Care Home: Herondale

What the care home does well People are assisted to see health care professionals when needed and have their health care needs met. Health care professionals told us: - `Staff under guidance of management are very supportive of my work and make me feel part of a team.` `Complex cases are managed very well, a wide range of activities, service users and carers are very pleased, excellent staff training and knowledge base.` `Provides and enhanced nursing service for people with dementia. Record keeping has improved recently.` `They manage challenging patients in a drug reduced environment.` A relative told us: - `They have always responded promptly when (my relative) is ill.` Medication was administered appropriately and this helps to keep people well. We received 9 surveys from relatives of people living in the home and almost all were very happy with the service the home provides. They told us:`I`m impressed by the way that staff treat all the residents in a professional way, with tenderness and compassion.` `Staff, patients and relatives are one big happy family.` `The staff are extremely patient and caring.` `Long term staff, management and carers make a difference by knowing the residents very well and making sure their needs are taken care of.` People have access to individual planned activities and these include therapies such as music and reflexology. In addition daily living activities such as bathing are looked at to see how they can be personalised to make them enjoyable experiences. People`s relatives were able to assist in the care of their person where this was appropriate and this can help the person adjust to being in a care home. On the day of the inspection the food was well prepared, tasty and the ingredients were fresh. Staff are well trained and a large number of care staff have a National Vocational Level 2 in care and this helps to ensure that people receive good care. The organisation does its own checks on the service and they produce an annual report and make recommendations about how they can improve. Where the home manages people`s money this is done well. There are good health and safety checks to ensure that people remain safe within the building. What has improved since the last inspection? People who may be moving to the home have an assessment completed before they are admitted. This is added to by a personal profile which gives more detail about people`s usual lifestyle pattern. Care plans are completed in a timely way. This ensures that staff have the information to give good care. Staff are completing the records expected by the organisation much more consistently and this helps us to check that all issues have been considered. The monitoring of accidents has improved with detail of how the accident happened. There is also details of the further checks over a number of days to make sure the person has suffered no ill effects. These records are now excellent. Sampled staff files showed that staff had the appropriate employment checks such as checks with Criminal Records Bureau, references and so on and this helps to ensure that people remain safe. What the care home could do better: There is currently only one person that doesn`t have a diagnosis of dementia the service needs to formally consider what arrangements they need to make for this person and any other people that may be admitted in the future. People do not have visits to the home before admission and the home loses the opportunity to see how the person manages in the new environment. Some health monitoring checks such as weight and blood sugars need to be more visible with the care plans to ensure that the checks are carried out with the frequency stated in the plan. Where health professionals have decided the frequency needs to change the care plan must also change. This is to ensure that people`s health difficulties are monitored well. We received two surveys telling us that the quality of the meals varied in the home. One told us on occasions their relative was given a soft diet although they could eat normally prepared food. Records of complaints and issues raised with the management of the home could be improved to assist the home to continually improve. Key inspection report Care homes for older people Name: Address: Herondale 175 Yardley Green Road Yardley Birmingham West Midlands B9 5PU     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: Jill Brown     Date: 2 1 1 0 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 29 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 29 Information about the care home Name of care home: Address: Herondale 175 Yardley Green Road Yardley Birmingham West Midlands B9 5PU 01217531653 01217714188 home.her@mha.org.uk www.mha.org.uk Methodist Homes for the Aged care home 36 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 36 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 36, Mental disorder, excluding learning disability or dementia (MD) 36 Date of last inspection Brief description of the care home Herondale is a purpose built; two storey home that is registered to provide care to 36 residents for reason of mental health problems, but predominantly specialise in dementia care. It is situated in a residential area within the boundary of Heartlands Hospital; it is close to shops, local amenities and is accessible to public transport systems. There is adequate parking to the front of the building with a large enclosed garden to the rear, which has a patio and seating for use by residents when weather permits. Care Homes for Older People Page 4 of 29 1 9 1 1 2 0 0 8 36 36 Over 65 0 0 Brief description of the care home The home is divided into four wings or house groups spread over the ground and first floors. The first floor is accessible by the stairs or a passenger lift. Each house group has its own lounge, dining area, kitchenette, a bathroom, a communal toilet plus nine en-suite bedrooms. The en-suite facilities consist of a toilet and shower facility and are of sufficient size for residents with mobility problems. There is a range of equipment for moving and handling residents plus pressure relief equipment for residents at risk of developing pressure sores. A passenger lift gives access to all areas in the home and there is wheelchair access to the front and rear of the building. The kitchen area is on the ground floor and this is separately staffed. The weekly fees are available on request, persons may wish to obtain more up to date information from the home. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home unannounced on a day in October 2009. We completed a key inspection which means we inspected the homes performance against most of the National Minimum Standards. The home gave us information in an Annual Quality Assurance Assessment before the inspection. The AQAA shows how the home rates their performance in the areas set out in this report and what improvements to the service they intend to make. During this inspection an expert by experience Caroline White accompanied us. An expert by experience is a person who, because of their shared experience of using services and/or ways of communicating, visits a service with inspectors to help them get a picture of what is like to live in or use a service. Almost all the people in this home have difficulties with their memory. Care Homes for Older People Page 6 of 29 The home is amidst refurbishment and we were not able to say that the environment met the needs of people at the moment although the plans would suggest that this will be case when this work is completed. Almost all the people in this home have difficulties with their memory. The expert by experience joined people for a lunch time meal and observed the interactions between staff and the people. During the inspection we case tracked four peoples care. This means we looked at all the homes records about the person, their medication, any money held on their behalf and their bedrooms. We looked around parts of the building. We also looked at other records about the safety of the building, complaints accidents and so on. We sent out surveys to relatives and health professionals and received 9 back from relatives and 4 back from health professionals who come into the home. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? People who may be moving to the home have an assessment completed before they are admitted. This is added to by a personal profile which gives more detail about peoples usual lifestyle pattern. Care plans are completed in a timely way. This ensures that staff have the information to give good care. Staff are completing the records expected by the organisation much more consistently Care Homes for Older People Page 8 of 29 and this helps us to check that all issues have been considered. The monitoring of accidents has improved with detail of how the accident happened. There is also details of the further checks over a number of days to make sure the person has suffered no ill effects. These records are now excellent. Sampled staff files showed that staff had the appropriate employment checks such as checks with Criminal Records Bureau, references and so on and this helps to ensure that people remain safe. 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. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to peoples representatives before people are admitted, however people do not visit the home before admission and this could assist the home and the person decide whether the home is suitable. The home collects detailed information about peoples needs before admission and this helps to ensure that peoples needs are met. Evidence: We looked at the information collected for 2 people before they were admitted to the home. We found that this information was collected by nurses, deputy or the manager of the home before people were admitted. The information collected covered details of the persons health conditions, help needed with their personal care, and areas where the person may have difficulties such as nutrition, mobility, skin care and mental health. Care Homes for Older People Page 11 of 29 Evidence: This information was added by a personal profile which included more detailed information about these areas. In addition peoples preferences about how their care was given and their family support were detailed. The persons ethnic origin and religion is recorded and this helps to ensure that appropriate planning takes place in these areas and that respects the persons personal history and culture. There is information available for peoples relatives and representatives to help them decide if the home will suit the person however often the individual persons disabilities make it difficult for them to access this written information. At present people do not usually visit the home although their representatives do. The manager was considering whether the visit should be part of the homes assessment process. This would help them determine whether the person has particular difficulties with the environment or other people living in the home. There is only one person living in the home that does not have a diagnosis of dementia. They are accommodated under the homes other category of registration, mental disorder. There are Registered Mental Health Nurses employed at the home that have the training to work with people with mental health issues however the home are having to consider the impact on the person of being the only person in the home with this diagnosis. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are having their care planned well and are benefitting from systems to monitor their health and well being. Medication administration is good and this ensure that peoples health is protected. Evidence: We looked at four peoples care plans and risk assessments. We found that people living in the home have extensive plans in place that describe how their health and personal care needs should be met and how the persons health can be promoted. Care plans appeared to be written in a timely way after admission to the home. People have risk assessments to ensure that their skin remains in a good condition, that they are moved from place to place safely and that concerns about their nutrition can be managed. Staff record against each plan of care on every shift. This means that some are written several times and can mean that it is not easy to get a time line of events. Care Homes for Older People Page 13 of 29 Evidence: Since the last inspection the completion of these records has improved with few gaps in recording being found. Reviews of care plans were being done at an appropriate frequency however we found that on occasion they did not take into account of all the events in the last month. Sometimes plans needed to be cross referenced with other plans, and staff needed to monitor aspects of care or changes to this monitoring these were not sufficiently highlighted. For example a record stated that a person needed their blood sugar levels monitored weekly, we checked, this was not being done at this frequency and no reason was given. Records indicated that blood sugar levels were not always within the range stated on the plan and the person had lost weight. We were told that a GP had not wanted these taking anymore but we could not find a record of this. This could mean that the persons health is deteriorating and further action was not being taken. The homes Annual Quality Assurance Assessment indicated that further training was needed on the cross referencing and care planning. The home has since the last inspection removed the need for bed rails to be used in the care of any person. They now only use beds that can be lowered to floor and this lessens the risks of people being hurt either by falling out of bed or being entrapped in bed rails. Records showed that people have access to health professionals when needed. We received 4 surveys from health professionals and they told us. Staff under guidance of management are very supportive of my work and make me feel part of a team. Complex cases are managed very well, a wide range of activities, service users and carers are very pleased, excellent staff training and knowledge base. Provides and enhanced nursing service for people with dementia. Record keeping has improved recently. They manage challenging patients in a drug reduced environment. A relative told us: - They have always responded promptly when (my relative) is ill. The home has significantly improved their monitoring of accidents. (Please see standard 38) We looked at the medication records, care plans and stocks of medication for 4 people. We found that medication was checked as it came into the home and was appropriately signed for. Medication that was no longer needed was accounted for and returned. Medication was stored appropriately and the medication room was well ordered. There was a photograph of the person with their Medication Administration Records (MAR) and this helps to ensure the right person receives the medication. There was also information about any special arrangements for the individual in taking Care Homes for Older People Page 14 of 29 Evidence: medication such as needs to take medication from a spoon or can have difficulty swallowing anything other than liquid medication. This can assist a nurse administering medication and the person prescribing it to choose the most appropriate form of medicine. The counts of medications checked indicated that medicines were given as prescribed. The MAR charts were difficult to read in places and staff that administer medication need to ensure that the pen they use is fit for the task. Controlled medication is stored, logged and administered appropriately. We received 9 surveys from relatives of people living in the home and almost all were very happy with the service the home provides. They told us:Im impressed by the way that staff treat all the residents in a professional way, with tenderness and compassion. Staff, patients and relatives are one big happy family. The staff are extremely patient and caring. Long term staff, management and carers make a difference by knowing the residents very well and making sure their needs are taken care of . One comment card told us that people needed more assistance to manage tasks on their own and that on occasions their relative has been dressed inappropriately for the outside weather when they have come to take them out. We found the home to be quite calm on the day of the inspection despite the home being refurbished. people were being assisted appropriately at meals times and relatives appeared to happy about the care their relative received. (please see Standards 12-15) We did not case track any body receiving terminal care on this inspection. However we were told that the home is using the Liverpool Care Pathway in this instance which is a recognised tool in ensuring good terminal care. The homes AQAA advised us that people are asked about their wishes where possible. The homes chaplain assists with arrangements and performs funerals where this is requested. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 this home can be assured that there will be good activities and food provided that will meet their needs. People have the possibility of receiving part of their care from their relatives where this is appropriate. Evidence: The home shares an activities coordinator with their sister home Kingfisher nursing home which is on the same site. Since the last inspection the plans to improve the day to day experience for people has been successful. There is a structured plan of activities which catered for all residents. The expert by experience found that there were efforts made to include people in some kind of activity as well as respect the wishes of those who did not readily participate. These activities were very well documented and included more personal information about peoples likes and dislikes in the way their care was managed. Complementary therapies for residents are included in the activities; these include massage and aromatherapy baths. The general tone of the home was very peaceful, with smoothing background music adding to the tranquility. Although television was a part of entertainment it did not dominate the home. Regular visits are made to the home by outside practitioners from a range of Care Homes for Older People Page 16 of 29 Evidence: professions, e.g. hair dressers, religious advisors and entertainers. Trips outside the home were also available. A health professional commented provides a calm caring unit where staff are happy to spend time with the residents, to reassure them, to achieve treatment aims, as well as extra activities such as shopping, musical activities and entertainment. The expert by experience spoke to six different visitors through out their visit. Several of these visited the home on a regular basis often daily to assist their loved ones at meal times and stayed several hours. This was not out of any care concerns but because they found the atmosphere of the home conducive to doing this. All visitors where highly complimentary of the home and its staff and where hard pressed to find fault. People could most times walk about unrestricted on each floor however due to refurbishments some restrictions were in place to keep people safe. The expert by experience stayed for a meal and found that there was a choice of meals available, which was clearly expressed ahead of time, through menus on the tables. It was obvious this food was not out of a packet but fresh, hot, tasty, well prepared and well balanced. Effort was made to suit peoples dietary requirements. Although meal times had a casual air, this in no way detracted from a positive experience. We were given menus for 4 weeks and we found that the home tended to offer traditionally English food and this may need to change as newer people admitted may have wider dietary experiences. People are offered a cooked breakfast everyday and a hot option at every meal time. The manager advised that they were considering moving the main meal to the evening as this has nutritional benefits to people and allows more time for activities for people. Two comment cards out of nine received stated that meals were variable one said Food is very variable can be excellent and on the whole is good but at times is very poor. The other said that their relative had on occasions been given pureed food despite being able to manage a normal diet. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be assured that their concerns are listened to and acted upon. Staff are well recruited and receive training in safeguarding and this helps to keep people safe. Evidence: We have had no complaints sent to us since the last inspection in November 2008. The home told us in their Annual Quality Assurance Assessment that they had received 2 complaints and that one of these had been upheld. We looked at the complaint record and found that the home had logged the complaints but the investigation notes and the outcome letter to the complainant were not available. These were supplied to us later. These documents must be available within the home for inspection. The AQAA stated a complaints policy was available but indicated that the old commission name and address. Further work could be undertaken to log informal issues so the response to these can be included in the homes improvement plan. The AQAA indicated that there had been a safeguarding incident in the home. This was appropriately referred to social services, the police and us and appropriate steps taken. Staff in the home have had safeguarding training and this assists in recognising potential abusive situations and confirms what their responsibilities are. Staff are Care Homes for Older People Page 18 of 29 Evidence: recruited appropriately with all necessary checks being undertaken. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the benefit of a home that has a layout and space to meet their needs. Refurbishment is underway but not yet completed enough to ensure that people have a comfortable and homely environment. Evidence: As previously stated the home was amidst refurbishment when the inspection was undertaken. This meant that there was considerable amount of work that had been done and was underway. The intention was to ensure that the home is brought up to a standard to meet the needs of people with dementia. Obviously there were some restrictions in free movement of people in the home and the home was not fully decorated to be the pleasant and enabling environment it is planned to be. At the time of the inspection en suites were having new showers and about 18 of the homes bedrooms had had these fitted. There were new hand rails and shower seats attached to the walls in these en suites. We were told that some shower chairs were also in place for those people who had poor balance. Decoration was now in progress for those bedrooms with new carpets, curtains and chairs being ordered and where necessary beds that lower to the floor. A health professional commented that the home could provide more moving and Care Homes for Older People Page 20 of 29 Evidence: handling equipment and a greater variety of seating. However also acknowledge that, it appears that this is currently being improved with the provision of new hoists, slings and refurbishment of the home. The expert by experience told us the garden had been under utilised and the management stated that development was underway. It was the expert by experiences opinion that If the action plan of improvements is carried out, weather permitting, the garden area could be a focal point of social interaction. We did not look at the kitchen facilities at this inspection, a previous report from the food safety department determined that the home had an excellent and well maintained kitchen facilities. The home was as clean and fresh as possible given the progress of the refurbishment. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have the benefit of enough staff that have had appropriate training to deliver good care. Evidence: The rotas showed that there was 1 to 4 ratio of staff to people living in the home. Care staff and nurses on day shift tend to work 8am to 8pm. There are always at least 2 nurses on duty during the day the numbers of care staff fluctuate but there is usually 9 or 10 (care and nursing staff) on the day shift. There is 1 nurse and 4 care staff on duty at night. These are supported by an activities co-ordinator, a music therapist, an administrator, a reflexologist, a chaplain, an administrator, housekeeping and catering staff. The manager of the home is in addition to this number. Comment cards and observations through the day would suggest that this is a sufficient number of staff. We looked at the training staff and found that 82 per cent of care staff (which includes the nursing qualified staff) have reached at least the National Vocational Qualification level 2 in care or equivalent. This is the qualification recognised by us as demonstrating that staff have had appropriate care training. We looked at the recruitment records for four staff and found that all the staff had completed an application form, and had checks including with Criminal Records Bureau and Protection of Vulnerable adult lists and references. Records could be enhanced by Care Homes for Older People Page 22 of 29 Evidence: ensuring that a reference is always gained from a previous employer, that references state in what capacity the person is known and wherever possible a stamp or headed paper on the reference. We looked at the training matrix for staff and found that almost all staff had up to date training in moving and handling of people, fire, safeguarding and food hygiene. The home has now registered staff for computer learning on some courses and intends to set up a full matrix to show what training people have undertaken. The staff records sampled indicate that staff have undertaken more training than the matrix shows and we saw certificates for first aid, end of life care and dementia care on one persons file. The home also sent us evidence of another staffs computer learning certificates on infection control, foundation in food hygiene, care induction standards and control of substances hazardous to health. We are aware that home has planned training and repeat training in Dementia care, end of life care, communication, deprivation of liberty and first aid. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home can be assured that the service is improving and that these improvements are being completed in their best interests. Peoples health and safety in the home is actively considered and plans are put in place where necessary. Evidence: The manager Debbie Green is awaiting registration with us and when completed this ensures further safeguards for people living in the home. There has been some delay in registration due to changes in the commissions administrative processes. The homes AQAA told us that the manager was continuing to undertake the Registered Managers Award. She hoped that she would be able to complete this by the end of January 2010. This course is recognised by us as the training required for managers of care homes. Care Homes for Older People Page 24 of 29 Evidence: The home supplied us with the AQAA and this was completed well. The organisation completes its own audit of the service that includes discussions with and observations of the people that live in the home. There was also evidence that visitors and staff were also spoken to. As a result a report with recommended actions to improve the service is written and the actions part of the report was shared with us. There were no people living in the home that were subject to a deprivation of liberty authorisation under the Mental Capacity Act at the time of the inspection. One person has had a best interest assessment but it was determined that the person had capacity to make decisions. Recommendations were made by the Independent Mental Capacity Advocate to improve the persons ability to be independent. We were shown a best interest care plan that had been put in place to facilitate this. (See choice of home section standards 1-6) We looked at a sample of money that was held on behalf of people living in the home and found that the money held matched the record. Receipts were kept for any service or goods that the home purchased on behalf of a person. Peoples money is usually brought in by family but for some people this is sent by solicitors or by social services. Money was usually spent on services such as hairdressing and chiropody. One persons records looked at requested shopping and held some money themselves. We looked at a number of health and safety records for gas, fire and water safety and found that these were in place. The home has had the electrical wiring checked as part of its refurbishment programme. We looked at the homes accident records. These have been improved following a fall people have enhanced monitoring for three days to check whether bruising has developed or whether people have had further problems not noticeable at the time of the accident. It records whether doctors have been called. The details on these records are excellent and give a clear picture of the accident and the checks on peoples of health and wellbeing. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 16 22 (8) Copies of records of complaints should be available for inspection. This is to ensure that the process of complaints can be seen. 30/11/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The home needs to consider ways of supplying people who are considering coming into the home with suitable information to assist them about whether this will suit them. Consideration needs to be given to the how the service is organised for people that do not have dementia existingly in the service and potential future admissions. Systems need to be reviewed to ensure that monitoring of weights, blood sugars are recorded as per the plan adn that changes to monitoring frequencies are adequately recorded. It is recommended the home monitor the food provided to ensure that it is at always at a consistent high standard. 2 4 3 8 4 15 Care Homes for Older People Page 27 of 29 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 5 16 It is recommended that a record of the issues raised with the management of the home and its resolution as this will inform the management of further improvements they could make. It is recommended that references include the capacity in which the referee knows the candidate. 6 29 Care Homes for Older People Page 28 of 29 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. 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