Care Home: Grapecroft Care Home Ltd

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What the care home does well Residents are happy living at the home. They speak positively of the staff and describe them as `friendly` and `caring`. Residents said `I like living at this home`. The staff are good at ensuring that residents health care needs are met in a proactive way. The activities officer provides a good range of group activities and the chef is committed to providing a good meals servicce which overall the residents are happy with. The management of the home is sound and the manager is good at dealing Whit any issues raised, including complaints, to which she has an objective approach. What has improved since the last inspection? The home has steadily improved since our last inspection. The staff team is more stable and because if this better trained. More staff are now trained in the care of people with dementia and adult safeguarding. Care planning and management also continues to improve. What the care home could do better: Whilst we have not set any regulatory requirements, there are areas for work for the manager and her team to attend to and these are outlined in the recommendations. More work is needed on developing a person centred approach to care, including social care. The activities programme at the home is quite good, whilst the activities officer is about, but when he is not there the care staff do not proactively take this on board as their role and this needs to be addressed. Key inspection report Care homes for older people Name: Address: Grapecroft Care Home Ltd 82-84 Calcutta Road Tilbury Essex RM18 7QJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Roberts     Date: 0 4 0 5 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: Grapecroft Care Home Ltd 82-84 Calcutta Road Tilbury Essex RM18 7QJ 01375852020 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Festival Care Homes Ltd Name of registered manager (if applicable) Phidelima Ajao Type of registration: Number of places registered: care home 62 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 62 The registered person may provide the following categories 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: Dementia - Code DE Mental Disorder, excluding learning disability or dementia - Code MD Learning Disability - Code LD Physical Disability - Code PD Past or present drug dependence Care Homes for Older People Page 4 of 28 62 62 62 62 62 0 62 Over 65 0 0 0 0 0 62 0 Code D Past or present alcohol dependence - Code A Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Grapecroft is a new, purpose built home set over three floors. At the current time some parts of the home are not operational due to the number of residents admitted, for example, Rosecroft the mental health rehabilitation unit for adults. All bedrooms are ensuite and there are communal lounges, a dining room and kitchen on each floor. The home has some secure gardens to the rear of the property and car parking space available. The home is located in central Tilbury, close to the local shops, bus route and train station. A statement of purpose and service user guide is available and the current fees for the home range from £407.26 to £595.77 per week, depending on need. Additional costs are charged for newspapers and hairdressing etc. 2 1 0 5 2 0 0 9 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home for a day and met with the responsible individual for the provider as the manager was on annual leave. Prior to this we reviewed all the information that we already had on the home and this included the managers Annual Quality Assurance Assessment. The manager was asked to complete this and this tells us how well they think are doing, what they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. On the day of the inspection we spoke to 4 residents, 2 relatives and 3 staff at the home and prior to that we sent out surveys to residents and staff asking for feedback on the home. The response was reasonable and their comments are referred to in the report. Whilst at the home we also reviewed records and undertook a tour of the home. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 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 8 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their needs would be properly assessed prior to admission to the home and that they would have the information they need. Evidence: The manager completes any pre-admission assessments for prospective residents. We reviewed two recently completed assessments and these were seen to be detailed and contained sufficient information on which to based a decision regarding admission to the home. The assessment also gave information on the persons ability to make choices and where appropriate, how their dementia affected their day to day life. In addition to the assessment tool a body map, to record skin condition etc. and a mental health assessment is also completed, giving a good overall process which means that people can be assured that their needs have been properly assessed. The manager in her AQAA said we provide a package of comprehensive information to all prospective residents. The last inspection report was seen to be easily available in Care Homes for Older People Page 9 of 28 Evidence: the reception area along with brochures on the home. There is also information on what you can expect in relation to the care you receive that primarily links to being cared for with dignity. In the future the manager plans to develop a pictorial service users guide, which would be more user friendly for some of the resident groups in the home. Relatives we spoke to were very happy with regard to the choice of home, information available and overall admission procedure. They felt that their relative had settled in well and was content and eating well. On our surveys, residents and relatives felt that they had enough information about the home at the time of admission. Care Homes for Older People Page 10 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. Residents can expect their care needs to be met but not always in a person centred way. Evidence: The manager has a care planing system in place and this continues to steadily improve. The care plan is developed from a comprehensive assessment of need. Residents generally had the care plans and risk assessments that they required in place. Whilst the care plans were sufficiently detailed to guide staff, they were not very person centred and lack detailed on residents preferences/choices and really the resident themselves. In some cases the residents family had completed social and family histories and these were seen to contain some good person centred information and preferences which staff should incorporate into the care plan. Consideration should be given to providing care plans for those residents experiencing pain, so staff identify how this affects their daily lives, for example with mobility, independence etc. Where possible, residents were seen to have signed their own care plans. Overall the care plans were up to date however, one resident who had been a respite resident at the home and then became permanent, had the same care plans in place, last Care Homes for Older People Page 11 of 28 Evidence: reviewed in March 2010. These should have been reviewed, as from talking to staff their needs had changed significantly. For example, the care plan stated that the resident required prompting with eating whilst staff told us that they were having to feed the resident and that they were not eating very much. From talking to the staff, they knew the residents quite well, being aware of their key needs but not always their social background etc. As the staff rotate between units, they need to ensure that they read the care plans as soon as possible after moving. Staff confirmed that they were not aware of the content of some of the care plans. Staff write daily notes for each resident. These were variable in quality with some being more informative about the resident than others. Work should be done to ensure that they reflect the resident, their care plan and their wellbeing rather than stating, for example, provided safety and comfort as this gives little information about the person. The manager in her AQAA said Whilst our care planning process and systems have improved and is more person centred, we continue to audit care plan standards and implement improvement strategies. We would agree that this is happening. Residents had a range of risk assessments in place that overall, were up to date and covered nutrition, falls, manual handling, tissue viability etc. The risk assessments were generally linked to care plans and the management was clear. More work is needed in relation to care planning for those at risk of pressure sores as the preventative measures being put in place were not always evident in the records, along with any reason why equipment was not being used for those identified at risk. This would aid with ongoing evaluation etc. Records showed that residents were being weighed regularly. Ideally residents should be weighed on admission to give the home a baseline weight and to help with risk assessing and care planning. On one record it showed that a resident had been weighed 9 days after admission. More could be done to record residents food preferences, especially those who are of concern with regard to their nutritional intake as this may help staff plan what snacks could be offered in order to improve dietary intake. Records showed that where staff were concerned regarding weight loss, they had referred this on. Records showed that residents had good access to their Doctor and that staff were proactive in contacting the surgery for advice and/or visits. Residents also see the chiropodist, community nurses and opticians etc. In addition to this some residents had a completed preferred priorities for care in the event of a major illness and where appropriate staff had completed mental capacity assessments. It was noted that staff are carrying out regular blood pressure checks and on occasions blood sugar checks on residents that have been assessed as needing residential and not nursing care and those where blood sugar checks are not indicated. The rational for this must be reviewed and the team must ensure that they are caring for residents in relation to their assessed needs and that Care Homes for Older People Page 12 of 28 Evidence: they are not carrying out unnecessary invasive procedures. Residents who commented on their care said there are not enough staff around to help me improve my mobility, at night I do have to wait for the toilet if I buzz, they use to come quickly before, I had a bath last night and the carer who helped me was very nice, they are good with your clothes and the laundry service is good, the care staff do not help me to walk at all and I would like to try - it would help me mentally and physically and any health issues are dealt with promptly. In our surveys residents said that their care needs were either always or usually met and that staff were either always or usually available to them. They also said that staff always or usually listened to them and acted upon what they said. They said that their medical care needs were always attended to well. We reviewed the medication system in the home. A blister pack system is primarily used. Overall the medication system was well managed. The administration sheets were clear, items had been checked in and where as and when medications were offered or given the correct codes etc were used. Blister packs checked tallied with the administration sheets and there was evidence of medications being reviewed. Controlled medications are stored, checked and recored correctly. We noted two areas for attention. Staff should note the date of opening on liquid medications so they can be audited if need be. It was also observed that staff on one unit were pre-dispensing medication to be given later. This is not an acceptable practice and increases the risk of medication errors. The item had been pre-dispensed and left unlabeled in the medication trolley. The item should be dispensed when required. There was no evidence to suggest that this was a widespread practice. The manager completes a comprehensive medication audit regularly and where shortfalls are identified staff are notified. There was also evidence that the supplying pharmacist visits to audit systems and provide the team with support. Whilst we were in the home, talking to residents, we noticed, on several occasions, that staff failed to knock on the door prior to coming in. This covered nursing, care and ancillary staff. This should be highlighted in order to maintain residents privacy. Care Homes for Older People Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect choice in their day to day lives and to enjoy a reasonably good activities and meals service. Evidence: From the records and talking to residents and staff, the routines of the day are generally resident led, as far as possible. Residents who commented said that I get a choice about when I get up and when I go to bed and I can do what I want during the day. Staff were observed to interact with residents in a friendly way and gave them choices with regard to drinks and how they wanted to spend their time. Relatives we spoke to confirmed that they had completed social histories for their relatives, where need be, at the request of staff. The majority of residents had social histories in place, but not all and this should be addressed. Again some residents had their social preferences recorded but not all. Social care plans were in place but overall these were generalised, not individual and did not always evidence an assessment of social need and what the team could do to meet those needs and promote independence, the retention of skills and self worth. Whilst, in some cases they promoted one to one time there was often no guidance for staff as to what could be done during this time and presences were not evident on the care plan. Activity Care Homes for Older People Page 14 of 28 Evidence: records justed stated individual interaction but there was nothing to state what this consisted of, or too see if it was needs led. Staff spoken to said that care staff really dont do many activities, if the activities officer is not on duty. An activities officer is in post and the provider told us that they plan to employ another person for 20-25 hrs a week now that 3 floors of the home are open and occupancy is up. A programme of activities was displayed on the noticeboards for the week ahead. This included, quizzes, coffee and chats, cake making, movement to music, board games, pampering, sing a long, shopping, library. On the day we inspected the activities officer was not on duty. Staff were seen looking at magazines with residents and they said that residents used the garden and that the staff took them on a Friday to a local market to look around and do some shopping. Activities were very limited on the day we visited and were either not carried out or primarily consisted of throwing a ball. Care staff need to appreciate their role with regard to the provision of activities and see this as a key part of their caring role and understand the value it brings. Activities records showed that the above programme was generally in place and that in addition entertainers visited the home and that key events were held at Easter etc. Residents who commented said that I dont do the activities, I would rather watch TV. They always tell me what is on though, the activities officer always gets me a newspaper, I am not aware of any outings, I like the outdoors, its extremely boring, too much sitting about when previously I was very active, I choose to stay in my room, I do see the activities officer, he does his best but he has a demanding job and the activities officer does do crosswords with me. Relatives we spoke to commented positively about the activities officer and said that he came to see their relative most days. Comments included the activities are varied and the activities are good for those who want to join in. We observed the lunchtime period on all three units. The tables were nicely laid, although many did not have condiments, and staff were helping residents in a sensitive way. More consideration could be given to promoting independence and choice on all three floors by residents having access to, for example , juice in jugs and gravy. The food looked and smelt appitising and the residents we spoke to after lunch spoke positively about the food and comments included I enjoyed my lunch today and ate it all up. We noted that by late morning residents still did not have jugs of juice available to them either in their rooms or in the lounges. On asking, this related to the fact that this was generally a domestic task and they were short of staff and had not got around to this. Senior nursing and care staff should notice this or staff should communicate the issue so that alternative arrangements can be made so residents have the fluids available that they need. On a positive note we did note that care staff Care Homes for Older People Page 15 of 28 Evidence: were giving residents drinks when they requested them and not making them wait until drinks rounds. Residents who we spoke to who commented said that sometimes the tables are not properly laid and things are missing, mainly the food is alright, at tea time though its mainly soup and only 2 sandwiches, sometimes there is no brown bread, the food is excellent, always well seasoned, A residents catering survey is carried out and the menus are altered following feedback. The results of the audit were seen and overall residents are very happy with the food and adverse comments were very minimal. Residents are asked to say what they like on the menu and what they dont like. The chef continues to provide themed menus on key days such as St Georges Day, Chinese Day and the Queens Birthday etc. The activities programme states that there is wine and sherry available on Sundays. Care Homes for Older People Page 16 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. Residents will have their concerns listened to and acted upon and, as far as possible, they will be protected from abuse in the home. Evidence: The complaints procedure is displayed on the main notice boards around the home and this has been updated since our last visit now showing that people can contact their referring authority. The manager maintains a detailed complaints log which we reviewed. The managers records show an objective approach to the management of complaints and any investigation and the outcome are noted. Where necessary letters are written to complainants and complaints were seen to be managed well. The manager records, as per the providers policy, all complaints no matter how minor and this is a positive approach to take. Since we last visited the home there have been 9 complaints and these related to, for example, medication, the conduct of agency staff, staff not speaking in English and the state of a bedroom. Records show that the manager also deals with any matters relating to staff in an objective way and in the best interests of the resident. The manager in her AQAA said all complaints are fully investigated and in every case the cause of the complaint is identified and an action plan is put into place to reduce the risk of it reoccurring. Residents we spoke to said I would feel confident raising any concerns and would be reassured that it would be attended to and if I had a complaint I would not hesitate in raising it. In our surveys, residents and relatives all said that they knew how to Care Homes for Older People Page 17 of 28 Evidence: raise a complaint. Equally the file shows recorded evidence of compliments to the team at the home and these show that people were happy with the care provided and the way that the home is managed. Relatives who made compliments also stated how their relative had improved in their health and wellbeing since admission and that residents were encouraged to take part in activities. The manager has local guidance in place in relation to the protection of vulnerable adults. Staff we spoke to showed and understanding of the procedures that would need to be followed should an incident arise. Staff training records showed that 31 out of the 38 staff employed had received training in adult protection. This has improved since our last inspection and the manager confirms in her AQAA that adult protection also forms part of the induction for any new staff. From our records, the manager appropriately refers any matters of concerns to the safeguarding team, should the need arise. Care Homes for Older People Page 18 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. Residents live in a clean, safe and well maintained home. Evidence: We toured the home and overall it is very clean, tidy and well maintained. We noted that some chairs in residents bedrooms, especially if they choose to spend the majority of their time there, could do with more cleaning. No odours were noted in the home. Residents and relatives who returned our surveys said that the home was always fresh and clean. The bathrooms are very clinical and could do with some colour etc. so that staff and residents have something to discuss and the provider, agreed and put this into action on the day we visited. Signage around the home for key rooms, especially on the unit for people living with dementia, has improved since our last visit. Some bedrooms have signs but these do not relate to the individual and may not help with aiding the person to find their room and in promoting their independence. More social stimulation could be provide around the home. There are odd pieces such as telephones etc. on walls but this could be improved upon in order to stimulate residents interaction, especially for those living with dementia. The manager in her AQAA says we will continue to improve the signage in the dementia unit by purchasing signage for each residents door to identify his or her own room with either a picture or something specific to the resident. A sensory room has been developed but this was seen to be basic with some flashing lights, which some people may find disturbing, and music on. More research and development should be carried Care Homes for Older People Page 19 of 28 Evidence: out in relation to the provision of such rooms in order to make them more appealing. Relatives we spoke to commented positively as to how helpful the maintenance man was and that he had painted a bedroom for them in the colour that they requested prior to the admission of their relative. A good system is in place for every floor where staff record items to be attended to and the maintenance man signs them off when complete. The outside of the home remains unkempt in some areas. The provider informed us that along the front of the home they plan to fit railings to stop people walking on the garden and they then plan to tidy this area up. The garden in the car park still requires work. The rear garden has now been opened up making a larger space for residents to spend time although areas of hardstanding are small. Raised vegetable beds have been provided for residents to use. The manager has an up to date fire safety risk assessment in place and records show that the systems are tested regularly and staff fire drills are held. Care Homes for Older People Page 20 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. Residents benefit from a stable staff team who are generally well trained and supported. Evidence: The manager also provides an out of hours on call cover rota for the home. Staff spoken to said that the management of the home was good as they do provide extra staff when needed, for example with residents that need more input/monitoring. From records the staffing levels were last reviewed in February 2010. The provider informed us that currently 3 residents are having one to one time paid for by the referring authority. Other than this they provide a 1:5 ratio and for over 15 residents four staff morning and afternoon. At night there are two staff on each floor. The rota shows that these levels are generally maintained with the occasional use of agency staff. Staff who commented said that more staff are needed at night and hire more staff so that we are not always short. Reviewing the rota, staff sickness is usually covered. Consideration may need to be given to some of the day staff starting earlier to support the night staff at the end of their shift, if this is a busy time. Residents who commented said that some of the staff are good and some talk in their own language, which is rude, the staff are lovely, I have not had any problems at all, some of the staff are very nice, the staff are excellent, very caring and friendly, I dont see the night staff much but they are always about, the staff are very nice and Care Homes for Older People Page 21 of 28 Evidence: attentive and the staff are very caring and have patience. The home employs a high number of overseas staff. We spoke to them about talking in their own language and they were very aware that this is not acceptable, the manager had spoken to them about it and they felt that on occasions they may slip into this and forget, but it was not something that they did deliberately to upset residents or visitors. Relatives who commented said that the staff were friendly, helpful and caring. The number of staff with NVQ qualifications continues to increase and the team now have over 50 of their staff with an NVQ. Staff files were reviewed to assess the robustness of the managers recruitment procedures. Overall these were in good order with all the required checks and documentation in place. There was also evidence of the induction of new staff on the files Training records showed that overall, compliance with staff training is generally good with staff nearly all trained in statutory subjects such as fire safety and manual handling. The majority of staff also have some training in caring for people with dementia but the level of the course is not evident. Staff have also been attending training in Mental Capacity and the Deprivation of Liberties. Consideration should be given to providing more training on conditions associated with old age, for example, Parkinsons Disease or Diabetes. IN her AQAA the manager says that nursing and care staff have attended end of life training from staff at the St Lukes Hospice in Basildon. Training in infection control was seen to be booked for 16 staff including the manager. From the staff files, records show that the manager writes formally to staff who fail to attend training. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well run home where the management has their interests at heart. Evidence: The manager has worked at the home since it opened. She is a qualified nurse and holds the Registered Managers Award. Records show that she keeps herself up to date with training.Relatives we spoke to said that they liked the manager and that she was very approachable. The staff spoken to said that the manager was unbiased and objective and felt that they could raise any issues with her. The manager regularly meets with the staff team and minutes held show that a range of issues are discussed that include care management and policy and procedures. These minutes also evidence that items raised at the residents and relatives meeting are being actioned, for example, staff name badges. The manager also holds health and safety meetings to progress any matters identified. Care Homes for Older People Page 23 of 28 Evidence: As part of the managers quality assurance system, residents and relatives views are sort on the services and facilities provided at the home. These are sent out every six months and during the year more specific feedback is sort on, for example, the food provided. Consideration should be given to the format of these feedback sheets to ensure that they are user friendly for residents as the print is small and the layout compact. Recorded evidence in staff communication books showed that the manager had been undertaking audits of the care planning/management system. In addition to this the manager completes medication, pressure sore and infection control audits. The manager also meets with residents and relatives twice a year. Residents who commented said I like living here. Relatives who commented said my relative has been very happy at the home, they are always eager to learn from relatives about residents and I dont know how many staff are dementia trained, I know some are but which ones, could this be on their name badges ? The staff supervision matrix shows that some staff are having regular supervision whilst others are not or inconstantly. This should be addressed. Accident records were reviewed. Staff complete these fully and where appropriate there is evidence that concerns have been followed up. No health and safety issues were noted. Care Homes for Older People Page 24 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 25 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 7 Continue to develop a person centred approach to care planning and ensure that the care plans are kept up to date for all residents. Consider developing care plans in relation to pain management where appropriate. Revisit the need for residents privacy with all staff. The social care plans need further work to ensure assessed needs are catered for and records should evidence that individual needs are met. Work should also be done with the care team so that they appreciate their role in relation to social care. Continue to develop facilities for residents in relation to social stimulation and signage, especially for those residents living with dementia. Review staffing levels to ensure sufficient support at busy times during shifts. Give consideration to providing staff training on conditions associated with old age. 2 3 4 8 10 12 5 19 6 7 27 30 Care Homes for Older People Page 26 of 28 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 8 33 Give consideration to the format of the quality assurance feedback forms for residents, to ensure that they are user friendly. Improve the consistency of staff supervision. 9 36 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. © 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. 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