Care Home: Humfrey Lodge

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What the care home does well Residents are happy living at Humfrey Lodge. They feel that they have choice in their day to day lives and they speak positively about the staff team and the care provided. Comments include `the staff are friendly and helpful`, `I have improved since I have been here` and `the staff keep your spirits up`. People are properly assessed before coming into the home and can expect a reasonable standard of care. Residents are happy with the activities offered and feel that they can raise any concerns they may have about any aspect of the home. The manager deals with complaints objectively and is working so that the home is run in the best interests of the residents. Residents meetings are held regularly. The environment is clean and well maintained and the residents enjoy using all parts of the home. There are some nice courtyard areas which are steadily being developed. The staff are recruited properly and the training and induction is generally good. What has improved since the last inspection? Since the last inspection, the agenda item relating to odour control in the home has been addressed. The domestic team is well organised and equipped. What the care home could do better: The new manager and her team have been working hard to address shortfalls that have occurred over the last year. Whilst progress has been good there are some areas that still require work but we have confidence that these will be addressed. For example, the care team need to be more aware of residents ongoing health care needs and ensure that they are properly planned for and monitored. This may be helped by some training on conditions associated with old age. The activities programme is developing nicely but residents need their social care needs assessed to see if there are any specific activities that could be developed/encourage that may help them as an individual, for example with their independence and/or self worth. The care team also need to appreciate their role more, in meeting these needs. Key inspection report Care homes for older people Name: Address: Humfrey Lodge Rochelle Close Thaxted Dunmow Essex CM6 2PX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Roberts     Date: 0 5 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Humfrey Lodge Rochelle Close Thaxted Dunmow Essex CM6 2PX 01371830878 01371831187 humfrey.lodge@runwoodhomes.co.uk www.runwoodhomecare.com Runwood Homes Plc care home 48 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 48 The registered person may provide the following category/ies of service only: Care home only Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category Code OP Dementia Code DE Date of last inspection Brief description of the care home Humfrey Lodge is a care home for older people over the age of 65 years. The home is registered to care for 48 people, 24 to 30 of whom currently may have dementia. The accommodation is all single rooms and is situated all on the ground floor. The home is divided into four units which each have communal rooms. There are a number of informal seating areas around the home and several garden and patio areas that are wheelchair accessible and secure. The home is situated in the attractive village of Thaxted in a residential area but close to shops and other amenities. The home is Care Homes for Older People Page 4 of 29 1 8 0 3 2 0 0 9 48 0 Over 65 0 48 Brief description of the care home owned by Runwood Homes PLC. Fees for accommodation in the home are 467.95 pounds - 600.00 pounds per week and do not include hairdressing, chiropody, newspapers, transport, toiletries or clothing. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home for a day and met with the manager and her team. Prior to this we reviewed all the information that we already had on the home and this included the managers Annual Quality Assurance Assessment. The manager was asked to complete this and this tells us how well they think are doing, what they think they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. On the day of the inspection we spoke to 5 residents and 3 staff at the home and prior to that we sent out surveys to residents and staff asking for feedback on the home. The response was quite good and these comments are referred to in the report. Whilst at the home we also reviewed records and undertook a tour of the home. Care Homes for Older People Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 7 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be properly assessed before coming into the home and to have all the information that they would need. Evidence: The service user guide has recently been reviewed in September 2009. It is printed in a large font and contains some good information, as well as the standard required subjects, for example, on advocacy. A more pictorial format could be used to help people with dementia and on discussion the manager is aware of this and plans further work. The manager has a Pre-admission assessment system in place. The manager, as well as key senior staff, undertake assessments. We looked at two recent assessments. Both were good, outlining residents needs socially, mentally and physically, in quite some detail, which would enable the team to decide as to whether admission would be suitable for that individual. Both assessments contained person centred information Care Homes for Older People Page 9 of 29 Evidence: including the individuals choices/wishes etc. but one was particularly good at providing this, which can only help ease the admission process. Some staff were also good at identifying a persons strengths and abilities as well as their needs. The manager in her AQAA said Senior staff are trained and monitored in their ability to complete assessment information. In addition to the teams own assessment, where appropriate, information had also been obtained from the referring social services department. It was noted that some key information from the referrers had not been noted in the teams own assessment and the subsequent care plans and therefore this potentially could be lost, as it is rarely referred back to. For example, one resident was noted to be at particularly risk of reoccurring infections and this had not been used and also mental health issues had also not been noted. The team need to address this in order to ensure that residents ongoing health care needs are not overlooked. Residents spoken to said the staff were good at helping me settle in and I chose this home myself and I have seen the service user guide, its out in the hall. Residents who commented on surveys said that they had enough information about the home prior to admission and the majority said that they had a contract in place. The local social services quality monitoring report along with our last inspection report was available in reception for viewing. The manager in her AQAA said that we welcome and prospective residents and family members to visit the home with no appointment necessary. Care Homes for Older People Page 10 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect a generally good standard of care but outcomes in relation to health care matters are not always so reliable. Evidence: The manager has a care planning system in place. Two care plans were reviewed in detail and two further care plans were used for cross reference. The manager has been working with the care team to improve upon the care planning and delivery in the home. The care plans are developed from an assessment of needs. These showed evidence of review approximately six monthly but did not always link to changes that staff have made in the subsequent care plans. Overall residents had the majority of care plans that they needed in place and they showed evidence of regular review. These were sufficiently detailed in order to guide staff but did vary in quality. The quality of the plans, in relation to containing person centred information was also variable with some identifying residents choices and preferences and others not. Staff need to ensure that all areas of the care plan are completed. One resident, who had been in the home some weeks, did not have a night care plan in place and from discussions with the resident and the family, there were concerns about the comfort of Care Homes for Older People Page 11 of 29 Evidence: the resident whilst in bed. Staff need to ensure that the care plans that are specific to the resident, especially in relation to health care needs are in place, for example residents with mental health needs, at risk of reoccurring infections and renal failure, did not have care plans. Social care plans, although in place were limited and these are discussed more in Section 3 of this report. Staff complete daily records which are informative in relation to the basic care provided but they do not give an insight into the resident themselves and their general wellbeing. This could be developed with the care team. On discussion with staff, they knew the residents quite well and confirmed that they had read the care plan. However, staff gave a more up to date account of the care/support required which was not always reflective of the care plan. Staff need to keep the records up to date in order to ensure that all staff have access to the information. Residents spoken to said I fall a lot less now than when I was at home and Im not frightened, I recently was unwell and the care was very good, I could not have wanted for better, You see the optician and the chiropodist, I have no regrets coming in here, it has worked out well , I miss being able to make myself a drink, the care is very good and they look after me well. Residents who commented on surveys said that they either always or usually got the care and support they needed and that always or usually the care staff were available to them and listened and acted upon what they said. Relatives spoken to felt that the care at the home was quite good although at times there were a few things to sort out, mainly in relation to health care. They felt that communication from the care team was good and they were told of any issues promptly. Comments on the surveys included My relative has improved a great deal during the x months they have been a resident. Residents had a range of risk assessments in place, covering, for example, falls, nutrition, mental health and pressure sores. Whilst these were up to date, where risks had been identified there was often no care plan or actual management of the risk in place to guide staff. For example, two residents identified at risk of pressure sores had no care plans in place, another residents, at high risk of falls also had no care plan in place or any guidance for staff. We noted from this visit, the AQAA and notifications to us that in total that in the last year, three residents in the home had developed home acquired pressure sores. The prevention of pressures sores needs to be reviewed. One resident with diabetes, who had a general risk assessment in place for the condition and a care plan with management guidance for staff, was found upon enquiry that staff had not followed the plan and the persons diabetes had not been monitored for two weeks. Another care plan said that a residents ears would be checked by the Care Homes for Older People Page 12 of 29 Evidence: district nurse team and on checking with staff, this had also not been actioned Overall the staff need to improve on the monitoring/follow up and management of residents ongoing health care needs. More attention is needed to ensure that outcomes are good and that residents are getting the level of input they need from either the staff team or the district nurses. The manager told us that all new residents are put on a food and fluid intake chart for the first month of admission in order to make a good assessment and check that everything is alright. Fluid charts were examined and it was noted that on some days, residents are not having any drinks other than at the set drinks rounds. This is coupled with the fact that not all the residents have access to a jug of water in their rooms, despite there being quite a few residents observed to be in and out of their rooms during the day. This should be addressed in order to promote fluid intake with residents and to make it easier for staff to offer this conveniently and as a key part of their role. From the records, residents are now being weighed regularly but for a period of time in the Autumn this was not monitored consistently. Of those care plans seen, residents weights were either stable or showing a steady/healthy increase. Risk assessments in relation to challenging behavior were in place and contained good guidance for care staff and included information on the triggers for the behavior and the best way to deal with any occurrence. Records show that residents are seeing their doctor when required for acute matters and other health care professionals such as opticians and chiropodists. Records also show that residents choices with regard to medical care are respected. From observation and discussion with senior care staff, it was noted that the medication round commences at 08.15 and was still underway at 10.00. This is not only very time consuming for the care team manager, whose skills may be needed elsewhere, but this also increases the risk of medications being given without sufficient time between. Whilst the team are trying to develop a resident led routine, the management of these rounds needs review and this was discussed with the manager. Residents had good medication profiles in place which gave staff information on the medicines and what they are used for. From the administration sheets, medications are checked in and overall the signing for medications was good. We noted that staff are not indicating whether they have considered or offered as and when medications by use of a code and this should be completed as good practice. Staff also have a double signing signature system for once weekly medications. On discussion there was no rational for this and from the records staff were noted to have signed for the medication in the separate folder and not on the administration sheet. This creates more of a risk of the medication being administered twice and should be Care Homes for Older People Page 13 of 29 Evidence: reviewed. Staff were seen to be managing other medications such as anticoagulants well. The recording and management of controlled medications was reviewed and generally found to be in order but old, out of date medications must be returned to the pharmacy. Dates of opening must be recorded on liquid medications for audit and expiry purposes. The care team said that they encourage all respite residents to self medicate whilst staying at the home. They confirmed that risk assessments are completed although the most recent one was not available to see. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to have choice in their daily lives and reasonable social life in the home. Evidence: From records and discussion with the residents and staff, the routines of the day are resident led as far as possible. Staff are clear that residents have choice and can give examples around this, such as when they get up and residents confirm that they have choice and can spend their time how they see fit. For example, records showed that some residents chose to go to bed New Years Eve and get up later to see the New Year in. Interaction between the staff and the residents was seen and heard to be polite and staff were giving residents choice about their day. Residents who we spoke to about choice said there is plenty of choice, you can please yourself and there is help if you need it, You do generally have choice but you cannot always please yourself with baths, you have to negotiate. Social care plans are in place, but these were limited and primarily consisted of listing residents preferences and stating encourage x to join in, this will help to stimulate x. At the current time there is no real assessment of social care needs or an understanding by care staff as to how social care input can help a person with their Care Homes for Older People Page 15 of 29 Evidence: independence, self worth or the retention of skills. The care plan format also asks for family tree information, which gives staff a good background on the individual. Where they had been completed they were very helpful but not all residents had them in place. We spoke to the activities officer, who had been in post 6 weeks. The activities officer works 30hrs per week and helps at lunchtime. She said that she was still at a stage of trying activities out with residents and getting feedback and using equipment that the team had before but had never been used, such as musical bingo. The activities officer said that she was organising group activities and visiting residents who choose to stay in their rooms. One to one time primarily consists of chatting and manicures and she also said that she had taken her dog around the home to meet residents, which had been received positively. External entertainers are booked and the activities officer is trying to organise outings to, for example, the local cinema this Saturday. The activities officer has completed profiles on the residents which contained a good level of information on again their social preferences and social/family history. There is also recorded evidence of consultation with residents and the development of activities that meet some of their preferences, such as setting up a knitting group. Some residents do help around the home, to lay tables and wash up etc and this is positive but not reflected as part of their plan of care as a therapeutic activity that makes them feel a valued person in themselves. More work could be done to develop this aspect of social care with residents. Current and planned activities are displayed all around the home, giving residents and visitors a good level of information. Adverts for a local cinemas are also available. On the day we visited an external theatre company visited the home and put on a pantomime. Residents spoken to after the event thought it was very good and enjoyable. The programmes seen showed that the following activities had been provided and they included Christmas art and craft, external entertainers, bingo, manicures, knitting club, armchair exercises, one to one visits, animal visitor, down memory lane, crosswords etc. Residents have also enjoyed musicians visiting the home, for example, who played the flute and the harp. Residents spoken to said they do quite well with the activities and the care staff help people to get ready, they are good enough to keep my interest, I do use the local day centre that I enjoy, Pictures displayed showed that residents had enjoyed some time when baby chicks were brought into the home for them to see and hold. Activities for the weekend have little structure and are led by the care staff, who when spoken to about this, said its carers choice, we put on music mainly, we encourage Care Homes for Older People Page 16 of 29 Evidence: dancing and knitting and we try and put a film on. This may not suit all the residents. Overall a good programme of group events is developing during the week. More focus needs to be put on assessing residents individual social needs and how social care may help and improve outcomes for them, as well as providing much valued entertainment. Residents were seen to be eating breakfast at 09.15, when we arrived at the home. On one unit they were still having breakfast at 10.00 due to a shortage of bread. Staff need to be more organised to avoid delays creating too short a gap between meals that does not encourage residents to eat properly. Lunch was observed and although residents do choose an option prior to the meal, they can choose on the day, enabling them to change their mind if they wish. Staff said if there is a request then we just log and the chef prepares it. Whilst the tables are nicely laid there are no table cloths and the manager confirmed that these are to be purchased shortly. We also noted that some residents are using plastic beakers instead of glasses and the manager said she would address this as well to ensure items were age appropriate. Staff and residents confirmed that fruit is available but this is on request as its stored in the kitchen. A more proactive approach could be used to encourage those less inclined to ask and those with dementia. Residents who commented said tea is always available 6 - 6.30 a.m if you want it, the food was a bit iffy but they are working on it and its getting better, there is variety and its generally well cooked and nicely served, you can say what you want and have seconds, the food is very good, better now than its ever been, the meals could be hotter and cook the veg a bit more and serve the meals hot. On our surveys the majority of residents said that they either always or usually like the meals but some did say they only sometimes or never liked the meals at the home. Consultation on this matter needs to continue with the residents. Relatives who commented on the food said we had Christmas dinner here and it was very good and every day there is a choice with good vegetables. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that they will be protected, as far as possible, from abuse and that their concerns will be listened to. Evidence: The complaints procedure is clearly displayed and is easy to understand. In her AQAA the manager said that she plans to develop a pictorial/easy read format to help any residents with communication needs or dementia in the home. The manager has a complaint logging system in place and we reviewed the records covering the new managers time in post. The manager had dealt with 4 complaints, relating to bedding, staff speaking in foreign languages, administration and medical care. Records showed that the manager had dealt with these in a timely manner, had met with people where required and had been objective in her approach. Good records were in place. Residents spoken to said if you report anything they deal with it straight away, the manager is very much at hand, she walks around the home and I have been to a meeting recently and there was a good discussion and you can bring up any point you want to raise. In the surveys, all the residents/relatives said that they knew how to raise any concerns or complaints. In the Summer of 2009, several adult safeguarding matters were raised and investigated. These related to staff treatment of residents. This matter is now concluded and where appropriate, staff have been disciplined and/or have left the employ of the proprietor. Records show that all the staff have been trained in adult Care Homes for Older People Page 18 of 29 Evidence: safeguarding matters and on discussion with them they showed a good understanding of the subject. The new management of the home is positively moving the team forward after this matter. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to live in a clean, safe and well maintained home. Evidence: We toured the home and visited all the communal areas and a number of bathrooms and bedrooms.The home was seen to be very clean and no odours were noted. On discussion with staff from the domestic team, they now have a system in place for deep cleaning rooms on a regular basis and they have all the specialist equipment that they need and feel the products they use help them to do the job well. Signage around the home is adequate, but it could be improved in order to promote residents independence and therefore self worth. Residents do have their names on the doors but no other memory prompts, which may help. It was also noted that their are only a few specialist sensory items of interest to stimulate residents with dementia, in order to prompt memory or conversation. Decoration in the home is generally good, primarily pastel colours. The home has a large footprint, as its all on one floor, but quite a confusing layout, with four units. This may be helped by identifying the corridors etc. with different colours or themes, again to help residents find their way around. The home has some good homely touches in the lounges and the bathrooms and this Care Homes for Older People Page 20 of 29 Evidence: helps to create a good/relaxed atmosphere. The manager in her AQAA said that there are plans to replace some dining room chairs and bedroom carpets in the next 12 months. The home has several garden areas and these are steadily being developed, for example with raised vegetable beds. There are courtyards within the footprint of the home and these are popular with residents who like to watch birds etc. A new summer house has also been put up at the rear of the home and a greenhouse is available. Residents enjoy sitting in many areas around the home and some of the wider corridors are popular for access to the courtyards and the livelier atmosphere with visitors etc. passing through and for bowling ! There are small lounges on the different units and a large dining room where residents can meet. There is a small smoking room off the main dining room and this has an extractor unit. Some people find this unacceptable, although on the day we did not find that it impinged on the dining room. However it is recommended that the manager review the siting of this room away from the main dining room. Residents commented positively on the home, saying that everything in their rooms was fine and that the cleaning was good. There was a concern that the toilet floors are sometimes wet. Records show that 36 staff have had training in infection control and the manager has a copy of the Health Protection Agencies guidance on infection control in residential homes. Records in relation to fire safety were checked and found to be in good order with regular system checks and staff fire drills. A fire safety risk assessment is in place but this was seen to require a review as it had last been looked at in October 2008. The manager employs a maintenance man that is responsible for checking equipment and systems in the home, for example, hot water temperatures. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a stable staff team who are generally well trained and recruited. Evidence: The staffing team is stable and at the current time there is no agency use, despite having 80 care hrs vacant. Care staff are covering this with overtime. Residents and visitors to the home are informed who is in charge of the shift by a board up in the main reception and on checking this was a true reflection of the staff on duty. The current staffing levels are 1 care team manager and 7 care staff in the morning, 1 and 6 in the afternoon and 1 and 3 care staff at night. This covers 4 units within the home. Each unit is assigned a member of care staff and staff are also assigned to float between units to help out where two staff are required etc. Units may have 11 or 15 residents on them. The layout of the home is quite complex although it benefits from being on one floor. The manager needs to keep the staffing levels under regular review in relation to this and the dependency of the residents. The rotas show that these levels are being maintained. The manager in her AQAA said We ensure that the staff numbers and skill mix are adeqaute through each 24 hour period to meet the assessed needs of the residents. Residents spoken to said that the staff are very good and if you buzz they come quickly, cheerful and pleasant staff, patient, you cant be miserable with them as Care Homes for Older People Page 22 of 29 Evidence: they raise your spirits - even if they are busy they go at your pace, the night staff are as good as the day staff, very good staff, nicest team since I have live here, the staff usually speak in English, they may talk to each other in their own language occasionally but its not in a nasty way, some days are rushed, staff need a little more time with residents and the carers are friendly and helpful. Relatives who commented on the staff team said they are brilliant with my relative, the care team managers do a good job, some carers need to speak better English and caring staff who are all approachable. Care staff have been undertaking NVQ qualifications in care and over 50 have achieved and NVQ levels 2 or 3. Staff files were reviewed in order to check the robustness of the recruitment procedures in the home. The files contained all the required checks and documentation required and where needed these had been done before the person commenced work at the home. New staff had completed the in house induction and were going on to complete the Skills for Care - common induction standards. The training matrix showed that there was 100 compliance with subjects such as safeguarding, manual handling and fire awareness. Compliance was also very good for first aid and dementia and health and safety. Approximately 50 of the care staff team had undertaken training in challenging behavior. Staff spoken to confirmed that they had a good training programme in the home and particularly commented that the quality of the training was good. The training schedule shows that in 2010 the team will also have access to training updates on some of the subjects mentioned. It would be of value to increase staff knowledge on medical conditions associated with old age and this may help to address the shortfall in relation to residents health care needs as identified in Section 2 of this report. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is sound and it is being run with the residents best interests paramount. Evidence: The new manager has been in post only a couple of months. She is a registered nursed and has a lot of experience in the care home sector, having held management posts previously. We have confidence that this manager has the skills and experience to move the home forward. The manager says that she has a good level of support from the operational management team and this includes teaching sessions on subjects such as dementia. Staff spoken to said that the manager is good, approachable, firm but fair. They said that staff meetings are good, people are allowed to say what they think and any issues are sorted out. Minutes of staff meetings were seen and the manager is meeting regularly with the teams in the home. Minutes of the last residents and relatives meetings are freely available in the main reception area. The minutes show that people have been kept up to date with the Care Homes for Older People Page 24 of 29 Evidence: safeguarding matters that arose over the summer and with any forthcoming changes. It was also clear that residents and relatives were able to raise any matters they wished. Residents spoken to said I feel fortunate to be here, Its a nice home, I like being here, Relatives spoken to said that there is a nice atmosphere in the home and people are happy. The provider has a quality assurance audit team that visit the homes and undertake in depth audits from which action plans are developed. These are usually completed yearly but this home has not been fully audited since September 2008. During the recent safeguarding issues the quality team did visit to support the home but not audit. A more up to date audit, including feedback from residents is needed to bring this system back on line. Due to the change in management there are gaps in the staff supervision process which the new manager is starting to address. The manager plans to meet with all staff this month and discuss the safeguarding issues that occurred during the last year and ensure that all staff have addressed any matters that they need to. Staff files showed evidence that they were having supervision. The accident book was reviewed and the records were good and all signed off by the manager. The manager said that they o use the local falls prevention team and post fall monitoring is put in place for 24 hrs, including reviewing falls risk assessment etc. No health and safety issues were noted at the time of our visit. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Residents must have all the 31/03/2010 care plans that they need in place, especially in relation to their health care needs and any plans must be up to date with current level of support etc. So that residents needs are met and in a way that they would wish 2 8 13 By means of risk assessments and care planning, residents health care needs must be monitored and managed correctly. So that outcomes in relation to the health of residents is improved. 31/03/2010 Care Homes for Older People Page 27 of 29 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 2 1 9 Continue to review and develop the format of the service users guide. Use a coding system for the administration of as and when medication and avoid separate double signatory systems where possible. Ongoing consultation with residents should continue about the food in the home and drinks should be available in all the bedrooms. Consider improving signage and signposting around the home to help residents maintain their independence. Review the fire safety risk assessment on a more regular basis. Keep the staffing levels under regular review. Expand the staff training programme to include medical conditions associated with old age. Ensure that the quality assurance programme is brought back on line. Continue to develop the staff supervision process. 3 15 4 5 6 7 8 9 19 19 27 30 33 36 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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