Care Home: Grosvenor Court Retirement Home

What the care home does well Residents say the like the staff and that they are caring and friendly. They enjoy some of the activities provided in the home and they like the opportunity to use the library and computer room. The home provides comfortable lounge and other communal areas. Robust recruitment processes are followed to help ensure the home employs only appropriate staff. The standard of cleanliness of the home seen is good and there are not any offensive odours. What has improved since the last inspection? The home has increased the number of care staff on shifts to be able to better meet residents` needs and help ensure their safety. There are improved bathroom facilities with adaptations for people with mobility difficulties. The en suite showers have been fitted with shower curtains. Also, where necessary, handrails and shower stools for those who find it difficult to stand for a shower. The home has introduced a robust system of monitoring the administration and recording of medicines to help further safeguard people. Documentation giving information about the home has been made available in large print. What the care home could do better: Two Requirements are made as a result of this inspection. They are in respect of more accurate care planning and improved risk assessments. These will better promote residents` needs and safety. Residents would benefit from a more efficient deployment of staff. Management strategies should be in place where residents have habitual tendencies that have a negative impact on others. The home should be better able to show that staff members have the skills to meet residents` care needs, particularly in respect of mental health, diabetes and the management of challenging behaviour. The routines of daily living and activities should be made flexible and varied to suit residents` preferences and capabilities. The home should be doing more to enable people and promote their independence within a risk assessed framework. Meal times should be less hurried for residents to have a congenial atmosphere in which to enjoy what should be a highlight of the day. Residents would benefit from being supported to personalise their own rooms. This would help create a more "homely" environment. Key inspection report Care homes for older people Name: Address: Grosvenor Court Retirement Home 1-5 First Avenue Cliftonville Margate Kent CT9 2LF     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: Gary Bartlett     Date: 1 1 0 1 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 30 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 30 Information about the care home Name of care home: Address: Grosvenor Court Retirement Home 1-5 First Avenue Cliftonville Margate Kent CT9 2LF 01843228761 01843228575 vanessa.cornfoot@highmeadowgroup.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Grosvenor Court Care Ltd Name of registered manager (if applicable) Ms Vanessa Hazel Cornfoot Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 40. 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). Date of last inspection Brief description of the care home Grosvenor Court is owned and managed by Grosvenor Court ltd. It is registered to provide accommodation and support for up to 60 older people, but some floors of the home are closed whilst refurbishments are planned. The home is situated adjacent to the seafront and overlooks the oval and bandstand. It Care Homes for Older People Page 4 of 30 Over 65 40 0 1 1 0 8 2 0 0 9 Brief description of the care home is within walking distance of local amenities and public transport. The ground floor of the home has lounge and dining space for residents. There are four floors of bedrooms above this, but only floors three and five are currently in use. These floors are accessed via a passenger lift. The current fee range for the service is £329.25 to £700 per week. Further information about the fees and additional costs cab be obtained from the Manager of the home. Care Homes for Older People Page 5 of 30 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: This key unannounced inspection was conducted by Gary Bartlett and Jo Griffiths, Regulatory Inspectors, who were in Grosvenor Court Retirement Home on Monday, 11th January 2010 from 8.30 a.m. until 4.00 pm. During that time the Inspectors spoke with some residents, some staff and visitors. Parts of the home and some records were inspected and care practices observed. The Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for Older People refer to people who use the service as service users. People living at Grosvenor Court prefer to be referred to as residents. Accordingly this shall be done in the text of this report. The Inspectors would like to thank everyone involved for their contribution to the inspection. Care Homes for Older People Page 6 of 30 Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Two Requirements are made as a result of this inspection. They are in respect of more accurate care planning and improved risk assessments. These will better promote residents needs and safety. Residents would benefit from a more efficient deployment of staff. Management strategies should be in place where residents have habitual tendencies that have a negative impact on others. The home should be better able to show that staff members have the skills to meet residents care needs, particularly in respect of mental health, diabetes and the management of challenging behaviour. The routines of daily living and activities should be made flexible and varied to suit residents preferences and capabilities. The home should be doing more to enable people and promote their independence within a risk assessed framework. Meal times should be less hurried for residents to have a congenial atmosphere in Care Homes for Older People Page 8 of 30 which to enjoy what should be a highlight of the day. Residents would benefit from being supported to personalise their own rooms. This would help create a more homely environment. 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An assessment of health and personal care needs is made before people move into the home. Residents can not be assured that the staff members always have the skills to fully meet their needs. Evidence: The home has as Statement of Purpose and Service Users Guide which were updated in December 2009. These have been made available in large print. The Manager said she is intending to make them available in an audio format as well. The home also uses a glossy brochure to provide people with information about the services it offers. The brochures that we saw stated dementia care was provided. The home is not registered for dementia care. Since our inspection, the Manager has told us she has addressed the inaccuracy of the brochure to help ensure that people using it as an initial reference to the home have accurate information. The organisation has policies and procedures for their home managers to follow when Care Homes for Older People Page 11 of 30 Evidence: assessing and admitting a resident to the home. Currently, the home owner has agreed to voluntarily suspend all new admissions to Grosvenor Court, consequent to our concerns raised in our last inspection report about staffing levels. The Manager described how she would visit prospective residents in their homes or hospital to help ensure the necessary information is obtained and that it is up to date and accurate. A pro forma is used to record this information which is used as a basis for the care plan. Information is sought about individuals personal support and health care needs, their social interests, spiritual and cultural beliefs and sexuality. Prospective residents, their families and advocates, and relevant health care professionals are involved in the assessment process. They are able to visit the home before making a decision about moving in. The home uses a training matrix to give a management overview of staff members training needs. This shows some gaps in mandatory training which the Manager stated are being addressed as soon as possible. Only six staff members have had diabetes awareness training, although there are people with diabetes living at the home. Records and notifications show there are some instances of challenging behaviour within the home. It is not clear from records or discussion with the Manager where staff receive training in managing such situations. The home must be able to show that staff have the training needed so they have the skills to meet residents basic care needs and to comply with current legislation and good practice guidelines. The AQAA states two residents have other mental health needs and one has a learning disability. This was evident in some of the care plans and daily records we saw. Mental health and learning disabilities training do not appear in the training matrix. Therefore, the home can not readily show that the staff group has the necessary knowledge and understanding to be able to understand all residents conditions and know how best to promote their welfare. Particularly where a resident is displaying behaviour associated with mental health problems, this could also place people at risk. The home does not offer intermediate care. Care Homes for Older People Page 12 of 30 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. Improved care planning and risk assessments would better promote residents health, safety and welfare. Evidence: To assess these standards we looked at care plans, risk assessments and records which told us how the home meets individuals health care needs including medication. We spoke with staff and residents about how the home ensures people are treated with respect and dignity. We also looked at the homes Annual Quality Assurance Assessment. Each resident has a care plan and four were inspected in detail. They show residents have access to health care professionals such as GPs, Psychiatrists, dentists, chiropodists etc. Whilst residents tell us they have ready access to health care support, records do not indicate the home is consistent in following up referrals. We read that one residents GP had referred to the mental health team and for a psychiatric referral in May 2009 but there was no record of the outcome of this. The Manager has since told us that she has pursued this. Care Homes for Older People Page 13 of 30 Evidence: The Manager acknowledges the care plans have to be more specific in detail as to how residents needs are to be met. One residents care plan indicates they have a very high risk assessment regarding their skin integrity but there are not recorded interventions for staff to follow. In another care plan, it is recorded that there are times when the person can become agitated but there is not guidance as to how staff should respond. A staff member told us that how it had been decided it was safer for a particular resident to always receive personal care from two staff members and this had been happening for approximately two weeks. We did not find this to be recorded in that persons care plan. It is important for staff to have up to date information with clear directives so they can have a good understanding of residents individual needs, welfare and preferences. The care plans include some information about individual preferences regarding personal care, interests and activities but it is not always included in the relevant parts of the care plan. For example, one residents pre admission assessment and life history show they like going out for walks. The social needs part of the care plan, which is where we would expect to see this information, does not include it. Consequently, staff may not be aware of the persons wish to go out and that might be the reason that it does not happen. There are some risk assessments but they are not always as comprehensive and detailed as they should be. It is not evident they are always written or reviewed in response to accidents, incidents or changes in residents welfare. For example, we saw a risk assessment in place which identified a number of falls each month but there was not a resultant action plan in place. The home must ensure it more consistently uses robust processes to minimise risks as far as is practicable. The responsibility for overseeing the storage and administration of medicines has been delegated to the Deputy Manager. She has introduced a robust system monitoring and weekly record sheets are kept. It is clear that anomalies are identified and acted on. Records show that staff administering medications have been trained and signed off as being competent to do so. The medicines room is well maintained, although small. Whilst adequate for the homes current occupancy levels, arrangements will have to be reviewed as more residents are admitted. The Manager undertook to implement a system of monitoring the medicines room temperature immediately to help ensure medications are stored at an appropriate temperature. Medicines were seen to be given in accordance with good practice guidelines. Residents say they like the staff and they are caring and friendly. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to participate in some activities in the home, but would benefit from more opportunity to exercise choice and autonomy. Residents do not have the opportunity to participate in activities outside the home as often as they wish. Residents are supported in receiving visitors to the home and to stay in touch with their friends and relatives. Meal times should be less hurried for residents to have a congenial atmosphere in which to enjoy what should be a highlight of the day. Evidence: An occupational therapist is employed in the home for two days each week. They support residents to play games, make cards, have music sessions and be involved in reminiscence sessions. The residents spoken with said they enjoy these activities. Sometimes entertainers such as singers visit the home. Some residents like to make use of the DVDS, books and audio books supplied by the visiting library service. There is a computer room that residents can use. Care Homes for Older People Page 15 of 30 Evidence: The occupational therapist was not present when we did our inspection and we observed very little interaction between staff and residents during the morning. Unless they had visitors, most resident spent the morning sitting in the lounge, some watching the television, most dozing. The opportunity to have a chat was clearly welcomed by them. The situation did improve during the latter part of the afternoon. We discussed this with the Manager who agreed to review the deployment of the staff on duty so they would be more available to the residents. As detailed elsewhere in this report, care plans do not always clearly outline residents preferences. A resident expressed their frustration at not being assisted to go out for walks that the pre admission assessment and life history indicate as being enjoyed prior to moving into the home. The homes Activities Record records three outings since March 2009. The Manager thought there had been an additional outing prior to Christmas but was not sure when. A resident told us residents seem to only go out when they have a doctors appointment. A staff member confirmed that residents are mostly dependant on their relatives for outings. We had sight of an incident report that records a resident being found in the kitchen trying to make them self a cup of tea. There is no indication that the home has subsequently explored how the person could be supported in doing this. The home should be doing more to enable people and promote their independence within a risk assessed framework. The AQAA indicates the home enables residents to attend religious services or practices should they expressed a desire to do so. The visitors book records regular visits by families, friends and others. The design of the home provides seating areas within various communal areas where residents can entertain their visitors, in addition to the privacy of their own room. Visitors told us they can visit at any reasonable time. One visitor said that staff are friendly but did mention that they never offer the visitor a cup of tea or coffee. At lunchtime, there is a choice of hot main meal with a salad as a further option. The menu board had not been updated to show the lunch time options available on the day of our visit. The need for this to be done was evident as the residents we spoke with could not remember the options they had to look forward to. The residents we spoke with were not aware that cooked breakfasts are available on request in addition Care Homes for Older People Page 16 of 30 Evidence: to every Sunday and Wednesday. The homes Statement of Purpose includes Your input and ideas in the planning of the menus are welcome. This statement is not supported by a resident who told us he loves boiled potatoes and beetroot but does not get these. He said he sometimes fills in a questionnaire and ticks that the food could be improved, but no one comes to talk to him about this. Most residents tell us they like the food, although two said the meals could be improved and another said the meals are sometimes cold. One resident told us he would like larger meals. When a staff member removed this persons empty plate, we observed her to comment to him that he must have been hungry but she did not ask if he would like more. The portions of the meals served, whilst well presented, were not reflective of peoples appetites. This can be off-putting for those with small appetites and frustrating for those with large appetites. Grosvenor Courts glossy brochure states Dining is a highlight of the day ... On the day of our inspection, the time from the first meal being served to the last desert bowl being cleared was less than twenty minutes. The atmosphere was hurried rather than relaxed. We observed staff members leave hot deserts uncovered and getting cold with people who were still eating their main course. We discussed these issues with the Manager who acknowledged that this is not as it should be and would include the need for making meals and meal times more conducive to residents preferences in a forthcoming staff meeting. Care Homes for Older People Page 17 of 30 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. There are procedures to protect residents from abuse and for people to make a complaint should they wish to. Evidence: The complaints procedure is readily available to residents and their relatives. It is also available in a large print format. The Manager said the home would keep a record of all complaints received by them, the result of the investigation and how the complaint has been resolved. She stated there have not been any complaints since she took post in September 2009. The Commission has not directly received any information regarding complaints about the home since the last inspection. The people we spoke with are generally aware they can make complaints or comments about the service. As detailed elsewhere in this report, the home should be able to better demonstrate that residents have a regular opportunity to speak with staff and that their views and opinions are acted on as far as practicable. This would make the service offered more person centered and improve peoples quality of life. There are procedures for responding to suspicion or evidence of abuse or neglect and ongoing training for staff to ensure the safety and protection of residents. Staff members spoken with have a sound understanding of need to report suspected abuse. There has been one safeguarding alert since the last inspection. This was raised by the home and is currently ongoing. Care Homes for Older People Page 18 of 30 Evidence: The Manager is aware of the assessments that need to be done in respect of Deprivation of Liberty Safeguards and reference to the Mental Capacity Act was seen in the care plans inspected. Care Homes for Older People Page 19 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean environment with comfortable communal areas. Residents would benefit from being supported to personalise their own rooms. Evidence: Grosvenor Court is a Victorian building located close to the seafront and to the local shopping area with all its amenities. The home is registered to provide accommodation and support for up to 60 older people, but currently only has 18 people using the service. There are four floors of bedrooms, but only two of these are currently in use. These are currently only accessible via a passenger lift, the stairs being closed off for safety reasons. This was seen to have an impact on peoples ability to get around the home, with everyone being dependant on the lift. The home has two large lounge areas, a large dining room and a smaller quiet room. There is a large screen television that can be seen from most parts of the lounge, but not all. A computer room is available for use by residents and there is a hairdressing salon that is used by the hairdresser on her weekly visits. There is not provision for residents to make themselves drinks or snacks within a risk assessed framework. Such a facility would encourage independence. Residents and staff tell us the toilet facilities are adequate for their purposes. There Care Homes for Older People Page 20 of 30 Evidence: are three toilets for females and one for males that is also suitable for people with physical disabilities, near the lounge. The decor of these is basic and beginning to look worn and is in contrast to the visitors/staff toilet situated nearby. The number of toilets close to communal areas is adequate for the current number of residents but will need to be reviewed when more people are admitted. The Manager undertook to arrange for the call bell cord in the toilet opposite room 409 to be made more acessible to people using that facility. There has been a problem with plumbing recently which was being dealt with whilst we were there. Residents and staff say there is hot water when they need it. All bedrooms are for single occupancy and have en suite facilities, some have a shower. Since our last inspection, these have been improved with the fixing of shower curtains and handrails where needed. Shower stools have also been provided. Residents are able to lock their bedroom doors and have a lockable facility within their room. Blinds have been fitted to the windows of the bedrooms that were identified as being too hot during the summer months. The last inspection report shows that some peoples bedrooms were quite bare and they had not been supported to personalise their rooms. There was a lack of shelving in the bedrooms for people to place their personal belongings. The bedrooms seen still showed little indication of the occupants tastes or preferences. This lack of personalisation does not help create a homely atmosphere. Additional lifting hoists are now in situ, enabling people with mobility difficulties to use the spa bath on the ground floor. The standard of cleanliness around the parts of the home seen was good and there were not any offensive odours. Care Homes for Older People Page 21 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst there are now appropriate staffing levels, more efficient deployment of the staff would better enable residents to receive the support they need. Evidence: As a result of our findings at the last inspection, we required the home to provide adequate numbers of staff. This has been addressed. There are now four care staff on duty in the mornings and three in the afternoons, seven days per week. This number includes the Deputy Manager or a Senior Health Care Assistant. In addition, there are catering and cleaning staff. The Manager understands that as numbers of residents increase or their needs change, the number of staff will have to be reviewed. We observed that staff were rarely present in the communal areas during the morning of our visit and there was little interaction with the residents. There was some improvement during the afternoon. Some account must be taken of the impact of everyones time caused by their reliance on having to use the shaft lift to gain access to other floors of the home. As detailed elsewhere in this report, some residents would benefit from more support in undertaking preferred activities such as walks out and being supported in independence. The Manager agreed to review the deployment of staff and daily routines to facilitate this. Residents say they like the staff, that they are friendly and polite. This was confirmed Care Homes for Older People Page 22 of 30 Evidence: by our observation. We looked at two staff files and these show the home has robust recruitment procedures to make sure only appropriate people work there. New staff are required to undertake an induction programme. The training matrix shows some gaps in mandatory training for staff. The Manager described how these are being addressed so that each shift comprises staff with the necessary skills to meet residents needs. Records and notifications show there are some instances of challenging behaviour within the home. It is not clear from records or discussion with the Manager where staff receive training in managing such situations. The AQAA states two residents have other mental health needs and one has a learning disability. This was evident in some of the care plans and daily records we saw. Mental health and learning disabilities training do not appear in the training matrix. Therefore, the home can not readily show that the staff group has the necessary knowledge and understanding to be able to understand all residents conditions and know how best to promote their welfare. Particularly where a resident is displaying behaviour associated with mental health problems, this could also place people at risk. The Manager undertook liaise with the organisations Training Manager so the home is more able to show that staff have the training needed so they have the skills to meet residents care needs. Care Homes for Older People Page 23 of 30 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. Residents interests would be better promoted by more robust management and quality assurance arrangements. Evidence: The Manager joined the home in September 2009 and has applied for registration. She has the Registered Managers Award, NVQ 4 in care and was previously the registered Manager for another care home owned by this organisation. She has also worked for the company as a Group Support Manager. Staff members spoke highly of the Manager and one said she is very approachable. The management team has been augmented by the appointment of a Deputy Manager who took post in November 2009 and demonstrated a good awareness of good practice and where further improvements need to be made to enhance the quality of life for people living at the home. Care Homes for Older People Page 24 of 30 Evidence: There have been improvements to staffing levels and aspects of the environment since our last inspection. Residents would further benefit from a more efficient deployment of staff, more proactive monitoring of care plans and risk assessments and more effective monitoring of individuals views of the service they receive. Management strategies should be in place where residents have habitual tendencies that have a negative impact on others. For example, we are told that one resident regularly removes the locks from toilet doors. Two were missing at the time of our visit. It is a legal requirement for the provider to arrange for the home to be visited at least once a month to evaluate the quality of service and for a report to be written. We had sight of the most recent report dated 6th January 2010. The report is largely reflective of what we observed but could be more detailed. For example, it does not include that there are holes in tiles of toilets on ground floor resultant of fixtures being removed and that they need to be repaired to help maintain infection control. As part of their quality assurance systems, the home has sent surveys to residents, relatives and health care professionals recently. The results of these are being collated. The Manager said when this has been done the results will be used to inform an action plan. The Manager said it is intended to hold residents meetings every three months and acknowledged this had not been done. She was able to show us that a meeting has been arranged to be held in the near future. As detailed earlier in this report, some residents do not feel their views are always taken account of. We recommend the home reviews its arrangements for security to protect the interests of people there. Whilst the main doors are protected by various locks, we observed a contractor make his initial entry to the building via a rear door that had been left open and no staff were in that area. The Manager agreed to remind staff of the necessity to keep the home safe from possible illegal entry. The home has effective systems for the safe holding of residents money. The records we inspected are detailed and accurate. There are records of fire systems checks and fire drills and training. The two staff members we spoke with about emergency procedures had a good understanding of them. The staff were seen to comply with COSHH guidelines to help ensure the safety of people. The Manager indicates all records of maintenance and safety checks are up to date and that the organisation regularly reviews policies and procedures to ensure they comply with current legislation and good practice advice. These were not inspected on Care Homes for Older People Page 25 of 30 Evidence: this occasion. Care Homes for Older People Page 26 of 30 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 30 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 17 The registered person shall maintain records as specified in Schedules 3 and 4 It is a legal requirement for the registered person to keep the service users plan under review. Service users individual plans and records must be up to date, consistent and specific in detail of information required. All service users must have an accurate care plan by the given timescale, if not sooner, which is maintained thereafter. 31/03/2010 2 7 13 The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. 31/03/2010 Care Homes for Older People Page 28 of 30 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 It is a legal requirement for the care home to minimise risks as far as is practicable. Risk assessments must be more comprehensive and recorded in response to incidents and changes in service users welfare. Comprehensive risk assessments must be in place by the given timescale, if not sooner, and maintained thereafter. 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 29 of 30 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). 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