Care Home: Haven Lodge Nursing Home

What the care home does well People enjoy living at Haven Lodge Nursing Home. The relatives of people living there made positive comments about many aspects of the service and were complimentary about the way their relatives are cared for. These comments are reflected throughout the report. The home encourages and promotes the involvement of family and friends. Relatives told us they are made welcome and are consulted about their relatives care. There are good relationships between the home and healthcare professionals, which ensures people`s healthcare needs are well met. There is a robust training programme in place which ensures staff`s skills are updated regularly and people living in the home can be confident their needs are met by staff who have the skills and knowledge to provide the support people need. The home is well managed in the interests of the people who live there. The manager is competent and experienced and people living in the home are complimentary about the way she manages the service. The manager is competently supported by the home`s administrator who has developed strengths and skills around maintaining the home`s records. What has improved since the last inspection? Since the last inspection there has been redecoration and refurbishment in some areas of the home. As part of the ongoing programme of maintenance and redecoration some individual bedrooms have been decorated. The conservatory has had climate control shading fitted so that people can comfortably and safely use the room in hot weather. People living in Haven Lodge Nursing Home have benefited from the purchase of new televisions. What the care home could do better: The storage of medication that requires controlled temperatures would be improved if staff received additional training to ensure they take appropriate action if fridge temperatures are outside the recommended safe range. The environment for people with dementia would be improved if there were signage, pictures and familiar objects to help them understand their surroundings better. Improvements to the range of social activities and social interactions between staff and people living in the home would enhance people`s lifestyle. Key inspection report Care homes for older people Name: Address: Haven Lodge Nursing Home Reckitts Close Holland Road Clacton on Sea Essex CO15 6PG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ray Finney     Date: 2 4 0 6 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 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Haven Lodge Nursing Home Reckitts Close Holland Road Clacton on Sea Essex CO15 6PG 01255435777 01255475680 manager.havenlodge@careuk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lanemile Limited care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia physical disability terminally ill Additional conditions: One person, under the age of 60 years, who requires care by reason of dementia, whose name was made known to the Commission in April 2003 Persons of either sex, aged 55 years and over, who require general palliative care (not to exceed 3 persons) Persons of either sex, aged 60 years and over, who require nursing care by reason of a physical illness (not to exceed 26 persons) Persons of either sex, aged 60 years and over, who require nursing care by reason of dementia (not to exceed 24 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 26 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 24 persons) The total number of service users accommodated in the home must not exceed 50 Care Homes for Older People Page 4 of 27 Over 65 24 26 0 24 26 3 persons Date of last inspection Brief description of the care home Haven Lodge is a purpose built, two-storey nursing home set in its own grounds. It provides care for up to 50 residents. The home is divided into two distinct units. Lanemile Ltd owns Haven Lodge and is part of the national company Care UK. The home is situated in a quiet residential cul-de-sac, approximately a mile and a half from Clacton town centre. The local bus services pass at the end of the drive and the railway station is half a mile away. The sea front is a short walk from the home. Speedwell, the first floor unit, cares for up to 26 residents over the age of 60 who require nursing care for a physical illness or disability or for palliative care. Mayflower, the ground floor unit, cares for up to 24 residents over 60 who require care for a progressive mental disorder. The home charges between £650 and £700 a week for the services it provides. This information was given to us in June 2009. Additional charges were made for private chiropody, hairdressing, the tuck shop and toiletries. Further information about the home can be obtained by contacting the Manager Care Homes for Older People Page 5 of 27 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: A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as care plans, rotas, menus and personnel files. The manager completed an Annual Quality Assurance Assessment with information about the home and sent it to us at the Commission when requested. Throughout the report this document will be referred to as the AQAA. A visit to the home took place on 24th June 2009 and included a tour of the premises, discussions with the relatives of people living in the home, visiting healthcare professionals and members of staff. Observations of how members of staff interact and communicate with people living in the home have also been taken into account. On the day of the inspection we were given every assistance from the manager and staff team. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 7 of 27 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 8 of 27 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 9 of 27 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. Through the comprehensive admission process people choosing to live at Haven Lodge Nursing Home can be confident their needs will be met. Evidence: The manager told us in the AQAA that they carry out, nursing needs assessments prior to admission and family members are invited and encouraged to be present at the assessment. There is a comprehensive pre-admission assessment process in place using the Care UK assessment documentation. This assessment covers a range of areas of need. These include cultural needs, dietary requirements, special needs regarding vision, hearing, speech and environment. Details of past and present physical health is recorded along with any medical history. Also details of past and present mental health and cognitive function including diagnosis, memory, orientation and behaviour. The assessment includes details of any medication the person has been prescribed. Care Homes for Older People Page 10 of 27 Evidence: There is a full assessment of what support the person needs around mobility that covers walking indoor or outside, use of wheelchair, negotiating steps. Also recorded is what support the person requires when transferring in and out of armchair, bed bath or on and off the toilet. Peoples needs around dressing, washing, bathing, eating and drinking are identified together with any specialist equipment required such as a specific bed, pressure relieving equipment or eating utensils. The manager was able to demonstrate a good awareness of the importance of carrying out a thorough assessment. A visiting health professional with a remit for commissioning palliative care services was confident that the home was able to meet peoples palliative care needs. Care Homes for Older People Page 11 of 27 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. People using the service can expect their personal and healthcare needs to be identified and to be provided with the support to ensure these needs are met as they would wish. Evidence: The manager told us in the AQAA that what they do well is, Risk assessments and assessments of needs, personal choices preferences, specialist dietary and spiritual needs and there are computerised care plans [and] regular monthly reviews and updates of all care plans and risk assessments. Care plans are compiled and stored electronically using a system called Saturn. The manager told us that there is also a paper back-up copy kept. Each care plan identifies the area that needs to be addressed or the problem, for example nutrition. There is a Caring Goal that sets out what they are trying to achieve for the person and includes the residents perception. Then there are Actions that detail what care is to be provided. There are a range of care plans in place covering peoples various assessed needs. One care plan examined contained good details about the persons likes and Care Homes for Older People Page 12 of 27 Evidence: wishes around personal care. The level of detail was variable in the care plans examined and some of them would benefit from having additional detail so that staff have sufficient guidance to provide care consistently in ways that the individual wants. Some could be more specific about what the person can do for themselves and what staff need to do for them. The manager and staff spoken with were able to demonstrate a good knowledge of peoples wishes and needs. Overall, care plans were good but some work could be done to bring them all up to the same standard and to reflect the knowledge of peoples needs and the care that is being provided. Care plans are evaluated every 28 days. The manager stated in the AQAA that what they do well includes, Management of pressure areas with access to tissue viability specialist services. Support and services of GPs and Pharmacy support and Medicine management. It is evident from care plans examined that peoples healthcare needs are met appropriately and people see a range of healthcare professionals including doctors, continence adviser and district nursing services. We had a discussion with two visiting healthcare professionals with a remit for commissioning palliative care services. One told us that the home always goes the extra mile to meet peoples healthcare needs. Relatives spoken with were also positive about the healthcare provided. One person explained that, following a poor experience when living in another home, their relative has thrived and gained weight since moving into Haven Lodge. They are very happy with the care provided. The home operates a monitored dose system (MDS) for medication. We carried out an examination of the medication rooms in both Mayflower and Speedwell units. Medication is stored is secure locked cupboards and trolleys secured to the wall. The separate controlled drugs cupboards are quite old and there was concern expressed at the time of the last inspection that they did not meet the requirements for a controlled drugs cupboard. The manager explained that new controlled drugs cabinets were ordered but the wrong type was delivered and they are awaiting a replacement from their pharmacy supplier. The controlled drugs register had been completed appropriately for drugs that had been dispensed. However, one person had refused to swallow a dose that had been dispensed and this was still in a pot in the cupboard and had not yet been destroyed. This should have been done more promptly and recorded appropriately. Each medication room has a lockable fridge for medication that requires controlled temperatures. The recording sheet showed the minimum and maximum range of temperature should be between 2 and 8 degrees and the optimum temperature should Care Homes for Older People Page 13 of 27 Evidence: be 5 degrees. Recorded temperatures varied from less than the minimum to higher than the recommended maximum. Temperatures recorded were as low as zero and as high as 13 degrees. Staff recording the temperatures re-set the thermometer after recording but did not take further action. We discussed the situation around the fridges with the manager who explained that Care UK are looking at replacing the fridges with some that have an integral thermometer and this is being followed up with the medication provider. However, additional action needs to be taken including training for staff around the reasons for recording temperatures. Staff need to be aware that this is not just a paper exercise and appropriate action must be taken in response to recorded temperatures that are outside the acceptable range. This includes an understanding of the specific medications stored in the fridge, such as eye drops, where the printed instructions clearly state they must be stored between 2 and 8 degrees. The manager said she will follow this up with the senior staff in both units. The manager told us in the AQAA that one of the things they address well is privacy and dignity. Relatives spoken with on the day of the inspection told us that staff always treat their relative with respect and personal care is carried out in a manner that maintains peoples dignity. On the day of the inspection we observed staff carrying out good practices when supporting people such as when helping them to eat. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people living in the home can expect to enjoy a lifestyle that meets their wishes and needs. Evidence: The homes activity co-ordinator has been on long-term sick leave and currently there is no-one covering the role. The manager explained that the activities co-ordinator worked for 18 hours per week but they had not yet managed to cover those hours. The home has two separate units both with people who have differing needs. The upstairs unit, Speedwell, caters for people with nursing needs, some of whom are admitted for palliative care. The downstairs unit, Mayflower, caters for people whose cognitive abilities are deteriorating because of dementia. The 18 activity hours that they are hoping to re-instate would not appear to be sufficient for the size of the home and to meet the differing needs of people in the two separate units. Although it was evident that peoples healthcare needs were being well met, social needs were not being adequately addressed. As the client group have both nursing needs and dementia, organised group activities may not be appropriate. However, individual activities such as talking to people, hand massage, reading etc would improve peoples quality of life. Further information can be found in the section of this report relating to staffing. Care Homes for Older People Page 15 of 27 Evidence: The manager told us in the AQAA they, Support the family and resident through transition. Consult residents and relatives on their views. On the day of the inspection we spoke with two visiting relatives and both were very positive and complimentary about the standard of care provided. Both confirmed that the home is very good at keeping them informed about any issues affecting their relatives and about their well-being. One person visited every few days and said they were happy to provide one-to-one care such as foot and nail care. They said that this was their choice because they wanted to be involved, but were also confident that when they were not visiting, their relatives care was carried out well. Both relatives spoken with were complimentary about the standard of care. The manager stated in the AQAA that they, Promote independence through informed choices to encourage purpose and satisfaction in daily life. Many of the people living in the home have severe cognitive impairment which impacts on their ability to make informed choices and have any significant level of control over their day to day lives. Relatives spoken with told us that they are consulted about their relatives likes and dislikes so that they can be offered appropriate choices and staff have a greater understanding of the person if they are unable to give this information themselves. The manager said in the AQAA that among the things they do well is, Relaxed meal times with sensitive support, family support welcomed at meal times. Menus examined showed a variety of meals are available, which are cooked by the chef using fresh ingredients. Stocks of food confirmed that there is a wide range of foods used including plenty of fresh fruit and vegetables. The chef was observed talking to people and asking them about their choices for the evening meal. As well as a cooked meal at lunchtime, there are hot choices available for tea. On the day of the inspection there was a choice of lasagne or soup and sandwiches, both of which looked attractive with an appetising aroma. Staff assisting people in the dementia unit were seen to be supporting people appropriately in a relaxed and unhurried manner. A relative spoken with said you could see how good the food is by how well the people in Mayflower eat and very little is thrown away because people enjoy their meals. The relative also said that this is because staff are very good at encouraging people to eat. Care Homes for Older People Page 16 of 27 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 using the service can be confident that their concerns about how they are treated are listened to and acted upon as stated in the complaints and safeguarding procedures. Evidence: The manager stated in the AQAA, Complaints are dealt with promptly and they have, Complaints policy and procedure. Complaints file, conclusions and action plans. As previously reported, the home has a robust complaints procedure in place and complaints are investigated thoroughly. The complaints log was examined and showed that any actions taken are recorded with a target date for putting the actions in place. There is a copy of the complaints procedure available in individual rooms. Through discussions the manager demonstrated that they deal with minor concerns promptly. The homes administrator deals with people in a friendly manner and responds appropriately to any issues raised by visitors or people telephoning the home. Relatives spoken with told us that the manager and the administrator are very approachable and they were confident that they could raise any concerns they might have and they would be dealt with appropriately. Visitors spoken with also said they had no complaints about the home. The manager told us in the AQAA that what they do well is, SOVA training for all members of staff both theory and practical. Care Homes for Older People Page 17 of 27 Evidence: Records examined confirm that staff receive training around safeguarding (previously referred to as Protection of Vulnerable Adults or POVA now called Safeguarding or SOVA). Staff spoken with were aware of their responsibilities around keeping people safe. There have been no referrals made to the local authority under their safeguarding procedures, but the manager was able to demonstrate a sound understanding of the process and of her responsibilities. A log is kept of all accidents and incidents, in which the incident is described, details of any injuries are recorded along with what treatment was required, what equipment if any was involved and what actions have been taken to prevent a recurrence. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can enjoy living in an environment that suits their lifestyle and which is well maintained and clean. Evidence: On the day of the inspection we carried out a full tour of the premises and the manager told us about improvements that have been put in place, including the ongoing programme of re-decoration. A grant from the local authority enabled climate control shades to be installed in the conservatory in Mayflower. This makes the room safer in the summer for people who have dementia and who have lost the cognitive ability to regulate their body heat by moving from an area if it became too hot. The manager stated in the AQAA, We encourage family members to decorate the residents room with personal possessions and to personalise the room prior to admission. Peoples individual rooms were well furnished and personalised with their own possessions, including ample evidence of things like ornaments, photographs and memorabilia. It was noted, however, that there is very little signage to assist people with dementia and enable them to make more sense of their environment. All the bedroom doors Care Homes for Older People Page 19 of 27 Evidence: look similar and have nothing to distinguish one from another other than a number and a small card with the name of the resident. We discussed with the manager how this could be improved by using appropriate photographs or other memorabilia to help orientate people and enable them to distinguish between different rooms. Some of the toilets did have a picture on the door, but appropriate signage that is clear should be on all the communal rooms, including all bathrooms and toilets. A visiting operations manager carrying out a regulation 26 audit visit had brought some memory boxes to demonstrate what can be done to improve the environment for people with dementia. These are deep photo frames that contain items relevant to the individual such as photographs, war medals or trinkets that reflect past interests. The manager was enthusiastic about developing these and plans to work with staff to implement these improvements. Some funds from a legacy left by a former resident were used to purchase a 42 inch wide-screen television for the Speedwell unit as well as ten smaller flat screen televisions complete with DVD players for individual bedrooms. Another large plasma screen television is on order and they are awaiting delivery. The home is clean and well-maintained throughout, including the kitchen and laundry areas. There are no offensive odours and the environment is fresh and bright. Records examined confirm that staff have received training around infection control. Care Homes for Older People Page 20 of 27 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 living in the home can be confident they are cared for by a competent staff team who can meet their needs. Evidence: Staffing rotas confirm that there are four carers and one qualified nurse on duty per shift on each of the two units. We observed that staff carry out their duties efficiently and people were not waiting unduly for their needs to be met. Interactions observed between staff and people in the dementia unit were seen to be supportive and friendly. However, our observations on Speedwell, where some of the people are receiving palliative care, were that staff demonstrated a more task orientated culture that reflected more of a medical or nursing model of care. Although this meant that peoples physical needs were being well attended to, there was little or not social interaction observed. It is recognised that the people living in Haven Lodge Nursing Home have a high level of physical dependency requiring significant nursing attention. The staffing levels and skills are appropriate to meet these needs. Peoples social needs, however, were not being met and staff need to develop a culture that recognises the value of social interaction. This would improve the lifestyle of people living in the unit. The manager told us in the AQAA that one of the things they do well is, Training Care Homes for Older People Page 21 of 27 Evidence: towards all levels of NVQ qualifications. Information provided in the AQAA dataset confirms that there are good levels of staff who have achieved a National Vocational Qualification (NVQ) at level 2 or above, with 29 out of 33 permanent care staff having completed the award. As at the last inspection the organisation has a robust process in place for staff recruitment. Records held for staff contain all the documentation required by regulation including application forms with employment history, relevant proofs of identity and appropriate references. Relevant checks are carried out before staff commence employment to ensure the person does not have any issues that would indicate that they should not be employed. These include Criminal Record Bureau (CRB) disclosures and a PovaFirst search to check that the prospective employee is not on the register of people who have been barred from working with vulnerable people. The Personal Identification Numbers (PIN) of registered nurses is on file and are checked with the Nursing and Midwifery Council (NMC). There is a wide range of training provided for staff. All staff are expected to attend training around Fire Drills and Fire Safety, Health and Safety, Infection Control, Manual Handling, Safeguarding (Previously referred to as Protection of Vulnerable Adults or POVA), Dementia Awareness, Control of Substances Hazardous to Health (COSHH), First Aid Awareness, Customer Care and Communication Skills. Some training is through courses arranged by the provider, others are delivered using a computerised training system called the el box. Using the el box the member of staff has to work their way through information and then complete an assessment online. The administrator explained that the system works well and there are safeguards built in to prevent people missing out or skipping any of the information sections. The el box is used for the theory aspect of training but other courses such as Fire Training are delivered by relevant professionals. The home now has a safeguarding trainer so that this training can be updated as and when required. Care Homes for Older People Page 22 of 27 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. The home is appropriately managed in the best interests of people living there. Evidence: The manager is appropriately qualified and skilled; she is a registered nurse and has completed an appropriate management qualification. Through discussions the manger was able to demonstrate a solid awareness of her responsibilities around managing the home for the benefit of the people using the service and taking account of their needs and wishes. People spoken with said the manager is approachable and they are confident they can bring any issues up with her and they will be dealt with appropriately. It was further evident that the manager and the administrator work well as a team with skills that complement one another and provide good management of the service. The manager told us in the AQAA that what they do well is, Staff meetings, relatives and staff surveys acting on results and findings. Care Homes for Older People Page 23 of 27 Evidence: As reported at the last inspection, there remains a good programme in place around Quality Assurance which follows Care UK processes. Surveys are carried out regularly to seek the opinions of people using the service. On the day of the inspection a regulation 26 audit visit was in progress. This is a thorough audit by an operations manager from another area and was carried out over two full days. The procedure is a comprehensive audit covering areas such as the environment, record keeping and outcomes for people living there. We spoke at length to the manager and the auditor and it was evident from these discussions that there is a commitment to developing and improving on what is already a good service. The manager stated in the AQAA that among the things they do well is, Supervision and management of individuals money with monitored ledger and electronic record system with secure record keeping. The home only manages small amounts of peoples spending monies. The administrator explained that she works closely with the manager to ensure robust recording and double checking of financial processes. The administrator was able to demonstrate a good level of knowledge about the homes processes and procedures and credit must be given for the high standards she maintains. We also observed that she deals with visitors in a friendly and welcoming manner. The home continues to have appropriate systems in place for servicing and maintenance of equipment. A sample of Health and safety documentation examined was all found to be in order. This included the homes gas certificate and a Comprehensive Fire Record file containing weekly fire alarm tests, monthly lighting tests and maintenance of fire fighting equipment including extinguishers and fire blankets. Records examined confirm that staff receive regular supervisions. Staff meetings are held monthly and recorded on the Saturn computer system. Staff spoken with on the day of the inspection felt well supported by the manager. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Improvements are needed in the way staff deal with information relating to fridge temperatures so that people living in the home can be confident that all their medication is stored appropriately. A better range of activities including one-to-one activities would enhance the lifestyle of people living in the home. Improvements to signage around the home, including the use of pictures and familiar objects would improve the environment for people who are confused because of dementia. Developing and improving staff culture around social interactions would improve the day to day lifestyle for some of the people living in the home 2 3 12 19 4 27 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!