Care Home: Hoyland Hall

What the care home does well People had confidence in the care home and the manager. People were assessed prior to their admission to the service, which enabled staff to be aware of people`s needs before they went to live there. People told us they received enough information about home before they moved in so they could decide if the place was right for them. People were receiving the health and personal care they needed. Peoples` comments about how their personal care and medical needs were met included, "I have only to ask for anything I want and if they can help me then they do their best to get it for me", "the care is very good", "if you go and ask them. I press my buzzer, they come", "in general, we are happy with the care my mother receives" and "if I go and tell them". Staff attitude and approach to care was based on respect for people, which helps safeguard and promote peoples` rights and dignity. Each person was treated as an individual. They were as independent as they could be, lead their chosen lifestyle and were given the opportunity to make the most of their abilities. People were able to keep in touch with family, friends and representatives. People had attractive meals that were good quality and met peoples` expectations. People said, "the meals are excellent. I have never left anything and it is cooked just like I like it and them around me do likewise", "very good indeed" and "very good food. Could not be bettered". A complaints procedure was in place that enabled people and their representatives to feel confident that any concerns they had would be listened to. People commented, "(they) can talk to anybody", "I have family visiting almost every day, friends and relatives, but haven`t had any grievances", "I have no complaints to make. If I had I would make them to the matron", "not well enough to speak up", "(I`d speak) to anyone" and "I speak up". There was a well maintained living environment that was a clean, tidy and comfortable environment for people to live and enjoy. On the whole, the environment was safe for people and staff, because appropriate health and safety practices were carried out. People received appropriate support as there were enough staff on duty. They could have confidence in the staff, because sufficient checks had been done to make sure they were suitable to care for them. People spoke well of the staff and commented, "it is a homely, welcoming and close knit little community, run by a consistent staff of locals and manager, senior nurse and cook who work well with energy and interest in everyone", "they`re kind and polite", "staff are very nice - all obliging and pleased to do anything for you", "staff very nice, a nice bunch of girls" and "I am speaking for myself and I have always found them all most helpful". People were able to access money held on their behalf by the service at all times. What has improved since the last inspection? The woodwork to the front porch of the home had been redecorated making the home more inviting to visitors and prospective people who might use the service.. What the care home could do better: The care home could support people better in following personal interests and activities by having a social care plan for all people that provides meaningful information about how to engage people in this. Monitor when staff require and need training better, so that staff training is provided and updated when required, appropriate to the work they perform. Formulate the results of surveys sent to stakeholders of the service about peoples` views of the quality of the service provided into a report and produce an action plan to address any issues, to improve the quality of the service for people. To make sure peoples` finances are safeguarded, provide more detail/information in the financial record/terms and condition/contract about payments made by people and what these are for. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hoyland Hall Market Street Hoyland Barnsley South Yorkshire S74 0EX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jayne White     Date: 2 5 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home Name of care home: Address: Hoyland Hall Market Street Hoyland Barnsley South Yorkshire S74 0EX 01226745480 01226742622 none Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Healthmade (Hoyland Hall) Limited Name of registered manager (if applicable) Mrs Cherryl Michelle Hayles Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Staffing must be provided at, at least, the levels specified by `Residential Forum Care Staffing in Care Homes for Older People` published April 2002. The 40 beds may instead be used for PD - Physical Disability, for persons 60 years and above where the physical disability is related to the aging process. The Manager`s hours (37 per week) must be over and above those specified at Condition 2. Date of last inspection Brief description of the care home Hoyland Hall is a care home providing personal care and accommodation for 40 older people. The homes registered owner is Healthmade (Hoyland Hall) Limited. Hoyland Hall is situated off the main road, close to the town centre at Hoyland, Barnsley, giving easy access to all local amenities and shops. Care Homes for Older People Page 4 of 32 care home 40 Over 65 40 0 Brief description of the care home The home is a two-storey building standing in its own grounds and has a garden area that is accessible to people. There are car-parking facilities at the front of the building. The weekly fees range from 351.50 - 375.00 pounds, with additional charges made for hairdressing. If prospective users of the service and their advocates require further information about the home they need to ask for a copy of the latest CSCI report, Statement of Purpose or the Service User Guide to be provided by the owners or manager. Care Homes for Older People Page 5 of 32 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 a key inspection conducted by Jayne White, inspector and Mick Hird, regulation manager. We visited without giving them any notice. Mrs Cheryl Hayles, the registered manager was present during the visit. The manager completed an Annual Quality Assurance Assessment before the site visit. This gives the service the opportunity to tell the CSCI how well they think they are meeting the needs of people using the service, what the home was doing well, what had improved since the last inspection on 1 November 2006 and any plans for improving the service in the next 12 months. Various aspects of the service were then checked during the site visit including inspection of parts of the environment, records relating to the running of the home, observing care practices and inspecting a sample Care Homes for Older People Page 6 of 32 of policies and procedures. The majority of people living at the home were seen throughout the visit and several were spoken with about the care they received and their views on aspects of living at the home. The care provided for six people was checked against their records to determine if their individual needs identified in their plan of care were being met. We also spoke with staff and the manager about their knowledge, skills and experiences of working at the home. Eight out of ten surveys sent to people asking them their views about the service were returned (80 ). Three out of five staff surveys asking them about their knowledge, skills and experiences of working at the home were returned (60 ). We checked all the key standards and requirement from the last key inspection. All this information and peoples, representatives and staffs opinions and comments were considered for inclusion in this report. The manager was provided with initial feedback from the inspection during and at the end of the visit. The CSCI wishes to thank people living at the home, the staff and the manager for their assistance and co-operation during the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 32 The woodwork to the front porch of the home had been redecorated making the home more inviting to visitors and prospective people who might use the service.. 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 set out 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 32 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 32 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 were confident the care home could support them. This was because there had been an accurate assessment of their needs, which told the home about them and the support they needed. Evidence: Seven out of eight surveys returned by people told us they had received enough information about home before they moved in so they could decide if the place was right for them. One commented, I had respite care for ... days and then after returning home entered permanently ... months later on doctors advice and with family support.. When we spoke to people they said, (my) brother looked round, Cheryl visited to see me at home, I looked round, I liked it, I liked how they looked after it and decided to stay and (my) previous home closed, therefore my daughters looked Care Homes for Older People Page 11 of 32 Evidence: round. It was a good choice and proved to be right and (they) look after me so well, very good. When we looked at information in the AQAA in the section what we do well, it stated ensure clients needs are fully assessed before admission and needs can be met. To confirm this we looked at three peoples files to check a full needs assessment had been undertaken. We concluded the registered manager carried out a needs assessment with prospective people prior to their admission. That the service were able to meet peoples needs had been confirmed in writing and meant that there was a shared clarity about what the home was able and willing to provide. Documentation also indicated that there was a clear mutual understanding of the terms and conditions under which people were looked after in the home. However, this might not always be clear to people (see management and administration). In one of the files an assessment had been received from the placing authority. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were receiving the health and personal care they needed because they had a plan of care that told staff what this was. The medication practices supported people in a safe way. Staff attitude and approach to care was based on respect for people, which helps safeguard and promote peoples rights and dignity. Evidence: Five out of eight surveys returned by people told us they always received the care they needed, the other 3 surveys that they usually did. Six out of eight stated they always received the medical care they needed, the other 2, that they usually did. Their comments about how their care and medical needs were met included, I have only to ask for anything I want and if they can help me then they do their best to get it for me, the care is very good, if you go and ask them. I press my buzzer, they come, in general, we are happy with the care my mother receives and if I go and tell them. Staff surveys told us staff were always given up to date information about the needs of Care Homes for Older People Page 13 of 32 Evidence: the people they cared for and one commented, update given at beginning of each shift. One also stated, a very good standard of care. Always respect the clients privacy and dignity as something they did well. The AQAA told us there was good documentation in care plans to demonstrate good health and personal care provided. We looked at six care plans to check this. The care plans were well indexed and included relevant information about people. Looking at changes in care plans alongside other sources of information about changes in peoples health, demonstrated that the way that care is planned is very responsive to change and peoples changing needs are rapidly recognised by the plan of care. This was supported by a systematic approach to risk assessment covering peoples skin, nutrition, delivery of personal care, help with movement and mobility and risk of falling. However, two people were using bedrails and there was no risk assessment associated with this. Documented interventions showed that assessed risks and associated care planning were generally supported by appropriate intervention, for example, one person who had been assessed as being at risk of becoming poorly nourished was being weighed at an appropriate frequency. Partly, as a result, their nutrition was maintained. During the feedback session the role of the manager in care planning was discussed. The generally high level of assessment, care planning and evaluation had been achieved by her ownership of the process. We discussed the possibility of delegation of responsibility, giving staff the opportunity to further develop their care design, implementation and review skills. The care plans identified that a range of health care professionals visited people to assist in maintaining their health care needs. This was confirmed when we spoke with people. When we spoke with staff they showed a good knowledge of peoples diagnosis and could verbally describe the health and personal care needs of the people they cared for. When we observed staff working there was clear and respectful communication between people and staff and staff treated people in a kind, warm manner. They used touch to offer support and this seemed to provide comfort to people. Staff spoke clearly and at a steady pace with people. They encouraged people to be active in their own care and activity. We saw that people were wearing clean clothes and attention had been paid to their hair and nail care. This indicated respect and dignity by staff when caring for them. Care Homes for Older People Page 14 of 32 Evidence: Although a medication round wasnt directly observed administration records indicated that medications were given safely. Signatures indicated that drugs were given at the prescribed times and dates. A sampled audit indicated that amounts of specific medications ordered by the home matched with administration and disposal records. This shows that the administration of drugs was recorded effectively and that the system for ensuring prescribed medication is available to be administered is working well. This means that people who are resident are getting the right amount of the right drug, at the right time. One person had needs related to the way that their medication was given. Discussion with staff and examination of documentation showed that the liaison between district nurses and Hoyland Hall staff was working to support this. There were several instances of documentation that showed that the home and health staff worked together to meet peoples needs effectively. Medication storage arrangements were appropriate. Care Homes for Older People Page 15 of 32 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. Each person was treated as an individual. They were as independent as they could be, lead their chosen lifestyle and were given the opportunity to make the most of their abilities. The care home could support people better in following personal interests and activities. People were able to keep in touch with family, friends and representatives. People had attractive meals that were good quality and met peoples expectations. Evidence: The AQAA told us good food and quality entertainment is something the service thought they did well. Staff comments from surveys included, if a client still wishes to go to church and carry on their religion as something they did well and not all users have families to take them out. It would be nice if we could take them out, if only to the shops or park, but all our entertainment is in-house and not out on trips. We, the staff do a lot of fundraising for treats for our users and arrange day trips out e.g. visit local market, have an events co-ordinator as something they could do better. When we spoke to staff about the leisure activities provided they told us dominoes, cards, connect 4, manicures, watching videos and talking to people about their history. They said, Care Homes for Older People Page 16 of 32 Evidence: people dont go out or to church. These activities were not descibed within the three peoples files we looked at or recalled when we spoke with people. If they were, it would reflect the quantity and quality of activities that the service say is available for people. In addition, a social plan of care was not in place to provide meaningful information about how to engage that person in activities that were appropriate for them, so that staff and the service could determine/plan how those needs could be met. The importance of this is demonstrated in the surveys returned by people. One of the surveys returned by people said there was always activities available they could take part in, two of the surveys that there usually was, four that there sometimes was and another one that there never was. One commented, I am limited in most areas. Have enjoyed the musical evenings, choirs and relative social evenings. We spent some time sitting with people in the lounges and their own rooms where we were able to speak with them about the lifestyle they experienced at the home and whether their social, cultural, religious and recreational need were met. We were able to observe their experiences of living in the home and their interactions with each other and the staff. During the observation we found that the majority of peoples moods were positive. Staff made efforts to include as many people as possible in conversation and day-to-day life and people also did this between themselves. Staff spoke clearly and at a steady pace with people and encouraged them to be active in their own care and activity. A friendly and welcoming feel was evident. On the day of the visit there was little activity or interaction taking place in the two day rooms, beyond the TV being on. During our conversations people said, its alright. Im content being in here, (I) go out for my hair cutting with carers, but not bothered for going out much, perfectly satisfied, prefer my own company in my room, can get up when I like, its nice and warm, fond of reading like my own company, but Ill sit in front entrance after lunch until tea, Ive a lovely family that visit, its boring sometimes - nothing to do, would like bingo just to break monotony, cant get up and go to bed when you like it has to be when theyre not busy, just routine - you have to fit in and hairdresser comes Monday. One person told us the service occasionally hold events for them. When we looked at the surveys that were returned and spoke to people about the meals that were served it told us five out of eight people always liked the meals they were served, three that they usually did. They commented, the meals are excellent. I have never left anything and it is cooked just like I like it and them around me do likewise, very good indeed and very good food. Could not be bettered. When we spoke to the cook she said in the main home cooking was provided, including cakes and buns. She was aware of the special diets needed by people and the portion sizes Care Homes for Older People Page 17 of 32 Evidence: people preferred. She took pride in the meals she served and realised that meals were often the highlight of the day for people. A staff member on the survey commented, home cooked food, special diets - soft diets etc as something the home did well. We saw the breakfast and lunch time meal being served. It was a positive and pleasant event, with food being nicely presented, hot and smelling nice and being appealing for people. There was no rush to the mealtime and people were given sufficient time to eat. Staff were patient and helpful and allowed people time to finish their meal. Care staff were sensitive to those people who found it difficult to eat their meal themselves and needed assistance. They helped the person at their pace, making them feel comfortable and unhurried. Extra portions were provided as required. Care Homes for Older People Page 18 of 32 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. A complaints procedure was in place that enabled people and their representatives to feel confident that any concerns they had would be listened to. Staff hadnt been trained in the recognition and reporting of abuse, but were able to verbally describe the action they would take to safeguard people should an allegation be made. Evidence: People and their representatives could access the complaints procedure because it was displayed in the entrance hall. It clearly described the procedure for people should they have any concerns. It was clearly written, easy to understand and explained what the procedure would be and how long the process would take. Surveys that were returned by people told us they all knew how to complain. Seven out of the eight always knew who they would speak to if not happy, one that they usually did. They commented, can talk to anybody, I have family visiting almost every day, friends and relatives, but havent had any grievances, I have no complaints to make. If I had I would make them to the matron, not well enough to speak up, to anyone and I speak up. When we spoke to people they said, any grumbles Id go to Cheryl. She deals with it, no grumbles, nothing to grumble about and no complaints - in big writing. Surveys returned by staff told us they all knew what to do if a person or their Care Homes for Older People Page 19 of 32 Evidence: representative had concerns about the service. The AQAA told us no complaints had been received by the service and we checked this by looking at the complaints record. No complaints had been made directly to CSCI. The AQAA told us there were policies/procedures/codes of practice in place to protect people from harm and abuse, that had been reviewed in April 2008. The service had the local adult safeguarding policy and procedure for South Yorkshire, which was readily available for guidance and if an incident took place. The manager was aware of the procedures to be followed in the event of any allegations being made. She herself had made a referral after concerns about the condition of someone who had been discharged from hospital. Although the manager stated staff had done adult safeguarding training, she stated updates were needed. We looked at the training records for four staff, but could not find a record of the training (see staffing). When we spoke to staff about reporting any allegations, they were clear they would report any allegations that were made or incidents of harm they saw. Care Homes for Older People Page 20 of 32 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. There was a well maintained living environment that was a clean, tidy and comfortable environment for people to live and enjoy, but the lighting could be brighter for people. Evidence: Six out of the eight surveys returned by people told us they thought the home was always fresh and clean, two of them that it was usually clean. Comments included, this home is kept spotless. Our bedrooms are cleaned every day and the cleaners are top class. This was confirmed when we spoke with people. The AQAA told us in the last 12 months refurbishment has taken place as necessary and window shutters fitted to provide more safety. When we looked round the home the environment was suitable for the needs of people that lived there. The home was clean and well decorated and maintained. There were sufficient bathrooms and toilets for people that were appropriately located and easily accessible. The toilets had been adapted to assist people with their independence when going to the toilet. Some communal areas had low energy light bulbs. Older people generally require more light to sense their environments. This had already been highlighted by someone in the homes own quality assurance survey when they said, lightings not good for reading especially for people with visual impairment. The Care Homes for Older People Page 21 of 32 Evidence: communal lounges and dining area were well decorated and were a comfortable environment for people to live. When we looked in some of the bedrooms they were comfortable and some people had personalised these with pieces of their own furniture and possessions. Bed linen was clean and in a good condition. Everyone we spoke with was happy with their room. The grounds were well maintained. The woodwork on the front porch had been redecorated, which made the home more inviting for visitors and prospective people who might move to the home. Care Homes for Older People Page 22 of 32 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 received appropriate support as there were enough staff on duty. They could have confidence in the staff, because sufficient checks had been done to make sure they were suitable to care for them. Peoples needs were met, but staff training needed updating. Evidence: When we spoke to people and looked at the surveys they returned it told us that generally they had confidence in the staff that cared for them. Surveys told us staff always listened and acted on what they said and six of the eight surveys stated staff were always available when needed, two that they usually were. They commented, after a while, it is a homely, welcoming and close knit little community, run by a consistent staff of locals and manager, senior nurse and cook who work well with energy and interest in everyone, theyre kind and polite, staff are very nice - all obliging and pleased to do anything for you, staff very nice, a nice bunch of girls and I am speaking for myself and I have always found them all most helpful. Two out of the three staff surveys staff always thought there was enough staff to meet the individual needs of all people using service, the other, usually. When we spoke with staff they said, its a good staff team. Care Homes for Older People Page 23 of 32 Evidence: The AQAA stated there was a good skill mix of staff. Two staff had left employment in the last 12 months, which meant a consistent staff team was in place, which is important when caring for people. When we observed staff on duty, they worked hard, were patient and showed empathy to people. There was mutual respect between people and staff and their conversations were relaxed and friendly. The staff group were well motivated and enthusiastic about their work. When we looked at staff surveys it told us checks had been carried out before they started work such as CRB and references, that their induction covered everything they needed to know to do the job when they started, that they received training relevant to their role, that helped them understand the needs of people and kept them up to date with new ways of working. All staff felt they had the right support, experience and knowledge to meet the different needs of people. One commented, we are always doing some kind of training. This told us staff felt supported by the manager and were encouraged to train and update their skills. The AQAA told us there was an appropriate ratio of trained staff and training was updated. It stated all staff had training in prevention and control of infection and half of the catering staff and 20 of care staff had received training in safe food handling. It also stated three quarters of care staff had obtained NVQ level 2 in Care or above. We looked at four staff files for supervision and training records to confirm information in the AQAA and what staff had told us when we spoke with them. There was some evidence that training took place in three of the files, including, induction, dementia, fire safety, infection control, manual handling, NVQ Level 2 in Care and health and safety. However, there had been no updates of any training since 2007. The manager said they were waiting for certificates for infection control training. Records and discussions with staff members indicated that they received an acceptable level of formal supervision that was responsive to the needs of people and staff members. The AQAA stated there was a recruitment policy in place and that everyone who had commenced employment in the last twelve months had satisfactory pre employment checks. Four personnel records were examined in detail. These showed that recruitment was conducted in a way that protected people. In particular enhanced Criminal Record Bureau disclosures had been achieved (this enables a check to be made against any criminal record) prior to completion of recruitment. Care Homes for Older People Page 24 of 32 Care Homes for Older People Page 25 of 32 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 had confidence in the care home because it was led and managed appropriately. People controlled their own money where they were able and chose how to spend it. On the whole, the environment was safe for people and staff, because appropriate health and safety practices were carried out. Evidence: People expressed satisfaction with the service they received. One person said, managers very nice. The manager was experienced in the care of older people and her direction and leadership promoted a relaxed and friendly atmosphere. The AQAA stated the manager has NVQ Level 4 and there was a good rapport with staff, clients and outside agencies. When the manager was not on duty, responsibilities for the day-to-day operation were carried out by the senior care on duty. When we spoke to staff they said the manager was approachable and they felt confident in her. They said she met with them and gave support and discussed how Care Homes for Older People Page 26 of 32 Evidence: they were working. They said, (we) work as a team, Cheryl and Diane approachable and have handovers (at the beginning of each shift). They said there were no staff meetings, but if wanted to broach any ideas would see Cheryl or Diane. In the staff survey they commented, always provide a cheerful and friendly environment for all - staff, families, visitors and clients, we make a real home for our users, a safe one and a happy one, good communications with clients and their families and a happy atmosphere as something they did well. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. It was brief and only gave one sentence answers to the questions asked, which did not give us the detailed information we require to fully support a good rating given at the last key inspection on 1 November 2006. The information did not provide a comprehensive picture of the current situation within the service, what they had improved in the last 12 months and what they could do better, to identify a plan for improving the quality of life for people. The AQAA stated holding more client, family meetings was something they could do better. Questionnaires were used to seek the views of people and other stakeholders, but these were not formulated into a report to identify peoples views of the quality of the service and any action to be taken (see environment). The registered person and the manager toured the building on a monthly basis during the proprietors visit to complete their duties under regulation 26. This regulation shows how the proprietor has to report to the CSCI on a monthly basis and provide evidence of issue with the homes environment being noted and addressed. Monies held by the home on behalf of people were inspected. The manager ensured people controlled their own money where they were able. Generally, their finances were safeguarded, but more information in the records would explain better what payments were for. This was highlighted by one person who had deducted from their personal allowances a third party agreement and didnt know what it was and the record of payments and receipts didnt explain this. There wasnt a contract/terms and conditions for this person. There were written records of all transactions. Records and receipts were in place, as were double signatories to confirm the transaction. Secure facilities were provided for the safekeeping of peoples money. The AQAA stated maintenance of equipment was in place for portable electrical equipment, lifts, hoists, fire detection and alarms, fire fighting equipment, emergency lighting, emergency call equipment, premises electrical circuits, heating and gas appliances. Care Homes for Older People Page 27 of 32 Evidence: Fire exits had been kept clear, which should make it easy for people and staff to leave the building in the event of a fire. One of the cleaning cupboards had been left unlocked and contained cleaning solutions. This would put people who were less able to recognise risk in jeopardy. Care Homes for Older People Page 28 of 32 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 29 of 32 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 7 13 Regulation 13 (4) (c) Where people use bed rails they must have a risk assessment carried out. To identify any unnecessary risks to the safety of the person and identify action to be taken to minimise/remove those risks. 30/05/2009 2 30 18 This also relates to standard 18. Regulation 18 (1) (c) (i) An audit of staff training must be done and where training updates are required this must be provided. So that staff are appropriately trained for the work they perform. 30/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of Care Homes for Older People Page 30 of 32 improving their service. No. Refer to Standard Good Practice Recommendations 1 12 So that staff and the service could determine/plan how peoples social, cultural, religious and recreational interests and needs could be met, a social care plan should be in place to provide meaningful information about how to engage that person in activities that are appropriate for them. So that people are able to sense their environment better and the lighting is sufficiently bright enough for people to read, the lighting should be brighter (recognised standards lux 150). The results of surveys about about peoples views of the quality of the service provided should be formulated into a report and an action plan identified to address any issues, to improve the quality of the service for people. To make sure peoples finances are safeguarded, the financial record/terms and condition/contract should provide more detail about payments made by people and what these are for. 2 19 3 33 4 35 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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