Care Home: Ingham House Ltd

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What the care home does well The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. The pre admission process ensures that only residents whose needs can be met at the home are admitted. Staff practice reflects a good understanding of residents` personal and healthcare needs, which ensure that needs are met. Residents privacy and dignity are respected. Residents are generally safeguarded by the medication procedures in place. Residents` lifestyles within the home are generally their own choice and are provided with sufficient stimulation to fulfil their interests. Residents are provided with a choice in meals to ensure their preferences are catered for. The home has systems in place to listen to residents` views and safeguard them from harm. Residents are provided with comfortable communal facilities. Residents` needs are being met with the skill mix of staff on duty. Feedback from residents showed they were happy residing at the home and some comments received were; `I`m very fond of the home`, Feel at home, it`s a lovely place. I wouldn`t want to go anywhere else`, `Looks after us very well` and `Fulfills it title, caring`. What has improved since the last inspection? Work has been done to address the six requirements made at the last inspection. The care planning system has been moved to a paper format, formerly computer based, which has assisted in addressing four of the requirements made in relation to risk assessments, care planning and individual involvement. The new process better identifies action to take to meet needs and ensure individual`s choice and preferences are accounted for. Medication practices have been amended to address the two requirements made in relation to medicines to ensure residents are safeguarded. Prescribed medicines are used only for whom it has been prescribed and medicines are administered to individuals when required and no longer being potted up. Any recommendations made at the last inspection report have been considered and action taken where deemed necessary. The AQAA identifies areas that the home has improved within the last 12 months and some examples given of changes they have made as a result of listening to residents are: provide an IT workstation and has training available to all interested residents and provides more regular trips and in house shows. An area is designated for self service ea, coffee and juice and the home provides two electric mobility buggies for free use by residents. What the care home could do better: Whilst shortfalls have been noted throughout this report, one requirement has been made in relation to risk assessments to further safeguard residents. Clear guidance must be provided to staff on action to take to reduce risks. Any minor shortfalls noted at the site visit, of which no requirement or recommendation has been made have been highlighted throughout the report of which the Responsible Individual confirmed they will address. The reader is advised to read the report for full details. The Responsible Individual has confirmed in writing immediately following inspection some of the changes that have already been implemented and demonstrated a commitment to ensure futher changes are implemented to ensure good outcomes continue to be provided to residents and built upon. Minor shortfalls noted were not consistent. Some areas of improvements are: further information regarding equality and diversity needs should be obtained at the pre admission assessment stage to ensure that all needs of an individual can be met, consistent information provided throughout care plans and evidence be provided that care plans are reviewed with the involvement of the individual/representative. Information needs to be provided regarding the level of self administration in relation to medicines. i.e. does the individual or home arrange repeat prescriptions, delivery of medicines etc to ensure that the processes in place are clear and in line with everyones expectations. Further work is needed in relation to recruitment records maintained. Whilst the home has a quality monitoring system in place, feedback regarding the service is currently not sought from other stakeholders and there is not a summary/report made available regarding quality assurance results. The Responsible Individual confirmed that these issues will be addressed. The AQAA received from the home evidences that the home continues to work to improve the quality of the service provided at Ingham 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. The Registered Providers have previously demonstrated a commitment to ensuring compliance and improving outcomes for residents. The AQAA identifies that they are committed to making further improvements and ensures the views of residents are included in future plans. Key inspection report Care homes for older people Name: Address: Ingham House Ltd 10-12 Carlisle Road Eastbourne East Sussex BN20 7EJ     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: 1 6 1 0 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: Ingham House Ltd 10-12 Carlisle Road Eastbourne East Sussex BN20 7EJ 01323734009 01323734471 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ingham House Limited care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: That a maximum number of service users to be accommodated must not exceed 37 The registered person may provide the following category 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 category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Ingham House is registered to provide care and accommodation for up to thirty-seven older people. Nursing care is not provided at this service. The home is close to Eastbourne town centre, shops and the seafront. It comprises of two Victorian properties linked together on three floors with a rear extension. There are well maintained gardens to the front and rear of the property. Service user accommodation comprises thirty-five single bedrooms and one double bedroom. All bedrooms have at least a hand wash basin. There are two lounges, a large dining room and a conservatory. There is a passenger shaft lift avaialble to assist service users accessing all floors. Some rooms are only accessible by the individual being able to mobilise five Care Homes for Older People Page 4 of 29 Over 65 37 0 Brief description of the care home steps independently. The location of the room is taken into account prior to admission. There are five communal bathrooms all of which are assisted. Grab and hand rails are provided where needed. A copy of the Service Users Guide, the Statement of Purpose and a contract is supplied at the time of the pre-admission assessment. Fees range from £363 to £700 per week. Additional charges are made for hairdressing, chiropody, newspapers and own expenses incurred when outside of the service. 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 service users prefer to be called people who use services. It was confirmed that the home uses the term residents. For the purpose of this report, people who use the service will be referred to as residents. This unannounced site visit took place on the 14 October 2009 over six hours and 40 minutes. 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 23 June 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 last key inspection was undertaken on the 17 September 2007 and an Annual Service Review (ASR) was completed on the 28 July 2008. Of the 28 residents in the dining room at lunchtime, 26 were met and advised to let us Care Homes for Older People Page 6 of 29 know if they wished to speak with us after lunch. Individual conversations were had with two residents. 15 resident surveys were taken to the site visit, of which all were returned either completed independently or with assistance. One pre admission assessment and care plan was viewed and specific areas of care looked at in a further eight care plans. Feedback was obtained from eight staff, two spoken with and six out of 10 staff surveys were returned. Discussions were held with the Responsible Individual throughout the site visit. Four staff files were inspected, along with some training records. Medication procedures were viewed. A brief tour of the environment was undertaken and some individual rooms were viewed. The quality assurance system, complaint records and quality monitoring checks in place were viewed/discussed. There were thirty-five residents residing at the home on the day of the site 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: Whilst shortfalls have been noted throughout this report, one requirement has been Care Homes for Older People Page 8 of 29 made in relation to risk assessments to further safeguard residents. Clear guidance must be provided to staff on action to take to reduce risks. Any minor shortfalls noted at the site visit, of which no requirement or recommendation has been made have been highlighted throughout the report of which the Responsible Individual confirmed they will address. The reader is advised to read the report for full details. The Responsible Individual has confirmed in writing immediately following inspection some of the changes that have already been implemented and demonstrated a commitment to ensure futher changes are implemented to ensure good outcomes continue to be provided to residents and built upon. Minor shortfalls noted were not consistent. Some areas of improvements are: further information regarding equality and diversity needs should be obtained at the pre admission assessment stage to ensure that all needs of an individual can be met, consistent information provided throughout care plans and evidence be provided that care plans are reviewed with the involvement of the individual/representative. Information needs to be provided regarding the level of self administration in relation to medicines. i.e. does the individual or home arrange repeat prescriptions, delivery of medicines etc to ensure that the processes in place are clear and in line with everyones expectations. Further work is needed in relation to recruitment records maintained. Whilst the home has a quality monitoring system in place, feedback regarding the service is currently not sought from other stakeholders and there is not a summary/report made available regarding quality assurance results. The Responsible Individual confirmed that these issues will be addressed. The AQAA received from the home evidences that the home continues to work to improve the quality of the service provided at Ingham 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. The Registered Providers have previously demonstrated a commitment to ensuring compliance and improving outcomes for residents. The AQAA identifies that they are committed to making further improvements and ensures the views of residents are included in future plans. 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. The pre admission process ensures that only residents whose needs can be met at the home are admitted. Evidence: The home has a Statement of Purpose and Service Users Guide that provides prospective residents with information regarding the services and facilities provided at the home. 73 of resident surveys received identified that they received enough information before they moved in to help them decide if this home was the right place for them. There was evidence of a pre admission assessment having been undertaken prior to a resident being admitted. Further information regarding equality and diversity needs should be obtained at the pre admission assessment stage to ensure that all needs of an individual can be met. A further assesment is undertaken with the individual upon arrival at the home. Information is obtained from other health professionals wherever Care Homes for Older People Page 11 of 29 Evidence: possible. Prospective residents are encouraged to visit the home prior to moving in to meet staff and other residents and to see if the home will meet their expectations. A resident confirmed that their family came to visit the home prior to them moving in and were pleased that they made the choice for them to live at Ingham House. The home does not have dedicated accommodation to provide intermediate care. Respite care is available if there is a spare place available. A staff member confirmed that management take appropriate action should an individuals needs no longer be able to be met at the 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. Staff practice reflects a good understanding of residents personal and healthcare needs, which ensure that needs are met. Residents are generally safeguarded by the medication procedures in place. Evidence: One care plan was viewed in detail along with specific areas of care in a further eight care plans. The home has moved from using a computer based care planning system to paper format. Whilst information is available regarding the assessed needs of individuals, we observed that information is kept in different places/files for individuals. Staff were able to provide the information we asked for and confirmed that they find the care plan process clear. Clear information should be provided to where information can be found so if agency/bank staff are needed continuity of care will be provided. All resident surveys identified that they always (47 ) or usually (53 ) receive the care and support they need. Whilst the care planning system is continuing to be worked upon and further developed, improvements could still be implemented. Some Care Homes for Older People Page 13 of 29 Evidence: staff confirmed that care is discussed with residents, however evidence needs to be provided that care plans are reviewed with the involvement of the individual/representative. There was an example where information obtained at initial assessment stage was not transferred to the care plan. It was confirmed that the home would address this. There was evidence that advice is sought from health professionals when the needs arise. Resident surveys identified that 67 percent felt that their medical needs were always met, 20 felt usually and 13 felt medical needs were sometimes met. The Responsible Individual confirmed that some residents remain independent and choose to arrange their own health professional access. Whilst work had been done to address risk assessments as required at the last inspection, further work is needed to ensure that clear guidance is provided to staff on action to take to reduce the risk. The detail of information in care plans was not contsistent. Assurance was made that this would be addressed. On discussion with a senior staff member regarding care plans, they demonstrated an understanding and willingness to make improvements. A resident confirmed that they knew who their key worker was and was familiar with their own care plan. A staff member confirmed that there are policies and procedures in place for all aspects of dealing with medicines. There were new Medication Administration Record (MAR) charts in place so limited entries were viewed. An improvement plan received in August 2008 following concerns raised with the service identified improvements the home implemented to ensure residents were safeguarded by medication procedures. A staff member was observed to be administering some medicines and following suitable practices. Clear information was not provided on the MAR charts in respect of prescribed creams/lotions. Staff confirmed that there is a creams folder where information is provided for correct administration/use of these creams. It was confirmed that only staff who have received relevant training administer medicines. Residents are provided with an opportunity to self administer if they wish and a risk assessment identified it is safe for them to do so. There was no evidence to identify that these risk assessments were being reviewed to ensure that residents and staff continue to be safeguarded. It is recommended that information be provided regarding the level of self administration. i.e. does the individual or home arrange Care Homes for Older People Page 14 of 29 Evidence: repeat prescriptions, delivery of medicines etc to ensure that the processes in place are clear and in line with everyones expectations. A resident confirmed that they felt their privacy and dignity are respected. 87 of resident surveys identified that staff always/usually listen and act on what they say. Staff were observed to have a good professional rapport with residents on the day of the site visit and were heard to be calling them by their preferred term. 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 generally their own choice and residents are provided with stimulation to fulfil their interests and needs. Residents are provided with a choice of meals. Evidence: There is an activities co-ordinator that works at the home for two full days per week. On other days this person works at a day centre located over the road, owned by the same providers. It was confirmed that residents at Ingham House are able to use this facility if they wish. The activities co-ordinator informed us that there is a monthly programme drawn up and staff intiate activities on the days that they are not at the home. Some examples of activities were: outside entertainers visit the home, weekly exercise class is held, monthly outings are undertaken and monthly parties are held, each having a different theme. We received mixed feedback from the resident surveys regarding the provision of activities at the home. 67 of resident surveys identified that there were always activities provided at the home that they could take part in. 20 stated there usually were activities and 13 identified there are sometimes activities provided at the home. Some written comments received were They endeavour to provide a home Care Homes for Older People Page 16 of 29 Evidence: from home with many activities, would like Christmas to be a bit more fun and exciting for the whole day, really enjoy the amount of activities on offer and Maybe a bus ride once a week would be nice. No requirement has been made in relation to the provision of activities, as this should be addressed through the homes own quality assurance and quality monitoring system i.e by discussion at resident meetings. Residents are encouraged to continue to involve themselves in any activities they may be invovlved in prior to moving into the home. One resident informed us that they still regularly go out for lunch with a group of people they went out with prior to moving in. The home has two mobility scooters for residents use if they wish to go out into the community and it is safe for them to use these scooters independently. There are no visiting restrictions imposed at the service. Residents are able to receive visitors in private. Residents were observed to move freely within and outside of the home on the day of the site visit. The AQAA identifies that there are choices in meals for residents. On discussion with some residents they were unable to inform us what was on the menu for lunchtime. Information was provided to us following the site visit that a display board is now located in the dining room, reminding residents what is on the daily menu. It was observed at lunch time that a resident was served rice, however they informed the staff that they did not like rice. An alternative was offered to the individual. 13 of resident surveys identified that they always liked the meals provided, 54 usually liked the meals and 33 sometimes liked the meals provided at the service. When asked what the service does well, written comments were: the meals and Well fed. When asked what the home could do better, someone wrote maybe more choice on the menu. No direct issues were relayed to us regarding meals. The provision of food and any changes necessary should be identified through the homes own quality assurance and quality monitoring system. 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. The home has systems in place to listen to residents views and safeguard them from harm. Evidence: There is a complaints procedures available at the home. 93 of resident surveys identified that there was someone they could speak informally to if they were not happy. 67 of surveys identified that residents knew how to make a formal complaint. Records are maintained of complaints investigated by the service. It was recommended to the Responsible Individual that a summary of complaints be maintained, along with outcomes. This will assist them to provide statistical information to us when we next ask for an AQAA. It will also assit them to ascertain if there are any recurring themes in relation complaints. Written confirmation was received following the site visit that the Responsible Individual has addressed this. The AQAA identified that there have been seven complaints made to the service within the last 12 months, of which all were upheld. A further seven had been received between completion of the AQAA and this site visit. Six were upheld and one not substantiated. Records viewed identified that complaints are dealt with in an unbiased manner. It is recognised by the service to ensure that verbal complaints are also recorded. Improvements identified for the next 12 months is to have some main Care Homes for Older People Page 18 of 29 Evidence: policies and procedures in audio format for vision impaired residents as they have identified alternative formats are not currently suitable. All staff surveys received identified that they know what to do if someone raises concerns about the home with them. The Responsible Individual confirmed that all staff have undertaken Safeguarding Adults training and there are policies and procedures in place advising staff on the procedures to follow in the event of an allegation being made. The AQAA identifies that there has been two Safeguarding Adults investigations made in the last 12 months. For one incident, the Safeguarding alert was raised by the service and found to be not substantiated. The second incident was not related to any practices within 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 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 within the environment was good. The AQAA identified that there have not been any major changes made to the environment since the last inspection and the provider is aware of improvements that could be made. 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 is to have a new slucing area and policy on commode cleansing, increased maintenance personnel hours, placed extra ramps outside and a grab rail by the front door, renovated the paving outside. Some communal areas within the home are being repainted and the home now has a dedicated weekend cleaner. A lounge area was being redecorated at the time of this site visit. Some individual rooms were seen to be personalised to reflect the individuals choice and character. There is a garden area that residents have access to. The AQAA identifies that the home proposes to introduce rasied vegetable gardens and a summer house for residents. Care Homes for Older People Page 20 of 29 Evidence: Not all individual rooms are currently provided with lockable facilities. The Responsible Individual confirmed that this is being addressed. Residents who self-medicate or wish to have lockable facilities have been provided with such. The Responsible Individual confirmed that he is currently making arrangements to replace the thermostats on radiators and have temperature controls on the wall, so it is easier for residents to control their rooms temperature. The AQAA identifies that all staff have received training in prevention and control of infection and they have an action plan to deliver best practice in prevention and control of infection. Further information needs to be included regarding Hygiene and Control of Infection as this is a key standard for assessment. All resident surveys identified that they always/usually find the home fresh and clean. Some written comments were laundry is very good and quick, its kept clean, they come and tidy your room and very clean. Providing pedal bins in communal areas will assist in promoting infection control. The home has confirmed that they will provide these. 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 being met with the skill mix of staff on duty. Residents are safeguarded by recruitment procedures. Evidence: The AQAA identifies that 26 care staff have left employment in the last 12 months. 40 of resident surveys identified that staff are always avaialble when needed and 53 felt they were usually available. Seven percent stated they are sometimes available. When asked for comments or what the home could od better, written comments on resident surveys were more staff, give the girls less to do so they can spend more time with us and the girls are overstretched, theres not enough staff. Its a wretched thing. Staff surveys identified that 67 felt there was always enough staff on duty to meet the needs of residents and 33 felt usually there was enough staff. Comments received from staff on what the home could do better were: Have an extra member of staff on afternoon shift, address the staffing problems, the turn around of staff is a lot I have noticed. You normally keep you main care of good workers and more staff. The Responsible Individual informed us that staffing levels are adjusted accordingly to the needs of the residents and is regularly reviewed. This level of staff needed is then reflected on a rota. No requirement or recommendation has been made in relation to Care Homes for Older People Page 22 of 29 Evidence: staffing levels, as the provider needs to address this through their own quality assurance and quality monitoring system. We were informed that a main core staff group remains consistent at the home and the high turnover of staff were mainly from part time staff who have left for genuine reasons. The AQAA identifies that all people who have started work in the home in the last 12 months have satisfactory pre-employment checks. Staff surveys identified that their employer carried out employment checks prior to them starting. There was evidence of this viewed in staff files. Four staff files viewed showed that some minor improvements could be made to the recruitment process. It is recommended that evidence be provided regarding the authenticity of references received, start dates of employment be easily identifiable and ensuring gaps in employment are accounted for. It was recommended that interview notes be maintained to evidence why the home found the person suitable for employment, particularly if the prospective employee has not previously had care experience. It was confirmed that if staff commence work on just a Protection of Vulnerable Adults (POVA) clearance, they work supernumary until full Criminal Record Bureau (CRB) is returned. There was evidence in staff files of training being provided, however no training matrix available for easy monitoring of staff training. Six 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. Staff 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. A written comment when asked what the service does well was provides regular training, mandatory and additional to improve knowledge and understanding for all staff. The AQAA identifies that there are 16 permanent care workers of which ten have undertaken induction training as recommended by Skills for Care. Thirteen permanent care staff have National Vocation Qualification level 2 or above. 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. Management ensures that the home is run safely and in the best interest of residents in the absence of a Registered Manger. Evidence: The service has been without a Registered Manager since January 2007. Whilst individuals have been appointed to manage the service for the registered providers, no one has completed the registration process with us. We have written to the service regarding this. We have received written confirmation that the current appointed manager will be submitting an application within the required timescale we have given them. This will continue to be monitored by us. The current appointed manager was previously the deputy manager and has worked at the service for approximately seven years. It was observed at the site visit that staff are aware of roles and responsibilities within the service. There are processes in place to ensure that areas for their own quality monitoring of areas within the service continue to be monitored in the absence of a Care Homes for Older People Page 24 of 29 Evidence: Registered Manager ie. health and safety checks, auditing of medicines, auditing documentation etc. Monthly management audits highlights any action points that are required. The appointed manager and Responsible Individual has undertaken training in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguard (DOLS). This informaiton has yet to be cascaded to staff. There are policies and procedures in place in relation to this and information available to staff if they need it. The Responsible Individual confirmed that there is currently no authorisations in place and no applications being processed. The AQAA identified and it was confirmed at the site visit that there are 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: having an IT workstation and training available for all interested residents, having more regular trips and more in house shows, a self service refreshment station is provided in the conservatory and the service now has two communal electric buggies for free use by residents. We were informed that resident questionairres are done monthly when care plans are reviewed. A staff meeting is held soon after the monthly resident forum, so ideas are shared and acted upon promptly within the service. Whilst the Responsible Individual informed us that management has an open door policy and staff are able to raise ideas/issues at any time, a staff questionairre is not available to provide individuals with an opportunity to raise issues anonymously. Feedback regarding the service is currently not sought from other stakeholders and there is not a summary/report made available regarding quality assurance results. Management undertake monthly internal audits such as care medication, documentation, training and health and safety checks to ensure the home is being run effectively. The Responsible Individual advised us that we had informed them that monthly visits (Regulation 26) from a representative for the registered providers was not required. We have no record of this information and as a Limited company, these visits will need to be undertaken. The home confirmed that these will be commenced again. Ways to improve the information in the AQAA when we next ask for it was discussed with the Responsible Individual. Clear information/evidence must be provided for all key standards. The AQAA 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 to ensure outcomes for residents are maintained and improved upon. The home holds personal allowance for residents when needed. There were no concerns noted at the last inspection regarding this process. Records were not viewed. The home confirmed that there have been no changes to processes of managing individuals finances. No one within the service is an appointee for any resident. 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 AQAA identifies that they have written assessments on hazardous substances, Control of Substances Hazardous to Health (COSHH). 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 7 13 That all relevant risk 22/01/2010 assessments be implemented for individuals and regularly reviewed. They must provide clear and consistent information for staff on how to reduce the risks. This is to ensure service users and staff are safeguarded so far as is practicable. 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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