Care Home: Hazeldene Care Home

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What the care home does well Pre admission processes that include assessments of people and the provision of information about the service provided at Hazeldene mean people move into the home with the belief that the home can meet all their needs and with an understanding about the running of the service. Effective involvement of health care professionals mean people living at the home have their health care needs met. People living and their relative`s told us their health care needs are met. Comments included the home `deals with mental health problems extremely well`, `so far I am quiet content and am being helped in several ways` and from a GP a comments that the service provided care`. People living at Hazeldene believe that any concerns or complaints they make will be treated seriously and effectively. By following recruitment procedures the home makes sure that people living there are being cared and supported by a staff team that is suitable to work in the care industry and have the relevant skills and experience. Effective quality assurance processes means the service is developed taking into account the views and wishes of people living at Hazeldene. What has improved since the last inspection? Since the new directors have taken over the management of Hazeldene in April 2009 there have been ongoing changes made to the running of the service with the aim to improve outcomes for people living there. New care planning processes are being put in place to ensure people living at the home receive individualised care and support. Training provision is ensuring all staff at the home have the relevant skills and knowledge to provide care and support to meet the needs of people living at the home. A dedicated activity coordinator is providing regular opportunities for people living at the home to take part in activities and social interactions. People living at the home told us `we have entertainment every afternoon from 2.30pm to 4pm.` A menu plan has been implemented to provide people living at the home with a choice to two cooked meals at lunch time. People enjoy the meals provided, they told us ` the meals are well cooked and can even be delicious`. The environment is being improved with decoration and new furnishings. What the care home could do better: For some specific medications staff are required to undergo separate training by a health care professional. The service needs to ensure that relevant documentation is completed to demonstrate that the relevant staff have been deemed competent to administer this medication. Some areas of the environment have the potential to pose a risk for people living at the home. The practise of having conservatory doors open means people could exit the home or strangers could enter the home through the garden area that fronts directly onto the main road. The laundry door could be opened by people living at the home who could then access cleaning fluids. Formal supervision of staff has yet to be implemented to fully ensure people living at the home are being supported and cared for by staff who are receiving support and supervision from the manager of the home. Key inspection report Care homes for older people Name: Address: Hazeldene Care Home 20 Bury Road Gosport Hants PO12 3UD     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: Gina Pickering     Date: 1 0 0 9 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 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Hazeldene Care Home 20 Bury Road Gosport Hants PO12 3UD 02392527153 02392524674 jim.hartley@firtreeassociates.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Firtree Associates Ltd Name of registered manager (if applicable) Mrs Tina Mary Foster Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service: Care home only (PC) to service users of the following gender : Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Hazeldene is a large two storey detached property, one mile from the town centre of Gosport, and is registered to provide residential accommodation and personal care to twenty-six people over the age of 65 and people with dementia. Hazeldene was registered as a new service in March 2009 when the provider changed from an individual to a Limited company: Firtree Associates Limited. Following this the Care Homes for Older People Page 4 of 30 Over 65 26 26 0 0 Brief description of the care home share capital of Firtree Assocates Ltd was sold to new directors in April 2009. Accommodation is offered within twenty-four single and one double room, the majority having en-suite facilities. Communal areas include a large comfortable lounge, leading into a conservatory, a smaller quiet lounge and a separate dining room. There is garden area at the front of the property and a car park is available at the rear. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The inspection considered information received about the home since the registration as a limited company in March 2009. This includes information provided to us in the form of the homes Annual Quality Assurance Assessment form in which the registered manager told us us how the service has developed since April 2009 and how herself and the registered provider propose to continue to improve the service. The AQAA was completed and returned to CQC within the required timescale and provided clear information about the service provided, improvements that had been made and improvements being planned for the service. We surveyed people who use the service, relatives, staff members and health care professionals that have contact with the service. We received seven surveys from people living at the home, six from relatives of people living at the home, five from staff members and four from GPs who visit people living at the home. Information from these has been used to inform the inspection process. Care Homes for Older People Page 6 of 30 A visit was made to the service on 10 September 2009. We looked at documentation relating to four people using the service. We toured the building looking at the communal areas, a sample of bedrooms, bathrooms and the laundry. We also had conversations with four people living at the home, six staff members, the registered manager and the two directors of Firtree Associates Ltd. We looked at a sample of documentation related to the management of the home. This included care planning documents, medication documents, training records, recruitment records, maintenance records, catering records and quality assurance records. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: For some specific medications staff are required to undergo separate training by a health care professional. The service needs to ensure that relevant documentation is completed to demonstrate that the relevant staff have been deemed competent to administer this medication. Some areas of the environment have the potential to pose a risk for people living at the home. The practise of having conservatory doors open means people could exit the home or strangers could enter the home through the garden area that fronts directly onto the main road. The laundry door could be opened by people living at the home who could then access cleaning fluids. Formal supervision of staff has yet to be implemented to fully ensure people living at the home are being supported and cared for by staff who are receiving support and supervision from the manager of the home. Care Homes for Older People Page 8 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People move into the home with an understanding about the running of the home and with the belief that the home can meet all their needs. Evidence: The AQAA told us the service carries out pre-admission assessments for people thinking of coming to live at the home. As part of the new care planning process being introduced new assessment forms allowing for greater detail about the individual needs of the person are now being used. The assessment includes details about the persons physical, health, personal and social care needs. Information about the person is also obtained from other sources such as social services, previous care providers and health care providers. This enables the home to make an informed decision as to whether Hazeldene can meet that persons needs. Written confirmation that the home can or cannot offer accommodation and care is provided to the person following the assessment process. Two people have moved into the home since the registration of the new providers in Care Homes for Older People Page 11 of 30 Evidence: April 2009. Their documents confirmed that the above processes had taken place. People living at the home were, because of their health conditions at the time of moving into the home, unable to remember the processes that took place and were unable to remember whether they had been visited by someone from the home. People who have an interest about moving into the home must be provided with information about the service provided at the home. The home has a detailed statement of purpose and service users guide that is available to all people living at the home and all people interested about the home. Both these documents contain the information as required by the Care Home Regulations 2001 and are provided in a print format that is easy to read. We were concerned that there was no format for people who have difficulties accessing written words and were told by the manager and the directors that they are in the process of providing this information on an audio disc. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for care planning mean that people living at the home will receive individualised care and support. Good medication practices protect the wellbeing of people living at the home. Evidence: The AQAA told us the care planning process has been reviewed and a new care planning system is being implemented. The manager and directors of Firtree Associates Ltd told us they had reviewed the care planning system that had been inherited from the previous provider and had concluded that to ensure people living at the home have their needs effectively monitored and met in the manner they prefer a new care planning system needed to be implemented. This new system was in the process of being implemented when we visited the service. We looked at the care documents for four people living at the home, two of which were being developed on the new care planning format and two were still on the previous care planning documents. This evidenced that the new care planning documents will provide greater detail in assessments and the description of actions needed to be taken to meet peoples individual goals and needs. It also provides the Care Homes for Older People Page 13 of 30 Evidence: format for risk assessments and detailing action to be taken to reduce any identified risks in areas such as moving and handling, pressure ulcers, falls and risks associated with the environment the person is living in. Care plans, we were informed, will be reviewed on a monthly basis or more frequently if a persons condition requires it, and changes to care provision will be recorded accordingly on the persons care plan. Comments received from people living at the service indicated that although people were aware of their care plans they were not being reviewed at regular intervals. Having viewed the care plans that were in place prior to the new registration there was little evidence to indicate that care plans were being reviewed at regular intervals or that plans of care were being amended as peoples needs changed. However the new management of the home have identified this shortfall and by introducing the new care planning system are addressing this issue. Care staff told us that following the commencement of the new management of the home, they are being involved in the care planning processes and they have continual access to the care plans. Staff spoke with enthusiasm about the new care planning system and how the new processes will help them provide the care and support to people living at the home in an individualised manner. Daily care records indicating peoples health care needs are being met. However some of the information provided by health care professionals in these reports need to be included in the care plans for that person. The management intends to address this issue with the new care planning processes. The manager told us that the programme for transferring care plans to the new system is due to be completed by the end of October 2009, this includes the training of care staff in the use of the new care plans. People living at the home told us in conversations and surveys that their health care needs are met. A medical practitioner commented that Hazeldene provides good care to the people living there. Surveys informed us that people have confidence that the home is providing the care and support required by their relatives living at the home. Comments received include Care for my relative is first rate, my relative is always healthy and happy and Hazeldene is a really good home and deals with my relatives mental health problems extremely well. Care staff told us residents are very well looked after and I think all the carers do the best they can to make sure residents needs are met to the best of our capability. Discussions with staff indicated their awareness of the need to protect the privacy and dignity of people living at the home. All personal care is provided in the privacy of bedrooms or the bathrooms. Medication policies and procedures are in place including a policy for people wishing to manage their own medications. At the time of our visit there was nobody at the home who was managing their medication them self. Assessments were in place to indicate the person did either not want to manage their own medications or were not able to manage their medication themselves. We looked at the medication administration records for four people living at the home. The charts detail the time and amount of Care Homes for Older People Page 14 of 30 Evidence: medication administered and the reasons for any medications not administered. Records confirm that details are kept for all medications ordered, received, administered and returned to the pharmacist. The senior staff member who orders medications confirmed to us she views the persons prescription before ordering medication; this ensures people living at the home are receiving medication as prescribed by their doctor. Records detail that staff who administer medication have received training about the safe management of medications. One person living at the home has a medication administered that staff are required to receive training about and be deemed competent to administer the named medication. Records from the health care professional training the staff members did not make it clear which staff had been deemed competent to administer this medication. The manager agreed to contact the relevant professional to ensure it was clearly document which staff members had been deemed competent to administer this medication. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Hazeldene have opportunities to take part in a variety of activities, maintain links with their family and friends and are provided with a varied a nutritious diet. Evidence: The AQAA told us that there are some activities at the home provided by external organisations and there are plans to employ a dedicated activity organiser and keep register of all activities. Since the AQAA was completed the home has now employed an activities coordinator who works every week day from 2.30pm till 4pm and has responsibility for arranging activities at the home. Within the care plans there is a social profile of each person living at the home that details their leisure interests and their past working life. This and discussions with people living at the home has been used at present to plan the activities. The format of the new care planning will allow for a detailed plan of care for each person with regard to social activities and interests and improved planning of activities to meet the individual and collective needs of people living at the home. Details of the weeks forthcoming activities are detailed on the notice board in the hall way of the home. Activities planned include reminiscence sessions, quizzes, bingo, exercises as well as visits from the hairdresser and the local church for holy communion. People living at the home told us there are usually Care Homes for Older People Page 16 of 30 Evidence: activities arranged at the home that they can join in with. Whilst we were visiting the home people were enjoying a game of bingo with the activity coordinator or spending time chatting with staff members. People told us they can take part in the planned activities if they wish or can chose to spend time in their own bedrooms or spend time chatting with staff members. People living at the home are supported to maintain interests and links with the community with some people attending day centres they went to prior to moving into into Hazeldene. Staff told us that people living at the home have a regular entertainment schedule. Several staff members suggested both in surveys and conversations that the provision of activities for people living at the home could further be improved with activities planned for the weekends and provision of trips for people outside the home, though they did comment that people get plenty of in house activities during the week. Discussion with the manager and the directors of the registered provider evidenced that they are aware of the potential improvements that can be made to activity provision at the home and will be considered as part of their planned improvements for the service. The Statement of Purpose details that people living at the home can receive their visitors at any time of the day. We did not see anybody visiting the home during out visit, but the visitors record book detailed that people received visits at varying times of the day. Throughout the inspection process evidence was gathered confirming that people living at the home are able to make their own choices about their daily lives. Examples of these include being able to make choices about their involvement in activities. People were observed moving around the home, choosing whether to use one of the communal areas of the home or spend time in their own bedrooms. People living at the home told us they choose what to do. The AQAA told us the service was planning to introduce a structured menu cycle. We were told during our visit that the new menu structure is allowing for a second choice of hot meal at lunch time rather than the previous choices of baked potato or omelet for those people that did not want the planned menu. The chef told us that she spends time with people living at the home getting to know their likes and dislikes for food and plans the menu according to their likes, dislikes and wishes. Care plans allow for details about peoples food and beverage preferences and where they prefer to take their meals whether it is in the dining room, their bedrooms or one of the of the communal areas. People living at the home expressed their satisfaction with the variety and quality of meals provided at the home with one person telling us the meals are well cooked and even delicious Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have confidence that the service will respond appropriately to complaints. People living at the home are protected by the effects of abuse by a workforce that have a good understanding of safeguarding procedures. Evidence: People living at the home are made aware of how to make a complaint by the use of discussion and written information in the assessment process before moving into the home, the display of the complaints procedure in the home and in general conversations between staff members and people living at the home. People living at the home told us they know who to talk to if they have any concerns or complaints and expressed their confidence that complaints will be taken seriously and acted upon promptly. The manager told us that people express their concerns in residents meetings. Minutes of these meetings are kept to evidence concerns raised and responses to such concerns. We looked at the complaint log book that details the complaint received, the action taken to resolve the complaint and the response made to the complainant. Policies and procedures are in place about the protection of vulnerable people that include the local authorities procedures. Staff training records indicate that all staff have received training about the safeguarding of vulnerable people since the new providers took over the management of the home. Two staff members have attended training about the Mental Capacity Act and Deprivation of Liberty Standards. The manager told us that it is the intention that all staff will attend training in these areas to ensure that all staff have the skills and knowledge to Care Homes for Older People Page 18 of 30 Evidence: effectively safeguard the wellbeing of all people living at the home. Discussion with staff members evidenced they would take the appropriate action if they suspected any act of abuse had occurred to protect people living at the home. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well maintained and safe. Evidence: Accommodation at the home is over two floors. The ground floor has communal areas, a large lounge, smaller quiet lounge, conservatory and dining room as well as private bedrooms and bathrooms. The first floor has private bedrooms and bathrooms. The AQAA told us a programme of decoration and refurbishment has been put in place and is being followed. Improvements that had already been made at the time of our visit to the home included the decoration and refurbishment of several bedrooms, the replacement of doors with new fire doors that have openings connected to mains fire alarm system, this means that people can chose to keep their bedrooms doors open without compromising their safety in the event of a fire occurring. People living at the home commented positively about the improvements being made to the environment, the new owners are now renewing a lot of things in the home including new doors, repainting rooms and corridors etc. Some people living at the home showed us their bedrooms, they were noted to be personalised with personal belongings such as small items of furniture and ornaments. People expressed how grateful they were that they could bring some of their personal belongings into the home to make their room seem more like home. We noted several areas of the environment that were tired and worn including the carpets, bathrooms and bedrooms that had not been recently decorated. The manager Care Homes for Older People Page 20 of 30 Evidence: shared the improvement plan that has been developed that addresses all these issues. Carpets have already been ordered for the complete home. A plan is in place to refurbish one of the bathrooms to make a large walk in wet room which will give people living at the home the choice of whether to have a bath or shower. The colour scheme and signage chosen for the home has been chosen with advice from relevant professionals to best meet the needs of people with dementia. The home has a garden area to the front of the building, however the garden is not secure and the main road can be accessed directly from the garden. This poses a risk to people living at the home wandering onto the main road and either getting lost or injured. People living at the home are able to access the garden on an individually risk assessed basis, consequently not all people are able to make full use of the garden area at present. Since the new providers have taken over the home the main door to the house that opens directly onto the driveway has been secured with a key pad. However the conservatory accesses straight into the garden. During our visit we observed the conservatory door was left open which meant that the safety of people was not being assured. People living at the home are at risk of walking out into the garden and consequently onto the main road, or there is a risk that strangers could walk into the home from the main road. The manager and directors have agreed to keep the conservatory door locked unless there is a member of staff to observe people in the conservatory and advised us that they will let all staff, people living at the home and relatives know this is being done to protect people living in the home. They told us that ultimately it is their plan to relocate the garden to the rear of the building so people living at the home can access a garden area in safety. Infection control policies and procedures are in place and records detail that all staff received training about the control of infection in August 2009. A team of housekeepers staff headed by a senior housekeeper are responsible for the cleaning of the home. When we visited the home was clean and tidy. People living at the home and staff commented that the home is usually clean and tidy. The laundry facilities are located on the ground floor. The laundry was clean and tidy but although the door was shut people living at the home would be able to open it and there were laundering fluids that could be accessed. The manager agreed to put a keypad on the laundry door to ensure the safety of people living at the home. The management told us improvements have been made to the kitchen to reduce the risks of any cross contamination. As well as complying with recommendations made following a food hygiene inspection made by the local authority procedures have been changed for staff entering the building. This means staff no longer enter the building through the kitchen, reducing risks of contamination of food whilst meals are being prepared. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Provision of training and recruitment processes mean people living at the home are being supported and cared for by staff who have the relevant skills and experience. Evidence: The AQAA told us that the service operates a robust recruitment procedure. We were told by the manager that since the new provider has been managing the service a review of all staff files has taken place which highlighted some areas of previous recruitment procedures that had not been fully followed. These areas have now been addressed resulting in some staff members having had new checks completed against the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) List. Two new members of staff have been recruited since the new providers took over the management of the home. Records evidenced that full recruitment procedures had been completed prior to them commencing employment at the home. This means the service is showing its commitment to protecting the welfare of people living at the home by recruiting staff who are suitable to work in the care industry. We were told by people living at the home there are usually sufficient staff on duty at any one time to meet their needs and that call bells are answered promptly. Whilst at the home we noted call bells to be answered promptly. A duty rota details which staff are on duty at any one time and in what capacity, for example care staff, kitchen staff or housekeeping staff. We were told that the staff rotas have recently been changed resulting in improved continuity of care for people living at the home. Staff indicated Care Homes for Older People Page 22 of 30 Evidence: in conversations that they feel the care provision for people living at the home has improved with the changes in the shift patterns. The AQAA told us that the training plan implemented since April 2009 will result in all staff having received training about mandatory topics by the end of 2009. We looked at the training records that detailed since April 2009 staff have undertaken training about fire safety, food hygiene, moving and handling, safeguarding, management of medications, control of substances hazardous to health, infection control, and first aid. By the end of 2009 the plan is that all staff will have undertaken further training about challenging behaviour, dementia, continence, nutrition, and palliative care. Staff we had conversations with told us that since the new provider and new manager had taken over the running of the service they had received large amounts of training and they valued the commitment to training demonstrated by the manager and provider. No concerns have been raised to us by health care professionals or people using the service about the skills and knowledge of people working at the home. Staff training records also indicate that the home has achieved over 50 of its staff having NVQ level 2 or above in care. The manager told us that all staff including housekeeping and kitchen staff are being encouraged and supported to undertake NVQ training in their relevant field. Staff confirmed in conversations that the management of the home are supporting them to undertake NVQ studies. Staff told us in surveys their induction programme covered what they needed to know to before beginning to support and care for people at the home. However the home has not employed any new care staff since the new providers took over the management of the home, so we were unable to evidence that the present induction programme complies with the Skills for Care Common Induction Standards. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is being managed effectively to improve outcomes for people living at the home. Some areas of the environment mean that the health and safety of people at the home is not consistently being protected. People living at the home receive their care and support from a staff team that has sufficient supervision and support from the management team. Evidence: Hazeldene was registered as a new service in March 2009 when the provider changed from an individual to a Limited company: Firtree Associates Limited. In April 2009 the the share capital of Firtree Associates Limited was sold to new directors. The manager, Tina Foster, has been working at the home since February 2009 and was registered by CQC in June 2009. The manager and the directors of Firtree Associates Limited have demonstrated their commitment to improving outcomes for people living at the home since taking over the management of the service. Changes and planned changes have been discussed in the relevant sections of this report. Examples include the Care Homes for Older People Page 24 of 30 Evidence: introduction of a new care planning system to promote individualised care for each person living at the home, commitment to staff training to ensure people living at the home are cared and supported by people with the relevant skills and knowledge and improvements being made to the environment of the home to make it a safe and pleasant place to live. A quality auditing process has been put in place that involves input from people living at the home and people working at the home. This includes the use of staff meetings, meetings of people living at the home, regulation 26 reports in which one of the Directors prepares a report about the conduct of the care home following a visit to the service and surveys to people living at the home and their relatives. The directors and the manager hold a monthly management surgery which uses all the information gathered by these processes and audits of the environment to plan the next months management activity that can included addressing issues about the environment, care issues or staffing issues. With this process the service is able to audit and demonstrate its commitment to improving the service provision at Hazeldene. There is no programme in place for formal supervision at present. The manager told us that two senior care staff will be undertaking training about the supervision process after which formal supervision will be introduced. However at present with the high input of training and staff meetings the manager feels that staff at the home are receiving sufficient informal to ensure they are being professionally developed and are fulfilling their work roles. This was confirmed in conversations with had Staff told us they feel well supported by the manager and they can approach the manager and the directors if they have any professional or personal problems. Health and safety procedures are in place. Staff records detail they have received training about areas of health and safety including moving and handling, fire safety, food hygiene and control of substances hazardous to health. It was unclear from the fire logbook whether fire safety checks were being completed in line with the relevant legislation. This was discussed with the manager and directors who agreed that they would ensure the service demonstrates that they are complying with the relevant legislation for maintaining a record of fire safety checks. Risk assessments have been completed for areas of the environment that could pose risks to people living at the home and it was evident on the day of our visit that work had been carried out to protect the wellbeing of people living at the home. This includes securing the main entrance to the home so people living at the home cannot access the driveway where they could be at risk of injury from vehicles coming in and out of the site, the provision of fire doors in each bedroom that have closing mechanisms wired into the fire alarm system and the ceasing of people entering the building through the kitchen to reduce risks of contamination of foodstuffs. However we did observe some areas of the home that have the potential to pose a risk to people living there and these were discussed with the manager and directors. These include the risk of people accessing cleaning detergents in the unlocked laundry; the providers agreed to put a keypad on Care Homes for Older People Page 25 of 30 Evidence: the laundry door to protect people, and the practise of having the conservatory doors open which poses a risk of people wandering onto the main road or strangers entering the building. The manager and directors agreed to put measures into to stop these doors being open when a member of staff is not able to be permanently the conservatory. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 36 18 A programme for formal supervision for care staff must be developed and adhered to. So people living at the home receive their support and care form a staff team that through supervision it can be assured have the necessary skills to do so. 30/10/2009 2 38 13 A risk assessment for the practise of keeping the conservatory doors must be completed and action must be taken to reduce any identified risks. So people living at the home are not put at risk of danger or injury because of leaving the premises through the doors or strangers entering the premises through the doors. 30/10/2009 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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