Care Home: Hilton Brook House

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What the care home does well The atmosphere within the home is warm and friendly. Staff provide a good standard of care to people living in the home, communicating with and managing residents in a thoughtful, respectful manner. On the day of arrival, a resident was overheard to reflect with a member of staff that staff at the home were, "beautiful, caring, beautiful people, I love it here." What has improved since the last inspection? The home has continued with a programme of internal decoration and improvement works. Since the last inspection, a downstairs bathroom has been damp coursed and replastered. A range of bedrooms have been redecorated and communal areas continue to be kept to a high standard. An assistant deputy manager has recently been appointed. This has strengthened the management team generally but has enhanced day to day leadership. What the care home could do better: As a result of this inspection, one requirement and five recommendations to improve practices in the home have been made. We found that the systems for the management of medication into and out of the home needed to be reviewed. In particular, the monitoring systems to ensure compliance with the home`s procedures and the early identification of issues needed to be developed. Information provided to us following this inspection has reassured us that these issues have been addressed in full. Key inspection report Care homes for older people Name: Address: Hilton Brook House Hilton Brook House Hilton Bridgnorth Shropshire WV15 5PE     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: Di Chadwick    Date: 2 3 1 2 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 28 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 28 Information about the care home Name of care home: Address: Hilton Brook House Hilton Brook House Hilton Bridgnorth Shropshire WV15 5PE 01746716577 01746716338 jen@hiltonbrookhouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Jennifer Jones care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 31 The registered person may provide the following category of service only: Care Home Only (Code 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) 21 Dementia (DE) 10 Date of last inspection Brief description of the care home Hilton Brook House is a residential home situated in the village of Hilton, South Shropshire. The home is registered to provide care for older people, including older people with dementia. The home is owned by Mrs Jennifer Jones, who is also the registered manager. There is a management team in place which supports the registered manager in the management of the home. The home has been previously extended and converted. The accommodation currently Care Homes for Older People Page 4 of 28 10 0 Over 65 0 21 Brief description of the care home provided is 21 single bedrooms (6 en-suite) and 5 double bedrooms, located over two floors. The upper floor can be accessed via two passenger lifts. The gardens outside the home are pleasant, well maintained and easily accessible. Residents also have the use of Mrs Jones garden, which adjoins the home, where there are a variety of pet animals and birds. Hilton Brook House delivers care in accordance with individual care plans, supported by an ongoing assessment of needs. All residents are allocated a key worker. Prospective service users are offered the opportunity to spend supported time in the home as part of the admission assessment process. The needs of residents are increasing and some are highly dependant on carers to ensure that personal care needs are met. The current weekly fees are published in the service user guide and marketing literature published for the home. These are currently £380 per week. There are additional charges for services such as hairdressing, chiropody and newspapers. Care Homes for Older People Page 5 of 28 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 peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: The inspection was carried out by one inspector across two days. The time on site lasted a total of 11.5 hours. The home was aware that an inspection was imminent but they were not aware of the date or time the inspection would take place. The main purpose of this unannounced inspection was to monitor the homes continued performance against standards. The service generally demonstrated systems and processes are in place to ensure that services provided meet the expected standards required by the regulations and national minimum standards. There were some areas for improvement identified. There was a requirement made at the last key inspection in respect to medicines management arrangements of the home and this was followed up as part of the inspection. The home sent us their annual quality assurance assessment (AQAA) before the inspection. This gave us information about what they are doing now, what they want to Care Homes for Older People Page 6 of 28 do in the future and how they have met the requirements from the last key inspection. The management team and the staff who assisted with the inspection across the day had a positive and helpful approach and the assessor felt welcome at all times. The inspection included observing activity within the home, inspecting the premises, and reviewing in depth a range of records. The opportunity was taken to talk with residents, staff and visitors to the home. As part of the inspection process, the Commission circulated questionnaires for people living, visiting and working at the home to expresses views and opinions for inclusion in this report. Care Homes for Older People Page 7 of 28 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. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 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. No individual moves into the home without having their needs assessed and where the home is confident it can meet these needs. All assessments are completed by competent members of staff. Hilton Brook House has a variety of information to offer people who are thinking about living at the home make an informed choice about whether the home is suitable to meet their individual needs. The home produces a well written and informative welcome pack, providing an overview of services and accommodation offered. There is the opportunity for individuals to spend time in the home to inform decisions on the choice of home. Hilton Brook House does not offer an intermediate care service. Evidence: The current statement of purpose and service user guide were freely available in the Care Homes for Older People Page 10 of 28 Evidence: reception area of the home, along with a well written booklet, providing a brief overview of services and accommodation provided at the home. The content of the statement of purpose and service user guide were consistent with the requirements of the regulations and reflected the current conditions of registration. The home also publishes a home welcome pack, giving a brief overview of services and accommodation. This document was considered to be particularly well written and informative and commits the home to six statements covering the standard of care residents can expect at the home. There was a discrepancy in information between the statement of purpose and the service user guide in respect to the number of bedrooms and ensuite facilities available. This was advised to the registered manager during the course of the inspection. The home issues a contract to all individuals living at the home, which clearly sets out the fees and other charges payable. Not all contracts were complete in content. The fee agreed was a detail that was often not recorded in the signed contract held on file. Individuals and relatives are encouraged to be involved in the assessment process. A comprehensive needs assessment is completed for most service users prior to admission by a skilled and experienced member of staff. This will be the registered manager, deputy manager of assistant deputy manager. The home will accept emergency respite and other placements where individual needs can be met and bed capacity allows. These assessments are informed by a wide range of sources and seek to ensure that the home is the right environment and can meet the needs of the service user. Prospective service users are offered the opportunity to spend supported time in the home as part of the assessment process. Care Homes for Older People Page 11 of 28 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. The health and personal care which an individual receives at Hilton Brook is based on an assessment of all health, personal preferences and social care needs, set out in an individual plan of care. The detail in care plans and the adjustment to plans in response to specific issues was not always clear. The health of individuals is promoted and maintained in the home, access to relevant health care services supported to meet assessed needs and medication regimes are complied with. It was also not always clear to what extent an individual or their representative had been involved in the care planning process Evidence: All of the written comments reviewed about the care carried out at the home were complimentary. Health professionals who work with the home were similarly positive about the care provided. Care Homes for Older People Page 12 of 28 Evidence: I know she was well looked after by you all,,, and I am always grateful for the piece of mind you gave me having not to worry about her so much Sadly her stay was short but we are pleased that at least she ended her days amongst people who showed her dignity and compassion All residents have an individual care plan in place, based on individual needs and preferences. The deputy manager advised that residents are involved in care planning to make decisions about their care. The approach reflected during observations and discussions with staff was to keep residents safe but promote independence as far as possible. No patients were self medicating at the time of the inspection. In order to check the approach reflected by staff at the home to care planning, sample care records were reviewed. The records included recent admissions, recent discharges and records for individuals who had recently been admitted to hospital for a period. This review confirmed that care plans are developed in response to individual needs but the detail in the ongoing recording and update was lacking and the adjustment of plans in response to specific issues and incidents was not always demonstrated. It was also not always clear to what extent an individual or their representative had been involved in the care planning process. The general standard of care plans was acceptable. There was an inconsistent approach to signing or initialling of entries in the care plans. The recording of observations was not demonstrated where frequent observations form part of the care plan. This was discussed with the registered manager as part of the inspection feedback, who confirmed that the observations take place but are not individually recorded, but anything exceptional would be recorded. The observations on the most recent admission at the time of the inspection need to be reflected. The individual had arrived at the home in a very frail, physically and mentally vulnerable state. The individual was too weak to mobilise and transfer independently. This was reflected in the photograph taken at the time of admission for the medication records. The individual was seen at the home during the inspection just over a month later. The individual was seen to be mobilising and transferring independently, having coherent discussions with staff and other residents and physically looked healthy and well looked after. The home promotes and maintains residents health, ensuring access to primary and secondary care services as required. The home has a good relationship with a local GP practice, with whom residents are registered during their stay at the home. This Care Homes for Older People Page 13 of 28 Evidence: includes temporary registration where a resident has been admitted for respite care. The practice visits the home every Wednesday but support visits in response to urgent needs as they arise. The home has good standing relationships with local community nursing services. Direct referrals are made to services to ensure timely advice is sought. During the first day of the inspection, there was various community nurses who visited the home. A district nurse attended in the morning to attend to residents dressings. In the afternoon, a member of the local community mental health team came to discuss with the home the management of a resident with emerging challenging behaviour. The opportunity was taken to speak with the nurse from the mental health team. They were very positive about the relationship with the home and the care and approach they offered to the residents. They confirmed that the home always approached for advice and input at an appropriate stage and worked well with staff to ensure that residents were kept safe and supported appropriately. A minimum of annual oral health and optician assessments are arranged within the home for residents, local domiciliary arrangements in place. The deputy manager advised that all new residents are referred and attendance requested where the need arises. There was a requirement set at the last inspection to review medication systems and processes which had not been followed up through a further compliance visit. There had also been a recent concern received on staff accessing medication for personal use. The registered manager had responded to this concern before the inspection. The medicines management arrangements at the home were therefore reviewed in detail during the first day of the inspection. The systems at the home do not always follow good practice or safe practice guidelines. General day to day processes to support the safe management of medicines were demonstrated. Staff involved in the administration of medication have completed and passed an appropriate medication course. Sample medication records were reviewed and demonstrated compliance with prescribing regimes set by health professionals. The storage of non routine medication, such as painkillers and cream & ointments, was chaotic. Space in the main medicines cupboard is limited, and a lot of this type of medication was placed in a separate pigeon hole type storage system. Some medication was stored in one place for individual patients but there was some mixing of medication between patients observed on inspection of the medicines cupboard. The handling of medication once received at the home was also inconsistent. Care Homes for Older People Page 14 of 28 Evidence: Regular management reviews are not recorded to monitor compliance with procedures or to reconcile stocks and identify discrepancies. There were several discrepancies identified in the controlled drugs register. These were resolved immediately following the inspection but reflected an inconsistent approach to recording and management processes. PRN medication is supplied in jars for use as and when required. The lack of management checks increases the risk of discrepancies going unidentified; we are now aware that a much more robust system of audit has been established at the home. Care Homes for Older People Page 15 of 28 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. Individuals living at Hilton Brook are able to choose their life style and social activities and are encouraged to maintain contact with family and friends. The food prepared at the home is healthy and varied to meet with assessed needs and choices. Evidence: From comments received and observations during the inspection, the home has a strong commitment to support residents makes choices about their day to day routines and lifestyles. She was always very happy in your home. Our family have fond memories of how she tootled around,chatting and laughing with staff and other residents, which obviously proved she was quite happy and content. Lots to do here, they keep me busy - and the companionship I have is precious Communication and relationships between staff, residents and visitors to the home Care Homes for Older People Page 16 of 28 Evidence: were observed to be positive. Conversations with visitors during the inspection reflected that they were always welcomed at the home by staff and that residents were actively encouraged to participate in activities taking place. A review of the visitors book confirmed that there are visitors to various residents across every day. The deputy managers responsibilities include the coordination and planning of activities. The home has invested in this area through training and resources for the deputy manager to support this role. There was evidence across the home of the range of activities supported, with display posters of photos of staff and residents participating in events organised. Residents looked to be having a fun time fruit picking and the staff try to enhance occasions by dressing up - all staff dressed up for Halloween. Routine activities organised include word searches, colouring, painting, knitting, bingo, pet therapy and exercise, aromatherapy and a range of outside entertainers are also organised. Gentle exercise through walks in the garden and orchard, looking after the pet chickens and owl also form a part of day to day routines. Discussions with staff, residents and visitors confirmed that residents are very engaged with activities organised, if they want to be and have the choice to participate or not. One to one activity sessions are also supported through key workers and the deputy/assistance deputy manager. All residents who made comments about the food were in agreement that the food was lovely. The home employs a cook who works across the week, with cooking duties covered by care staff every other weekend. Discussions with the cook reflected a commitment to preparing nutritious, homely meals using home grown produce - eggs from the chickens and fruit from the orchard. The food is excellent. The food is excellent and always lovely. On both inspection days, there was a homely cooking smell coming from the kitchen leading up to lunchtime. The cook appeared keen to ensure that meals are well presented and as afar as possible, truly home made. On the first day of the inspection, the cook was preparing home made lemon cake and rice pudding for the lunch time sitting. The encouragement and assistance for individuals was observed at lunch time on both days on site. Both observations reflected a sensitive and respectful approach by staff. Care Homes for Older People Page 17 of 28 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. Individuals living at Hilton Brook have access to an open and transparent complaints procedure, with support and advocacy easily accessed through the home. Individuals are protected from abuse and have their legal rights protected. Evidence: The home has a complaints procedure in place, which was available at the reception to the home, advised across the home and referenced in the statement of purpose, service user guide and supporting information about the home. The complaints policy is clearly written and easy to understand.Information on advocacy services was clearly on display across communal areas. Residents confirmed they were aware of how to raise concerns. The home has safeguarding procedures in place.The mandatory training programme for staff includes safeguarding and this training considers the different forms of abuse that can take place. Understanding of the policy arrangements and how to respond was discussed with individual staff. Their understanding reflected the training provided and procedures at the home. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe, well-maintained, homely environment. A programme of routine and developmental maintenance is in place. Indoor and outdoor communal areas are provided at the home. All areas of the home are well maintained and cleaned on a routine basis. Evidence: The registered manager confirmed that reactive maintenance is covered by the maintenance man in post, who could attend to most routine and ongoing maintenance work without the need to call in external contractors. Improvement and development maintenance remained a discussion at management level with staff input. The registered manager confirmed that the current budget arrangements provided funding for both reactive and proactive maintenance works. There was a forward plan of works to extend the kitchen area and works to continue to upgrade bedroom areas and develop ensuite facilities remained the priority for the next 12 months. A full guided tour of the premises was provided on the first day of inspection. The home generally appeared clean, tidy and fit for use. There were discreet areas where noxious odours were detected - immediately outside the staff toilet area on the ground floor, in the shared male bedroom on the upper floor and the single female bedroom on the upper floor. These areas were revisited on the second day of the inspection. The noxious smells were no longer present. Care Homes for Older People Page 19 of 28 Evidence: The bedrooms are a mix of ensuite and shared accommodation. Personalisation of bedrooms was evident across the site and some areas had recently been redecorated and recarpeted. During the first day on site, the maintenance man was undertaking works to the radiators in the bedrooms to ensure the control of temperature in each room was working properly. The standard of upkeep generally on the fabric and fittings across the site was observed to be good. The home benefits from a garden area that is set against beautiful countryside. The home has recently introduced chickens, which residents clearly enjoyed, particularly when the chickens laid eggs. The managers own home is next door and residents are welcome to enjoy the orchard and gardens attached. The managers own cat often visits the home, again much enjoyed by residents. There were clear schedules for cleaning across the home in place, to include a specific rota for night shift staff. The kitchen has a rolling programme of routine and less frequent cleaning tasks and it was evidenced that completion of the tasks is checked. Hand gel dispensers were in place and actively used by staff and visitors within all communal areas and along corridors. Infection control is included within the mandatory training programme for the home and observations on site confirmed that good infection control practice was observed by care staff. The range of health and safety checks and documents were reviewed and found to be in order and up to date. Fire fighting equipment and electrical equipment at random were reviewed and all were labelled as up to date on required checks/testing and appeared to be in safe working order. The environmental health officer had completed an inspection on the 15th January 2009. There was a recommendation to clean the canopy to the extractor fan in the kitchen but no other issues were noted. Residents confirmed they were comfortable at the home and that they had been able to bring a little bit of their own home to Hilton Brook. The personalisation of bedrooms was observed during the time on site. Residents felt that the home was kept clean and that bedding was regularly changed. Care Homes for Older People Page 20 of 28 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. Staff in the home are trained and competent to support individuals in the home and meet assessed needs. The home continues to have satisfactory recruitment and vetting procedures and monitors practice on an ongoing basis to identify gaps in completion of procedures. There was a query raised during the inspection on the sufficiency of staff numbers and skill mix across shifts. This was discussed with the registered manager, who confirmed that staff numbers was considered to be adequate at this time. Evidence: Staff cover for both expected and unexpected absences is generally covered through existing staff resources. The home currently does not have any bank staff arrangements and does not use agency staff. At the time of the inspection there were two members of staff on sick leave - one following an accident, the other following an expected operation. Both members of staff were designated senior care workers, leaving three seniors actively working shifts at the time of the inspection. The home has recently strengthened management support at weekends, with presence on site through the deputy and assistant deputy manager hours including weekends. The on call arrangements in place ensure there is always a designated member of management for staff to refer to as required. Care Homes for Older People Page 21 of 28 Evidence: The home reflected in its AQQA October 2009 that there were nine service users who require two to one support of staff to manage their needs. The staffing levels were discussed in this context with the registered manager. There are two members of staff on duty at night to support 31 people. We discussed our concern that staff may not be able to respond both to urgent events and maintain an overview of other residents with this ratio. However there is no evidence in the accident book or daily records to indicate any incidents due to staffing levels and the registered manager is satisfied that adequate staffing is in place. All interactions between staff, residents and visitors were positive. Staff were gentle and respectful to all residents, encouraging involvement and residents to take control of tasks and routines. Kitchen and maintenance staff knew all the residents names they came into contact with and enjoyed friendly banter. The home has a programme of ongoing mandatory training. Core areas include infection control, health and safety, fire safety, abuse, food hygiene, dementia care and managing challenging behaviour. The home has moved to computer based training packages where possible to provide flexibility for both the staff and the home to meet training needs. It was not clear from the evidence reviewed and the discussions with the registered manager on the follow up of mandatory training and the frequency at which refresher training across the core areas forming the mandatory training programme was completed. The home also has links with Ludlow College. Training and education around palliative care and dementia care has been provided through the college and there is link tutor in place. The home was pursuing additional dementia mapping training for staff to access to enhance knowledge and competency in this area, recognising the increasing needs being presented and increased length of stay at the home. There is a high level of NVQ achievement amongst the staff - 70 have achieved NVQ 2 or above, with more staff due to start NVQs in the New Year (2010). Four sample staff recruitment files were reviewed during the second day of the inspection. Recruitment practice generally meets with expected requirements and standards. There were some gaps identified in respect to references and checks undertaken but the registered manager had made specific decisions in these areas. The home was monitoring the content and standard of recruitment files at the time of the inspection and was aware of where other gaps in information existed. The registered manager was advised to ensure that these gaps were rectified to ensure that files were complete and up to date. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by an experienced manager, supported by a skilled and experienced management team and loyal staff group. The health, safety and welfare of residents and staff are promoted, training and procedures in place to support safe working practices. Evidence: The registered manager has demonstrated that generally, the home is being managed appropriately and has effective processes in place to ensure the delivery of safe, quality care. The manager has the necessary experience to run the home, supported by a management team who bring a broad range of skills and experience to the home. The manager is aware of the emerging demands on social care locally and has redesigned admission processes so that respite care, planned and emergency, can be provided where bed capacity allows. The manager has also identified training needs around palliative care and dementia mapping, to reflect the increasing needs of residents admitted and to ensure staff are skilled up to meet these needs. The increasing needs of individuals admitted to the home reflect that individuals are Care Homes for Older People Page 23 of 28 Evidence: staying at home longer. The registered manager participates in the training programme of the home. The home ensures that quality and outcomes are reviewed on a regular basis. The deputy manager is responsible for the completion of audits across a range of activity taking place at the home. There is a policy for audit adopted by the home. There was evidence to demonstrate that certain audits were taking place but the scope of these audits was limited and there was no clear evidence referenced to support the findings of the audits. Learning from accidents, incidents and complaints is shared with staff through the monthly staff meetings. Incidents are reported and recorded within the home but the linkage to care planning and individual risk assessments was not always explicit. Various staff reflected that working at the home was a positive experience. They felt supported by management through the appraisal and supervision process in place and that they were confident they could raise issues and be taken seriously. These staff also reflected that access to training was encouraged at the home. Many of the staff had been working at the home for a number of years and the information provided b the home prior to the inspection reflected a very small turnover of staff. Residents are encouraged to manage their own finances.There is a procedure in place for the management, recording and reconciliation of residents monies, which was reviewed in September 2009. Regular checks and reconciliation was evidenced. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13(2) Medication management systems in the home must be further developed to ensure the safe storage, recording, handling safekeeping and administration of insulin and controlled drugs within the home. This means people will benefit from medication being appropiately and safely stored and suitable for administration. 05/03/2008 Care Homes for Older People Page 25 of 28 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 9 13 Medication management systems in the home must be further developed to ensure the safe storage, recording, handling safekeeping and administration drugs within the home. The medication policy and supporting procedures need updating to reflect local practice and expected standards, which staff understand and follow. A programme of regular management checks should be implemented to monitor compliance of staff with policies and procedures. 30/04/2010 Care Homes for Older People Page 26 of 28 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The registered manager is recommended to review the guidance issued to staff on the development and content of care plans to ensure expected standards and the involvement of the individual and families is clear. The registered manager is further recommended to ensure that care plans are reviewed in response to specific issues and incidents 2 27 The registered manager is recommended to ensure that staffing at the home is kept under regular review to ensure that staffing levels and skill mix is adequate to meet the needs of residents in the home. The registered manager should ensure the gaps in information held on staff files are rectified as soon as reasonably possible. The registered manager is recommended to develop the mandatory training programme to ensure that the frequency of undertaking each area of training is clear. It is recommended that the registered manager develops the frequency and content of the audits completed at the home to ensure that audits are meaningful and timely. 3 29 4 30 5 33 Care Homes for Older People Page 27 of 28 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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