints. All concerns and complaints are dealt with swiftly, seriously and are fully investigated and action is taken well within the timescales allotted. We keep all records of complaints and action taken. We have policies and procedures in place which explains how to deal with challenging behaviour and staff will have training sessions on this. All staff are aware of the Protection of Vulnerable Adults and have attended training workshops in house and externally. All of our staff have been CRB checked to ensure their suitability to work with vulnerable adults. Policies and Procedures are in place on receiving gifts or money from our residents and any financial transactions on behalf of the residents are duly recorded. The home has complaints procedure, which are outlined in the Statement of Purpose and Service User Guide and on display in on a notice board above the visitors signing in book. We saw that the address for the commission was Worthing which has not been an office for us for some time. We bought this to the attention of the area manager who altered this whilst we were there. It now includes the timescale of Care Homes for Older People Page 19 of 31 Evidence: response and the address and phone number of CQC. The homes safe guarding adults policy was observed to have been regularly updated and included the West Sussex Multi Agency Adult Protection flow chart on how to report suspected abuse. The acting manager has attended a safeguarding update and attended a session on the Mental Capacity Act. We saw that the home had purchased information relating to this Act and guidance on Deprivation of Liberty. We saw that some staff at the home have had training in safeguarding in July and that training is undertaken with new staff as part of their induction. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a living environment which continues to have ongoing redecoration and refurbishment to improve it. Evidence: The AQAA for the home said: The home has an ongoing programme of renewal and refurbishment. Several bed-rooms have been decorated and residents are encouraged to personalise them. New flooring has been laid in several rooms. Systems are in place to control the spread of infection in accordance with relevant legislation. these include clinical waste disposal and the provision of protective clothing. We have a full time maintenance person who attends to all repairs and requirements promptly. We looked around some of the home and we were able to see communal areas such as the dining room, lounge, bedrooms and bathrooms. People who live at the home are encouraged to furnish the room with personal belongings such as furniture and pictures. The home was seen to be very clean throughout, with no malodour. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work are covered. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home. Individuals commented to us that they were happy with their accommodation those that had them liked having en suite facilities. They described small pieces of furniture Care Homes for Older People Page 21 of 31 Evidence: that they had been able to bring. They liked the lounges where they could sit with others and chat, watch television, read or listen to music or just be quiet. Laundry facilities are sited away from areas where food is prepared and stored. Care Homes for Older People Page 22 of 31 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. Current recruitment practices at the home help to protect the people who use the service. Staff have received all the mandatory training that is expected each year, and training to help them meet specific individual needs. Evidence: The AQAA for the home said: Full recruitment and selection procedures are carried out using a newly updated procedure to ensure equality and diversity. Staff rotas are clearly displayed and all staff are aware of their shifts. All new staff receive Skills for Care compliant induction training and full induction procedures specific to the home and residents needs. All staff receive regular mandatory and extra non mandatory training sessions. The acting manager has recently finished the NVQ Level 4. 50 of our care staff have NVQ level 2 or above. 25 of ancillary staff have NVQ level 2 or above. 46 are near to completing levels 2 or 3. All staff receive copies of the Statement of Terms and Conditions, Codes of Practice, Equal Opportunities Policy, Grievance and Disciplinary Procedures in an Employees handbook. Regular staff meetings are held and all staff have the opportunity to contribute in the development of services within the home. Staff receive regular supervision and can ask for support from the manager when required. At the time of the visit there were twenty three people living at the home. The staffing structure at the home consists of the responsible individual Mr Pinsent, the registered Care Homes for Older People Page 23 of 31 Evidence: manager which is a vacant post at the moment although the head of care has been acting manger for six months, head of care vacant as she is acting as the manager, senior care staff, care staff, kitchen staff, and housekeeping. There are two night staff one awake and one asleep. Staff spoken with on the day of inspection indicated that they were aware of the needs of the people who live at the home. On the day of our visit there were four care staff working in the morning and three in the afternoon/evening. The area manager said this was not usually the case as there were usually three care staff only on in the morning. The area manager and acting manager have made this change whilst the care plans are being altered. Three people have been employed to work at the home recently and we saw that there were two references, there was evidence that a CRB had been received or applied for and that a POVA First check had been carried out and they were dated before the employee commenced work at the home. We saw that the individuals had commenced an induction process. Supervised placements take place before the employee has begun work, and after recruitment checks have been returned. All staff information is kept at the home in the managers office. The training plan was not available at the time of the visit, the area manager sent us a copy three days after we had been to the home. We saw the training plan for staff for the years 2009 to 2010, we could see what staff had done and what was planned. Staff have undertaken medication administration training, food hygiene, fire safety, first aid, infection control and moving and handling. The new staff undertake induction training which includes an introduction to the home for example fire procedures. The individual works through a pack with questionnaires on areas such as the home, safeguarding and their own personal development. We saw that the individual meets with the manager as needed before being signed off as completing the induction. Four surveys returned by staff state that there are usually enough staff on to meet individual needs and four surveys indicated that there were always enough staff. Six surveys from people that use the service indicated that they receive the care they need and staff are always available when they need them, three surveys indicated that they usually receive the support they need and that staff are usually available when they need them. Care Homes for Older People Page 24 of 31 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. The systems and procedures monitor and maintain the quality of the service provided and promote the safety and welfare of those living and working in the home, except with fire training and equipment testing and care planning where the change over in system has led to there being gaps. Evidence: The AQAA for the home said: There is a structured Quality Assurance system is in place which ensures that we can monitor the service we offer more fully i.e. relative questionnaires, health and safety. The acting manager attends regular workshops and training courses as part of her management development and constantly seeks to improve her knowledge and that of the staff. The proprietor supervises the Manager on a two-monthly basis and offers support when needed. Regulation 26 visits are presently being done by an administrator whilst the Area Manager is currently Acting Manager of the home. The Manager regularly liaises with the proprietors who are fully supportive of her and of any decisions she makes for the welfare of the residents and of the service we provide. Risk assessments are carried out to ensure good, safe Care Homes for Older People Page 25 of 31 Evidence: working practices and these are reviewed on a regular basis. There is on going fire drills and fire safety training. The company administer supports the manager with updates and changes in legislation from various sources i.e. CQC. Guide to Care. We ensure safe working practices which include moving and handling, food hygiene, infection control, health and safety, challenging behaviour, safeguarding adults, equality and diversity and first aid. All catering staff have attended an accredited training course for food hygiene and 90 of all other staff have attended training sessions internally. Everyone involved in the preparing of food and drink has been trained. There is currently no registered manager for this home. We spoke with the head of care who is acting manager for the home and she said she would inform the commission about her decision of applying to be registered. She has recently completed the NVQ4 and is looking at the registered managers award. She has completed training in areas such as dementia at Chichester. The area manager is supporting the acting manager; she is also waiting for the responsible individual for the home to confirm her appointment. We saw that the certificate related to the homes registration was displayed in the hallway and displays the details of the core registration for the home. We saw that the acting manager has undertaken staff and resident meetings. The residents commented on food and activities. The acting manager informed the commission in the AQAA that the servicing of all utilities and equipment used in the home has taken place. We saw the policies available to staff and that new ones have been introduced as necessary for example training and medication. We looked at the records for fire safety training and monitoring of equipment we saw records that indicated that some staff have received training every six months, whilst the records indicated that three staff had missed the training in November 2008 and June 2009. The records for testing the equipment had not been completed weekly with only a record for one test in June and some months only two or three dates with gaps of up to sixteen days. This was the same for the weekly checks on the fire extinguishers. We saw that the records for the monthly checks on emergency lighting were last completed in May 2009. The area manager said that an external company had carried out their check in June 2009 we saw paperwork confirming this. Care Homes for Older People Page 26 of 31 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 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 15 Sch 3 (1)(b)Residents must have clear individual care plans describing the support that staff give to meet identified needs. To ensure that individual needs are met staff must have information that is detailed and reviewed. 10/11/2009 2 8 13 13(2) The registered person 10/09/2009 must ensure that lotions and creams are administered at the times and in the amount that it has been prescribed, and that a record is kept. This will ensure that the individual receives the correct medication and helps to monitor their health. 3 9 13 13 (2) The registered person 10/09/2009 must ensure that a record is kept of the amount of medication that is given where there is a variable dosage and why and when Page 28 of 31 Care Homes for Older People 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 an as required medication is given and its effect. This will ensure that the individual receives the correct medication and helps to monitor their health. 4 31 8 8 (1)(2) 9 The registered person must ensure that there is a registered manager for the service. This must be done as a legal requirement and to ensure the safe running of the service. 5 38 23 23(4)(c) (v) The registered 10/09/2009 person must ensure that records are kept of tests and checks on fire fighting and warning equipment. This must be done to ensure the safety of those that live and work at the service. 6 38 23 23 (4)(d) The registered 10/09/2009 person must ensure that fire training is undertaken regularly by all staff. This must be done to ensure the safety of those that live and work at the service. 10/11/2009 Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 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 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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