Care Home: Icknield Court

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What the care home does well People`s needs are ascertained before a placement is offered to them to make sure that the service can meet these needs. There is a good range of information to help people make a decision if this is the right place for them to move into. The health and personal care needs of people living at the service are well met, promoting health, well-being, taking into account their preferences and religious or cultural requirements and ensuring that they receive medication in a safe and consistent manner. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met and respecting people`s preferences and religious or cultural requirements. Complaints and safeguarding are effectively managed to listen to views of people who live at the service and reducing the risk of harm to them. The premises are clean, well decorated and adequately maintained, promoting a positive environment for the people who live there and which are suitable for the range of disabilities that people have. The service provides staff cover to meet needs and ensures that training is undertaken to keep skills and knowledge up to date. The management and administration of the service promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. What has improved since the last inspection? Medication was better managed at the service, with regular auditing promptly picking up any discrepancies. What the care home could do better: Assessments for falls and fractures were seen in some but not all of the care plan files that were looked at. We would advise these be extended to all service users, as a good practice. Advice was given to make sure that the safeguarding procedure contained the up to date contact details for CQC, to make sure that staff have these readily to hand when they need them. The use of staff shop loyalty cards was noticed for some purchases made on behalf of service users. We would advise that this cease, as a good practice. Gaps to people`s working history were evident on some of the job application forms. These need to be explored to make sure that full background information is obtained before staff start working with vulnerable adults. Key inspection report Care homes for older people Name: Address: Icknield Court Icknield Court Berryfield Road Princes Risborough Buckinghamshire HP27 0HE     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: Chris Schwarz     Date: 1 4 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Icknield Court Icknield Court Berryfield Road Princes Risborough Buckinghamshire HP27 0HE 01844275563 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.fremantletrust.org The Fremantle Trust Name of registered manager (if applicable) Helen Diane Jeffrey Type of registration: Number of places registered: care home 90 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 90 The registered person may provide the following category/ies of service only: Care home only -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 -OP Dementia -DE Date of last inspection Brief description of the care home Icknield Court is a purpose built care service located close to shops and transport links in Princes Risborough. Accommodation is on two floors with six house groups, three of which are for people with dementia. Houses have their own dining area and kitchen facilities and a lounge. Each person has a single bedroom with ensuite shower and toilet. Communal bathrooms have adapted baths suitable for people with disabilities. Care Homes for Older People Page 4 of 29 Over 65 0 90 90 0 0 7 0 7 2 0 0 9 Brief description of the care home There are pleasant garden areas with seating for people to enjoy some fresh air. Fess at the time of this visit ranged from £640 to £779 per week. Information about the service is contained within a statement of purpose and service users guide which were available in the entrance hall. 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: This unannounced key inspection was conducted over the course of a day from 8.15 am until 6.00 pm and covered all of the key National Minimum Standards for older people. The last key inspection of the service took place on 7 July 2009. Prior to the visit, a detailed self-assessment questionnaire, the Annual Quality Assurance Assessment, was sent to the manager for completion and surveys were sent to a selection of people living at the service, staff and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, observation of practice and a tour of the premises. Some of the required records were looked at such as care plans, medication administration records, staff recruitment files, training records and health and safety checks. A key theme of the visit was how effectively the service meets needs arising Care Homes for Older People Page 6 of 29 from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager and the services line manager at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. 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: Assessments for falls and fractures were seen in some but not all of the care plan files that were looked at. We would advise these be extended to all service users, as a good practice. Advice was given to make sure that the safeguarding procedure contained the up to date contact details for CQC, to make sure that staff have these readily to hand when they need them. The use of staff shop loyalty cards was noticed for some purchases made on behalf of service users. We would advise that this cease, as a good practice. Gaps to peoples working history were evident on some of the job application forms. These need to be explored to make sure that full background information is obtained before staff start working with vulnerable adults. Care Homes for Older People Page 8 of 29 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. Peoples needs are ascertained before a placement is offered to them to make sure that the service can meet these needs. There is a good range of information to help people make a decision if this is the right place for them to move into. Evidence: Information provided in the Annual Quality Assurance Assessment showed that a thorough assessment is made for all prospective service users and that they have opportunity to visit and have a look around. The manager told us that the first four weeks after admission are a decision making time and that this can be extended if people need more time. We were advised that the service had a statement of purpose and service users guide and that new service users receive a copy of these with their contract of residence. Most people who returned surveys said they had received enough information about Icknield Court to help them decide if it was the right place for them to move into. Care Homes for Older People Page 11 of 29 Evidence: Some said they had received a written contract which outlined the terms and conditions of residence, others could not recall. During the visit to the service, a couple of pre-admission assessments were looked at. One had been completed by a care manager from the local authority in relation to an emergency admission. It gave a comprehensive outline of the persons needs and why an emergency placement was being sought. Medical information had also been obtained from the persons doctor. The file showed that staff at Icknield Court had then put together a care plan for the person very shortly after he was admitted. The other assessment had been carried out by a senior member of staff and followed the typical format used to assess peoples needs. It provided information such as the persons name, their next of kin, date of birth, ethnic origin, religion, occupation, key people, name of doctor, the type of care being considered, a summary of needs, significant areas of risk and personal care requirements. The assessment had been signed and dated. Copies of the statement of purpose and service users guide were readily available in the entrance hall alongside other information that people would find useful. The range of fees was stated and information was provided about additional costs such as hairdressing, chiropody, toiletries and newspapers. Intermediate care is not provided at this service. 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. The health and personal care needs of people living at the service are well met, promoting health, well-being, taking into account their preferences and religious or cultural requirements and ensuring that they receive medication in a safe and consistent manner. Evidence: We were told in the Annual Quality Assurance Assessment that each person had a care plan which is reviewed and updated as required. The manager told us that any falls are assessed and that the service had excellent relationships with health care professionals. We were told that peoples privacy and dignity were respected. Arrangements were described for visiting doctors and a chiropodist to visit the service. Icknield Court was using a monitored dose medication system with monitoring, auditing and training provided by the pharmacy. The manager advised us that there had been improvement to this area of practice since the last inspection with regular in house auditing carried out by senior staff to highlight any issues. Various assessments were described to support peoples health care needs such as pressure area care and risk of malnutrition. Care Homes for Older People Page 13 of 29 Evidence: People using the service said in surveys that they received the support they needed and that staff were usually available when they needed them. Most said the service always made sure they got the medical care they needed. Relatives who returned surveys said they usually get enough information about the care service to help them make decisions. They said they felt the service was meeting needs and that service users were helped to keep in contact with them. Relatives said they are always/usually kept up to date with important issues affecting service users. They said the service provided the support or care that they expected or agreed and staff had the right skills and experience to look after people properly. Relatives considered that the service usually responded to the different needs of people, such as needs arising from equality and diversity. Additional comments included what I have seen the service do well is looking after people in their care and the cleanliness of rooms, I am delighted with the constant level of care and support offered to my father. He has been a resident for the past year and his physical and mental health have been far better as a result. He is the happiest and healthiest he has been in years and patience with patients. One person felt the service could improve by providing carers who are properly trained in caring for people who have dementia. Have, on occasions, witnessed carers not giving residents proper respect. Would like to see more interaction with residents and more one to one time. Another relative told us their mothers hearing aid was frequently missing. A member of staff said the service provided a high quality of person centred care. A sample of care plans was read from two of the houses. These followed a corporate format and showed that a new care plan format was being introduced. A photograph of the person was included at the front of their care plan file and essential information was provided such as name, date of birth, ethnic origin, religion, occupation, next of kin, doctor and emergency contacts. A personal lifestyle summary was included and a summary of the care plan assessment. Peoples needs were identified under headings such as communication, mobility, personal grooming/dressing, washing and bathing, continence and night time needs. Where people had dementia, there was information on how this affected the persons daily life. Risk assessments were in place for moving and handling and areas such as leaving the building, using a hot water bottle and taking medication home. Assessments were in place for likelihood of developing pressure damage, nutritional needs, dependency levels and in some cases risk of falls and fractures. We would advise that the assessments for falls and fractures be extended to all service users, as a good practice. Risk assessments showed evidence of being reviewed and all that were seen were up to date. Where assessments showed that action was necessary, this was largely being addressed. Records were being kept Care Homes for Older People Page 14 of 29 Evidence: of peoples weight and any visits or appointments with health care professionals and accidents. Medication practice was looked at in two of the houses plus management and storage of controlled drugs. A requirement was made at the previous key inspection to improve medication practice and this had been addressed from evidence seen on this occasion. Staff administering medication were seen to wear red tabards and focused on medication until the round was completed. Medication was securely stored with keys kept on the senior person. Medication administration records were in good order with signatures alongside prescribed dose times. A photograph of each service user was contained with the records, to easily identify them. There were samples of staff signatures and initials. Dates of opening had been written on items such as creams and medicines that require cool storage were being kept refrigerated. Controlled medicines were being kept in a secure, air conditioned room with the key kept on the duty senior. A check of some of the controlled medication tallied with recorded balances. Records showed that daily medication audits have been introduced since the last inspection. These have identified any discrepancies with medication practice with action taken promptly to address them. 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. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met and respecting peoples preferences and religious or cultural requirements. Evidence: The manager told us in the Annual Quality Assurance Assessment that there were three activity organisers at the service and an activity programme which is displayed around the building. A daily newsletter was also said to be in place. The manager advised us that the service had strong links with the community, such as local churches and schools and that two more volunteers had been acquired to visit and befriend service users. We were advised that there were now more pets at the service and that the service had acquired cinema style audio visual equipment to increase entertainment activities. We were told that menus are placed on each dining table and that a nutritious, balanced diet was provided. People using the service said in surveys that there are always activities arranged that they can take part in if they wish. They said they usually liked the meals provided for Care Homes for Older People Page 16 of 29 Evidence: them. A relative commented in a survey that the service could improve by organising more trips out in order that people could engage more with the community. Another said one of the areas that the service does well was provides a lot of entertainment in the day. A member of staff said in a survey that one of the areas the service managed well was provides a varied programme of activities on a daily basis. Another said a good activity programme is in place. We have regular residents meetings and have recently set up a residents committee. Notice boards in the houses contained the programme of activities and dates of residents meetings. One of the activity co-ordinators was met during the course of the visit. Service users were seen doing word search puzzles, reading newspapers, listening to music, going into town and having their hair done in the hair salon. People were also seen making use of the garden to walk around and get some fresh air. One of the carers spoken with had some positive ideas for the house she works in, such as purchasing craft materials to make cards. A four week rotating menu was in place at the service. Daily menus were displayed on each of the dining tables in houses. People had a choice of foods at meal times and dining areas were attractively arranged. The manager advised that audits were being undertaken currently to get peoples feedback on the meals provided for them. People using the service were offered drinks throughout the day; we saw that home made cake was offered with afternoon tea, which people were enjoying. 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. Complaints and safeguarding are effectively managed to listen to views of people who live at the service and reducing the risk of harm to them. Evidence: Statistical information provided in the Annual Quality Assurance Assessment showed that there had been five complaints made to the service. Two safeguarding investigations had taken place. The manager told us there had not been any use of restraint. We were advised that any complaints are logged and that complaints are an agenda item during monthly residents meetings. Feedback forms were said to be available around the building to people using the service. We were also advised that a residents committee has been set up. The manager told us that staff receive biannual safeguarding training and that they understand the procedures to be used if abuse is suspected. The manager indicated that staff were thoroughly recruited, to protect people from potentially unscrupulous workers. People using the service said in surveys that there was someone they could speak with informally if they were not happy and that they knew how to make a formal complaint. They also said that staff usually listen and act on what they say. Most relatives who completed surveys said they knew how to make a complaint. All staff who returned our surveys said they know what to do if anyone raised any concerns about the service. Care Homes for Older People Page 18 of 29 Evidence: During the visit to the service it was possible to see that any complaints or compliments had been logged, with a note of any action taken where it was necessary. Icknield Court had received mostly compliments about the quality of care. There was a complaints procedure to refer to in the operations manual; information was also provided in the statement of purpose, service users guide and on notice boards in the houses. The service had a safeguarding procedure in place and the manager has kept us informed of safeguarding incidents during the period under review. Advice was given to make sure that the safeguarding procedure contained the up to date contact details for CQC, to make sure that staff have these readily to hand when they need them. A requirement has been made under the staffing section to make sure that gaps to peoples work history are explored before they start working at the service. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are clean, well decorated and adequately maintained, promoting a positive environment for the people who live there and which are suitable for the range of disabilities that people have. Evidence: We were advised in the Annual Quality Assurance Assessment that the service is a purpose built home for ninety people, divided into house groups of fifteen people. All parts of the building were described as wheelchair accessible with adaptations to assist with daily living. Information showed that bedrooms were all single occupancy with en-suite shower rooms. The manager said that there were quiet spaces for people to use and a smoking room for service users. We were advised that regular checks are made of the premises to ensure they are safe. The manager advised us that the pathway around the building had been extended and that more profiling beds had been acquired for those people who need them. People using the service said in surveys that the building is always kept fresh and clean. One said I have been able to make my room my own. A relative commented in a survey that the service could improve by making sure patients own clothes are returned to them after laundry. Another relative told us that the service could improve its hygiene standards. A member of staff commented in a survey that the accommodation provided to residents is first class. Another member of staff said I Care Homes for Older People Page 20 of 29 Evidence: feel our residents benefit greatly from the garden and patio areas. We regularly see residents going in and out freely. Icknield Court is located close to the town centre with access to shops, restaurants, churches, doctors surgeries and public transport links. The building is designed and arranged to a high specification and has full access throughout for people with disabilities. Corridors and all doorways are spacious, there are sensory nodules on grab rails in the corridors and bathrooms and toilets have been fitted with the appropriate aids and adaptations to meet the needs of people with disabilities. All bedrooms are spacious and have an en-suite shower and toilet. Those bedrooms that were seen had been personalised and people said their rooms were comfortable and kept clean. Lounge areas had plenty of small tables for people to rest cups and other items on and widescreen televisions had been provided. Plants and pictures added homely touches. Each house had a kitchen/diner. Downstairs houses had patio door access to the garden; the garden is also accessible from the entrance hall and seating areas had been provided outside for people to enjoy the fresh air. Issues related to the layout of the main kitchen had been resolved to provide a better working environment. The laundry was clean and in good order. There was good odour control around the building and arrangements were in place for safe disposal of clinical waste. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides staff cover to meet needs and ensures that training is undertaken to keep skills and knowledge up to date. Some attention is needed to recruitment practice to make sure that peoples backgrounds are fully checked before they start working with vulnerable adults. Evidence: We were told in the Annual Quality Assurance Assessment that staffing levels were in line with guidance and had been assessed according to needs. The manager confirmed that there were satisfactory pre-employment checks for people who started at the service in the past twelve months and that the staff development programme met the National Minimum Standards. We were advised that all staff undertake a six day induction and that mandatory training can now be delivered in house at the service. The manager told us that staff work in line with the General Social Care Council code of practice. We were also advised that the number of relief staff had increased, reducing the need to use agency workers. Statistical information showed that thirty one staff had achieved National Vocational Qualification level 2 or above. Staff who completed surveys said they are always given up to date information about the needs of people they support. They said their employer carried out checks before they started working and that their induction covered the areas they needed to know about very well. Staff said that they receive training that is relevant to their role, Care Homes for Older People Page 22 of 29 Evidence: helps them understand and meet the individual needs of people, keeps them up to date with new ways of working and gives then enough knowledge about health care and medication. Staff said they regularly receive support from their manager. They said the ways in which information is shared usually worked well and that there were always/usually enough staff to meet the needs of the people who use the service. Staff considered they had enough support, experience and knowledge to meet the different needs of people at the service. Additional comments under what does the home do well? included we meet the individual needs of each service user to a high standard, as best as possible. Staff are given good quality training in a wide range of areas. The home is a happy place for residents and staff, meets the needs of individual residents very well, a very pleasant place to work, support and enable residents to live a good life, I feel the standard of care is high and resident-focused, not institutionalised. Areas where staff felt the service could improve included communication, more time to spend with service users and more one to one meetings with seniors/managers. Comments from relatives in surveys included I find all staff are friendly and sociable with patients and visitors. I am happy with the staff performance, staff are always cheery and calm and seem to be happy in their work, which creates a positive atmosphere. I appreciate that someone always calls to let me know my father has requested to see a doctor or if he has had any changes in medication etc. Another relative commented that there was too much use of agency staff. Residents prefer to see familiar faces. During the visit we could see that the service was staffed with a mix of senior staff and carers with a duty senior identified for each shift. The manager, deputy manager and facilities manager were also on duty plus catering, activity, administrative and domestic staff. The manager advised that use of agency staff was much reduced since the last inspection; agency staff had been needed during a recent viral infection at the service to maintain safe staffing levels. A sample of five recruitment files was looked at. Each contained an application form, satisfactory Criminal Records Bureau clearance, references, proof of identity, interview notes and health clearance. In three of the files, there were substantial gaps in peoples work history which had not been checked as part of the interview process. A requirement is made to address this, to ensure that all required information about peoples backgrounds is sought before they work with vulnerable adults. In one persons file, both references were exactly the same, which had not been noticed. The manager acted on this when it was brought to her attention. Care Homes for Older People Page 23 of 29 Evidence: Staff files contained evidence that they undertake the Skills for Care induction as well as an in house induction. Training records showed that gaps in peoples mandatory training or out of date courses had already been identified and a range of courses were taking place up until 18 June this year, after which time all staff would then be up to date. Staff met or observed during the inspection were respectful and courteous to service users. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the service promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. Evidence: The manager told us she had completed National Vocational Qualification level 4 since the last inspection. She said she has undertaken training to keep up to date and that she provides clear direction for the staff team. We were advised that there is an annual quality audit of the service which includes dementia care mapping; an external company audits finances. Two administrators were being employed at the service and there was a facilities manager based on site to oversee health and safety and maintenance of the property. Statistical information showed that equipment was being maintained, such as gas appliances, hoists and fire fighting equipment. The manager told us there were written assessments on the safe handling of hazardous substances. Sixty seven staff had undertaken training on infection control and fifty six on safe food handling. Care Homes for Older People Page 25 of 29 Evidence: During the visit we saw that the certificate of registration was displayed in the entrance, as was a current certificate of employers liability insurance. There were reports of regular monitoring visits by the provider up until January this year. The last quality assurance audit of the service took place in March last year with another planned for the end of April this year. A dementia care audit took place in March 2009 and an external infection control audit was undertaken in March this year with the service achieving a 90 score. Peoples money was being managed in a residents savings scheme with restricted staff access to the computerised records. Manual records showed that receipts are kept to verify expenditure; some of these receipts showed use of shop loyalty cards which the service users did not possess. The use of staff loyalty cards for service users purchases is contrary to the providers policies and good practice; this was brought to the managers attention for her to address. A sample of health and safety records was looked at such as the gas safety certificate, evidence of portable electrical appliance testing, records of hoist servicing and generic and fire risk assessments and these were in good order. Staff training on health and safety related areas was being brought up to date where necessary. Staff had access to personal protective items such as gloves and aprons. 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 29 19 Gaps to peoples working history are to be explored. This is to make sure that full background information is obtained before staff start working with vulnerable adults. 31/05/2010 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. 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