Care Home: Highfield House Nursing Home

What the care home does well People using the service have good access to health care and there are good working relationships with other health care providers to ensure that both intermediate care and longer stays in the home are well managed. The home provides a clean, homely and comfortable environment with a wide choice of communal space. All bedrooms are single and people are encouraged to bring personal possessions when they move in to make their room homely and personal. Care is provided by staff who are trained and supported for the work they do. People are offered a programme of activities and social events to meet different choices and expectations. What has improved since the last inspection? The inspection visit reviewed practice in the home, particularly to ensure compliance with previous regulatory requirements. The body of the report provides evidence of the action and progress that has been made to improve practice and improve outcomes for people using the service. Since the last inspection, action has been taken to comply with regulatory requirements in key areas of practice in the home: care assessment and planning, medication management, maintaining records of complaints and concerns, ensuring that staff are trained, ensuring that records are available when required. The home has also identified where further improvements can be made in areas of care planning and care reviews. New systems for auditing and monitoring the care provided have been developed and will be further developed as part of the home`s quality assurance processes. Since the last inspection a new manager has been appointed who has extensive and relevant skills and experience, and is in the process of applying to be registered with the Commission. The home has told us that they plan to complete building work to the ground floor laundry and staff rooms. upgrade the intermediate care rooms, cover some radiators, and resolve an area where people have access to a steep staircase. What the care home could do better: Although we did not identify any new or additional requirements, the service must ensure that the improvements made, are sustained and embedded in the practice of the home, to ensure people receive a safe and consistent service that meets their care needs at all times. Key inspection report Care homes for older people Name: Address: Highfield House Nursing Home 33 Queens Road Ryde Isle of Wight PO33 3BG     The quality rating for this care home is:   one star adequate 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: Annie Kentfield     Date: 2 5 0 8 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Highfield House Nursing Home 33 Queens Road Ryde Isle of Wight PO33 3BG 01983811015 01983614713 info@sciohealthcare.co.uk www.sciohealthcare.co.uk Scio Healthcare Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Barbara Alice Waymont Type of registration: Number of places registered: care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia physical disability Additional conditions: The maximum number of service users to be accommodated is 46. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Physical disability (PD). Date of last inspection Brief description of the care home Highfield House provides personal care and nursing care for up to forty-six older people. The home has a number of intermediate care places that are funded by the NHS. The home is a period property that has been extended over recent years and is conveniently located in Ryde with easy access to local facilities and public transport. Care Homes for Older People Page 4 of 29 Over 65 0 0 46 46 1 6 0 9 2 0 0 9 Brief description of the care home The home offers accommodation arranged over three floors and the building is accessible. There are two internal lifts and stairs. All of the bedrooms are single and most of the bedrooms have en-suite facilities. Other bedrooms have a wash-hand basin with a toilet and bathroom close by. There is a range of communal space available to people living in the home including a large and pleasant dining room and lounges arranged over the three floors, with quiet areas that offer privacy to residents and their visitors. The home has a reception area and there are refreshment facilities offered to visitors. A separate area for people who have dementia care needs is located on the ground flooor with a lounge, dining room and easy access to a large central courtyard garden. Information about fees and any additional charges is available 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: one star adequate 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 made an unannounced visit to the home on 25 August 2010. Between 9.30 am and 5.30 pm, two inspectors spoke to service users, staff and visitors who were involved in the visit. We also spoke to the directors of the company and with the manager. (The manager was on annual leave but volunteered to come back to work to assist with the inspection). The visit included some private meetings with service users and staff and general discussion with people who were in the communal areas of the home. We also looked at records, including care plans, medication records, training records and records required for the management of the home. Before the inspection we received an improvement plan from the home with details of what action they have taken to meet previous regulatory requirements and improve outcomes for people using the service. We also spoke to the Local Authority/Safeguarding Team to discuss the outcome of a Care Homes for Older People Page 6 of 29 recent investigation into alleged poor practice. The investigation was completed and closed and the allegations were not substantiated. The home co-operated fully with the investigation. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 29 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. Procedures are in place to make sure that the home can properly meet the care needs of people who move in; for either respite care or longer term care. The home works closely with the local health trust to ensure that people receiving respite or intermediate care receive a good service with access to all the specialist services they may require. Evidence: When we last visited the home we had concerns that a proper assessment of peoples care needs had not been carried out for two people and that this put them at risk of not receiving the appropriate care to meet their needs. Following our visit, the home has taken action to improve their assessment and admission process to ensure that all relevant information about care needs is gathered, before people move into the home. We looked at two recent assessments Care Homes for Older People Page 11 of 29 Evidence: and the information was detailed and comprehensive. Some people refer themselves to the home and some people are referred by the Local Authority or by the NHS. In all cases, the manager carries out an assessment of care need in order to draw up a plan of care for each person. Where possible, the home gathers a personal and social history to make sure staff have the information they need about personal choices and preferences and how people wish to receive their care. The manager works closely with the local NHS where people are to be admitted from hospital to ensure that all information is up to date. People are assessed by the NHS Trust for their suitability for intermediate care at Highfield. The assessment is then discussed with the home who make the final decision as to whether the home can provide the care that is needed.This means that people can be confident that the home can provide the care they need when they move into the home. We spoke to a local health care professional who told us that the home and the NHS Trust share information to ensure that individuals receive the specific aids and equipment they may need. Staff can also communicate any problems or issues that need additional support. We were told by a health care professional that the communication and skills of staff in the home have improved greatly over the last 18 months and there has been lots of positive feedback from people who have enjoyed their stay in the home. All of the intermediate care bedrooms are now in one place and there are plans for these rooms to be upgraded. The Intermediate Care Team has been asked to consult with the home on the best way for the rooms to be upgraded to ensure that the home provides best practice resources. We spoke to one person who was receiving intermediate care and they were very happy with the care they were receiving and had no concerns. They told us that staff provided support to get to the dining room for meals, or to the lounge, as they requested. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to health care services to meet their needs and according to their plan of care. Medication is safely managed to ensure that people receive their medication as it has been prescribed by their doctor. Dignity and privacy in the provision of care is promoted. Evidence: We looked at the care plans for six people and paid particular attention to those areas of care where we previously had concerns about people being at risk from poor practice. Care plans contained an assessment for dietary and nutritional care needs with a plan of care where a specific need had been identified. Where people need to have their food or fluid intake monitored, this was properly recorded and staff note each day the amount that has been taken. The manager told us that this area of care is reviewed at the end of each shift to ensure people are receiving the nutrition they need and further specialist intervention can be sought when required. Care Homes for Older People Page 13 of 29 Evidence: Another care plan contained a detailed wound assessment and care plan with details of where improvement has been made. All of the care plans that we looked at contained records of regular weight checks with any changes noted and reviewed. Following a recent review of care plans by Social Services, some changes are being made to the way that care is recorded. This will mean, for example, where staff record details of any continence care - more detailed information will be recorded to demonstrate that all personal care needs are being met on a daily basis. At the moment the daily care record sheet is basic, with tick box columns. The recommendation was in regard to expanding the column to record that people receive a wash whenever pads are changed. Other parts of the care plans provide limited information. However, the new manager told us that she will be reviewing the care plan format to move to a more person centred approach. The manager told us that care plans and risk assessments will be kept together to provide more easily accessible information and guidance for care staff. People have access to chiropody, dental treatment and other health care services, this is recorded in their care plan. The manager told us that there are plans to develop access to a specialist hearing aid service to ensure that equipment is maintained in good working order for the benefit of the service users. During the visit, we noted that people have access to the specialist aids and equipment they need. We spoke to a representative of the NHS, who works closely with the manager and staff to ensure that people have access to support and equipment as it is needed. This ensures that people receive a person centred care that aims to meet needs on an individual and personal level. During our last visit we had concerns about poor practice in the management of medication. A regulatory requirement was made to ensure that people receive their medication, as prescribed, at all times. We spoke to a senior member of staff who has been given time and responsibility to manage medication. We found evidence of a clear policy, procedures and practice to efficiently organise some medication that is prescribed and received in bulk. The systems in place ensure that the home is not overstocked and supplies are used in rotation. A new medication audit means that the person in charge of each shift has to check Care Homes for Older People Page 14 of 29 Evidence: and sign to show that all medication has been given or accounted for. This has significantly reduced any errors in the medication recording. The member of staff showed us a number of new innovations and procedures that have ensured the organised and efficient dispensing and recording of medicines received into the home. For example, staff who are dispensing medication wear a tabard that reminds others that they cannot be disturbed when dispensing medication. There are also clear procedures to ensure that disposal systems for medication and equipment are safely maintained. We saw evidence that staff who dispense medication have received training updates in the safe administration of medicines and also the management of bulk prescriptions. Since we last visited, the home has reported two incidents where people did not receive their medication as they should have done. The home took prompt action to ensure that people were not at risk of harm. Appropriate action was taken by the home to reduce the risk of any further errors when dispensing medication. During our visit we spoke to service users and staff who confirmed that privacy and dignity is respected. One person told us that she had complained about some laundry that had been returned creased and this was taken away and ironed. We also saw evidence of examples of staff practice that aims to provide care that is tailored to meet individual needs. 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 the home have the opportunity to take part in social and leisure activities both individually and communally. Visitors to the home are made welcome. Attention is paid to providing people with an attractive, varied and nutritious choice of meals and snacks. Evidence: The home employs two people to co-ordinate activities and events for people living in the home. A programme of events is on display in the main entrance. On the day we visited, a film was being shown in the dining room in the afternoon. We also saw staff engaged with people individually for social activities, people also have access to TV, books, games, talking books and craft activities. There is a visiting hairdresser and two people told us they enjoy having their hair washed and styled. Following feedback from service users and visitors, we were told that there are plans to start a gardening club in the courtyard garden at the rear of the building. Staff told us that the manager has reviewed the staffing rota to allow the activity coordinators more time for engaging in activities. We were also told that there are plans to develop more activities at weekends; following feedback from service users. Care Homes for Older People Page 16 of 29 Evidence: The home has an open visiting policy and the visitors book demonstrated that people visit at different times of the day. Drinks and refreshments are available for visitors. The service has a planned menu that is rotated on a four weekly basis. Peoples dietary needs and choices are assessed by the catering manager and there is a choice of main meal each day. Three people told us that they are always encouraged to take their meals in the main dining room. There is also a dining area on the ground floor or people can have meals in their room. One person told us: the food is good and you have a choice of two meals and if you dont like them you can have something else. I dont like gravy and prefer my meals dry, they do this, it took a bit of time for this to happen, but now I take my meals in the dining room for a change of scene. If I need extra drinks or snacks I use my call bell. 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. Staff have an understanding of their responsibilities to respond to any allegations of abuse. People are protected by thorough staff recruitment checks to ensure that staff are suitable to work in the home. Evidence: When we last visited the home we made two regulatory requirements for the registered person to ensure that a record is kept of any complaints and for all allegations of potential abuse to be reported with a record kept of the outcome. The home sent us their improvement plan: this told us that all complaints, concerns or comments are now recorded with details of the action taken and outcomes. Also, that a similar record will be kept of any safeguarding concerns or allegations of poor practice or abuse. During our visit we looked at the records and this confirms the information in the improvement plan. The record of complaints shows that the home had responded in a prompt and appropriate way to demonstrate that all comments and complaints are taken seriously and responded to. We also saw evidence of lots of compliments and positive feedback and we were told that this would also be used as part of the homes overall review of the service and quality assurance. Care Homes for Older People Page 18 of 29 Evidence: One person we spoke to said they did not know how to make a complaint, they said the staff are very supportive and had been involved in their care plan and the care plan reviews. This person commented that they would like more hoists on occasions when they have had to wait. Two other people we spoke to had no concerns and said they would feel comfortable speaking to the manager or deputy manager in the event of any concerns. The home are now keeping a record of any allegations or safeguarding concerns and the outcomes. Our records show that the home has notified us of any events or concerns since the last inspection. A safeguarding investigation by Social Services took place recently following an anonymous complaint about the home. The home cooperated fully with the investigation and the complaints were not substantiated. Some recommendations were made by Social Services to improve record keeping in the home and we were told that these recommendations are being actioned. Staff that we spoke to demonstrated a good understanding of their responsibilities to ensure that people are protected, and the action they must take in the event of any concerns or suspicion of abuse. Staff also demonstrated a good awareness of the need for privacy, for care to be provided with dignity and respect, and the importance of confidentiality. Staff training records confirmed that staff have received appropriate training in safeguarding awareness. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a homely and comfortable environment to live in that has the relevant aids and equipment to allow their needs to be met. Evidence: Appropriate equipment to meet the health, personal, and social care needs of people was evident in the home. This included pressure relieving equipment, call bells, profiling beds, hoists and wheelchairs. Bathrooms contain assisted baths and there is also a walk-in shower room. We were told that there are plans to upgrade the intermediate care bedrooms that are now all in one place in the older part of the building. The manager told us that since being appointed, she has recognised a problem with the calls bells not being used correctly by service users. Staff are now reminded to ensure that people have the call bell lead with a button to press when they require assistance, rather than the control box that is designed for staff use. Ten call sets have been sent for repair. However, the manager told us that the home carries a stock of spares ensuring that people have the means to call for assistance. The manager told us that peoples capacity to use the call alarm system will be assessed to ensure that people have the means to call for assistance at all times. We spoke to one person who was in their bedroom; they told us that staff usually respond very promptly when called, but there are sometimes periods when staff are very busy. Care Homes for Older People Page 20 of 29 Evidence: The staff area and laundry facilities are in the lower ground floor and this part of the building is awaiting completion following recent building work to extend the home. We looked at all parts of the home during our visit and the home was warm and homely with a good standard of decoration, furnishings and fittings. The home employs a housekeeping team and it is evident that there is a cleaning programme in place. In only one area did we found evidence of an odour of urine. This was discussed with the manager who told us what action is being taken to remedy this. In the interim period, the carpet is being shampooed every day. There are sluicing facilities on each floor, and staff have access to gloves and aprons as part of the infection control measures in the home. Toilets and bathrooms are supplied with liquid soap and paper towels and there are dispensers for anti-bacterial spray around the home. The home has a range of communal rooms and these provide opportunities for people to sit quietly or to have privacy to meet with visitors. Windows on the upper floors are fitted with restrictors to ensure the safety of people in the home. However, during our visit, we found that some window restrictors had been disabled and windows were open wide. The home took immediate action to address this and we were told later in the day that all restrictors were now in place and one had been found to be broken and would be repaired. Two radiators in the intermediate area of the home are not covered and a pole is situated across some stairs in the same area to prevent people from using these stairs as they are very steep. The manager stated that the radiators are going to be covered. We were also told that people using those bedrooms are unable to mobilise without assistance and are supported by staff down the corridors and to use the lift. We were told that when the rooms in this part of the home are upgraded, the access to the steep stairs would be changed to provide an additional storage area. 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 receive their care from staff who are trained for the work they do. Staff recruitment checks are in place to ensure that people are not at risk of harm. Evidence: We spoke to the training co-ordinator and looked at staff training records - these are organised so that people receive a reminder for when training updates are due. The records demonstrate that staff receive regular training in all areas of safe working practice such as moving and handling, infection control and food hygiene. Additional training is offered in specific areas such as dementia care and information about conditions and treatment for particular areas of health care, such as medicines management and inhaler technique and respiratory care. We spoke to five members of staff who confirmed that they had received training for the work they do and they have the opportunity to identify further training needs during their 6 monthly appraisal of performance. More than half of the care staff team have achieved an NVQ (National Vocational Qualification) in care at level 2 or 3 and one person we spoke to was planning to become registered as an NVQ assessor, in care. Staff we spoke to had worked in the home from between two years and eight years and felt supported and able to speak to a senior member of staff whenever the need Care Homes for Older People Page 22 of 29 Evidence: arose. All staff spoken to commented positively on the changes that had been made to areas of practice in the home. We were told that changes to the staff rota meant that more staff were available at busy times of the working day and this was better for the people living in the home. The manager has reviewed the staff rota to provide more time for staff to work with people with social activities. The twilight shift has been extended from 10pm to midnight to give greater flexibility for people who want to go to bed later. These changes have followed initial consultation meetings by the manager with all of the staff, with the aim of seeking feedback on how the staffing structure can better meet the needs of the service users. At the moment, there are 2 nurses and either 7 or 8 carers on the day time shift and 1 nurse and 3 carers at night. Management, housekeeping, catering, administrative and maintenance staff are employed in addition to care staff. The manager told us that she is able to employ agency nurses and carers to cover any shortfalls in the staffing rota. The home uses the same agencies on a regular basis with regular staff to ensure continuity for the people in the home. People that we spoke to generally expressed satisfaction with the care they receive. One person told us: I cannot fault the home in any way, staff are nice. Another person told us:Staff do the best they can - but they are always busy. One person told us: very happy with everything, they had no concerns and told us the call bell is mostly answered promptly or as soon as possible, depending how busy staff are. The five members of staff that we spoke to agreed that they were busy but felt that there was usually sufficient numbers of staff for the work they do. We were told that the only times when this was difficult is in periods of sickness absence when it was not possible to get agency staff at short notice. Staff told us that the manager and deputy manager are very flexible and will assist staff when required. The home told us in their improvement plan that they are auditing all staff recruitment records on a monthly basis. This ensures that all checks that are required by law, are satisfactory and in place prior to employment. We saw evidence of these regular audits and checks during our visit. This ensures that people living in the home are protected from harm and demonstrates that staff are suitable to work in the home. The manager showed us the staff appraisal process and this takes place every six months to review practice and performance and identify any additional support or training needs. This was confirmed by staff that we spoke to. Care Homes for Older People Page 23 of 29 Evidence: Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a new manager who has responsibility for the day to day running of the home. Improvement has been made to key areas of the service such as care planning, medication management and staffing to ensure that people receive the service they need. These improvements must be sustained and embedded in the practice of the home to ensure people receive a consistently good service. Evidence: Since the last inspection a new manager has been appointed. This person has been in post for two months and is in the process of applying for registration with the Commission. The new manager has extensive and relevant clinical and management experience and has previously been registered as manager of a nursing home. The new manager has an organised, open and positive approach to running the home in the best interests of the service users and this was confirmed in the feedback we received from staff and service users. We found evidence to demonstrate that record keeping has improved and records Care Homes for Older People Page 25 of 29 Evidence: required to be available for inspection were easily accessible. The home has developed new systems for auditing the service provided and details of these were provided in the improvement plan and verified during our visit. This means that the home is actively monitoring the service they provide to ensure improved outcomes for service users. As the monitoring systems are still being developed, further review of this will be ongoing. All of the internal audits and monitoring systems will become part of the homes quality assurance systems and we were told that there are plans to set up a quality services management team. The team will be made up from staff representatives to collectively take forward the outcomes of the consultation meetings with staff, service users and visitors. In addition, the directors of the company are involved in the day to day organisation of the home and we saw evidence of regular inspection visits by the nominated responsible person. These inspections are recorded with evidence of recommendations followed up and actioned. The home confirmed that they are compliant with all relevant health and safety legislation including fire safety with records available to demonstrate compliance. The home was recently inspected for food safety and hygiene and received a five star rating (the maximum rating). Since our last visit, improvement has been made to aspects of care assessments, care planning and medication management. Although further improvement is planned, this demonstrates that action has been taken to ensure that people are receiving care to meet their health care needs. Improvements to the management of medication demonstrates that people are receiving their medication as it has been prescribed by their doctor. The service must ensure that improvements are sustained and become part of the practice of the home to ensure that people receive a consistent service that meets their care needs at all times. Some parts of the home environment require attention: covers on radiators, review of the call bell system, monitoring of window restrictors, upgrading of the intermediate care rooms, review of access to steep stairs, and completion of the laundry and staff areas. The home has told us that they will be addressing all of these issues. We have recommended that they send us their environment action plan with proposed timescales for completion. Care Homes for Older People Page 26 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 27 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 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 19 It is recommended that the registered person provides a plan of repairs and improvements to be carried out with a timescale for completion. 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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