Care Home: Ireland Lodge

What the care home does well The home provides residents with a homely, relaxed and caring environment. Residents are enabled where possible to exercise choice and control over their lives whilst resident in the home. Residents and relatives spoke positively about their experiences at the home. Care staff demonstrated an understanding of the individual care needs of the residents and was attentive to them on the day. Residents have access to health care professionals as required. Residents and relatives spoken with stated they would feel comfortable in raising any concerns and that action would be taken where needed. The staff were observed to deliver care with dignity and respect. The two residents and two relatives spoken with felt the care provided respected their or their relatives privacy and dignity. Residents live in a clean and homely environment. What has improved since the last inspection? A detailed improvement plan was received following the last key inspection as required. This provided us with information on the action taken by the home to address the previous Requirements. A deputy manager has been seconded from another of the organisations homes for six months to work with the Manager in developing systems and records in the home. A letter is now given to potential residents or their representatives to confirm their care needs can be met in the home. Work has continued to ensure clear information pertaining to individual needs are reflected in care plans to provide guidance for staff on how to meet needs of individuals. Recruitment procedures are being followed to protect residents. There has been further redecoration of the environment. Quality monitoring processes have been developed. What the care home could do better: The Statement of Purpose and Service Users Guide would benefit from a review to ensure all the information is up-to-date. A copy of the letter to prospective residents or their representatives that their care needs can be met in the home should be kept for reference. Medication practices should be kept under review to ensure the safety of the residents.Staff training records need to be in place to identify staff training needs. Key inspection report Care homes for older people Name: Address: Ireland Lodge Lockwood Crescent Woodingdean Brighton East Sussex BN2 6UH     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: Judy Gossedge     Date: 1 1 0 5 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: Ireland Lodge Lockwood Crescent Woodingdean Brighton East Sussex BN2 6UH 01273296120 01273296145 Louisa.Young@brighton-hove.gov.uk www.brighton-hove.gov.uk Brighton & Hove City Council Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Neil Bain Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 23. 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: Dementia (DE). Date of last inspection Brief description of the care home Ireland Lodge is owned by Brighton and Hove City Council and is registered to provide accommodation and personal care for up to twenty-three older people who have a dementia type illness. The home provides various placement arrangements that are long term, transitional and respite care. No nursing care is provided at the home. District nurses will supply nursing input when needed. The home is located in the Woodingdean area of Brighton with access to transport and Care Homes for Older People Page 4 of 29 Over 65 0 0 Brief description of the care home local amenities. The home is single storey purpose built facility with residents accommodation being provided in single bedrooms, of which all have en -suite facilities. Shared facilities include three combined lounge/dining rooms and two enclosed garden areas. Part of the building is used as a day centre which residents also have access to. There are suitable numbers of communal bathrooms and toilets located throughout the home to meet the needs of residents. The fees for residential care are dependent on the outcome of a financial assessment and at the time of the Inspection are £110.30 to £740.32 per week. Additional costs are for newspapers, hairdressing, chiropody, transport and toiletries at cost. Further information regarding additional costs is available from the service. A copy of the Statement of Purpose and Service Users Guide is available to view in the home. 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: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001 uses the term service users to describe those living in care home settings. For the purpose of this report, those living at Ireland Lodge will be referred to as residents. The last unannounced key inspection of Ireland Lodge was on 18 June 2009. Following this the Provider was asked to provide a improvement plan to address the issues highlighted. This unannounced key inspection took place over five hours between 10:45 and 17:45 on 11 May 2010. 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. The Manager had been not been asked to complete an Annual Quality Assurance Assessment (AQAA) on this occasion. Care Homes for Older People Page 6 of 29 A sample of the homes communal areas and residents bedrooms were viewed during the inspection. A sample of care records were viewed and are detailed in the report, but included information about the home, care records, medication records, staff records, records of residents finances, complaints records and health and safety records. Twenty-three people were resident and two residents were spoken with individually in their bedroom and a number as part of the inspection process. No residents surveys were sent out on this occasion. The care that four of the residents received was reviewed. The opportunity was also taken to observe the interaction between staff and residents in the communal areas. Information was sought individually on the day from three care workers, three senior care workers, the shift leader for the afternoon, two transitional care staff, the laundry assistant, an administrative assistant ,the Manager and the deputy manager. No care workers surveys were sent out on this occasion. Information was sought from two visitors to the home during the inspection. 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: The Statement of Purpose and Service Users Guide would benefit from a review to ensure all the information is up-to-date. A copy of the letter to prospective residents or their representatives that their care needs can be met in the home should be kept for reference. Medication practices should be kept under review to ensure the safety of the residents. Care Homes for Older People Page 8 of 29 Staff training records need to be in place to identify staff training needs. 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. There is information about the home available for residents and their representatives to view. Potential new residents are individually assessed prior to an admission to ensure that their care needs can be met in the home. Intermediate care is not provided in the home. Evidence: The Statement of Purpose and Service Users Guide were read following the inspection. Some updating of the information is required in relation to the CQC, which the Manager subsequently stated would be addressed. So a Requirement has not been made on this occasion. A copy of the last inspection report is available to read in the home. The two relatives spoken with stated they had received enough information about the service prior to their relative moving in. The various placement arrangements in the home leads to a large number of admissions and discharges within the service every month. The volume of admissions Care Homes for Older People Page 11 of 29 Evidence: and discharges on individual days should be kept under review to ensure that the needs of the residents continue to be met. There are currently three permanent residents residing in the home. Other places are allocated for periods of respite care of one to two weeks, or transitional care of an average of up to a six week stay. All placements at Ireland Lodge are referred through the organisations Care Matching Team. Staff stated no referral is accepted without all relevant information being provided. An assessment is undertaken with prospective residents. This is to ensure individual residents care needs can be met in the home and to provide staff with information on the care to be provided. A detailed pre-admissions format was seen to be in place, and for three new residents admitted to the home there was detailed preadmission information viewed, which had been completed and available to reference. Assessment documentation would benefit from always being dated to fully evidence the process followed. This was discussed with the Manager who stated that this would be addressed. Staff stated that wherever possible, the person who undertook the pre admission assessment is on duty on the day of arrival to meet and greet the new resident into the home. The two residents relatives spoken with were able to confirm a representative from the home had visited their relative prior to their admission to discuss their care needs. One relative did state that an update of their relatives care needs had been requested for a subsequent admission for respite care, and for another it had not. It has previously been confirmed that if a person is provided respite on a regular basis it would be ascertained if their needs have changed. If the period between visits is over three months, the service ensures that another assessment is undertaken by them. This was discussed with the Manager who stated that this would be addressed, so a Requirement has not been made on this occasion. There was no evidence that a letter is provided to prospective residents, confirming that following an assessment the care home is suitable for the purpose of meeting their needs in respect of their health and welfare. This was discussed with the Manager who stated that a letter has been drawn up and is taken and given to the person during the initial assessment visit, but that a copy of the letter is not then retained for reference. He acknowledged that this is an area which needs to be improved and options to address this were in the process of being considered and that this would be addressed with immediate effect. So a further Requirement has not been made on this occasion. There is no dedicated accommodation for intermediate care 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. Residents are protected by a detailed individual plan of care being in place with supporting risk assessments, where all their personal, social and health care needs are identified at the start of their stay and which informs staff of the care, which needs to be provided. Medication policies and procedures are in place but it should be ensured that these are always followed to protect residents. Evidence: There was evidence that further work has been completed to improve the detail of the information recorded on individual residents care plans. Four of the residents individual care plans were viewed and are kept in well-structured folders. These were detailed and gave clear guidance to staff of the care to be provided, residents health care requirements, dietary needs, and social and leisure interests. Supporting risk assessments were also viewed and where there are any identified risks the recording detailed how these will be managed. Care planning documentation would benefit from being dated to fully evidence the process followed. This was discussed with the Manager who stated that this would be addressed. Staff spoken with were positive about the changes that have been made and confirmed that they found care plans to Care Homes for Older People Page 13 of 29 Evidence: provide very clear information regarding the individual care needs of the residents. Both of the relatives spoken with stated they were aware of their relatives care plan and had been consulted with in the drawing up of the plan. There was evidence of reviews being completed as required. Recent results from the homes own quality assurance and quality monitoring system identified that residents felt that their individual care needs had been very well understood during their stay in the home and they had been very or quite involved in the decisions made about their care. The home has access to a full time Registered Mental Nurse (RMN) who develops care plans regarding the mental health needs of residents. A sample of these were viewed. The home maintains and promotes residents health and help them access health care services to meet their needs. Records viewed evidenced residents are registered with a local General Practitioner (GP) and have access to other health care professionals, including district nurses, via the surgeries. It was noted, in care plans that were examined, those appointments with or visits by health care professionals are recorded. Residents and relatives spoken with confirmed good access to health care professionals as required. The Manager stated that the home has a policy for the handling of medication which includes receiving, recording, storage, handling, administration and disposal of medicine. That residents are supported to self medicate under the management risk assessment framework. None of the residents self medicated at the time of the inspection. Medication is stored in lockable facilities in the home and a sample of the recording of medication administered was viewed. The deputy manager was working on the administration and recording of medication in the home at the time of the Inspection, and stated she was in the process of updating and introducing the organisations paperwork to be used in the home, and that PRN guidance which has been put in place will be further developed. Information and advice is sought from a pharmacist who visits the home. The records were not available to view on this occasion. The medication area was also being used for storage of equipment, which the deputy manager stated would be rectified with immediate effect. The deputy manager and two of the care workers spoken with confirmed they had received medication training and for the third they had received training prior to working in the home. The two residents spoken with both had medication administered and they and their relatives stated that their or their relatives medication needs were met in the home. The Manager stated that three medication errors had just occurred in the home and that these were in the process of being investigated The Manager stated that procedures are being put in place to address this and further training and competency assessments will be undertaken. So a further Requirement has not been made on this occasion. The CQC have subsequently received written notification of these and a Care Homes for Older People Page 14 of 29 Evidence: further medication error which had occurred. The atmosphere of the home was comfortable, open and relaxed and residents are encouraged to remain independent and to exercise choice over their daily lives. The staff was observed to deliver care with dignity and respect. The residents and relatives spoken with felt the care provided respected their privacy and dignity and that they were pleased with the overall care provided in the home. Recent results from the homes own quality assurance and quality monitoring system identified that all of the residents thought that overall they were treated with dignity and respect very well or quite well and that staff always wait for an answer when knocking on their room doors. All the carers stated they were very satisfied with the care the person they cared for received. 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. Where possible residents are enabled to exercise choice in their lives whist resident in the home, there are opportunities to participate in social and recreational activities provided and would benefit from continued development. Residents are encouraged to maintain contact with family and friends as they wish. A varied diet is provided. Evidence: Residents social interests are recorded on their individual care plans. Records viewed detailed that activities are facilitated and activities include videos, bingo, making bird boxes, reading groups, gardening, arts and crafts, trips out to places of interest and lunch/pub meals out, board games, cookery, discussion groups and reminiscence groups and exercise sessions. Staff spoken with stated that the range of activities provided is an area that it is intended to continue to be developed in the home over the next twelve months in particular more opportunities for residents to go out on outings. A notice board within the home informs residents and visitors of upcoming events. On the day one unit ran a general knowledge quiz, on another there was a music session and on the last unit a discussion and a newspaper reading followed by a celebration for a residents birthday. Residents are also able to join in the activities which are organised in the day centre also based in Ireland Lodge. One of the residents spoken with joined in the activities the other stated they preferred to stay in Care Homes for Older People Page 16 of 29 Evidence: their own bedroom and did not wish to join in the activities. Both of the relatives spoken with spoke of activities provided and both stated that that their relative had had the opportunity to go out on the outings. Both residents and relatives asked confirmed that their or their relatives lifestyle within the home is to their own choice and preference. Residents were observed to move freely around the home on the day of the site visit. Recent results from the homes own quality assurance and quality monitoring system identified that usually or sometimes were happy with the activities provided. Assessment documentation viewed recorded that residents are asked about their religious requirements and the Manager stated that staff will discuss and help facilitate any other requirements to meet individual residents spiritual needs. The Statement of Purpose details that a priest from a local church visits weekly and provides Holy Communion for those who wish to attend. The Statement of Purpose details that residents are free to have visitors at any reasonable time. Residents and the relatives spoken with confirmed there was flexible visiting that staff team are very welcoming, and they could see their relatives and friends in private if they wished. Recent results from the homes own quality assurance and quality monitoring system identified that all the carers felt they were made welcome when they visited the home and that visiting times are flexible enough for their needs. The care and support provided was observed to enable residents where possible to exercise choice whilst at Ireland Lodge. A good rapport was observed between staff of the home and residents. The two residents and two relatives spoken with stated that the staff assist them to maintain their independence with their daily living and daily routines and confirmed there is flexibility in their daily routine for example the time they get up in the morning and when they go to bed at night. A rotating menu is place, which identifies that choices available at all meals, and staff and residents all confirmed if they do not like what is on the menu there are always a range of alternatives. The Inspector sat with the residents in one of the lounges at lunch time and residents spoken with spoke well of the food provided and had selected a range of options for the meal. Lunch on the day was assorted fruit juices, pork casserole or leek bake and vegetables followed rice and sultana pudding. Special diets are catered for. Fresh fruit was available in the lounge and drinks and snacks are provided during the day. Some residents were observed eating their lunch in the dining room. It was a relaxed environment taking into account the different length of time that individual residents would need to finish their meal. Records are kept of food Care Homes for Older People Page 17 of 29 Evidence: consumed individually by each resident to ensure they are receiving an adequate diet and a sample of the records were viewed. The two residents and relatives spoken with were happy with the meals provided. Recent results from the homes own quality assurance and quality monitoring system identified that two residents felt the choices of food suited their taste and dietary need and one did not. Responses were varied when asked if the food was hot enough and about the portion sizes. The Manager stated that menus are in the process of being reviewed. Residents are actively encouraged to help themselves to snacks and drinks whenever they wish. There are three small kitchenette areas located throughout the home for residents use and one relative was able to confirmed the availability of this facility. Care Homes for Older People Page 18 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. Policies and procedures are in place to enable residents or their representatives to raise any concerns about the care being provided and to ensure that residents are protected from abuse. Evidence: A complaints policy and procedure is in place, and a copy of the procedure is available to view in the home, and which details how to make a complaint in the information provided to residents and their representatives. The Manager stated that two complaints had been received since the last inspection, both of which are recorded as substantiated and that the recording of complaints received is an area which it is intended will be further improved. The two relatives spoken with confirmed that they would feel comfortable in raising any concerns with staff in the home. Recent results from the homes own quality assurance and quality monitoring system identified that all of the carers and residents felt able to raise any issues that they were not happy about. There are policies and procedures in place in relation to the safeguarding of vulnerable adults. All the care staff spoken with all confirmed they had attended this training and demonstrated an awareness of the policies and procedures. 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. The home provides residents with a homely, clean and tidy environment. Evidence: The home is located in a residential area of Woodingdean within walking distance of bus routes. The homes layout consists of three units, with a day centre occupying part of the premises. All areas of the home are on ground floor and there is level access throughout the service. The Manager stated that there is an ongoing maintenance programme for routine maintenance. That a number of the residents bedrooms have been redecorated in the last twelve months, so that all the residents bedrooms have now been redecorated in the last two years, all the corridors and one lounge has been redecorated and recarpeted, three new televisions have been purchased and new plants and garden furniture purchased to improve the garden areas. That over the next twelve months it is planned to renew the internal courtyards guttering, redecorate and re-carpet another lounge and the reception area. A sample of communal areas and residents bedrooms were viewed during the inspection. The home is decorated and furnished in a homely style. Pictures and photos have been used throughout these areas as points of interest for residents and to assist with orientation. There are twenty-three single bedrooms. Although the majority of the residents are Care Homes for Older People Page 20 of 29 Evidence: accommodated for a short period a number of the bedrooms viewed had been personalised with some of the residents belongings. All bedrooms have an emergency call bell system. All of the bedrooms have en-suite facilities of a toilet and wash-handbasin. Communal bathroom facilities are provided in the home. The two residents and one relative spoken with confirmed they were happy with the bedroom they or their relative occupied and there is adequate heating and hot water in the home. There are a range of individual aids and adaptations to assist residents mobility and independence, including raised toilet seats, walking aids, grab rails, hoists and moving and handling equipment. There are three lounges with a dining area and a conservatory. The conservatory is used by residents who wish to smoke. Concerns have been previously raised about the smell of cigarette smoke in the adjoining lounge and dining area. The Manager stated that he is monitoring this to ensure that smoke does not permeate into the non smoking areas. Residents have access to two secure gardens. Staff spoke of recent purchases of plants and garden furniture to further improve the garden areas. There is a policy for the managing infection control and the deputy manager stated that she is a champion in infection control and is in the process of drawing up an action plan to deliver best practice in the prevention and control of infection. The home was clean and free from offensive odours at the time of the inspection. The residents and relatives spoken that the home was always fresh and clean. The care workers spoken with stated they had received infection control training and that there was good access to protective clothing, liquid soap and paper towels. A sample of records were viewed of routine fire checks which had been carried out in the home. 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 in the home with the skill mix of staff on duty. A robust recruitment process is in place to protect residents. Evidence: Information was sought from staff on duty and and a sample of staff duty rotas were viewed. On the day two care workers were deployed to work in each lounge in the home with a duty officer during the day. The Manager was on duty during the day, the deputy manager with the RMN. Further senior care officers were working in the home and staff working on the transitional care. There are ancillary staff who cover the domestic and catering tasks and administrative staff who cover the reception area and providing administrative support. Staff stated that care staff continue to do the laundry in the afternoons when the laundry person has finished their shift. The residents and relatives spoken with stated staff are available when they needed them. The Manager provided updated information on the number of care staff who hold a National Vocational Qualification (NVQ) Level 2 in care, which at the time of the inspection is eighteen care workers and two further care workers are working towards this qualification, six care workers hold NVQ Level 3 and one is working towards this qualification and two senior care officers hold NVQ Level 4 and the Registered Managers Award. One care worker spoken with stated she had just completed NVQ Level 2. Care Homes for Older People Page 22 of 29 Evidence: The documentation was viewed for two new members of staff, who had been recruited since the last inspection. This demonstrated the completion of an application form, one had one written reference in place the other had two references in place, there was a record of completed a Criminal Records Bureau (CRB) and or a Pova First check having been received. The Manager has subsequently confirmed that a second reference had been received by the organisation but which was not held in the home. The Manager stated that recruitment documentation was in the process of being audited ad made more accessible to ensure all the required documentation is available to reference. The Manager confirmed that the RMN is on secondment to the home from another trust, and that recruitment information for this individual has been requested and is now available to view. The Manager stated that induction for care staff meets the requirements of the Skills for Care Induction Standards. The file for one new care worker viewed had a record of an induction having been completed. One new care worker spoken with had not received this induction. This was discussed with the Manager who stated that this would be addressed and it would be ensured that new care workers receive this induction within the required timescale. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team have strived to create an atmosphere within the home, which is open, relaxed, homely and caring. Quality assurance systems are in place to enable ongoing feedback about the care provided in the home. Systems are in place to ensure a safe environment for staff and residents. Evidence: There is a new Registered Manager of the home Mr Neil Bain, who has achieved the Registered Managers Award, NVQ Level 4 in care, the Certificate in Management and a Foundation Certificate in Health and Social Care. The Manager is supported by a deputy manager and four senior care officers. Feedback received was that the Managers are friendly, approachable and always take residents concerns or comments about the home seriously. The Manager, deputy manager and the senior care officers spoken with stated they had an awareness of the Mental Capacity Act and the Deprivation of Liberty, and that no applications have been made under the Deprivation of Liberty. Care Homes for Older People Page 24 of 29 Evidence: A quality assurance system is in place and continues to be developed. It was evidenced that feedback about the service provided has been sought from residents through residents meetings and ongoing surveys. The information from the surveys are collated quarterly and the last quarters information of feedback from three residents and three carers is available to view in the home and is quoted in this report. A sample of minutes from staff and residents meetings were viewed and it was evident that both groups are given the opportunity to influence how the home is run. Clocks are being purchased for the home at the request of the residents following a recent residents meeting. A comments and complaints box is also located at the reception to enable comments to be made anonymously should people wish to do so. The Manager stated that policies and procedures are now in place for staff to reference and those which are specific to the home and within older peoples services have been reviewed. Not all the corporate policies and procedures have been subject to a review, but work is being completed to review and provide a comprehensive database for staff to access. A sample of records of visits to the home to meet the Requirements of Regulation thirty-six were viewed. The Manager stated that representatives from the organisation had also just undertaken a detailed audit of the home. Residents are encouraged to retain control of their own finances for as long as they are able to do so. Where residents money is kept in safe keeping a sample of the records held were viewed and were adequate. All the care workers spoken with confirmed and the sample of the records viewed evidenced they have regular supervision with their manager to meet requirements. Training records were not viewed on this occasion as they were in the process of being updated, The Manager stated that an audit is being undertaken of all the training that has been completed, that there is an ongoing rolling programme for training and updates of training and staff will be nominated to attend this where any training is not in place as required. Staff spoken with confirmed they have received the required training and updates in moving and handling, basic food hygiene, first aid and infection control within the required timescales. A detailed check of the environment had been completed and the Manager subsequently provided details of the maintenance of equipment and services which has been carried out. A sample of the risk assessments in place in the home were viewed. A sample of the records of the testing of the hot water temperatures at outlets accessed by residents to ensure these are being maintained at close to 43 degrees centigrade were viewed. Care Homes for Older People Page 25 of 29 Evidence: The Manager stated a fire risk assessment is in place, which has been reviewed. This was not viewed on this occasion. Records were viewed of regular checks of the fire procedures in the home, fire drills and training. Where one care worker spoken with had not attended a fire drill since they commenced working in the home, the Manager stated this would be addressed as further fire training was being arranged and it would be ensured that all staff would attend as required. A sample of recording was viewed of incidents and accidents, which had occurred in the home, which are monitored by representatives within the organisation. 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 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. © 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. 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. Re-publishing this information is in breach of the terms of use of that website. 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