Care Home: Hadfield House

What the care home does well People were given information about the home and their needs were assessed before they moved in. This meant that they knew that their needs could be met. People were supported through the admission process sensitively. One person`s relative said that, "the manager gave me all the time I needed to discuss things" and added, "I was quite impressed with all the time they spent with me". The manager ensured that a social history was recorded for each individual person by their family and friends, with their input. We saw that these contained family details, where the person went to school, what their occupation was and other useful information about likes and dislikes. This enabled staff to understand what had been, and what was, important to each individual. People said that visitors are, "made welcome" and we witnessed visitors being greeted by the manager and staff in a friendly and welcoming manner. This is good at it allows people to maintain their relationships with family and friends. The people and their relatives we spoke to were pleased with the standard of care at the home. In particular, all seven people who filled in a survey said that the staff always listened and acted on what they said and that they always received the medical support they needed. One person`s relative said that they were, "happy with the home, it`s A1" and added that their relative was, "well looked after". and had, "improved tremendously", People were pleased about the way the staff respected them. One person`s relative who visits the home regularly and observes the staff said that staff, "don`t treat (people) like a nuisance", they are, "respectful" , and are, "good about privacy". This is good for the people using the service. People, their relatives and the staff were happy with the manager and said that they could go to the manager with any problem and knew how to make a complaint.. A relative said that the manager was, "honest, friendly and helpful". Staff`s comments about the manager included that she was, "great", "listens to you", is, "very understanding", is, "approachable you can ask her anything", and, "puts the residents first". People were also happy with the staff. One person`s relative said that they, " trusted the staff, absolutely", and that they were,"very caring","very good", and, "gentle". What has improved since the last inspection? Some redecoration and replacement of some carpets had improved the environment since the last inspection. The manager had started to hold resident`s meetings to obtain people`s views on the running of the home and planned to hold these meetings regularly. What the care home could do better: The manager needed to provide more social activities. The manager knew this and said that it would be addressed. Security of the medication trolley needed to improve, records of sample signatures of staff who administer medication needed to be held and a care plan which detailed a person`s specific needs concerning their medication needed to be in place. Alternative menu choices needed to be provided at the main meal so that people had more meaningful choices. While the manager and staff demonstrated an open and committed approach to the protection of vulnerable adults, they needed to have regularly updated training so that staff were confident about the practical steps they need to take should an allegation be made. Some aspects of recruitment practice needed to improve, to ensure that people who use the service are supported by staff who are consistently vetted. The manager needed to ensure that the environment consistently meets the fire department safety standards. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hadfield House 39/41 Queens Road Oldham OL8 2BA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Dempster     Date: 3 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 29 Information about the care home Name of care home: Address: Hadfield House 39/41 Queens Road Oldham OL8 2BA 01616200348 NOFAX hadfieldhouse@masterpalm.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Masterpalm Properties Limited care home 28 Number of places (if applicable): Under 65 Over 65 8 0 21 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 0 3 0 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 28 Date of last inspection Brief description of the care home Hadfield House is a Victorian detached house, situated one mile from Oldham Town Centre, close to local amenities and public transport. The home is registered to provide care for up to twenty eight older people, some of whom have Dementia. Accommodation consists of two large lounges and a lounge/dining room. There are 26 single bedrooms, 17 of which have en-suites. An additional eight single bedrooms share an adjoining en-suite and there is one shared room. There are large wellCare Homes for Older People Page 4 of 29 Brief description of the care home established gardens to the front of the property, which overlook the local park. Seating areas are provided for people to use. The range of fees charged at the service are from 360 pounds to 380 pounds per week. Information about the service can be obtained from the manager. Care Homes for Older People Page 5 of 29 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: This key unannounced inspection included a site visit. The manager and staff at the home did not know that the visit was going to take place. On 25th April 2008, an Annual Service Review (ASR) was done, as part of the lead up to this inspection. This involved the manager filling in an annual quality assurance assessment (AQAA), and people who use the service and staff filling in surveys to tell us their views of the home. We then considered this information, and all the other information we had received about the service, so that we could decide when we needed to visit the home to do a key inspection. The outcomes for people who used the service at that time were good. This reassured us that people at the home continued to be happy with the way they were supported at the home and that they continued to receive a good service and this helped us to plan the timing of this inspection. Prior to this inspection, Care Homes for Older People Page 6 of 29 we sent surveys out again to people who use the service and staff so they could tell us what they thought about the service. Eight of the staff and seven people who use the service returned their surveys. Comments from these surveys are included in the report. We asked the manager of the service to complete an AQAA again. This form gave the manager the opportunity to tell us what they feel they do well, what they needed to do better and what had changed since the last key inspection and ASR. This helps us to determine if the management of the service see the service they provide in the same way that we see it. The form needed to be completed in more detail and the manager was advised as to the level of detail we need to tell us what plans there were to develop the service. All of the key inspection standards were assessed at the site visit and information was taken from various sources. This included observing care practices, talking with people who use the service, their relatives, the manager, one of the owners of the service and members of the staff team. Three people were looked at in detail to learn about their experience of the service from when they first used it to the present-day. A selection of records were looked at, including medication records, training records and care records. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 29 The manager needed to provide more social activities. The manager knew this and said that it would be addressed. Security of the medication trolley needed to improve, records of sample signatures of staff who administer medication needed to be held and a care plan which detailed a persons specific needs concerning their medication needed to be in place. Alternative menu choices needed to be provided at the main meal so that people had more meaningful choices. While the manager and staff demonstrated an open and committed approach to the protection of vulnerable adults, they needed to have regularly updated training so that staff were confident about the practical steps they need to take should an allegation be made. Some aspects of recruitment practice needed to improve, to ensure that people who use the service are supported by staff who are consistently vetted. The manager needed to ensure that the environment consistently meets the fire department safety standards. 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 set out 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 29 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 29 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 are given information, and have their needs assessed before moving into the home, so they know that their needs can be met. Evidence: In the AQAA the manager stated that people, are assessed prior to admission, trial visits are encouraged and assessments from outside agencies are requested so a care plan can be completed. To find out whether this was the case, we looked at a range of documents and we looked carefully at the care provided to three people from the point of their admission, to the present time. We also talked to people using the service and looked at the information in surveys that seven of the people using the service and eight of the staff had filled in. People received information about the service from the statement of purpose and the Care Homes for Older People Page 11 of 29 Evidence: service users guide which provided information about what a person can expect from the service. All seven people who completed a survey said that they had received information about the home before they moved in so that they could decide if it was the right place for them. Of the eight staff who completed a survey, two said that they were always given up-to-date information about the needs of the people they support, five staff said that they usually were and one member of staff said that they sometimes were. We saw the manager talking to the relative of a person who was being admitted to the home. We saw that the manager was friendly, reassuring and helpful and that she gave the relative a number of documents to complete to provide information about the persons social history, needs, preferences and any other information that would help them. The manager asked the relative about the persons falls history, any special needs or wants and discussed the choice of GP. The manager also gave the relative a copy of the complaints procedure. This is good for the person, as this information enabled staff to care for the person in the way that they wished to be cared for and to be aware of what was, and is, important to them. It was evident that the manager was organised for the admission and that this proved supportive for the resident and their relative. The relative of one person described the admission process. This person explained that they picked this home because, they liked the attitude of the staff,they are welcoming, and, they have more interest in dementia here. This relative said that, the manager gave me all the time I needed to discuss things, and added, I was quite impressed with all the time they spent with me. The relative confirmed that the manager had assessed their relative before the admission to the home and that they were encouraged to bring in their own furniture and personal things into the allocated room, which had been redecorated. The relative concluded that the admission process was very positive and that the manager and staff had been, very supportive. When we looked at the assessments for three of the people who use the service, we saw that assessments of needs were carried out so that a clear care plan could be formed. The manager said that she always considers the dependency levels of people already at the home when considering the admission of a new person to assess how the admission may impact on the needs of others. Care Homes for Older People Page 12 of 29 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. Peoples health and personal care needs were met in the way they preferred and with respect for their privacy and dignity. Evidence: In the AQAA the manager stated that people, are assessed individually and files are updated on a regular basis. To find out whether this was the case, we looked at a range of documents and we looked carefully at the care provided to three people from the point of their admission, to the present time. We also talked to people using the service and looked at the information in surveys that seven of the people using the service and eight of the staff had filled in. We saw that each person has two files, one of which contained medical information, including NHS documents, and risk assessments. The other file contained the care plan and daily records of peoples progress. We saw that records were made about each persons progress twice daily. In an attempt to make sure that staff recorded all Care Homes for Older People Page 13 of 29 Evidence: information about people consistently, the manager had introduced a day-to-day diary. Unfortunately, this diary did not meet data protection requirements because it contained detailed information about individuals on the same pages as detailed information about others. This meant that people could not read what was written about them without compromising the confidentiality of others. Advice was given on reviewing the way that records are completed and a recommendation was made. (See management and administration for details) . The manager changed the way that the staff recorded information and by the occasion of the second visit to the home we saw that the level of information recorded about people had improved and staff said that they found the new system to be more user-friendly and it enabled them to make better records. We saw that the care plan was based on 14 areas of need for each person. These included a safe environment, communication, breathing, dietary needs, elimination, hygiene and dressing, body temperature, mobility, social activities, skin integrity, sleeping, perception of health status (aware/unaware), medication and pain management. The care plans we saw were written from the point of view of the person receiving the care and provided staff with clear guidance as to how to meet their needs in a respectful manner. Care plans were also being reviewed regularly. Information about peoples health care needs and the outcomes of visits made by healthcare professionals, including doctors and nurses, was recorded separately so that any patterns in health-related issues could be seen. We saw risk assessments which addressed a range of risks associated with behaviour/harm to self and others, personal hygiene and dressing, a persons medical condition and mobility. However, some were more detailed than others. It was recommended that risk assessments, including those concerning the risk of falls, contained sufficient detail to support staff to minimise the risk People who used the service and their relatives were pleased with the care received. In particular, all seven people who had filled in a survey said that the staff listen and act on what they say and that they always receive the medical support they need. One relative who completed a survey said that the staff had been, very helpful in caring for my relative. Another relative, spoken to during the inspection visit, said that they were,happy with the home, its A1 ,and added that their relative was, well looked after. This person talked about how pleased they were that their relative had, improved tremendously,since being in the home, including taking less medication and developing some new skills, e.g. being able to use a knife and fork again more independently. This person said that they visit the home regularly and often watch the staff who they felt were, very good and gentle. This person was pleased with the way that staff behaved towards their relative and other people in the home. This Care Homes for Older People Page 14 of 29 Evidence: person concluded that staff, dont treat them like a nuisance, they are, respectful , and are, good about privacy. This is good for the people using the service. Medication was dispensed from a monitored dosage system and we saw that the drug cabinet was well organised and that the records were well maintained. Overall, the way the people were supported to take their medication was good. There was some things that could be improved. This included ensuring that the medication trolley could be secured to the wall of the dining room in which it is situated for security reasons and that a record of sample signatures of staff who administer medication are held. A recommendation was made about these issues. In addition, while we saw that photographs of each person for whom medication was being administered, and some basic details of their needs were held, it was recommended that a care plan which detailed a persons specific needs concerning their medication, what it is prescribed for, and any possible side-effects was completed. The manager and staff who administer medication felt that this would prove helpful and said that the recommendation would be implemented. Care Homes for Older People Page 15 of 29 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. Overall, people benefit from choices to enable them to exercise day to day control over their lives. However, their preferences and social life would be better met by providing alternative choices of food and by extending the range of activities. Evidence: In the AQAA the manager stated that, activities are being promoted to encourage more resident social interaction with each other. The manager did however acknowledge in the AQAA that there was a need to have more staff trained in providing activities for people and to offer more outside activities. To assess whether this was the case, we talked to people, their relatives and staff, looked at the programme of activities and looked at menu planning. One thing that the manager and staff did well was making sure that a social history was recorded for each individual person by their family and friends, with their input. The social histories we saw contained family details, where the person went to school, what their occupation was and other useful information about likes and dislikes. We found that the practice of taking a detailed personal history for each person enabled Care Homes for Older People Page 16 of 29 Evidence: staff to understand what had been, and what was, important to each individual. All the people we spoke to and their relatives said that visitors to the home are, made welcome. We witnessed visitors being greeted by the manager and staff and saw that they were friendly and welcoming in their approach. This is good at it allows people to maintain their relationships with family and friends. People have their meals in the dining room, but some people who need one-to-one support with eating receive this help in their room. Of the seven people who filled in a survey, four always liked the meals at the home and three people usually did. People have alternative choices at breakfast and teatime, but not at the main meal at lunchtime. People said that if they dont like what is served, they can ask for something different. However, providing an alternative to the main meal would mean that people had more meaningful choices. The manager said that they intended to start providing alternative choices at the lunchtime meal when they revised menus. The manager talked about some improvements they had made since the last inspection. This included having a residents meeting in February 2009 to obtain peoples views on the running of the home and what activities they would like. Minutes of this meeting were taken and as people had said that they enjoyed the meeting, the manager said they plan to hold these meetings regularly. Care Homes for Older People Page 17 of 29 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 were confident that the manager and staff would listen to their concerns and staff commitment to, and imminent staff training in, the protection of vulnerable adults would ensure that people were safeguarded from abuse. Evidence: In the AQAA, the manager stated that, families and residents are encouraged to speak with the manager and staff about any concerns they may be having. The manager also stated that, all staff have training in abuse and protection. To see if this was the case, we looked at policies, procedures and records and talked to people, their relatives and the staff. A complaints procedure was in place and we witnessed the manager giving this procedure to a relative when their relative was being admitted to the home. The manager said that since the last inspection she had introduced a suggestions and complaints box, stressing that any comment can be anonymous. We saw the record of complaints which included details of the investigation of complaints and a copy of a letter to a complainant advising them of the outcome of their complaint. Of the seven people who filled in a survey, four people said that they, always knew who to speak to if they were not happy, two people usually did and one Care Homes for Older People Page 18 of 29 Evidence: person sometimes did. All seven people said that they knew how to make a complaint. We saw that policies and procedures concerning the protection of vulnerable adults were in place at the home. We also saw evidence which demonstrated that the manager had been involved in the investigation of two allegations concerning the protection of vulnerable adults. The manager talked about having a good working relationship with Oldham Councils protection of vulnerable adults team and we know through our involvement with these cases that the protection of vulnerable adults team did feel that the manager bought matters to their attention openly and worked well with them. The manager said that if she had any issues concerning the protection of vulnerable adults, she raised them with the protection of vulnerable adults team and added that she has had a briefing and regular discussions with the team concerning the protection of vulnerable adults. However, we saw that the manager and staff had not had formal training in the practical implementation of the protection of vulnerable adults process. We used practical scenarios to check out the manager and staffs understanding of the practical steps which needed to be taken when an allegation of abuse was made. We found that while they demonstrated an open, caring and committed approach to the protection of vulnerable adults, they were unsure about some of the practical details. The need to obtain formal training for the manager and staff was discussed. On the occasion of the second visit to the home we saw evidence to demonstrate that the manager had arranged training to be provided by the Oldham Council protection of vulnerable adults team for herself and all the staff, which was due to take place on 10th June 2009. The manager said the staff were also about to have training in understanding of new guidance concerning the deprivation of liberty. We therefore concluded that outcomes remained good for people using the service and recommended that training in the protection of vulnerable adults is regularly updated and that the manager makes sure that all staff would be confident about what to do if an allegation was made to them personally. People said that the manager and staff were approachable. People, their relatives and the staff said that they could go to the manager with any problem and one relative said that they, trusted the staff, absolutely. Care Homes for Older People Page 19 of 29 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. People benefited from a warm, clean and well maintained environment, but fire safety standards at the premises didnt fully protect people. Evidence: In the AQAA, the manager stated that, Hadfield House provides a warm, clean and friendly environment. The manager also stated that a number of improvements had been made to the environment in the last 12 months including replacing some carpets and furniture. To see if this was the case we looked at the communal areas, some bathrooms, toilets and bedrooms. We also talked to people, their relatives and staff about the environment. All seven people who filled in a survey said that the home was always fresh and clean. People and their relatives said that they were happy with the environment. One relative said, the home is very clean everywhere. We also saw that the home was comfortable and clean and that some improvements, including replacing some carpets have been made since the last inspection. At the time of the first visit to the home, the majority of interior fire doors, including bedroom doors, were wedged open. Exterior fire escapes were found to be clear, as the manager had ensured that obstacles in the way of fire doors found at the last Care Homes for Older People Page 20 of 29 Evidence: inspection had been removed in accordance with the requirement made at that time. The service had been inspected by the fire department on 10/11/08 and we saw the letter from the fire department which summarised the outcome of this visit. We saw that there was a, minor breach, to guidelines which related to the need to provide smoke seals to a number of interior doors. The fire department had not given the service a timescale to complete this work and the work had not been completed. On the occasion of the second visit to the home, a week later, most of the fire doors had been fitted with smoke seals and the manager stated that the work on the remaining doors would be completed that week. The practice of wedging doors open had also ceased. The manager had acted quickly to minimise risks to people by ensuring that work on the premises to bring it up to fire standards was completed. A requirement was made about the need to consistently ensure that the environment meets the fire department safety standards. Care Homes for Older People Page 21 of 29 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. People who use the service benefit from support provided by experienced and committed staff who they trust. Aspects of the recruitment procedure are not always robust enough to protect people and this was recognised by the organisation. Evidence: In the AQAA the manager stated that, all staff are interviewed prior to employment and police checks are applied for, and that, induction training is given and training needs are identified. The manager added that, communication between shifts could be improved. To see if this was the case we looked at the recruitment procedure, staff files and training records and we talked to people, their relatives, the manager, and the staff. We saw that the recruitment procedure includes potential staff completing an application form, being interviewed and providing references. Although the manager and staff said that a Criminal Records Bureau (CRB) check was undertaken for each staff member employed, the records were held at the homes head office and it was recommended that this information is also held on site. Overall, we saw that people were cared for by staff that had been vetted. However, when looking at staff files, we saw that a full employment history wasnt always taken to identify any gaps in employment. A recommendation was made that all applications were carefully checked Care Homes for Older People Page 22 of 29 Evidence: to make sure that a full employment history was provided. The staff we spoke to said that they did have an induction and supervision. We did not see induction or supervision records on all the files we saw. It was recommended that the outcome of staff induction and supervision is consistently recorded. We saw from records that the manager actively encouraged staff to complete training. This was confirmed by staff in surveys and in person. In particular, all eight staff who completed a survey said that they had been given training which was relevant to their role, helped them to understand and meet the individual needs of people, and kept them up-to-date with new ways of working. We saw that staffing levels were sufficient to meet the needs of people and this was confirmed by the staff. In particular, all eight staff who completed surveys said that there were either usually, or always, enough staff to meet the needs of people. People and their relatives were very happy with the staff. Comments included that, I trust the staff, absolutely, and they are, very caring. One relative who visits regularly talked about the staff being, very good, and, gentle. Care Homes for Older People Page 23 of 29 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. People and their relatives were confident that the manager ran the home in the best interests of people who live there and that their safety and welfare were promoted. Evidence: In the AQAA, the manager stated that, the prime objective is to ensure that residents receive a high priority of care and that positive relationships are formed with families, advocates and friends. The manager added that the service needed to improve arrangements for staff supervision and appraisals. To see if this was the case we looked at records and spoke to people and their relatives, the manager and staff. The manager had managed the service for 11 years. We saw her detailed training record which demonstrated that she had regularly updated her training. The qualifications she held included the registered managers award, the NVQ assessor award and a qualification in palliative care. Care Homes for Older People Page 24 of 29 Evidence: People and their relatives were pleased with the manager. One relative said that the manager was, honest, friendly and helpful. Staff were also pleased with the manager. Comments included that the manager was, great, listens to you, very understanding, is, approachable you can ask her anything, and, puts the residents first. We saw that all interactions between the manager and staff, and between the manager and people who use the service, and their relatives, were caring and reassuring. People using the service were billed individually for their care. Most people using the service were supported by their family to manage their finances. The manager explained that the service does not hold money for people, but uses petty cash if people need purchases to be made on their behalf. People and/or their relative then receive a bill for these purchases. We saw evidence that the manager had recently completed quality assurance questionnaires for residents, their relatives and health care professionals and was in the process of collating outcomes to form an action plan to address any concerns. One record we saw did not meet data protection guidelines. (See health and personal care for details). A recommendation was made to the effect that this record was reviewed so that people could read what was written about them without compromising the confidentiality of others. The manager addressed this during the inspection. The manager recorded information in the AQAA which demonstrated that health and safety procedures and checks were carried out at the home. Fire safety checks will undertaken regularly, but some of the fire doors needed some work to bring them up to fire safety standards. This work was almost completed during the inspection. (See environment for details). Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 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 19 23 The manager must ensure that the premises consistently meets the fire departments required standards. This is necessary in order that people are consistently protected from the risk of fire. 29/05/2009 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 It is strongly recommended that all risk assessments provide staff with specific details of how known risks aassociated with daily living, including the risk of falls, can be minimised for each individual person. This is necessary to protect people from harm. It is strongly recommended that the medication cabinet is secured to the wall, a record of sample signatures of staff who administer medication is held and that a care plan which details a persons specific needs concerning their medication, what it is prescribed for, and any possible sideeffects was completed. This is necessary to ensure that medication storage is always safe and people receive their Page 27 of 29 2 9 Care Homes for Older People medication in the way that they prefer. 3 12 It is strongly recommended that the range of activities of the home is reviewed and extended to better meet peoples social needs. It is strongly recommended that the menus are reviewed to provide alternative choices at all meals served, to enable people using the service to make meaningful choices. It is strongly recommended that the manager ensures that staff training in the protection of vulnerable adults policy is regularly updated so that staff are confident about the practical steps they need to take should an allegation be made. This is necessary so that people are always safeguarded. It is strongly recommended that information about individuals is always recorded on their personal record and that detailed information about individuals is never held on the same pages of a record as detailed information about others. This is necessary in order that people can read what is written about them without compromising the confidentiality of others and that records meet data protection guidelines. 4 15 5 18 6 37 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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