Care Home: Homelands Nursing Home

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What the care home does well People considering moving into the home are able to visit the home and some of their needs are assessed prior to them moving in. Peoples medical and health care needs are met and are specified in their care plan. Referrals are made to other health professionals when needed. Comments made on surveys in relation to what the home does well include, "The staff have a detailed knowledge of each resident so the care provided is tailored to meet the needs of every resident. The management is very thoughtful in dealing with residents." "The home looks after my relative very well. They really love this home and they are very happy." "Cater for my needs I am happy and settled here. My family are happy for me to stay here." "Patient care." Another person wrote "Always 100 per cent attention." The food provided at meal times is nutritious and well presented. Some activities take place and are enjoyed by those who are able to participate. Visitors are welcomed into the home. Staff receive training relevant to their job role and there are sufficient staff on duty to meet the nursing and care needs of the people who live here. The manager is undertaking a comprehensive quality audit of the home that is identifying areas in need of improvement. People who live here are listened to and have regular meetings. People are protected from harm. The people who live here are listened to and feel able to raise concerns if they are not happy. What has improved since the last inspection? A new web site and brochure about the home has been produced. Risk assessments are now completed in respect of the use of lap straps and bed rails for those who use them. An activity organiser has been employed and the home now has an activity / hairdressing room. Polices and procedures have been updated to include information about a variety of cultures and religions. A high / low bath and over head tracking had been installed in the completely refurbished first floor bathroom. A modern shower room has been installed on the ground floor. There are no longer any shared rooms. The manager told us that 14 more profiling beds have been purchased and that rooms are generally redecorated when they become vacant. New commodes have been purchased. What the care home could do better: The registered provider must ensure that all sections of assessments and care plans are completed to ensure that they are holistic. Care plans and risk assessments must be routinely reviewed when a person has a fall and each section of the care plans must be reviewed on a monthly basis. The registered provider must ensure that medication administration records only specify the medicines currently prescribed and individuals must have guidelines in place specifically for them for staff to follow when administering `as and when` medication and homely remedies. The registered provider must ensure that people have the opportunity to take part in activities, social interaction and mental stimulation in line with their preferences and capacities and that this is documented. The registered provider must ensure that recruitment procedures are robust and are followed at all times. Gaps in employment histories must be accounted for, 2 references must be obtained for each member of staff employed. Confirmation that the Protection of Vulnerable Adults (PoVA) first clearances have been obtained must be held on file in the home. Documented induction must be completed and kept on file at the home. The manager has been employed since November 2007 but has not yet applied to be registered with the Commission and this is overdue. Key inspection report Care homes for older people Name: Address: Homelands Nursing Home Horsham Road Cowfold West Sussex RH13 8AJ     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: Elaine Green     Date: 3 0 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 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 31 Information about the care home Name of care home: Address: Homelands Nursing Home Horsham Road Cowfold West Sussex RH13 8AJ 01403864581 01403865066 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Medicrest Limited care home 43 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 to be accommodated is 43 The registered person may provide the following category of service: 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 category ; Dementia (DE) Old age, not failing within any other category (OP) Date of last inspection Brief description of the care home Homelands is a care home, which is registered to provide nursing care. It has two separate buildings known as the Main House and the Coach House and is located in the village of Cowfold. The Main House accommodates up to 26 service users in the category old age not falling within any other category (OP). The Coach House accommodates up to 17 service users in the category dementia, over the age of 65 years (DE(E)). Private accommodation provided in each house are single rooms some of which include en-suite facilities. Communal accommodation includes two lounges and a dining room in the Main House and a lounge/dining room in the Coach House. Care Homes for Older People Page 4 of 31 43 0 Over 65 0 43 Brief description of the care home The registered provider is Medicrest Ltd who has appointed Mr S Alagaratnam as the Responsible Individual who is responsible for supervising the management of the care home. The manager has been in post since November 2007 and is responsible for the day to day running of the care home. The application for the manager to become registered with the Commission is overdue. The fees for this care home currently range from £540 which is the lowest fee that is charged for someone who is funded by the lcoal authority to £800 per week, which is the maximum fee for someone who is paying for their care privately. All fees are assessed on on an indiviual basis and are based on the amount of care needed. Care Homes for Older People Page 5 of 31 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: An Unannounced visit was made to this home on the 30th June 2009. This visit took place over an 8 hour period between 9.20 and 17.20 Before the visit to the home we looked at all the information we have received from the home. This information included an Annual Quality Assurance Assessment (AQAA) which is a document completed by the home. This document gives the home the opportunity to say what it does well and provide evidence of that. It also gives them the opportunity to say what they feel they could do better and what their future plans are, how it dealt with any complaints and concerns, any changes to how the home is run, the providers view of how well they care for people, the views of the people who live there, their relatives, staff and other professionals who visit the service. This was completed and returned to us within the time limits. We sent 20 surveys to the people who live there and had 11 completed forms returned to us. We sent 12 staff survey forms and received 5 completed forms. Care Homes for Older People Page 6 of 31 During the visit we talked with people who live in the home, the staff and the manager. We looked at information about the people who live in the home and how well their needs are met. We looked at other records that must be kept and checked that staff had the skills, knowledge and training to meet the needs of the people they support and care for. We met residents and staff in communal areas, we also saw into the kitchen and laundry and some bedrooms. We checked what improvements had been made since the last visit and before we left we told the manager of the home what we had found. The outcomes for the people who live in this home are adequate and the overall quality rating of the home is a one star, adequate rating. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? A new web site and brochure about the home has been produced. Risk assessments are now completed in respect of the use of lap straps and bed rails for those who use them. An activity organiser has been employed and the home now has an activity / hairdressing room. Polices and procedures have been updated to include information about a variety of cultures and religions. A high / low bath and over head tracking had been installed in the completely refurbished first floor bathroom. A modern shower room has been installed on the ground floor. There are no longer any shared rooms. The manager told us that 14 more profiling beds have been purchased and that rooms are generally redecorated when they become vacant. New commodes have been Care Homes for Older People Page 8 of 31 purchased. 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 31 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 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information provided to people considering moving into the home is not always up to date. Albeit preadmission assessments take place before someone is offered a place at the home these assessments are not holistic. Evidence: In the section of the AQAA titled What we could do better. It states Our Statement of Purpose needs to be updated more often to notify changes in staffing. To date, self funded service users contracts have not been amended to reflect new room rates for the current year. The manager told us that a quality assurance audit recently completed had identified shortfalls in these documents and that updated copies would be given out to the people as soon as they were available. The manager told us that the manager or a senior nurse complete the preadmission assessments and that they rarely admit anyone on an emergency basis but if they do then their needs are assessed on the day they are admitted to the home. We looked Care Homes for Older People Page 11 of 31 Evidence: at the homes preadmission assessments for 6 people and can confirm that they had all taken place prior to them moving in. However not all sections of the assessments had been completed for all people. For one person for example, the communication section of the admission sheet was blank, personal valuables were not specified, the description of person was not completed, there was no information in respect of communicating, social contacts or of the persons wishes on death. The AQAA completed by the manager of the home states A copy of our Statement of Purpose and Service Users Guide is given to each service user. Each self-funded service user receives a written contract on admission. Each social service funded service user receives a copy of their individual contract. It also informed us that a new web site and brochure about the home has been produced. We sent 20 surveys to the people who live at the home and 11 completed forms were returned to us, one of which was only partly completed. When we asked Did you receive enough information to help you decide if this home was the right place for you, before you moved in? 10 of the 11 people said yes. We also asked Have you received a contract? 8 people stated yes, 1 person stated that they didnt know and 2 people stated that no they hadnt received one. We asked to see the contracts for the people whose assessments we had seen and we were told that these are kept at the organisations head office so we were unable to look at them. In the section of the surveys titled Any thing else you would like to tell us? One person wrote My relative was admitted to Homelands at very short notice which was very much appreciated by all the family. Care Homes for Older People Page 12 of 31 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. Care plans are not holistic and do not provide the guidance and documented evidence that staff need to provide support to people in all areas of their life. Recording of as required medication needs to be more robust to protect individuals and demonstrate how decision are safely made. People are treated with respect and dignity at all times including the end of their life . Evidence: The AQAA completed by the homes manager states The service users care plans are instructed by the pre-assessment and a completed dependency profile. Each service user has a unique personalised plan of care. Care plans are formed during the first seven days from admittance, with consultation with the service user and or their next of kin, and are reviewed at least monthly by the named nurse for that service user. We looked at six peoples care plans and can confirm that they are based on the initial preadmission assessment and where applicable the social services assessment. However some sections of the homes assessments and care plans had not been completed and most care plans did not have a recent photograph of the person. The Care Homes for Older People Page 13 of 31 Evidence: manager explained a camera has been obtained by the home and that photographs would soon be taken. In most instances peoples social care needs, interests and preferred activities were not recorded and there were no care plans in place for how these needs were to be met. Additionally not all sections of the care plans have been signed to show they have been reviewed on a monthly basis. Care plans are not always updated when needed for example falls risk assessments and mobility care plans are not routinely reviewed and or updated following someone having a fall. A requirement made at the last inspection in respect of risk assessments being undertaken for the use of bed rails and lap straps has been met and are now recorded on the care plan. Of the 11 surveys completed by the people who live here 8 people stated that they always receive the care and support they need and 3 that they usually do. When asked Does the home make sure you get the medical care you need? 10 people stated yes and one person did not complete this part of the form. Records show that referrals are made to health care professionals when needed. Comments made on surveys in relation to what the home does well include, The staff have a detailed knowledge of each resident so the care provided is tailored to meet the needs of every resident. The management is very thoughtful in dealing with residents. The home looks after my relative very well. They really love this home and they are very happy. Cater for my needs I am happy and settled here. My family are happy for me to stay here. Patient care. Another person wrote Always 100 per cent attention. Of the twelve staff surveys sent 5 completed forms were returned to us. When asked Are you given up to date information about the needs of the people you support or care for, for example, in the care plan? all 5 staff members said always. We looked at records relating to the management and administration of medicines and they confirmed that people were receiving their medication in the right dose and at the prescribed times however, records still specified some medication that people were no longer taking. In addition to this there were no guidelines in place for when people could take prescribed PRN or as and when medication or to specify specifically which homely remedies individuals could be given and under what circumstances. The manager stated that the nurses know the people who live here well and know when these medicines can be administered and how long for. The AQAA states that All staff are instructed, during induction, on treating service users with respect at all times including death. Relatives and friends are supported through the death of a service user and given advice on registering a death. Two members of staff attend each funeral, as a mark of respect, and as the final act that Care Homes for Older People Page 14 of 31 Evidence: we can perform for the service user. It also told us that polices and procedures have been updated to include information about a variety of cultures and religions concerning death and dying. In the section of the survey Any thing else you would like to tell us? One person told us that when their relatives health had deteriorated The care and attention given to them was excellent. During the last fortnight of their life they were treated with great consideration and dignity. Consequently it was of great support and comfort to my family. Staff were seen to be treating people with dignity and respect throughout the day of the site visit. Care Homes for Older People Page 15 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not everyone is fulfilled due to lack of social interaction, some of the activities and mental stimulation does not suit all individuals. Meals provided are nutritious and well presented. Evidence: The completed AQAA states If the weather is warm and dry the care staff are encouraged to take service users out for a walk in the grounds. The activity coordinator consults the service users each day to plan what they would like to do that day. As already stated assessments are not completed in respect of activities and care plans do not specify peoples preferences for the arrangements for the provision of social interaction, activities or mental stimulation for the people who live here. The home does employ an activity organiser and we met with them on the day we visited the home. They told us that currently they are employed for 15 hours per week over 5 days Monday to Friday and support people in the main house and in the Coach House which is a dementia care unit. They told us that activities do take place for people and an examination of daily records confirmed this. The activity organiser also told us that they try to do one to one sessions with people doing things that they enjoy. They told us that most of the time this is spontaneous and is based very much on how people are feeling on a particular day and what they fancy doing. Activities are not routinely Care Homes for Older People Page 16 of 31 Evidence: provided for people on the days that the activity organiser does not work. Of the 11 completed surveys for people who live in the home when asked Does the home arrange activities that you can take part in if you want? 3 people stated always, 6 people stated usually and 1 person stated sometimes. In response to the question What could the home do better? comments included A few more activities and More activities to create motivation of residents. A staff member wrote Perhaps a little more activities such as reading, writing letters, taking residents for walks and wheelchair rides. Records show that visitors come to the home at different times of day and that visiting is not restricted. Regular residents meetings are held and relatives and friends are also invited to attend. Minutes of these meetings were seen. There is a notice board in the entrance hall to the home on which are details of forthcoming events and meetings. A relative commented The home maintains a happy welcoming environment for the residents and visitors. We asked about the arrangements for the provision of food at meal times. The manager told us that the home has a weekly menu which is displayed on the notice board. Staff ask people what they would like to have for their main meal from the menu the day before. We were told that there are 2 choices and if preferred the cook could prepare something different on request. We saw food being served to people in the Coach House and can confirm that the food was hot, well presented, homemade and appetising. Those people who needed it received the support that they needed to eat. On the surveys for the people who live in the home we asked Do you like the meals at the home? Of the 10 people who answered this five stated always, four usually and one person stated sometimes. Comments made in relation to what the home does well included Good food and I am given plenty of time to eat it. Drinks available all day. A staff member wrote on their survey Provide a very good meal to residents in abundance. In the section of the surveys titled Any thing else you would like to tell us? One person wrote My relative enjoys their food which they can eat at their own pace. They always have a drink available. Homelands is a very happy environment and we as a family and our relative are very thankful. Care Homes for Older People Page 17 of 31 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. The people who live at this home are listened to and the home has systems in place to make sure that it deals with formal complaints effectively. The people who live here are protected from harm. Evidence: Since the last inspection this home has raised one safeguarding alert with the local authority. The home followed the local protocols and raised the alert appropriately and in a timely manner. Staff are given training on the safeguarding of vulnerable adults and of what constitutes abuse. The homes has a complaints procedure and the manager explained that they try to deal with any issues raised as soon as they occur and take steps to make sure the issue does not arise again. the home has a system for recording formal complaints. Of the 11 surveys that were completed by the people who live in the home or their representatives 10 people said that there was someone they could speak to informally if they were not happy and 1 form was not completed. We also asked Do you know how to make a formal complaint? and 8 people said yes, 1 person said no and 2 people did not complete this question. We asked staff Do you know what to do if someone has concerns about the home? the 5 members of staff that completed the surveys all said yes they did. Care Homes for Older People Page 18 of 31 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. Albeit the home is clean and hygienic and some improvements have been made the home is in need of updating. Equipment stored in communal areas poses a risk to the people who live there. Evidence: The manager told us that there are plans to totally refurbish, modernise and extend Homelands and that when this is completed the people currently living in the Coach House would be offered accommodation in the main building. A requirement was made a the last inspection that the registered person must provide the Commission with comprehensive details of the planned refurbishments including timescales for actions required, to ensure that the building is suitable to meet the needs of the people who use the service. This was due to be completed by the 8th September 2008 and to date such a plan has not been received by the Commission. However, the provider did send us an improvement plan which was received on the 16th September 2008 and this details that torn wall paper in the corridor of the Coach House has been repaired, radiator covers have been supplied and that the Occupational Therapist recommendations had all been completed by Handyman. It also stated that a new bathroom and 2 new showers were to be fitted by the 31/01/09. The new bathroom was seen and has been refurbished with a high / low bath and overhead tracking but the finishing touches to the tiling were still being made when we visited. The manager assured us that this room would soon be available for use. The manager also told us Care Homes for Older People Page 19 of 31 Evidence: that 14 more profiling beds have been purchased and that individual rooms are redecorated when they become vacant. Hot water pipes are being covered as rooms are decorated. A shower room has been installed on the ground floor and this was bright and modern however the other shower room was out of use and the manager has told us that work to refurbish this is planned. A new shower room has also been installed in the Coach House. New commodes and toilet seat raisers have also been purchased. There are no longer any shared rooms at Homelands and there is now a room specifically for activities and hairdressing. When not in use the manager told us that this room can also be used by visitors. The manager told us five people choose to eat their meals in the dining room whilst others eat theirs seated at portable tables in the lounge or in their own rooms. The home doesnt have any storage areas so currently hoists, chairs and other equipment are stored in communal areas of the home such as corridors, the dining room and the activity room. This causes obstructions around the home and restricts the use of rooms. The corridors of the home that have been repainted are again scuffed. The lighting in the corridors of the main home is strip lighting with domestic wall lights. Two rooms on the first floor of the main building are only accessible via stairs. The manager stated that issues identified would be addressed by the refurbishment. Of 8 surveys sent completed by the people who live in the home or their representative 7 people stated that the home is usually or always fresh and clean and one person did not complete this part of the form. One person also wrote under What could the home do better? Provision of dining tables for those residents physically able to sit up at a table for meals, instead of sitting in armchairs and eating from a portable table. Another person wrote The home a the moment is requiring updating. This is slowly being achieved, hopefully this will not be too disruptive for the current residents. Re-decoration and up grading of residents and communal rooms. Care Homes for Older People Page 20 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in the staff recruitment procedures have the potential to place people at risk. A comprehensive staff training programme ensures that staff have the skills they need to perform their job. There is evidence that the staff induction does not always provide the underpinning knowledge of the home and the people that live here. Evidence: We looked a the recruitment files for 4 of the most recently employed members of staff. Confirmation that a Protection of Vulnerable Adults PoVA check had been completed for two of the people recently employed were sent by e-mail to the managers home address and evidence of this was not kept at the home. Following our visit to the home evidence that these clearances had been received prior to these people starting work in the home was sent to us. In addition to this the home had not obtained references for overseas staff that had been recruited via an employment agency. There were gaps in the employment history for one person and another person had not provided exact dates. The manager told us that all new members of staff complete an induction and work alongside an experienced member of staff at all times until their induction is completed. The manager explained that staff induction includes written work which is assessed by the manager but that this is kept by the staff member themselves so this was not seen. On the staff survey we asked staff Did your induction cover everything Care Homes for Older People Page 21 of 31 Evidence: you needed to know to do the job when you started? 3 people said very well 1 person stated mostly and one person partly. Staff comments in the section What the home could do better. include Proper induction is very vital for the delivery of good care. and under Any thing else youd like to tell us? a staff member wrote To give a refresher induction course on a periodic basis for example every 9 months. Evidence that staff attend regular training was seen and this included all the mandatory training and updates. In addition to the mandatory training the home regularly provides specialist training which is provided by a local training company and is tailored to the needs of the people living at the home. Training is provided every 2 weeks and training planned for the next few months included safeguarding, wound care, responding to the needs of service users, catheter care, medication administration, challenging behaviour and code of professional conduct. Confirmation that these courses had been booked was seen. Copies of certificates of attendance to training courses were seen on the staff files examined however these copies did not detail what the course had covered. All 5 returned staff surveys stated that the training given was relevant to their work, helped them to understand needs, kept them up to date and gave them knowledge. On the surveys we received from the people who live in the home or their relatives 9 people said that staff were always available when they need them and 2 people said they usually were. One staff member felt that there were not enough staff to meet the needs of all the people who live at the home whilst the other 4 who completed surveys said there were. When we asked the people who live in the home Do the staff listen to you and act on what you say? 8 people said always and 3 people said usually. One staff member stated on their survey that they felt that they did not have enough support, experience & knowledge to meet the different needs of people who live at the home whilst the other 4 who completed forms all did. Staff meetings are held on a regular basis and minutes of these meetings are kept. An examination of records confirmed this. Care Homes for Older People Page 22 of 31 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 home needs to have a registered manager who ensures all aspects of the home is run well enough to protect the interest and welfare of all those living at the home at all times including for assessments care planning, medication and social interaction and activities. The home currently does not ensure that documentation reflects accurately the work carried out by the home putting people at risk. Evidence: The manager has been in post since November 2007. However, we have not, as yet, received an application from the manager for them to become registered. When we asked the manager about this they told us that they were in the process of collating the information they needed for the application and that they would be submitting this to us in the near future. The manager explained that the home is in the process of trying to recruit a deputy manager to replace the one who has recently left. Care Homes for Older People Page 23 of 31 Evidence: In the What the home does well. section of the surveys we received from the people who live here one person wrote The manager seems to have good working relationships with the staff and consequently the home seems organised and the staff happy and always keen to do as much as they can to help residents and relatives. In the section of the surveys titled Any thing else you would like to tell us? One person wrote This is my relatives first experience of the care environment. They are very happy here and we as a family are sure it is due to the nurses and the manager. Homelands is a very happy environment and we as a family and our relative are very thankful. When we asked staff Does your manager give you enough support and meet you to discuss how you are working? all 5 said regularly. We asked the manager about staff supervision and they explained that staff have not been receiving supervision as regular as they should and that they hope that this will improve when they have a new deputy in place to assist them. Additionally they told us that more senior staff were to be given supervision training to enable them to undertake supervisions. The AQAA completed by the manager stated The home does not manage accounts for service users. If any service user is admitted without a next of kin, the manager takes steps to insure that an independent financial adviser is found for them. Advocates are contacted if it would be beneficial to the service user. All replies to a recent questionnaire to service users stated that they all felt that the manager was approachable. The manager is on call and will contact any concerned party outside of office hours if the need arises. It alsos told us tht the manager operates an open door policy and that an independent assessor has been requested to undertake a new risk assessment of both houses to assist the manager in updating records correctly. The manager is aware of the need to provide the Care Quality Commission with notifications of incidents that affect the safety of the people who live in the home and an examination of records confirmed that this happens. In addition to this safeguarding alerts have been raised when they should be in line with local protocol. The manager told us that there is a formal Quality Assurance Audit in place which they have started using. This audit will identify to the manager any shortfalls in the services provided and the records kept. The manager explained that they are working through this audit which will examine the homes performance in relation to each of the National Minimum Standards. The manager told us that one of the shortfalls identified to date included omissions from the statement of Purpose which is now being updated as a result of their findings. The home also sends out surveys to the people who live in the home, their relatives and friends and the staff, the results of Care Homes for Older People Page 24 of 31 Evidence: which are fed back at residents meetings and staff meetings. The manager explained that these results will also be made available to people in a bar chart. The AQAA states that unannounced visits take place in order to monitor the homes performance. We looked at the record of these visits and can confirm that they do take place however they do not cover everything they should do and in particular there is very little input from the people who live at the homes as is required. AQAA specified that the homes policies and procedures were all reviewed within the last 12 months. It also states that the following were either serviced or tested within the last 12 months, premises electrical circuits , lifts/stairs, hoists, fire detection and fighting equipment, gas appliances, the emergency call equipment, the heating system and the soiled waste disposal. Care Homes for Older People Page 25 of 31 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 31 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 3 14 The registered person must ensure that no service user moves into the home without having had their needs fully assessed as specified in Schedule 3 and been assured that these needs can and will be met. To ensure that the home is able to meet the needs of the people that it admits and that people can be confident that the home can provide the holistic support that they require. 30/08/2009 2 7 15 The registered person must 31/08/2009 ensure that a service users health, personal and social care needs are set out in an individual plan of care that is drawn up with the service user and or their representative as specified in Schedule 3. Care Homes for Older People Page 27 of 31 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 In order to ensure that staff have the guidance they need to support service users safely and consistently. 3 8 13 The registered person must ensure that appropriate interventions are taken for people who are at risk of falling. This must include reviewing the falls risk assessment and care plan following a fall as specified in schedule 3. To ensure that service users health and safety are promoted and maintained. 4 9 13 The registered person must 31/08/2009 ensure that medication charts only reflect current medication prescribed and that clear guidance on PRN administration is included in care plans and records are kept of why and when this is given and details the effectiveness of a PRN when given. To ensure service users receive their medicines safely and to allow the review of care needs. The registered person must 30/09/2009 make sure that service users have the opportunity to 31/08/2009 5 12 14 Care Homes for Older People Page 28 of 31 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 exercise their choice in relation to leisure and social activities, cultural interests, food, meals and meal times, routines of daily living and religious observance. These interests must be recorded in their plan of care and service users must be given opportunities for stimulation through leisure and recreational activities that suit their capacities, needs and preferences. To ensure that service users are able to enjoy the lifestyle that matches their expectations. 6 24 12 The registered provider must ensure that there is sufficient storage. The provider must also ensure the completion of unfinished work such as the shower facility and the covering of hot water pipes. To ensure that the environment is clutter free to make all communal areas safe for use for access and freedom of movement. and to minimise the risk to service users health and safety. 30/09/2009 Care Homes for Older People Page 29 of 31 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 7 29 18 The registered provider must ensure that the recruitment practices are robust and followed at all times. To ensure service users are in safe hands at all times. 31/08/2009 8 30 9 The registered provider 30/09/2009 must ensure that all staff receive a documented induction to the home within the first six weeks of employment and that this is kept in the home. To ensure that staff are trained and competent to do their jobs. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 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). 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