Care Home: Haldane House Nursing Home

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What the care home does well The staff work hard to ensure that residents` needs are appropriately assessed and monitored and that their care is planned to ensure that their needs are met, whilst encouraging and enabling residents to maintain their independence where possible. On the survey forms many positive comments were received from relatives. These comments included: `The home is efficiently run and staff show a high standard of care and attention to residents and relatives. There is a family atmosphere and the residents are always treated with affection and respect.`, `The most amazing and dedicated staff and care you could wish for your loved ones.` and `Cares for the residents in all ways to make their lives more comfortable, almost a home from home. Dedicated staff with excellent, strong management.` Comments received on survey forms from social and health care professionals included: `Give very good care to people in advanced stages of dementia. Particularly good in providing stimulation and activities.`, `Person centred care is at the heart of the home. Excellent understanding and provision of care for people with advanced dementia.` and `They know and understand the residents. They are aware of the problems with looking after people with dementia. Good end of life care.` All interactions observed between the management, staff and residents evidenced that the home has a close and caring staff team who show skill and dedication in their work with the residents who live at Haldane House. On their survey form, comments received from staff included: `We provide a home from home environment and make the residents, their family and friends all welcome (always). We also ensure all residents are given time, attention and lots of TLC.` and `We have a very good, caring manager who looks after the residents well.` What has improved since the last inspection? There were no requirements made at the last inspection. In their AQAA to demonstrate what has improved in the last twelve months the manager stated: `Full review of care planning documentation to ensure all risks are assessed and addressed in order to influence the individualised residents centred care. We have installed a wet room with a shower to offer more choice in bathing facilities. Redecoration of eight bedrooms, lounges, dining room and hallway. We have reviewed our activities programme and invested in a large number of interactive games and instruments and added more professional therapy input. There is an anonymous complaints/comments box in the hallway. Adjustment of shifts to allow more staff to be present with the feeding of residents at breakfast time. We have reviewed our menus to incorporate more choice and improve nutritional content. Installation of comments/suggestion box for all to use. Five carers have completed NVQ Level 2, three have completed Level 3 and many staff have completed distant learning packages which are sector specific.` What the care home could do better: Requirements have been made as a result of this inspection. The home need to improve staff recruitment practices and the manager needs to `double check` that all required checks have been carried out before allowing new staff to begin working at the home. The provider must identify, and fit, appropriate locking mechanisms to all communal toilet and bathroom doors to ensure that instances of residents entering these rooms, while they are being used by other residents, are prevented or substantially reduced. Recommendations have been made that the home expand the information documented in the residents` care plans and evidence that residents or their representatives have been involved in, and agree to the contents. Steps also need to be taken to ensure that all staff understand how the forms and documentation used at the home should be used and that registered nurses are working to their professional guidelines on record keeping. The provider needs to review the current decision not to provide the home with a computer or internet access and to ensure that they are providing the manager and the staff at the home with the administrative tools and equipment they need in order to administer the home in the most efficient and effective manner. Key inspection report Care homes for older people Name: Address: Haldane House Nursing Home 127 Yorktown Road Sandhurst Berks GU47 9BW     The quality rating for this care home is:   three star excellent 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: Denise Debieux     Date: 3 0 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Haldane House Nursing Home 127 Yorktown Road Sandhurst Berks GU47 9BW . Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): A.V. Atkinson Ltd Name of registered manager (if applicable) Mrs Margaret Dawn Ritchie Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 25 The registered person may provider the following category/ies of service: Care home with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Haldane House is a care home registered to provide nursing care and support to up to 25 older people. The home is a large detached house, situated on a main road in Sandhurst. Accommodation is provided over three floors and there is a small garden to the rear of the property with parking available at the front. Care Homes for Older People Page 4 of 34 25 0 25 Over 65 0 25 0 Brief description of the care home Fees range from £650 to £850 per week. This information was provided on 30 November 2009. Care Homes for Older People Page 5 of 34 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The previous registered provider of this service became a limited company and reregistered with us on the 1st February 2010 in the new name. Apart from the change to the name of the registered provider, there have been no changes to the management or running of this home. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out on 30 November 2009, starting at 10.15am. The registered manager was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager and any information that CQC/CSCI has received about the service since the last inspection on 28th February 2007. The people living at this home prefer to be referred to as residents. For clarity and Care Homes for Older People Page 6 of 34 consistency this term will be used throughout this report. On the day of this visit all of the residents were involved in the inspection and information was gained from five on duty staff. Prior to the inspection, survey forms were sent to fifteen residents, eight social and health care professionals and to ten members of staff employed at the home. Survey forms were completed by eleven residents (with the assistance of their relatives and friends), eight social and health care professionals and ten members of staff. These survey forms were correlated and the results were shared with the manager during the inspection. Comments made on the survey forms, both positive and negative, were included in the correlation. Care was taken to exclude any comments that could identify the writer. The manager demonstrated a pro active attitude to the results of our survey and plans to explore any concerns raised further as part of the homes quality assurance process. Some of the comments made to us on the day of this visit and made on the survey forms are quoted in this report. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The AQAA was clear and gave us all the information we asked for. Residents care plans, staff recruitment and training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all seen and assessed on the day of this visit. We looked at how well the service was meeting the standards set by the government and have in this report made judgements about the standard of the service. We would like to thank the residents and staff for their time, assistance and hospitality during this visit and the residents, social and health care professionals and staff who provided additional information and participated in the surveys. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Requirements have been made as a result of this inspection. The home need to improve staff recruitment practices and the manager needs to double check that all Care Homes for Older People Page 8 of 34 required checks have been carried out before allowing new staff to begin working at the home. The provider must identify, and fit, appropriate locking mechanisms to all communal toilet and bathroom doors to ensure that instances of residents entering these rooms, while they are being used by other residents, are prevented or substantially reduced. Recommendations have been made that the home expand the information documented in the residents care plans and evidence that residents or their representatives have been involved in, and agree to the contents. Steps also need to be taken to ensure that all staff understand how the forms and documentation used at the home should be used and that registered nurses are working to their professional guidelines on record keeping. The provider needs to review the current decision not to provide the home with a computer or internet access and to ensure that they are providing the manager and the staff at the home with the administrative tools and equipment they need in order to administer the home in the most efficient and effective manner. 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 34 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 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be 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. Each resident is only admitted to the home following a comprehensive needs assessment to ensure that the home can meet the residents identified needs. This home does not offer intermediate care. Evidence: We were advised that, on the first enquiry from a prospective resident or their representative, the resident or their representative will be invited to visit the home. During that visit the home provide an information pack and discuss the service offered at the home. Following the initial visit, and if the resident or their representative wishes to continue, the manager or deputy will visit the resident and carry out a pre admission assessment to ensure that the home can meet the residents needs and Care Homes for Older People Page 11 of 34 Evidence: wishes. In the AQAA, to demonstrate what the home does well, the manager stated: Full assessment of resident prior to admission is carried out by the Manager or Deputy Manager both of whom are experienced in undertaking individualised preadmission assessments to ascertain whether the home can meet their needs. We endeavour to ensure that the potential resident will fit in with other residents and that the staff compliment will be able to cope with their level of dependency. This statement is supported by the findings on the day of this inspection. Three care plans were sampled during this visit. In each case comprehensive pre admission assessments had been carried out to ensure that the home could meet the residents identified needs. Relatives who returned survey forms all felt they had received enough information so that they could decide if the home was the right place for their relative. One social and health care professional commented on their survey form: The manager and deputy are very thorough in the information they gather, not only diagnosis etc., but about the person and what is important to them and their family. They are careful about admission and how any transition to a new environment can affect a person, so they plan this carefully. In their AQAA the manager set out the plans for improvements over the next twelve months, they hope to offer: Opportunities for admission for short term care (one night to two weeks) to see how the home suits the individuals needs. Care Homes for Older People Page 12 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health, personal and social care needs are met and the home has a plan of care that the person, or someone close to them, has been involved in making. The home supports residents to take their medicines in a safe way. Residents are treated with respect and the support they get from staff is given in a way that maintains their dignity. Evidence: The home has a small and close care team and the staff demonstrate an in depth knowledge of each individual residents needs, abilities and preferences in how they wish their care to be delivered. On the survey forms returned by relatives comments included: The level of care is very high., We are very pleased with the care provided for our relative. and My relative is certainly cared for in every way in this warm, loving environment. In the AQAA, to demonstrate what the home does well, the manager stated that: Care is always flexible to accommodate the ever changing needs of the resident. Care Homes for Older People Page 13 of 34 Evidence: Residents are registered with the G.P. to ensure best possible outcomes. We have a variety of visiting professionals that we can turn to for support and advice: Speech and language therapists, dentists, community psychiatric nurse, Consultant Psycho geriatrician, chiropodist, audiologist, physiotherapist, Macmillan nurses, opticians, tissue viabilities nurses. We have fully embraced and implemented the Gold Standards framework for end of life care promoting the dignity and choice for all. Advance care planning ensures that all are aware of the residents choice and directive for their end of life care. This statement is supported by the evidence seen at this inspection. Three care plans were sampled during this visit, all were based on pre admission assessments and had been drawn up shortly after each residents admission to the home. In depth risk assessments were included with areas covered including: falls; nutrition; pain; skin; moving and handling; dependency level; challenging behaviour; continence. Where risks had been identified measures to minimise the risk were included in the plans. The care plans also set out the actions which staff need to take to meet the health, personal and social care needs of each resident. Care plans are reviewed on a monthly basis and daily notes are kept that reflect the care given. These daily notes demonstrated that any changes or new concerns are promptly acted upon. Data provided in the homes AQAA does not identify any residents with specific religious, racial or cultural needs at this time. However, from the evidence seen and comments received, we consider that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. As stated above, the staff know the residents very well and have in depth knowledge of the way they prefer their care to be delivered, but this knowledge is not always detailed in the care plans. A recommendation has been made that this information be documented in more detail in the residents care plans so that new staff have access to the information more readily. Residents or their representatives should also be asked to sign the care plans to show that they have been involved in, and agree to, the content. Part of the lunchtime medication round was observed and the medication administration records, medication storage, policies and procedures were all sampled and found to be in good order. During this visit there was one occasion when a resident entered a toilet while another resident was in there being assisted by a member of staff. The situation was promptly and effectively dealt with by the staff present. However, at present none of the Care Homes for Older People Page 14 of 34 Evidence: bathrooms or toilets are fitted with locks that would aid staff to ensure that this cannot happen. The manager explained that there are no locks on these doors due to safety concerns, as residents may lock themselves in and not be able to get out. The manager also explained that in some instances the staff could be at risk if a resident became agitated and they needed assistance from other staff quickly. A requirement has been made that the provider identify and fit suitable locks to communal toilets and bathrooms (for example ones that can be quickly and easily opened by the staff from the outside). Where there are concerns for staff safety identified on risk assessment, specific risk reduction measures can be identified and put in place. On the day of this visit staff were observed to always knock before entering the residents bedrooms and all interactions observed between staff and residents were seen to be caring and respectful with staff taking great care to ensure that residents dignity was maintained. When asked on the survey forms if the residents privacy and dignity is respected, all eight social and health care professionals answered always. In their AQAA the manager set out the plans for improvements over the next twelve months: Continue to review all nursing documentation to ensure it remains appropriate and fit for purpose. To review general communication systems within the team. Care Homes for Older People Page 15 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities provided by the home are individualised to each resident and include contact with the local community both within and outside the home. Residents are able to keep in touch with family, friends and representatives. They are as independent as they can be and have the opportunity to make the most of their abilities. Residents have nutritious and attractive meals and snacks, at a time and place to suit them. Evidence: The routines of daily living are arranged to suit individual residents preferences and choices. This was confirmed by comments received on survey forms and by observations made on the day of this visit. In the AQAA, to demonstrate what the home does well, the manager stated that: We actively encourage choice to help improve the quality of life for individuals, we want our residents lives to be enjoyable, meaningful and worthwhile. Actively assist the residents in maintaining a sense of identity through a wide variety of activities both Care Homes for Older People Page 16 of 34 Evidence: structured and organised and on an ad hoc basis. We provide individualised activities and large and small group activities geared towards the individual residents living in the home at any one time. All staff are responsible for activities at any opportunity and every afternoon to optimise mental stimulation and quality of life. We have a minibus available for twice weekly trips within the local area. Personal profiles are developed to enable staff and residents to maximise interaction through reminiscence therapy. This statement was supported by the findings on the day of this visit and by comments received on survey forms. When asked on the survey forms what they felt the home does well, comments received from relatives included: Interaction with residents., A very caring, supportive environment, sensitive to the needs of residents and relatives. A positive, informal, friendly and homely place. and Always try to stimulate them with activities, parties, barbeques, musical events. Also one to one activities are always encouraged. Comments received from social and health care professionals included: Particularly good in providing stimulation and activities. Menus sampled showed that the home offers a varied and well balanced menu. Each residents food likes and dislikes are well known and meals are individualised to encourage people to eat. The meals are staggered over three sittings so that all residents are able to have the level of staff support they require. The home shows a very good understanding of the importance of nutrition in this resident group. Nutritional screening is in place for each resident and food intake is carefully monitored so that any potential problems are identified early and can be promptly dealt with. Relatives who returned survey forms said that their relatives always or usually liked the meals at the home with one relative commenting that the food is always excellent. In their AQAA the manager set out their plans for improvements over the next twelve months: Ongoing training for staff in activities for residents with cognitive impairments. Continue to research new and innovative ideas which can have a positive impact on our residents. We will develop a newsletter for our residents relatives and visitors in order to keep them abreast of news and information relating to the home. Care Homes for Older People Page 17 of 34 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. 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. Evidence: The home has a complaints procedure in place that is available to all residents and their relatives or representatives. All relatives who returned survey forms said there was someone they could talk to if they had any concerns. All staff surveyed knew what to do if anyone had concerns about the home and social and health care professionals all said that the home always responds appropriately if concerns are raised. In the AQAA, to demonstrate what the home does well, the manager stated that: Appropriate training is provided regarding the protection of vulnerable adults and embedded in all staff that safeguarding residents is the essential part of the care we deliver. The home operates a restraint policy which explains how angry/aggressive behaviour is to be managed and that physical intervention will only occur as a last resort. Residents and relatives are provided with advocacy service information and action on elder abuse. This statement was supported by the findings on the day of this inspection. There is a whistle blowing policy in place and the home has a copy of Care Homes for Older People Page 18 of 34 Evidence: the latest Berkshire Safeguarding Adults Policy and Procedure. Training in safeguarding adults is included in the homes staff induction and all staff receive regular updates on any changes to the local safeguarding procedures. The manager has a good understanding of the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) and a rolling programme of staff training in both these new subjects is underway. In their AQAA the manager set out their plans for improvements over the next twelve months: To continue to train staff regarding the implication of the Mental Capacity Act and DOLS. To maintain staff knowledge and skill with regard to safeguarding. To keep abreast of any other changes in legislation. Care Homes for Older People Page 19 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe and well-maintained home that is homely, clean, pleasant and hygienic. Evidence: Haldane House is a large detached house, situated on a main road in Sandhurst. Accommodation is provided over three floors, with access to the upper floors provided by a number of stair lifts. There are six single bedrooms, twelve two bedded bedrooms and one three bedded bedroom. The residents that share the three bedded room have done so for a number of years and had previously chosen to do so. The provider has an agreement with CSCI/CQC that on each and every vacancy arising at the home they will consult with the residents of the triple bedded room to see if they wish to use the vacant room, with support from their relatives or other advocates where needed. Should they wish to remain in the triple bedded room then they should be able to do so. The agreement is that this process will continue until one of the three residents leaves the home, at which time the third bed will be removed and the homes registration will need to be reduced by one. The bedrooms that are not for single occupancy are arranged to provide maximum privacy and screens are available to preserve dignity. In the AQAA, to demonstrate what the home does well, the manager stated that: We ensure that the environment is well maintained and offers residents a comfortable and Care Homes for Older People Page 20 of 34 Evidence: homely place to live. Residents are able to bring in furniture and personal possessions to enhance their own specific environment. Adaptations and appropriate equipment are present to aid residents with limitations in their abilities to be independent. A cleaning schedule is in place with a committed domestic team striving for excellence. Cleanliness and infection control methods are in place and audited monthly to optimise the well being of residents, staff and visitors. Gardeners maintain the garden on a regular basis. This statement was supported by the findings on the day of this inspection. On the day of this visit we were shown around all areas of the home and grounds. The furniture and furnishings were seen to be of a good quality and personal bedrooms were seen to be personalised with residents own belongings and mementos. The maintenance and redecoration programme for the home was seen to be ongoing, with a number of improvements to the communal and individual areas of the home. These improvements included the installation of a wet room with a shower to and the redecoration of the lounges, dining room, hallway and eight bedrooms. Relatives that returned survey forms were complimentary about the environment of the home with comments including: Clean and well maintained premises. A positive, informal, friendly and homely place. and Very small, friendly and homely. Atmosphere always cheerful. Laundry facilities are sited on the ground floor with washing machines suitable for the needs of the residents at the home. In their AQAA the manager set out their plans for improvements over the next twelve months: Replace the garden furniture in time for Spring/Summer 2010. To review and replace as necessary beds and mattresses. To review the lounge areas and seating arrangements. Continue refurbishment of the remaining bedrooms. General redecoration on a rolling programme with maintenance team. Refurbishment of general bathroom. On the day of this visit the home was found to be warm and bright with a homely atmosphere and a high standard of housekeeping apparent. Care Homes for Older People Page 21 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have safe and appropriate support as there are enough competent staff on duty at all times. The home has a staff recruitment procedure in place but the registered manager needs to double check that all required checks have been carried out before allowing new staff to begin working at the home. The residents needs are met and they are cared for by staff who get the relevant training and support from their managers. Evidence: The staff rota evidenced that the home provides a high staff to resident ratio which takes into account the high needs of the residents who live at the home. This staffing ratio enables the staff to continue to provide a high quality of life for all residents. The morning (7.30am to 3pm) shift is covered by two registered nurses and five care workers, one registered nurse and four care workers cover the afternoon/evening shift (3pm to 9pm) and the waking night staff consists of one registered nurse and two care workers. Ancillary staff includes a chef, three cleaning staff and the organisation has their own maintenance team. Of the eleven relatives who returned survey forms, ten stated that staff are always available when needed and one answered usually. The staff who returned survey forms all felt there were always/usually enough staff to meet the individual needs of the residents. Care Homes for Older People Page 22 of 34 Evidence: Of the twenty two care workers, fifteen hold a National Vocational Qualification (NVQ) level 2 or above in care, with the manager demonstrating a strong commitment to working towards all care staff eventually achieving the qualification. We were advised that, in the past twelve months, five carers have undertaken and completed NVQ Level 2 with a further three working towards this level. Three carers are currently undergoing NVQ Level 3 and two more are booked to commence. In the AQAA, to demonstrate what the home does well, the manager stated that: Staffing levels are adjusted according to the dependency levels of the home at any given time. The home has a suitably qualified workforce with more than 75 of staff delivering personal care holding an NVQ Level 2 (or equivalent) or above. This statement was supported by the findings on the day of this inspection. During this visit the files of three recently recruited members of staff were sampled. All files were seen to contain proof of identity, two references and a completed application form. Enhanced Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) list checks had been obtained for two people with one person awaiting the full CRB certificate and working on the basis of a POVA first check. We were advised that this member of staff is being supervised at all times when working with residents pending receipt of their full CRB, as required. However, not all required documentation and checks had been carried out prior to the people starting work. One person did not have a full employment history on file and did not have a reference from the last place of employment working with vulnerable adults. There was no evidence that any references obtained had been verified as authentic and there was no written verification of why people had left their last place of employment working with vulnerable adults. We were advised that it is the practice of the company that staff recruitment administration is carried out by staff at the organisations head office, with the registered manager carrying out the interviews. Once all the paperwork has been received at head office the manager is then advised that the new member of staff can start work. However it must be remembered that, whilst tasks related to recruitment may be delegated to other people within the organisation, accountability remains with the registered person to ensure that the requirements of the regulations are met. The manager was not aware of the full requirements relating to staff recruitment set out in The Care Homes Regulations or of the documents and checks required of Schedule 2 of the regulations. The recruitment regulation and the amended Schedule 2 were reviewed with the manager and a requirement has been made. Care Homes for Older People Page 23 of 34 Evidence: It is positive to note that, on the day following this inspection, the manager contacted us by email and advised that the missing full employment history had been located at the head office where it was waiting to be filed. We were also advised in the email that: we have checked our staff files and, having identified a few discrepancies, we confirm that the staff members concerned will not be employed until these matters have been rectified, in accordance with Schedule 2. CQC have produced guidance relating to CRB checks and staff recruitment that is available on the CQC website and explains the requirements of the regulations in more detail. Staff induction is in line with the mandatory Skills for Care common induction standards and we were advised that staff are supervised until they have completed their induction. Staff are booked on additional training and updates as the courses become available. In the AQAA, to demonstrate what the home does well, the manager stated that: All staff receive current induction training and regular training to update and improve their skills, knowledge and expertise. Training record is in place with all staff actively encouraged and supported to undertake training that is relevant to the environment. Bespoke training to enable staff to meet individual needs and personal development. We embrace the train the trainer philosophy and one RGN is responsible for cascade training in moving and handling, day to day management/induction and infection control issues. We are committed to a robust training programme and actively encourage our staff to develop through formalised training using local colleges, distant learning etc. Several staff have now completed dementia care training packages. Three of our staff have completed supervisory development training. This statement was supported by the findings on the day of this inspection. Care staff that returned survey forms all confirmed that they are given training which is relevant to their role; helps them understand and meet the individual needs of the residents and which keeps them up to date with new ways of working. When asked on the survey form if they felt the manager and staff have the right skills and experience to support the residents social and health care needs, all social and health care professionals answered always, adding additional comments: The staff are very caring and all excellent at their jobs., Excellent understanding and provision of care for people with advanced dementia. and They know and understand the residents. They are aware of the problems with looking after people with dementia. One member of staff commented on their survey form that: Haldane House is a care Care Homes for Older People Page 24 of 34 Evidence: home that provides quality care to the residents and keeps staff training up to date. Relatives were complimentary about the staff team with comments received on survey forms including: A very caring, supportive environment, sensitive to the needs of residents and relatives. and Lots of smiles between staff and good connections and contact between staff and residents. All interactions observed between the management, staff and residents evidenced that the home has a close and caring staff team who show skill and dedication in their work with the residents who live at Haldane House. In their AQAA the manager set out their plans for improvements over the next twelve months: Continue with training programme and access bespoke training that is sector specific. Aim to achieve 100 of carers with NVQ Level 2. Registered nurses to continue developing teaching roles to cascade information and best practice. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the clear management approach at the home providing an open, positive and inclusive atmosphere. The home has an effective quality assurance and monitoring system in place that is based on seeking the views of the residents. Policies and procedures are in place to protect residents financial interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. Evidence: The manager is a registered nurse and holds her Registered Managers Award qualification. Her management style is inclusive and the residents benefit from the ethos, leadership and clear management approach of the home. On the survey forms returned by care staff, all felt that they always had enough support, experience and knowledge to meet the different needs of the residents. From observations made on the day and from comments made on the survey forms it is Care Homes for Older People Page 26 of 34 Evidence: clear that the home have a close and happy staff team. Staff comments on the survey forms returned included: Haldane House is a care home that provides quality care to the residents and keeps staff training up to date., Is interested in the wellbeing and future of its staff. and Trains its employees. Manager always helpful to the staff. In the AQAA, to demonstrate what the home does well, the manager stated that: We send out bi-annual quality assurance questionnaires to relatives, friends and visitors. All staff are trained to listen and take on board residents and relatives views at all times A suggestion box is available in the front hall for relatives and friends to provide anonymous comments which are reviewed and acted upon. To demonstrate changes made as a result of listening to the residents, the manager stated: We have installed a wet room with a shower to offer more choice in bathing facilities. We have reviewed our menus to incorporate more choice and improve nutritional content. We have reviewed our activities programme and invested in a large number of interactive games and instruments and added more professional therapy input. We have purchased a new larger minibus in order to give more residents the opportunity to access the area. These statements were supported by the findings on the day of this inspection. Also in their AQAA the manager set out their plans for improvements over the next twelve months: Redesign the Quality Assurance questionnaire for relative and visitors to enable us to obtain a wider variety of information so that we can ensure that we promote the best possible care and enhance the lives of our residents to the full. We will develop a newsletter for our residents relatives and visitors in order to keep them abreast of news and information relating to the home. During the sampling of care plans it was noted that staff are not always signing and dating their entries in the residents records and the monthly audit of care plans identified that correction fluid is sometimes being used. On some forms staff are initialling where signatures are asked for and on other forms the staff are not always completing all sections of the form. For example, on the monthly audit of care plans form, in the column provided for staff to enter the action taken as a result of finding a problem with documentation, some staff have provided details of actions taken where issues are identified but others have only entered what the identified issue is. It was not possible to identify what, or if, action had been taken. Recommendations have been made relating to record keeping: that the manager review, with all registered nurses, the Nursing and Midwifery Councils latest guidance on record keeping and that the manager review the new care planning and associated documentation, with the staff team, so that all are clear on the homes expectations of how the system is to be used and how the different forms should be completed. Care Homes for Older People Page 27 of 34 Evidence: At present, all administration has to be either done by hand or taken to the head office to be typed as the home do not have a computer. The staff explained that this is time consuming and took them away from direct support with service users, especially as many administrative tasks are repetitive. The lack of a computer also means that the home has no access to the internet and no e-mail facility. Also of concern is that the management at the home were unaware of important changes in current legislation and guidance; e.g.: the home still work to the original version of The Care Homes Regulations and were unaware that there have been a number of amendments since they first came into force, including substantial changes to the requirements for staff recruitment, training, supervision and important changes made by the Mental Capacity Act. The CQC website has a guidance section which has been set up specifically to enable managers and providers to keep up to date with changes in what they need to do. This is especially relevant at this time with the totally new regulations and guidance that will be coming into effect in the very near future. The AQAA evidences that the manager has a good understanding of the areas they wish to improve. Many of these areas involve amending, improving and adapting the documentation currently in use. The manager explained that she sometimes uses her own home computer in her own time and, whilst this is commendable on the part of the manager, the provider needs to review whether they are providing the manager and the staff at the home with the administrative tools and equipment they need in order to administer the home in the most efficient and effective manner. A recommendation has been made. Policies and procedures are in place to protect residents financial interests. The manager stated that the home does not handle the financial affairs for residents. Health and safety monitoring check sheets were sampled and found to be well maintained and up to date. All staff have received required safe working practice training and updates. Staff were observed to be following appropriate health and safety practices as they went about their work. All interactions observed between the manager, staff and residents were inclusive, caring and respectful. In reference to the management of the home, one social and health care professional commented on their survey form: On any visit to the home, the manager, deputy manager and the staff are able to give me a detailed account of how the resident is, health and personally, how they are adjusting, how the staff are meeting their needs in how they would like to live and the strategy they use for behaviours that compromise safety and dignity. There seems to be a very person centred way of working. They also actively welcome and include families to be Care Homes for Older People Page 28 of 34 Evidence: involved with giving information that helps them care for the residents and have a very good way of helping family members to come to terms/accept the difficulties that their family member has. They are able to transfer feelings of friendship, trust and emotional safety without being patronising. Care Homes for Older People Page 29 of 34 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 30 of 34 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 10 23 The registered person must identify, and fit, appropriate locking mechanisms to all communal toilet and bathroom doors. So that residents can be confident that the home takes every effort to protect their rights to privacy and dignity. 30/01/2010 2 29 19 The registered person must ensure that no person is employed to work at the home without first making sure that all the required checks and documentation have been obtained and must ensure that all staff involved in recruitment are fully aware of, and adhere to, the requirements of the Care Homes Regulations 2001 as amended by The Care Standards Act 2000 (Establishments and Agencies) (Miscellaneous 30/12/2009 Care Homes for Older People Page 31 of 34 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 Amendments) Regulations 2004. So that residents and their relatives or representatives can be confident that all required checks have been done on the staff to make sure that they are suitable to care for them. 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 recommended that the methods staff should follow, when supporting residents with their care, are included in the residents individual care plans. For example: when assisting an individual resident with their meals; enabling them to make choices; etc. It is recommended that the residents or their representatives are asked to sign their care plans to show that they have been involved in, and agree to, the content. It is recommended that the findings of routine quality assurance audits are correlated and recorded so that the registered manager is able to identify any recurring issues that may need further investigation and action. (For example: the monthly care plan audit.) Actions taken as a result of the findings of any audits should also be clearly documented so that the manager can later review that the actions taken have successfully addressed the issue. It is recommended that the registered manager review the new care planning and associated documentation, with the staff team, so that all are clear on the homes expectations of how the system is to be used and how the different documents should be completed. It is recommended that the organisation provide the home 2 7 3 33 4 37 5 37 Care Homes for Older People Page 32 of 34 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 with a computer system and internet access to enable the registered manager to access and keep up to date with her responsibilities under changing legislation and guidance; to facilitate the identified improvements to documentation and to reduce the staff time taken away from direct support with residents in repetitive administration tasks. 6 37 It is recommended that the registered manager review, with all registered nurses, the Nursing and Midwifery Councils latest guidance on record keeping. 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