Care Home: Hyman Fine House

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What the care home does well The pre admission assessment ensures only those whose needs can be met are admitted into the home. The homes ethos is to provide a culturally sensitive service for those who feel themselves to be Jewish in terms of culture and/or religion. Care staff demonstrated an understanding of the individual needs of residents and was attentive to them on the day of the site visits. Residents make decisions about their lives and are consulted on aspects of life in the home to ensure choice and preferences are accounted for. Residents have access to health professionals when the need arises. Residents are provided with opportunities to involve themselves in activities if they wish. Resident`s routines are to their own choice and preference. Visitors are welcomed at the home and there are no restrictions imposed. The home employs a stable and committed team of staff who know the needs of the people who live there. There are systems in place to ensure residents feel free to air their views and know that action will be taken where needed. Residents live in a homely environment and are provided with comfortable communal facilities. Some comments received from residents in what the home does well were: `Gives you a chance to meet different people and talk on many subjects`, `It takes care of the patient and also more than enough food`, `makes you welcome` and `keeps fresh and inviting`. One visitor commented that `religious needs are being met` and was impressed with the home. They thought staff are very attentive. A staff member commented on what the home does well `It offers person centred care to all residents and has the collaboration of relatives and significant others`. All staff surveys identified in what they do well is to look after the residents. Further changes they are planning to make as a result of listening to people are: to purchase a gazebo for the garden, redecorate and refurbish the dementia unit, involving residents in choosing colours to repaint the lounge area and to purchase a larger fridge for the communal area to make available a bigger selection of sandwiches at night time. What has improved since the last inspection? An Annual Service Review was undertaken in July 2008 that showed that the previous requirement relating to risk assessments had been addressed. Risk assessments continue to be in place and are reviewed regularly to assist in promoting the safety of residents and staff. The AQAA identifies areas that they have improved in the last 12 months. The most improvements have been made are in the provision of food and the planning of person centred activities. These changes were made as a result of listening to people. Other areas of improvement identified have been in relation to fire safety, promoting the health and safety of all people using/visiting this service. They have also introduced an option for prospective residents to stay overnight as guests in order for them to get a feel what it is like to live at the home. What the care home could do better: One requirement has been made as a result of this inspection. Policies and procedures must be updated and reviewed regularly. This will ensure that staff within the home are provided with up to date information and procedures are reflective of current good practice guidelines. This shortfall has been noted throughout the previous inspection process and the registered providers have still not addressed this. This has now been made a requirement in which compliance must be achieved. Other shortfalls are noted throughout the content of the report that we are confident the Registered Manager will address. Surveys received, feedback obtained at this site visit and the homes own quality monitoring results identified that residents are overall satisfied living in the home. Some shortfalls were addressed immediately by the home. Some areas of improvements are: to ensure clear information is available for the use of prescribed creams/lotions, to ensure staff double sign any hand written prescriptions and any amendments made, the recording of information must be improved to evidence that care as per agreed in care plans is provided, keep staffing levels under review and for the dementia unit ensure staff working are familiar with residents routines and preferences and ensure applications forms are fully completed. The shortfalls noted were not consistently observed throughout the site visit. The AQAA received from the home evidences that the home is working to improve the quality of the service provided at Hyman Fine House. It provides us with information on areas that have been improved in the last twelve months and what their plans for improvement are within the next twelve months to benefit the residents. Feedback from residents and staff when asked what the home could do better, identified the majority thought nothing else. Some identified that more outings could be provided. One identified that more night staff are needed. Key inspection report Care homes for older people Name: Address: Hyman Fine House 20 Burlington Street Brighton East Sussex BN2 1AU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jennie Williams     Date: 0 2 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Hyman Fine House 20 Burlington Street Brighton East Sussex BN2 1AU 01273688226 01273695233 wsmith@jcare.org www.jewishcare.org Jewish Care care home 51 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 to be accommodated is 51. The registered person may provide the following category/ies of service only: Care Home with Nursing - (N) to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not following within any other category - (OP), Dementia - (DE) (13) Date of last inspection Brief description of the care home Hyman Fine House is owned by Jewish Care and is a care home that provides accommodation for up to fifty-one (51) residents. It is registered with the above written conditions of registration. The home is divided into three working units. One being for residents requiring nursing care, one unit accommodating up to 12 residents with a dementia type illness and one to accommodate residential residents. The home is located in a residential area of Kemptown, Brighton. There is limited parking at the home, but paid parking is available in adjacent streets. The home is Care Homes for Older People Page 4 of 29 13 0 Over 65 0 51 Brief description of the care home located within easy walking distance of the seafront, local amenities and public bus routes. It is a large home and residents rooms are spread out over three floors. There is a passenger shaft lift and stair lift available to all floors within the home. All rooms are for single occupancy and provided with en suite facilities. The home provides a variety of communal areas. The home has its own synagogue on site. There are nine communal toilets located throughout the home and six bathrooms. Specialist equipment is provided at the home as needs arise. Weekly fees range from £391 to £892. There are additional fees such as for Hairdressing, Chiropody and newspapers. Full information regarding additional costs are available from the home. This information was provided to us on the 24 June 2009. 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: 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: It should be noted that following consultation, it was identified that service users prefer to be called people who use services. For the purpose of this report, people who use the service will be referred to as residents. This site visit was facilitated by the Registered Manager. The last inspection was undertaken on the 18 July 2007 and an Annual Service Review (ASR) was undertaken on 18 July 2008. This unannounced site visit took place over two days for a total of 11.5 hours. Evidence obtained at this site visit, previous information regarding this service and information that we have received since the last inspection forms this key inspection report. An annual quality assurance assessment (AQAA) was sent to us by the service, completed by the home on the 09 April 2009. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The AQAA was completed by the Registered Manager and returned when we asked for it. Care Homes for Older People Page 6 of 29 Eleven residents were involved in the inspection process via discussions with us or through observation. Fifteen resident surveys were sent to the home of which all were returned. These were completed independently or with assistance from friends/relatives/staff member. One care plan was viewed and specific areas of care looked at in a further six care plans. One visitor requested to speak with us. Seven staff were involved in the inspection process via discussion or through observation. Ten staff surveys were sent to the home of which nine were returned. Four staff files were viewed. A training matrix and training records were viewed. Medication procedures were looked at and the procedures and records for handling residents finances were inspected. Some individual rooms were viewed, along with communal areas. The quality assurance system, complaint records and quality monitoring checks in place were viewed/discussed. There were 42 residents residing at the home at the time of this site visit. Six in receipt of nursing care, 19 in receipt of personal care only, five people on respite and 12 people accommodated with a dementia type illness. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 29 One requirement has been made as a result of this inspection. Policies and procedures must be updated and reviewed regularly. This will ensure that staff within the home are provided with up to date information and procedures are reflective of current good practice guidelines. This shortfall has been noted throughout the previous inspection process and the registered providers have still not addressed this. This has now been made a requirement in which compliance must be achieved. Other shortfalls are noted throughout the content of the report that we are confident the Registered Manager will address. Surveys received, feedback obtained at this site visit and the homes own quality monitoring results identified that residents are overall satisfied living in the home. Some shortfalls were addressed immediately by the home. Some areas of improvements are: to ensure clear information is available for the use of prescribed creams/lotions, to ensure staff double sign any hand written prescriptions and any amendments made, the recording of information must be improved to evidence that care as per agreed in care plans is provided, keep staffing levels under review and for the dementia unit ensure staff working are familiar with residents routines and preferences and ensure applications forms are fully completed. The shortfalls noted were not consistently observed throughout the site visit. The AQAA received from the home evidences that the home is working to improve the quality of the service provided at Hyman Fine House. It provides us with information on areas that have been improved in the last twelve months and what their plans for improvement are within the next twelve months to benefit the residents. Feedback from residents and staff when asked what the home could do better, identified the majority thought nothing else. Some identified that more outings could be provided. One identified that more night staff are needed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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 10 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. Only residents whose needs can be met are admitted into the home. Evidence: There is a Statement of Purpose and Service Users Guide that is available at the home and provides residents with information about the service and facilities provided at the home. These documents are being reviewed and an easy to use format being devised for residents with a dementia type illness. The Registered Manager proposes to also have these documents be made available in an audio format. Nine of the resident surveys received identified that they received enough information before they moved in about the home to help them decide if this was the right place for them and have received a contract. Three said they did not receive information and two did not know if they received information. Residents personal allowance kept for safekeeping at the home is only accessible when administration people or the Registered Manager is on duty. It was Care Homes for Older People Page 11 of 29 Evidence: recommended that information regarding this process be included in the Statement of Purpose/Service Users Guide. The AQAA identifies that the purpose of Hyman fine House is to provide a culturally sensitive service for those who feel themselves to be Jewish in terms of culture and/or religion. A relative felt that the home did well to meet the religious needs. There is a synagogue on site and the home provides kosher food and offer residents the opportunity to take part in Jewish festivals. There was evidence that residents are assessed by the home prior to admission. Information from social services or other health professionals is obtained wherever possible. Written confirmation is provided to prospective residents following their assessment that the home can meet their needs. The Registered Manager confirmed that they have improved the pre admission assessment to ensure it is more holistic. Prospective residents are encouraged to visit the home prior to admission. A relative spoken with confirmed that they were happy with the admission process and stated admission process was easy. Intermediate care is not provided at the home. Respite care is available if there is a spare place available. Care Homes for Older People Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff practice generally reflects an understanding of residents personal and healthcare needs, however the documentation in place for some people does not fully reflect the level of care provided and there is a risk that care may not be consistently provided. Evidence: Specific areas of care viewed identified that there was guidance in the care plans for staff on how to meet the needs of residents. There were some minor shortfalls noted in individual care plans that were discussed with the care manager and Registered Manager on the day of the site visit. Examples were: it was not clear if an individual needed to continue exercises as advised by a physiotherapist or if an individual required to wear a hip protector or not. Some monitoring charts for specific care needs were not being completed accurately. Staff confirmed that it is because the recordings have not been completed by staff and not because the need had not been addressed. A brief summary of needs is provided as a quick reference. Staff must ensure these are completed for all residents. The recording of information must be improved to evidence that care as per agreed in Care Homes for Older People Page 13 of 29 Evidence: care plans is provided. The information noted in care plans was not consistent for all residents. No requirement has been made in relation to care plans as the home confirmed that they will address the shortfalls. All resident surveys received identified that they always/usually receive the care and support they need. When asked what the home does well, four residents wrote look after me and it looks after the people. Staff surveys also identified in what they do well is to care for the residents. One staff member wrote it offers person centred care to all residents and has the collaboration of relatives and significant others. A visitor confirmed that they had been involved in the care plan of their relative. A Quality Review Nurse from the local purchasing authority undertook a clinical quality review in March 2009, of which the home was happy to share their report with us. These reports advise the home on areas for improvement and provide them with an action plan and timescales within which to comply. The last report from the Quality Review Nurse identified some similar shortfalls noted by us. They will continue to monitor the home to ensure the action plan is complied with and improvements are maintained. There was evidence that professional advice is sought from other health professionals when the need arises. All resident surveys identified that the home always/usually makes sure they get the medical care they need. A relative spoken with felt the whole philosophy and outlook was for the individual and that staff are very attentive. The Registered Manager confirmed that improvements have been made in relation to risk assessments and there is a folder in place to provide guidance for staff. It was confirmed that these are reviewed at the same time as care plans. It was confirmed that staff administering medicines have undertaken relevant training. Further work is needed in relation to ensuring clear information is provided regarding the use of prescribed lotions/thickener etc for all residents. The information contained on Medication Administration Record (MAR) charts was not consistent for all residents. Where it was prescribed apply/use as directed, there was not always clear guidance to identify where or when the medicine/cream should be used, not signed for and no information was found in some care plans to clarify this information. Creams/lotions were noted to be in the individuals room, however were not being signed for. Not all hand written prescriptions were double signed, this a good practice recommendation. For one original prescription it identified take one three time per day, this had been changed to take three tablets at night. There was no information to identify who changed the prescription. Staff must sign if they make any changes to the MAR charts. There was one incident noted where a tablet had been removed from the blister pack, Care Homes for Older People Page 14 of 29 Evidence: however not signed for. There was no information available to identify if this had been administered or not. Overall, MAR charts and blister packs corresponded, identifying that medicines are being signed for at the time of administration. Risk assessments were observed to be in place for those who self-medicate. There was evidence that accurate records are being maintained of controlled drugs. Staff were observed to have a good professional rapport with residents and were heard to be calling them by their preferred term. A staff member was observed to knock on a residents room door and wait for an answer prior to entering. On observation in one unit, there was one staff member assisting two residents at the one time to eat their meals. This did not promote their dignity or offer the individuals discreet personalised assistance. No communication was heard during this interaction. The staff member was observed to clean a residents face without informing them what they were going to do. This was addressed with the individual at the time and discussed with the Registered Manager. It was confirmed that this occurred due to only one staff member being available to assist at meal time. We were informed that another staff member had to go on their meal break at that time or they would not get a meal themselves. This is for the home to address to ensure the home is run for the benefit of residents and not staff. The Registered Manager confirmed she will address this with the catering manager to ensure a similar incident does not occur again. On discussion with another staff member, residents in the dementia unit were referred to as being special. Whilst it was used in a non derogative manner, it needs to be reiterated to staff to be aware of terminology used. Care Homes for Older People Page 15 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 lifestyle within the home is their own choice and residents are generally provided with sufficient stimulation to fulfil their interests and needs. Choices and preferences are catered for at meal times. Evidence: There is an activities person employed at the home who devises a programme of activities. External entertainers are invited to the home and outings for residents are arranged. Some residents visit a day centre. Fourteen resident surveys identified that the home always/usually arranges activities they can take part in if they want to. Some staff surveys identified in what they could do better is to provide more outings. This is for the home to assess. The Registered Manager confirmed that a weekly programme is devised and individual activities are accommodated where possible. An example given was where an individual likes movies, this is arranged for them and others may join in with this. Staff initiate activities for those in the dementia unit and residents are also able to join others in group activities in the main lounge room if they wish and the activity is within their interest. The activities person provides the Registered Manager with a Care Homes for Older People Page 16 of 29 Evidence: monthly report regarding activities within the home. It was observed on the dementia unit that the television and radio were both on at the same time. A staff member confirmed this occurred regularly. The home needs to ensure that this is within the interest of residents and to make arrangements that the equipment be moved to separate areas if they are to be on at the same time, to ensure residents are able to enjoy them individually. Discussions were had with the Registered Manager that we observed three residents in the dementia unit sitting in front of the television watching tennis for the whole day. We could not ascertain if residents enjoyed the tennis, however it was observed that they did not display a great interest. A staff member working confirmed that they dont normally work in this unit and was not familiar with the residents preferred routines. This is for the home to address to ensure staff working in this unit a familiar with individuals preferences. There are no visiting restrictions at the home and there is involvement with the Jewish and local community. A visitor confirmed that they are always welcomed at the home. A resident confirmed that their lifestyle within the home is generally their own choice. Twelve resident surveys identified that they always/usually like the meals at the home. Kosher food is provided in ethos with the Jewish way of life. Catering within the home is subcontracted out to an external company. A catering forum is held monthly so residents are able to voice their opinions on the food provided. Menus are provided on tables in the dining room and choices are made at point of service. One written comment was more than enough food. One resident wrote that food could be a little more interesting. Two other residents wrote in what the home does well was meals. There are hot and cold drinking machines located at two central points within the home. This provides an opportunity for residents and visitors to help themselves to refreshments. To avoid confusion, these should be labelled so people can easily identify which machine provides coffee or hot chocolate. The Statement of Purpose advises people that they are able to bring non kosher food items into the home provided they are kept in individual rooms and disposable cutlery and plates are used. 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 know how to make a complaint, reassuring those involved that they are being listened to and that action will be taken, if necessary. Evidence: There is a complaints procedure available at the home. Ten resident surveys identified that there is someone they can speak to informally if they are not happy, four did not answer this question. Twelve surveys identified that they know how to make a formal complaint. A visitor and residents spoken with confirmed that they would feel comfortable to raise any concerns within the service. All staff surveys identified that they know what to do if someone has concerns about the home. The AQAA identified that there has been four complaints made to the home in the last 12 months, of which none were upheld. On viewing documents, some areas of complaints made were partially upheld. There was evidence that the home investigates complaints in a non biased manner and takes appropriate action to reduce the risk of the same complaint reoccurring. Copies of all correspondence relating to complaints are maintained at the home. We have been informed of four Safeguarding Adults investigations in the last 12 months. Two were inconclusive, one unsubstantiated and one substantiated. Action has been taken by the home to ensure similar instances do not arise again and to further safeguard residents. The home is co-operative with the investigating authority. Care Homes for Older People Page 18 of 29 Evidence: One issue was related to care practices within the service. The home arranged training for staff to ensure a similar incident did not reoccur. Some staff have not received Safeguarding Adults training. The home will be addressing this. The Registered Manager is to be assessed by the local authority as an approved trainer so that this training can be provided regularly to staff in house. A senior staff member was able to demonstrate her understanding of dealing with Safeguarding Adults issues. The home reported to us at the second site visit that they were raising an alert in relation to an agency person who worked at the home following allegations made by a resident. This evidenced that the home was being proactive in ensuring residents are safeguarded. 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 live in a homely environment and are provided with comfortable indoor communal facilities and their private accommodation personalised to suit their taste. Evidence: The last inspection report identified that the outcome for residents with the environment was good. The AQAA identified that there have not been any major changes made to the environment since the last inspection. Whilst walking around the home, it was noted that the home continues to be well maintained. The AQAA identifies that some improvements they have made in the last 12 months are: restricted number of staff having to enter the kitchen, placed a key pad lock in the lift to restrict resident access to the basement, new improved fire alarm has been installed and all rooms leading into the courtyard are now ramped and is safer for residents to access the garden. Some residents were happy for us to visit their individual rooms and these were seen to be personalised to reflect the individuals choice and character. All resident surveys identified that the home is always/usually fresh and clean. The AQAA identifies that staff receive training in prevention and control of infection and they have an action plan to deliver best practice in prevention and control of Care Homes for Older People Page 20 of 29 Evidence: infection. 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 needs are generally being met with the skill mix of staff on duty. Residents are safeguarded by recruitment procedures. Evidence: The last inspection report identified that the outcome for residents was good in relation to staffing. The AQAA identifies that four care staff/registered nurses have left employment in the home in the last 12 months. This low turnover of staff assists in promoting continuity of care. Whilst we observed limited staff in the dementia unit at a meal time, there was a relaxed atmosphere throughout the home during the site visit and staff were observed to be enjoying their work. Five staff surveys identified that they felt there is always enough staff on duty to meet the needs of the residents. Three identified there usually is enough staff and one felt sometimes there is enough staff. Nine resident surveys identified that staff were always available when needed and six identified staff are usually available. Some written comments from residents in what the home could do better are: more staff in the dining room and more night time staff, help. Long time answering bell can be 15 to 20 minutes sometimes. No requirement has been made in relation to this; however management must ensure that they keep staffing levels under review to ensure staff are supplied in sufficient numbers with the qualifications, knowledge, skills and experience to meet the needs of residents. Care Homes for Older People Page 22 of 29 Evidence: The AQAA identifies that 49 Nursing shifts and 331 care staff shifts have been covered by temporary or agency staff in the past 3 months. The same person is used wherever possible to promote continuity. Two agency workers were noted to be on duty at the site visit and demonstrated that they were familiar with the residents and the way of life within the home. Four staff files were viewed. Ensuring applications are fully completed will assist the home in addressing shortfalls in recruitment procedures are followed such as ensuring gaps in employment are explained and reasons for leaving employment are identified. Action must be taken by management to ensure that all relevant qualifications/registrations remain valid. It was observed at the first site visit that there was no evidence to identify that registered nurses continued to have registration with the Nursing and Midwifery Council. (NMC). Personal Identification Numbers (PIN) were out of date. This was addressed immediately by the home. It was discussed with the Registered Manager that this should have been noted through their own quality monitoring systems/checks as some PINs had been expired for over a year. The AQAA identifies and staff surveys confirmed that the home undertook all relevant checks prior to an individual commencing employment. There was one incident where an employee commenced employment prior to a POVA check or CRB having been returned. The Registered Manager was open and honest and confirmed that this error occurred due to miscommunication within the service. This person was stopped working as soon as they realised the error. Staff surveys identified that they are provided with training that is relevant to their role, helps them to understand and meet the individual needs of residents, keeps them up to date with new ways of working and gives them enough knowledge about health care and medication. All surveys identified that staff felt they always/usually have enough support, experience and knowledge to meet the different needs of people who live at the home. There is a training matrix at the home and the care manager has the responsibility of ensuring all staff are kept up to date with mandatory training. There was evidence of training records in a staff file viewed. It was noted that 15 out of the 33 staff were out of date with manual handling training. Following the inspection, confirmation was received from the home that this training has been arranged for the near future. Some staff were out of date with fire training; this also needs to be addressed. The Registered Manager confirmed that all new staff complete the Common Induction Standards as set by Skills for Care. 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. Residents benefit from the home being run by an experienced and dedicated Registered Manager who ensures that the home is run safely and generally in the best interest of residents. Evidence: The Registered Manager has current registration with the NMC and is currently doing her dissertation towards a Masters Degree in Business Administration, along with holding other management qualifications. She keeps herself up to date through reading current literature, internet, accessing a variety of courses and is kept up to date by the organisations head office. The AQAA identifies that she has completed a five day course in dementia care mapping. The last inspection report identified some people commented that the lack of management at weekends can have a detrimental effect on the standards within the home being maintained. The home has addressed this by having some senior nurse staff undertake a course in management and leadership. The home is planning to Care Homes for Older People Page 24 of 29 Evidence: implement continuing development for nurses in management skills and not just clinical skills. There is information available at the home regarding Deprivation of Liberty Safeguard (DOLS) to ensure staff are familiar with new legislation. The Registered Manager attends training and cascades the information to staff. There was currently no application for authorisation being processed. The AQAA identified that there a numerous procedures implemented within the home to provide an opportunity for residents to have their say about the service. Some examples of changes made as a result of listening to people who use their service are: changes to the menu, introducing a breakfast and supper buffet, more residents attending a day centre, making the garden accessible from some individual rooms and purchasing new garden furniture etc. An independent company undertakes an annual questionnaire for residents. The most recent results identified that 91.7 were overall satisfied and 90.3 of relatives identified satisfaction. Resident and staff surveys are undertaken by the organisation. Comments noted from the homes own quality assurance system were I have no complaints and am happy here, on the whole very good and a relative wrote nursing care is excellent and carers are always aware if my relative has any discomfort. A negative comment was some furnishings are tired and tatty. The home has various internal monitoring systems in place and monthly visits are undertaken by a representative within the organisation. They have also commenced this year an additional visit that looks at specific areas in depth. The last key inspection identified that some policies and procedures had not been reviewed for many years. The AQAA identifies there are still some policies and procedures that have not been reviewed for up to six years. Some of these are related to equality and diversity issues. The Registered Manager confirmed these are developed by head office of the organisation. The registered providers must be pro active and ensure policies and procedures are reflective of up to date good practice guidance. Whilst the AQAA contained the information we needed, the Registered Manager was reminded to ensure the next time we ask for it that the correct document is downloaded. They provided one to us for Care Homes for Adults (18-65) and not Care Home for Older People. It identifies areas in what they could do better, how they have improved in the last 12 months and their plans for improvements in the next 12 Care Homes for Older People Page 25 of 29 Evidence: months. Some areas they identified there was nothing they could do better but will continue to monitor the home and make improvements where identified. No representative within the home is an appointee for any resident. The home will hold personal allowances for people for safekeeping. Records viewed and money counted identified that there are robust procedures in place for the safe handling of residents finances. Receipts are maintained of any financial transactions. It was confirmed that regular health and safety checks are undertaken and the AQAA identifies that equipment in use has been serviced or tested as recommended by the manufacturer or other regulatory body. The Registered Manager confirmed that the home receives input from relevant fire officers and environmental health. The AQAA identifies that they have written assessments on hazardous substances, Control of Substances Hazardous to Health (COSHH). It was identified at the last inspection that staff needed COSHH training. The care manager confirmed that no training has been provided as yet, however was being arranged. Care Homes for Older People Page 26 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 27 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 33 24 That policies and procedures 30/09/2009 are updated and reviewed regularly. This will ensure that staff within the home are provided with up to date information and procedures are reflective of current good practice guidelines. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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