Care Home: I Care Residential Homes Limited

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What the care home does well The manager is leading the continued development of the home, both in the environment, and in the way care is provided at the home. People living at the home are given choices, and are helped to maintain their usual daily routines as much as possible. Assessments of need and care plans provide person-centred information for staff, enabling them to know how best to look after each individual. Daily records made by staff give a good picture of the life of each resident in the home. The residents` surveys returned to us told us that they usually received the care and support they needed. `The staff are very pleasant and helpful`, and `Staff are approachable, I`m never afraid to ask questions or make requests or ask for help if I need it`, were some comments. Staff we spoke to had a good understanding of residents` needs, and we saw good interaction between the staff and the residents living at the home. Staff attend various training courses, and 69% of them hold NVQ qualifications. The home has a relaxed and friendly atmosphere, and the furnishings are very homely and comfortable. Bedrooms are attractive, with matching fabrics and cosy features. The addition of personal belongings makes them all individual. Residents told us that there are some activities organised that they could take part in if they wish, and discussed the crafts they did, the exercise sessions and the singing. The manager was aware of the need for more outings, and had plans in place for fund raising to hopefully purchase some form of transport for the home. Personal interests are taken into consideration, and one resident enjoyed growing tomatoes in the space at the rear of the home. A dedicated cook plans and prepares meals, and all of the residents told us they enjoyed the food at the home. Meetings with residents are held to discuss different meals they would enjoy. The manager told us that the approach in the home is open, and she tries to encourage staff to discuss issues, and residents to chat freely and express opinions. All of the residents we spoke to were satisfied with the way they were looked after, and could not think of anything they would like done differently. What has improved since the last inspection? The manager is promoting principles of care that encourage residents to participate more fully in the running of their home, and also encourage the development of the environment to be as inviting, homely, and personalised as possible. The home is now fully furnished following the past refurbishment. A new recording system has been introduced at the home, which prompts staff to record more person centred information about residents, and so enables staff to provide care that is individual to that person. The manager has developed the activities provided, and turned a relatively unused `quiet` room into an activities room, allowing people the choice on whether they join in or not. Residents` interests have been incorporated into their daily life, for example one resident enjoys a bit of gardening. Residents and families are encouraged to complete questionnaires when they wish, and they are freely available. These are used to identify areas for improvement. Meetings with residents are held more frequently, so that they are able to voice their opinions and see that action is taken when necessary. There has been an 11% increase in the number of staff who hold National Vocational Qualification (NVQ) awards, with 69% now successfully achieving them. Supervision for the manager is ongoing, and the manager told us she feels well supported by the organisation. What the care home could do better: The home could ensure there is evidence, with the residents` signature, that they have participated in their assessment of need and care plan. Staff could also make sure they always complete all of the areas of the care plan they are using, to give a full picture of the residents` circumstances. The manager could ensure that all of the medication practices staff are following are efficient and effective, so that the residents` health and welfare is protected. Residents could confirm their agreement that the home is taking responsibility for their medication, with a signature. To further show that the quality of the service is monitored, there could be evidence of any audits made in the home, for example, a managers` signature to show records have been checked as correct. Key inspection report Care homes for older people Name: Address: I Care Residential Homes Limited 14-18 Beach Road Cleveleys Lancashire FY5 1EQ     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: Jennifer Hughes     Date: 0 5 0 8 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 30 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 30 Information about the care home Name of care home: Address: I Care Residential Homes Limited 14-18 Beach Road Cleveleys Lancashire FY5 1EQ 01253852414 01253829140 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): I Care Residential Homes Limited Name of registered manager (if applicable) Mrs Lynsey Turley Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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 The maximum number of service users who can be accommodated is: 15 Date of last inspection Brief description of the care home I Care has been adapted from three adjoining two-storey residential properties, into a care home, which suits the needs of older people. It is close to the centre of Cleveleys, with easy access to transport links. It is equipped to suit the needs of its residents, for example there is a stair lift, grab rails and ramps. Single and double rooms are sited on both floors, with toilets and bathrooms being conveniently situated. There is sufficient communal space, with two lounges and a dining room. Outside seating is available in the pleasant front garden, and in the paved area at the rear of the Care Homes for Older People Page 4 of 30 Over 65 15 0 Brief description of the care home home. Information about the service the home provides is available in the form of a standard brochure, and also a clearly written guide which tries to cover everything a resident needs to know about daily life in the home. CQC reports are readily available from the manager to anyone who asks to see them. As at August 2009, the fee scale ranged from £365 to £405.50 per week, with additional charges for chiropody and hairdresser visits, and extra toiletries requested. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit to the home, in that the organisation and the manager were not aware that it was to take place. The site visit was part of the key inspection of the home. A key inspection takes place over a period of time, and involves gathering and analysing written information, as well as visiting the home. The length of the visit was for 6 hours. Every year the registered persons are asked to provide us (Care Quality Commission, CQC) with written information about the quality of the service they provide. We use this information, in part, to focus our assessment activity. This document is called the Annual Quality Assurance Assessment (AQAA). Surveys were sent and received from residents and staff of the home. Care Homes for Older People Page 6 of 30 During the site visit staff records and resident care records were viewed, alongside policies and procedures of the home. The manager, residents, and care staff were spoken to, and their responses are reflected in the body of this report. A tour of the home was made, viewing lounges, dining room, bedrooms and bathrooms. Everyone was friendly and cooperative during the visit. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? The manager is promoting principles of care that encourage residents to participate more fully in the running of their home, and also encourage the development of the environment to be as inviting, homely, and personalised as possible. The home is now fully furnished following the past refurbishment. A new recording system has been introduced at the home, which prompts staff to record more person centred information about residents, and so enables staff to provide care that is individual to that person. Care Homes for Older People Page 8 of 30 The manager has developed the activities provided, and turned a relatively unused quiet room into an activities room, allowing people the choice on whether they join in or not. Residents interests have been incorporated into their daily life, for example one resident enjoys a bit of gardening. Residents and families are encouraged to complete questionnaires when they wish, and they are freely available. These are used to identify areas for improvement. Meetings with residents are held more frequently, so that they are able to voice their opinions and see that action is taken when necessary. There has been an 11 increase in the number of staff who hold National Vocational Qualification (NVQ) awards, with 69 now successfully achieving them. Supervision for the manager is ongoing, and the manager told us she feels well supported by the organisation. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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. Clear information is provided, which enables people to make an informed decision about the home. The assessment that is carried out for all residents means that a service is provided that is tailored to an individuals needs and preferences. Evidence: The home provides very clear information about the service it provides in the form of a Statement of Purpose and Service User Guide that clearly details who owns and manages the home, and what services the home provides.There is detail on what people who live there can expect from the day to day running of the home, and the staff who will look after them. Residents told us that they knew about the home before they moved in.I came and had a look first said one resident. We viewed the individual records of three residents we randomly selected. The Care Homes for Older People Page 11 of 30 Evidence: manager is presently transferring information into a new assessment and care plan format. There is a set procedure for admitting someone to the home, and two of the files held pre-admission assessments in the new format. We found that the assessments held information about all aspects of the physical, social and psychological care of the individuals. The assessments made sure that the individual needs were identified, and the home could meet those needs. However, only one held some evidence that the resident and their family had been involved in the assessment, and the manager needs to ensure all assessments identify this is done. The new format did not clearly show a date of admission, which is needed to fully audit patterns of need. One of the residents had been at the home a while, and information had been transferred over to the new formats, with the other being archived. We advised the manager that they should retain some of this information in working files, for example in an overview of the history of the persons needs and care provided, so that staff can easily refer back to it should they need to. Staff told us that they are always given up to date information about the care needs of people they support, and are able to view the assessments the manager has made for more information. They were able to tell us about the needs of residents, and how to meet those needs.Good staff communication stated one staff survey. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents are generally well met in this home. Some medication practices could effect residents health if they continued. Evidence: Care plans are written records that describe the care that is given to each resident. We noted that the new care plan formats that were being introduced at the home prompted comprehensive information and were very structured. The files we viewed held some good person centred information about individuals and the care they required, such as likes warm milky drink, ensure temperature and lighting are to her liking. Some had informative life histories completed that gave staff an insight into peoples interests and background, helping towards providing care that was more individual to that person. Generally the plans identified the areas of need for each person, with good instructions for staff on what they must do to meet that need. Appropriate aids and adaptations are assessed for by professionals, and available in the home for those residents who need them. Only one of the files showed that the resident had agreed with the care plan, and we Care Homes for Older People Page 13 of 30 Evidence: advised the manager to ensure this is done with all residents, by a signature of agreement from the resident or their relative. We discussed with the manager where the new care plans could be improved with the information they held. We were aware that not all information had yet been transferred from old files. The format has only recently been introduced, and there are areas within them that we found not yet completed. For example the key-worker input forms, nutritional assessment forms, mental health assessment form, mental capacity assessment forms and some life history details. The manager needs to ensure the staff are consistently completing these new records by carrying out regular audits and formally identifying issues to address with staff. The manager told us she is due to attend training on the Mental Capacity Act, when she will have more information to be able to complete that section. Some records were only rarely completed, such as bowel charts, and we discussed the need to identify whether some of these records were required, or whether the same information was elsewhere. Where life histories are difficult to complete, the reason why should be recorded. Risk assessments are carried out on falls, and on mental health. A scoring system is used to identify the level of risk, and we advised that it should be made clear how the concluding score has been reached. There are two bathing records made, one within the care plan format, and a separate one in the shower area. This can cause confusion when one is completed differently to the other, as for example the new plans we viewed had sometimes only recorded that showers had been taken every two or three weeks. The manager needs to identify where staff are to record this information, so that it is clear who has gone an unacceptable length of time without one, and so action can then be taken to address this. This information would then be in the care plan for staff to follow. We saw that regular monthly reviews of the care provided were carried out, with additional guidance for staff if there were any changes. We aim to provide individual care to each of our residents, We give the residents the chance to get involved in how they are cared for,and healthy resident/carer relationships, were some comments from staff surveys. We saw residents being treated with respect, and heard staff chatting with residents who clearly felt able to say how they felt and what they wanted. They look after me well, said one resident, I think its as near as you can get to Care Homes for Older People Page 14 of 30 Evidence: being home, said another. We looked at a sample of medication records and stock. We also observed a medication round, and advised that staff should sign the Medication Administration Record (MAR) after each individual has been administered with their medication, and not after all residents have received their medication. This minimises errors and mirror signing, which we found staff had done when we examined the MAR of one resident. This means medication had been signed as taken by the resident when it had not been given. Not taking medication at the right time or in the right dosage can seriously effect peoples health. We advised that eye drops, ointments and nasal sprays should be dated when opened, so that their expiry date can be calculated. Also some eye drops are required to be stored in a fridge, and these should be identified and stored accordingly. The MAR for one medication was missing, and the manager told us it was due to the pharmacist needing to correct an administering error. We advised there should be a record of this event so that the medication was not missed if the MAR was not returned in time. We saw that medication deliveries were checked into the home,and a returns book notes medication returns with the signatures of the staff and pharmacist. We advised a date and signature on the MAR were needed for the receipt of medication of each individual. One resident had recently been prescribed a controlled drug (medication open to misuse), and the manager had put appropriate procedures in place to store and record this until a more appropriate storage and record book could be obtained. The manager told us she audits the medication every month. We advised she formally evidences when this is done, addressing areas for improvement with staff. We saw that the manager had carried out risk assessments on residents abilities to manage medication. We advised that the resident should sign this as an agreement on whether the home takes responsibility for their medication, or they take responsibility themselves. There was good information held on homely remedies for staff, and patient information leaflets for the medication stored were available. There were example signatures listed for all the staff who were trained and involved in medication administration. On viewing our findings, the manager immediately organised further training in Care Homes for Older People Page 15 of 30 Evidence: medication administration and awareness for herself and staff, through Boots pharmacists.I want to make sure we do this properly, she commented. Care Homes for Older People Page 16 of 30 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 daily lives and social activities are generally catered for, and people benefit from living in a home that tries to continually develop to provide people with opportunities to live lives that are fulfilled. Evidence: The individual care plans we saw included information on each persons life history, their religious needs, and what hobbies and activities they preferred. We advised it should be recorded if this information was difficult to obtain from the resident or their relatives. Residents told us that there are some activities organised that they can take part in if they wish. They told us about crafts and singing and exercise sessions. The exercise trainer called during our visit, and spent part of the afternoon enthusiastically encouraging residents to join in with chair exercises. We saw staff sitting and chatting with residents when they could, and relatives called in as they wished. The manager told us the activities tended to be spontaneous rather than planned, as it depended on how the residents were feeling as to what they wanted to do. Staff commented in surveys that they would like to provide more outdoor activities for residents, and more trips out when the weather is right, and the manager told us of fund raising Care Homes for Older People Page 17 of 30 Evidence: events they were planning, to try and purchase some form of transport for the home. One resident told us about tomato plants they were growing in the outside patio area of the home. We saw these, alongside the table and seating available for residents to use in the good weather, or when they wished. One staff told us that the home was not regimented or clinical. We provide a friendly atmosphere. We saw that the Statement of Purpose of the home states that residents have the right to regard it as a home from home, and not somewhere with rules and regulations. A tasty sample meal was taken of cottage pie with fresh vegetables, followed by jam sponge and custard. Drinks of juice or tea were readily available, and staff made sure everyone had had their fill. Residents told us that if they did not like or want something, staff would always see what else they could make for them. We saw that the cook was helping to serve the meal in the dining room, where residents were able to chat with her, and she could see if there were any problems with the meals. She was very aware of the residents likes and dislikes, and any special diets. We heard a resident comment That was good!, as they walked past the cook. We saw the meal time was peaceful and unhurried, with staff helping tactfully when needed. We saw that staff addressed any diverse and individual needs in order to make sure each person was cared for equally, and felt as much at home as possible. It doesnt feel like a residential home to me, it feels like a little community, which I like. I feel quite at home here, stated a resident in a survey. The cook followed strict routines in the kitchen, ensuring health and food hygiene procedures were complied with. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit by being supported and protected. Evidence: There is a complaints procedure in place, and a file in which to record any complaints which come to the owners attention. There are copies of this available in the entrance of the home, and in information about the home given to residents. There has been one complaint received by the home and by the Care Quality Commission since our last visit.This was regarding some omissions in the care of an individual by some staff. We saw that the home dealt appropriately with the concerns, in liaison with social services and the complainant. All of the residents we spoke to said that they knew how to make a complaint, and what they would do. Id tell any of the staff here if I didnt like something, said one resident, they would be more than able to help me out. The manager told us in information sent to us, We encourage service users (residents) to share their concerns with key workers to minimise problems from the outset and to prevent minor, easily solvable problems from becoming more significant. We saw that staff had attended training about safeguarding procedures. These are procedures all homes must have in place that must be followed if it is suspected that a resident has been the victim of any kind of abuse. We spoke to staff on duty, and found they had a good understanding of the procedures. Care Homes for Older People Page 19 of 30 Evidence: Advocacy services are well advertised in the home. Care Homes for Older People Page 20 of 30 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. The home has a well maintained environment, which provides aids and equipment to meet the care needs of the residents. It is a pleasant, safe and homely place to live. Evidence: The home has a well kept exterior, with a small and neat garden area at the front, where residents can sit and watch the world go by. There is a paved area at the rear of the home, with seating and plants for residents to use if they wish. The manager hopes to continue to develop the homes environment, making it more homely, and a comfortable place to live and work in. We toured the home, and saw that all of the home was clean, tidy and fresh. The home was kept comfortably warm. Domestic staff have set routines to follow to keep the home to a good standard of hygiene. Surveys returned from residents told us that the home is always fresh and clean. There is equal access to all areas of the home for residents and visitors with mobility problems, in that there are ramps and a stair lift in place. Aids and adaptations are also in place to help with toileting and bathing needs.There are no baths provided in this home, only showers. Staff said they found it easier to help residents with a shower than a bath, and the residents we spoke to said they enjoyed their showers. Care Homes for Older People Page 21 of 30 Evidence: We found the water temperature fluctuated in different parts of the home. The home was originally three houses, and the manager confirmed that there are different boilers in use.In one part of the home the water temperature was found to be very hot, and the manager needs to ensure the temperature is around 43 degrees centigrade when it is delivered to residents in all parts of the home. The bedrooms we saw were personalised with residents own belongings, such as pictures, ornaments, and small pieces of furniture. All of the residents said that they were happy with their rooms, and that they were kept clean. The manager told us of plans to continually personalise the home for residents, making personal space more individual to them.The manager informed us,As items in residents rooms require replacing we will provide a choice of furnishings and allow residents to select which items they would most like and feel at home with, to really make it their personal space. The laundry room was clean and tidy. Policies are in place for the prevention of cross infection, and we saw that staff had attended infection control training. Care Homes for Older People Page 22 of 30 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. The home is properly staffed, which means that the residents are supported by sufficient numbers of trained staff. Evidence: Two staff files were selected, and we saw there is a recruitment procedure in place showing that the necessary recruitment checks are carried out to ensure the protection of residents. References and Criminal Records Bureau (CRB) disclosures had been carried out for all staff prior to them starting work at the home. The CRB documents were held in the companys personnel department, and we advised that if the actual documents are not on file there should be evidence on the individual staff file of the date of the return of the CRB disclosure, and the disclosure number, and whether it was satisfactory. Where there is a check on the Protection of Vulnerable Adults (POVA) list, there should also be a record kept on the individual file of the date of its return and the outcome. All new staff are given induction training, when they are given guidance and information on their terms and conditions, and working practices in the home. All of the staff we contacted confirmed that they felt their induction generally covered very well what they needed to know to do the job. The manager told us that new staff work in a supernumerary capacity, with a mentor, until they, and their manager, feel they Care Homes for Older People Page 23 of 30 Evidence: are competent enough in their role. Staff told us about training they have received, finding it relevant to their role, and helping them to understand and meet the individual needs of people. The manager told us in information sent to us that 69 of staff have obtained National Vocational Qualifications (NVQ). A training matrix showed a variety of training that staff have attended, for example training covered food safety, abuse awareness,medication awareness, health and safety,moving and handling, strokes, and infection control. The staff rota showed us that there are appropriate staff on duty at all times, to meet the needs of the residents. Staff told us that they felt well supported with regular contact with the manager, as this is a small home. We work well as a team, its a friendly, happy environment said a staff member.Formal staff meetings take place about every two months. The home holds the Investors In People award, which demonstrates a commitment to developing staff. Care Homes for Older People Page 24 of 30 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 manager leads a team of staff who work to make sure people who live at the home are as safe and comfortable as possible. Their aim is to improve services and so provide a good quality of life for residents. Evidence: The manager has been at the home for over a year, and is due to complete the Registered Managers Award. She told us that in that time staff turnover has been reduced, and more staff have achieved NVQ qualifications. The home also retained its Investors In People accreditation, showing a commitment to developing staff. The manager told us about plans she has to further develop the involvement of residents in the running of their own home, and of training staff to enhance the standards of care provided. Surveys to residents are given out at random times, and are also always available in the entrance to the home. We viewed some responses, which were generally positive about the care they received. Care Homes for Older People Page 25 of 30 Evidence: The manager told us Residents financial interests are safeguarded by a robust procedure and supported by the Finance Team within the company. A communication book for staff to pass on daily information about residents, and a shift handover session, ensures all staff on duty are up to date with events in the home. We saw that staff receive supervision sessions from the manager, and annual appraisals, which identify any problems or training needs. Records show that maintenance and servicing checks of equipment were up to date and correct. Care Homes for Older People Page 26 of 30 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 30 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 9 13 There must be dated and signed records on the MAR of receipt of medication for each individual into the home. To ensure each individual receives medication as prescribed. 31/08/2009 2 9 13 A Controlled Drugs cabinet and register must be obtained and used when needed. To ensure the safe storage and monitoring of drugs that could be misused 31/08/2009 3 9 13 Medication records must be completed by staff following the administration to each individual and not when the administration round has been completed. To minimise the risk of errors and ensure residents receive the right medication. 31/08/2009 Care Homes for Older People Page 28 of 30 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 3 There should be evidence that the prospective resident has been involved in the pre-admission assessment, with a signed agreement. The manager should ensure that all areas within the care plan format used at the home are completed by staff, to give an overall picture of the continued assessments and provision of care. There should be evidence of any audits made in the home, for example, a managers signature to show records have been checked as correct. The resident should evidence with their signature that they have agreed with the plan of care provided by the home. There should be evidence with the residents signature that they have consented to the carers giving their medicine. It should be clear that regular audits of medication are carried out to ensure identification of errors such as mirror signing. Eye drops and nasal sprays should be dated on opening so their expiry date can be calculated. When required, eye drops should be stored in a fridge. The water temperature should continue to be monitored in all parts of the home to make sure it is provided to residents at about 43 degrees centigrade. A record of the receipt of CRB and POVA checks should be recorded in each individuals file, to enable clear auditing that the recruitment process is complete. The manager should continue with and complete the Registered Managers Award 2 7 3 4 5 7 9 9 6 9 7 25 8 29 9 31 Care Homes for Older People Page 29 of 30 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. 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