Care Home: Hopes Green Care Centre

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What the care home does well Prospective people wishing to live at Hopes Green Care Centre, are assessed prior to admission so that they are able to meet the individual`s needs. Staff working at the home, have a good rapport with individual people and demonstrated a good knowledge and understanding of peoples care needs. Visitors to the home are made to feel welcome and staff morale at the home is good. Many members of staff have been employed at Hopes Green Care Centre for some considerable time, providing stability and continuity of care to the people who live there. People who live at the home and their representatives can raise concerns about the service freely and any complaints received are listened to, taken seriously and acted upon in a timely manner. People who live at the home are enabled to participate in a range of activities, which meet their social care needs. Staffing levels remain appropriate for the numbers and needs of people who currently live at the home. Recruitment procedures within the home are robust so as to protect people who live at Hopes Green Care Centre. There is a quality assurance system in place so as to seek the views of people at the home and their representatives about the services and facilities provided at the home. Where comments have been made these have been incorporated into the main body of the report. What has improved since the last inspection? Staff rosters and deployment of staff on the day of the site visit show that staffing levels are appropriate for the numbers and needs of people currently living at Hopes Green Care Centre. Improvements continue to be made to the home`s care planning systems so as to ensure staff have the information they need to provide appropriate care to meet people`s care needs. On inspection of Medication Administration Records (MAR) for several people these showed that sufficient stocks of medication were available so as to ensure people`s safety and wellbeing. An Infection Control policy and procedure is readily available for staff to access. What the care home could do better: The care planning system within the home would benefit from further improvements so as to ensure there are support plans and risk assessments in place for all of the identified needs of the person concerned. Specific examples are detailed within the main text of the report. Appropriate measures must be taken to ensure that medication is stored securely at all times and that it is not easily accessible to people who live at the home or for those people who it is not intended for. While we recognise that staff training in core subject areas is given high priority, consideration for those conditions associated with the needs of older people should also be taken into account. Review the number of training courses that can be undertaken by any one person on any given day. Key inspection report Care homes for older people Name: Address: Hopes Green Care Centre 16 Brook Road Benfleet Essex SS7 5JA     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: Michelle Love     Date: 0 6 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) © 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 31 Information about the care home Name of care home: Address: Hopes Green Care Centre 16 Brook Road Benfleet Essex SS7 5JA 01268752327 01268755518 hopesgreen@schealthcare.co.uk www.schealthcare.co.uk Exceler Healthcare Services Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Philomena Heather Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Personal care to be provided to no more than fifty service users over the age of 65 years. Total number of service users for whom personal care is to be provided shall not exceed 50. Date of last inspection Brief description of the care home Hopes Green Care Centre is a large home providing accommodation and personal care for up to fifty older people aged over 65 years of age who need assistance with personal care. The homes facilities include several communal lounge/dining areas and fifty single bedrooms all with ensuite facilities. The home is situated within easy walking distance of local shops and amenities, with Southend and Canvey Island main shopping centres a short car or train journey away. There are good bus and train links Care Homes for Older People Page 4 of 31 Over 65 50 0 1 6 0 7 2 0 0 9 Brief description of the care home to the area. The garden enables service users to access a patio area and garden safely. There is ample car parking for visitors and the home has adequate wheelchair accessibility throughout. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 9 hours, with all key standards inspected. Additionally progress against previous requirements and recommendations from the last key inspection were also inspected. Prior to this inspection, the manager had submitted an Annual Quality Assurance Assessment (AQAA). This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to people who live at the home, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, people who live at the home and members of staff were spoken with and their comments are used throughout the main text of the Care Homes for Older People Page 6 of 31 report. Prior to the site visit, surveys for people who live at the home and staff were requested to be sent to the home. We received 10 completed surveys from people who live at the home and 9 completed surveys from staff who work at Hopes Green Care Centre. Where comments have been recorded, these have been incorporated into the main text of the report. The manager and other members of the staff team assisted the inspector on the day of the site visit and feedback on the inspection findings were given. The opportunity for discussion and/or clarification was given. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The care planning system within the home would benefit from further improvements so as to ensure there are support plans and risk assessments in place for all of the identified needs of the person concerned. Specific examples are detailed within the main text of the report. Appropriate measures must be taken to ensure that medication is stored securely at all Care Homes for Older People Page 8 of 31 times and that it is not easily accessible to people who live at the home or for those people who it is not intended for. While we recognise that staff training in core subject areas is given high priority, consideration for those conditions associated with the needs of older people should also be taken into account. Review the number of training courses that can be undertaken by any one person on any given day. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who come to live at the home can be confident they will be assessed prior to admission and their needs will be met. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff and management team are able to meet the prospective persons needs. Admissions are not made to the home until a full needs assessment has been undertaken. In addition where appropriate, supplementary information is provided by the persons Placing Authority or Primary Care Trust. Records also showed that formal assessments are also completed in relation to dependency, moving and handling, pressure area care, nutrition and continence. Records showed the above information is used to inform the persons plan of care. No changes have been made to the referral process since the last key inspection to Care Homes for Older People Page 11 of 31 Evidence: the service. The Statement of Purpose confirms that when a referral is received and prior to agreement that the prospective person can be admitted to the home, the home manager or a senior member of staff undertake a pre admission assessment so as to determine if the prospective persons needs can be met. The AQAA tells us that there is currently a waiting list of prospective people wishing to move into Hopes Green Care Centre. The care files for the two newest people admitted to Hopes Green Care Centre were requested. Records showed that a pre admission assessment was completed for each person. There was evidence to show that information recorded as part of the pre admission assessment process was informative and included individuals personal wishes and preferences. Records showed that both people were admitted to the home as an emergency and as a result of their personal circumstances at that time. One person spoken with confirmed the admission process had been smooth and they had been made to feel very welcome by members of the management and care staff teams. In addition they stated they were happy living at Hopes Green Care Centre and were grateful for the care and support they had received. The manager confirmed that usual practice is for the prospective person and/or their representative to be given the opportunity to visit Hopes Green Care Centre prior to admission so as to look around the premises, to have a meal, to meet people who already live in the home and to meet staff. A Statement of Purpose and Service Users Guide was readily available detailing the aims and objectives of the home and the services and facilities provided. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care needs of individual people are clearly recorded detailing their specific care needs and how these are to be met by the home. However some aspects of medication practices and procedures need to be improved so as to ensure positive and safe outcomes for people. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual people and to specify how these are to be met by staff who work in the home. As previously stated, in addition to the care plan, formal assessments are completed in relation to manual handling, nutrition, pressure area care, falls, continence and dependency levels. Of those people case tracked, each person was observed to have a plan of care and these were devised from information undertaken as part of the pre admission assessment and as stated previously, from other associated information provided by external stakeholders. As part of the inspection process we looked at 4 peoples care files (2 in full and 2 in relation to specific healthcare needs). Care Homes for Older People Page 13 of 31 Evidence: Records showed that continued efforts are being made by the management team to ensure that care plans provide clear information about the individual persons care needs and provide appropriate guidance to care staff as to how the persons care needs are to be met. Each care plan was seen to be written in plain language and was easy to understand. In addition efforts have been made to demonstrate where people are independent and able to retain skills and where they still require support from care staff. In general terms each of the care plans was seen to be regularly reviewed and where changes had occured the care records were amended to reflect this and included evidence of interventions provided by either care staff or by a healthcare professional. For example one persons care file recorded them as refusing medication on a regular basis. Records showed their plan of care was recorded each month and appropriate healthcare professionals had been contacted for support and advice. Another care plan showed the person as being at risk of weight loss. The care plan was detailed and included information as to the persons ability to eat and drink, associated risks, evidence the person was weighed weekly and health professionals involved. In addition their weight was being monitored to show both weight gain and loss. A risk assessment was available detailing measures in place to control the risk. On inspection of one persons pre admission assessment by the Local Authority, this recorded the person as having poor self image and poor self esteem. From inspection of the persons plan of care and from discussions with them and the manager, it was evident that their self image, self esteem and sense of self worth has improved greatly since their admission. This has been as a result of the management and care staff teams sensitive approach with the individual so as to ensure positive outcomes. The care plan for one person recorded them as having a degenerative joint disease which can cause pain and stiffness of the joints. Records showed when this was first diagnosed and detailed the person as having medication prescribed. No information was recorded in relation to how the degenerative joint disease affects their abilities of daily living. The care plan also showed that the person was assessed as high risk of falls. The risk assessment details the following instruction, Falls risk scores of 4 and above must have a care plan however there was no plan of care completed relating to falls. Records also showed the person as having lost over 4KG in weight in recent months. From discussions with the manager we were advised that at the end of February 2010 several people who live at the home had been struck down with the Winter vomitting virus and several people had lost weight. From inspection of the Care Homes for Older People Page 14 of 31 Evidence: persons daily care records and professional visitors record, there was no evidence to show that this person had experienced the virus and on inspection of the homes Practice Nurse records there was no evidence to show they were aware of the weight loss. Daily care records showed consistently over a 4 month period that there were many occasions whereby the person refused to eat some meals and/or ate a small diet. The plan of care had not been updated to reflect this. Of 4 peoples care plans examined, 2 care plan documents showed that they were at risk of falls. As stated above, neither person had a plan of care relating to falls and neither person had a completed manual handling assessment. This was verified with the manager at the time of the site visit. The manager confirmed that it is the expectation of the organisation that all people living at the home should have a manual handling assessment completed, especially where they have been identified as at risk of falls. No rationale could be provided as to why this had not been completed on this occasion. The staff training matrix provided to us on the day of inspection and looked at following the site visit, showed the deputy manager and all senior care staff have received training relating to care planning in 2009 and 2010. Records showed that people living at Hopes Green Care Centre continue to have access to a range of healthcare professionals and services as and when required, both at the care home and within the local community. These include attendance at hospital appointments, optician, dentist, District Nurse Services, Community Psychiatric Nurse, GP, Dietician, Practice Nurse etc. Staff spoken with were able to demonstrate a good understanding and awareness of individual peoples care needs and throughout the day of the inspection, there were positive interactions between care staff and people who live at the home. Where support and assistance was provided by staff in relation to individuals personal care, this was conducted with respect and sensitivity. Staff confirmed there are daily handovers and communication is good. Several people who live at the home were spoken with during the site visit about the quality of care provided. All comments provided were complimentary and included the girls are lovely, they work so hard, I have no complaints and Yes, I think everything is alright. Practices and procedures for the safe storage, handling and recording of medication were examined as part of this inspection. We looked at the Medication Administration Records (MAR) for a random sample of 12 Care Homes for Older People Page 15 of 31 Evidence: people. These showed that records were of a good standard with few unexplained gaps or omissions. Where people are prescribed medication in a variable dose e.g. one or two tablets, the actual quantity was recorded each time, ensuring that people receiving this medication do not receive too much or too little medication. The temperature of the medication storage area is monitored and recorded each day. Records showed that the temperature where medication is stored was within recommended guidelines. In addition the temperature of the dedicated fridge used to store medication that requires cold storage was also recorded each day and this too was within recommended guidelines. We completed an audit for 4 people who are prescribed Controlled Drug medication. Records and actual stocks of medication were observed to tally with records well maintained. The manager was advised that packets and bottles of medication which are not delivered as part of the Monitored Dosage System (MDS), should as part of good practice procedures be signed and dated by staff when first commenced/administered. At lunchtime we observed one senior member of staff to undertake the medication round. The administration of medication was observed to be good with due regard to peoples dignity. However we are concerned that on 2 out of 3 occasions we witnessed unsafe practices which could potentially place people who live at the home at risk. This refers specifically to the trolley carrying medication left unattended while the staff member administered medication to people in the dining area and while they got themselves a cold drink. The trolley was left open on one occasion with the keys in the lock and on another occasion the trolley was locked and the keys left in the lock. Medication was observed to be easily accessible inside the trolley and on top of it. On the second occasion this was also witnessed by the manager and they were able to take the medication keys out of the locked trolley without the senior member of staff being aware. The staff training matrix showed that all staff who administer medication to people living at the home have up to date training. A recent visit by Boots Pharmacy in April 2010 showed that the home had complied with their audit. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the care home can expect to have their social care needs met. The dining experience for people in the home ensures positive outcomes. Evidence: An activities co-ordinator is employed at Hopes Green Care Centre for 35 hours per week Monday to Friday, however we were advised that these hours are flexible to cover weekends, evenings and special events. An assessment of individuals social care needs is carried out by the activities co-ordinator and includes looking at peoples personal preferences, likes and dislikes and past hobbies and interests. There is an activities programme and this offers people the opportunity to participate in a varied range of activities. Activities include karioke, films, flower arranging, bingo, quizzes, crosswords, coffee mornings, gentle exercises, reminiscence, religious observance and external trips out in the local community. The AQAA told us that there is fund raising for activities and where appropriate relatives and representatives involvement in activities and events is actively encouraged and welcomed. The manager told us that from previous fund raising, a karioke machine, digital satellite receiver box and Wii game had been purchased. Care Homes for Older People Page 17 of 31 Evidence: People who live at the home are encouraged to celebrate their birthday and are given the opportunity to have a party where their friends and relatives are welcome to attend. On the day of the site visit one person who had recently celebrated their 100th birthday showed us their birthday cards, showed photographs of the party, showed us their telegram from The Queen and expressed happiness at having their relatives and friends attend their party. The home has a pets policy and where possible people are encouraged to bring into the care home their pets. At the time of the site visit one person was observed to have their cat and appropriate arrangements were in place whereby staff buy cat litter and cat food on behalf of the owner and they assist them to look after their pet. People who use the service are actively encouraged and supported to maintain important personal and family relationships. There remains an open visiting policy whereby visitors to the home can visit at any reasonable time. One visitor spoken with confirmed they can visit the home when they like and are made to feel welcome by staff. The dining experience for people was observed to be positive. Fourteen people were seen to eat in the dining room on the ground floor and eight people to have their meal in their room. The atmosphere was observed to be calm and relaxed and staff on duty worked cohesively as a team so as to ensure that people received their meal in a timely manner. The tables were attractively laid with tablecloths, placemats, cutlery, glasses, serviettes, vase of flowers and condiments. People were given a choice of drinks and choice of meals and the menu on each table was in a written format. We discussed with the manager that a pictorial menu to enable people to make an informed choice should be considered. In addition to the main menu several people were observed to have an alternative meal choice according to their needs and personal preferences. It was also positive to note that it was not assumed by care staff that everyone in the home likes all of the vegetables provided at each meal or wants gravy and each person was offered a choice. Care staff asked people if they had enjoyed their meal and also offered people more food. Where people require assistance and/or prompting by staff to eat their meal, this was undertaken with respect, sensitivity and dignity. Comments from people who live at the home included that was nice, enjoyed that and oh the food isnt too bad it suits me most of the time. However out of 10 completed surveys from people who live at the home, 7 people stated sometimes to the question Do you like the meals at the home. Care Homes for Older People Page 18 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. People who use the service are able to express their concerns and are protected from abuse. Evidence: The home has a complaints procedure that explains to people how to raise issues and the timescales by which they can expect a response. This was clearly displayed in the entrance to the home and also detailed within the Statement of Purpose and Service Users Guide. Since the last key inspection to the service in July 2009 there have been no complaints. People who live at the home are aware of how to raise concerns and said they would discuss this with their member of family, a member of care staff or the manager. People spoken with also indicated they were confident to raise issues and felt their concerns and/or worries would be listened to and dealt with promptly. We also looked at several compliments received at the home and these included I just wanted to say thanks for showing us around your home yesterday. It was really nice of you to take us round and talk to us about the home, even though you didnt know we were coming round. You have a really nice home and the atmosphere is great, Many thanks to the staff who cared for my relative and to the residents they were friends with for making the past months a happy time for them and Thanks for all your help and kindness. Care Homes for Older People Page 19 of 31 Evidence: Since the last key inspection there have been no safeguarding alerts or referrals. Staff spoken with were able to demonstrate a good understanding and awareness of safeguarding procedures and said that should an issue arise information would be passed to the senior person in charge, deputy manager or manager. On inspection of the staff training matrix this shows that all staff have up to date SOVA (Safeguarding of Vulnerable Adults) training. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, well maintained and comfortable environment which meets their needs. Evidence: A partial tour of the premises was undertaken on the day of inspection. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home environment continues to be maintained, decorated and furnished to a good standard and is both homely and comfortable. There is sufficient communal space on both the ground and first floors and this refers specifically to 3 lounge areas, 2 dining rooms, visitors lounge and activities room. There are sufficient bathing and communal toileting facilities available which enable immediate access and these are fitted with appropriate aids and adaptations. On inspection of peoples rooms these were seen to be individualised and personalised. The AQAA details that bedrooms are decorated and furnished according to individuals taste and people are actively encouraged and supported to bring in their own belongings to further enhance the importance of having items around them that are familiar and which provide security. The AQAA details that within the last 12 months, new armchairs have been purchased for lounge areas and bedrooms and new beds are being purchased for every bedroom. Care Homes for Older People Page 21 of 31 Evidence: A random sample of hot water emitting from wash hand basins and baths were examined. The hot water temperature was observed to be satisfactory to meet peoples needs. There is a secure garden to the side of the premises with full wheelchair access. There is outdoor garden furniture and benches for people to sit on. The AQAA details that in the last 12 months an awning has been erected to provide more shade for people. It is hoped within the next 12 months for a summer house to be purchased from fund raising events and for raised flower beds to be made. No health and safety issues were highlighted at the inspection and the premises were seen to be clean, tidy and odour free. A maintenance person is employed at the home for 37.5 hours per week Monday to Friday, however their hours are flexible to cover emergencies at evenings and weekends. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Hopes Green Care Centre can expect to be cared for by sufficient numbers of competent and safely recruited staff who can meet their needs. Evidence: The manager told us there were 45 people living at Hopes Green Care Centre and current staffing levels are 7 staff (including 2 seniors) between 07.30 and 14.30, 7 or 6 staff (including 1 or 2 seniors) between 14.30 and 21.30 and 2 or 3 waking night staff (including 1 senior) between 21.30 and 07.30 each day. The managers hours are supernumerary to the staff roster and the deputy manager undertakes a combination of supernumerary shifts and shifts worked as part of the staff roster. There are additional ancillary staff employed and these include a chef, kitchen assistant, housekeeper and domestic staff. An administrator is employed at the home for 37.5 hours Monday to Friday. On inspection of 4 weeks staff rosters, records showed that the above figures have been maintained. We checked the staff roster on the day of the site visit and this reflected accurately the staff on duty. The staff rosters show that no agency staff have been used at the home for some considerable time. Deployment of staff on the day of the site visit was observed to be appropriate for the needs and numbers of people in the home. Observation at this site visit showed that staff were working effectively as a team, are available throughout the day for people in the home whether they are in the Care Homes for Older People Page 23 of 31 Evidence: communal lounge areas or choose to spend time in their room and there was good interaction by staff with residents. Out of 10 completed surveys from people who live at the home, 6 recorded usually or sometimes to the questions Are staff available when you need them and Do the staff listen to you and act on what you say. Nobody at the home on the day of the site visit voiced concerns about the staffing levels at the home or lack of availability of staff during the day. Out of 9 staff surveys returned to us, 5 recorded that there were usually enough staff on duty to meet the needs of people in the home. We looked at the staff employment files for 2 people newly employed since the last key inspection to the home in July 2009. The purpose of this was to check the recruitment process in the home. Records showed there is a good recruitment procedure and process in place and required documentation is received prior to the employee starting work. Each member of staff was noted to have received the homes in house induction (Day 1 and 2) and completed Skills for Care. We requested a copy of the staff training matrix and advised the manager this would be examined following the site visit. Records showed that all staff working at the home have up to date training in core subject areas e.g. manual handling, fire safety awareness, health and safety, food and hygiene, infection control, safeguarding, COSHH (Control of Substances Hazardous to Health) and nutrition awareness. Records also showed that all staff have received training within the past 18-24 months pertaining to pressure area care, customer care, challenging behaviour, dementia awareness and bedrail safety. Further consideration should also be made for those conditions associated with the specific needs of older people e.g. Parkinsons Disease, sensory impairment, Diabetes Awareness, continence, bereavement and care of the dying etc. On case tracking one persons training records it was noted that in one day they participated and undertook 12 individual training courses by the deputy manager. We would question the validity of undertaking so many training courses in one day while retaining a good understanding and knowledge of each subject. This requires reviewing. National Vocational Qualification (NVQ) records provided to us by the manager show that out of a total of 28 care staff, 17 people have attained NVQ Level 2 and 5 people have achieved NVQ Level 3. Care Homes for Older People Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well managed so as to ensure positive outcomes for people who live there. Evidence: The manager has managed Hopes Green Care Centre for the past 4 years and was formally registered with us in January 2009. Evidence showed that on a day-to-day basis the home is well run and provides positive outcomes for the people who live at Hopes Green Care Centre. Staff and people who live at the home were positive about the manager and the continuing improvements made. Comments from staff surveys included All staff work well together giving 100 care to residents and Hopes Green is a lovely home to work in, its friendly and everyone works well together. We do our best to look after all residents and ensure they are well. We all work together as a team. At the previous key inspection to the home 4 requirements and 3 recommendations were made. It is positive that at this inspection all outstanding requirements and all Care Homes for Older People Page 25 of 31 Evidence: but one recommendation have been met. The AQAA was completed and the document returned to us when requested. The AQAA lets us know about the changes they have made, where they still need to make improvements and how they are going to do this. The evidence to support the comments made is satisfactory and fully concurs with our findings. The organisation have several ways of monitoring the quality of the service provided at Hopes Green Care Centre. These include monthly Regulation 26 visits, medication audits, health and safety audits and a Key Outcome Audit that is comprehensive, detailed and based on outcome groups as detailed within the National Minimum Standards and Care Homes Regulations for Older People. We requested records of Regulation 26 visits and noted these have not been undertaken as regularly as they should, the last one on file being March 2010 and the previous one October 2009. The manager advised that 48 questionnaires had recently been sent out (February 2010) to people who live at the home and their relatives and/or representatives to seek their views about the quality of care, service and facilities provided at the home. The manager confirmed these were in the process of being collated and comments had been received from 14 people. However we were able to look at the comments made and in general these were seen to be positive, with the exception of comments made about the quality of meals provided at the home on occasions. Comments included I am more than happy with the care, kindness and patience shown to our relative, While the carers are very good and helpful, staffing levels are extremely low and at times I am quite concerned as what would happen in an emergency, The food continues to be of variable standard, the quality is often below par and the menu is predictable and needs more variation and The variable quality of the food is an on-going issue that we consider needs resolving. From discussions with the manager and deputy manager both are aware of the issues with the chef and we were given assurances that this is being dealt with. We were advised by the manager that meetings with people who live at the home and their relatives/representatives are held every 3 to 4 months. We looked at the minutes of the most recent meeting and this showed that a cheese and wine evening was held on 6th April 2010. Matters for discussion included the purchase of a summer house, raised flower beds to be made, garden party and meals and/or snacks that people who live at Hopes Green would like. Corporate health and safety policies and procedures were observed to be in place within the home. The staff training matrix showed that all staff have updated health Care Homes for Older People Page 26 of 31 Evidence: and safety training. Accident records were reviewed and noted to be completed well. Where appropriate, we had been notified under Regulation 37 of the Care Standards Act 2000 of any deaths, illness or other significant events. Care Homes for Older People Page 27 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 28 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 8 13 Ensure within each persons plan of care there is a comprehensive assessment relating to their moving and handling requirements. So as to ensure peoples health and welfare. 14/06/2010 2 9 13 Appropriate measures must 04/06/2010 be taken to ensure that medication is stored securely at all times and that it is not easily accessible to people who live at the home or for those people who it is not intended for. So as to ensure peoples health and welfare. 3 30 18 Ensure that all care staff receive appropriate training to do their job. This refers specifically to those conditions associated with the needs of older people. 01/09/2010 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 So that staff working at the home are able to meet peoples care needs. 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 Ensure the care planning system within the home continues to improve so as to ensure there are support plans and risk assessments in place for all of the identified needs of the person concerned. Packets and bottles of medication should be signed and dated when commenced. This is a repeat recommendation. Consider devising the menu in a pictorial format so as to enable people who live at the home to make an informed choice. Review the number of training courses that can be undertaken by any one person on any given day. Ensure that Regulation 26 visits are conducted each month and a report compiled. 2 3 9 15 4 5 30 33 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. © 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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