Care Home: John Dando Residential Centre

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What the care home does well We heard from people that live at the home that staff provide a service that offers good standards of care, and is pro active in encouraging the involvement of community health services. Staff are friendly and the service is active in encouraging individuals to express their views. Information about the service is freely available prior to people moving into the home. The home provides ample privacy, with all single room accommodation. There is a range of adaptations and aids that assist with the promotion of independence and choice for individuals. What has improved since the last inspection? Individual plans have improved, these now available in an easy read format. Medication practice has improved with better recording and storage seen. Staff have a better understanding of adult protection and how to promote safeguarding, this supported by recent training in this area. There has been further improvement to enhance infection control, through the fitting of hand wash facilities in the laundry and hand wash signs put on display. Systems for consultation with people using the service have improved, with more meetings and reviews, this better informing management of areas where they can improve outcomes for people using the service. There is now an additional sitting area available for visitors, this providing a pleasant private area. What the care home could do better: Whilst there has been improvement in respect of care planning more care needs to be taken to ensure that information recorded is accurate and reflects individuals current needs and how care is provided. The potential range of fees for the service need to be made available in the homes statement of purpose. There is still some scope to improve some specific recording in respect of medication management and there is a need to ensure the contracted pharmacist carries out regular audits. There is scope to improve the frequency of activities and stimulation available to individuals living at the home. Records of monies for individuals coming to the home for short stays need to be betterdocumented. Night staff need more regular involvement in fire drills. Inspecting for better lives Key inspection report Care homes for older people Name: Address: John Dando Residential Centre Hamstead Road Great Barr Birmingham B43 5EL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jonathan Potts     Date: 1 8 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home Name of care home: Address: John Dando Residential Centre Hamstead Road Great Barr Birmingham B43 5EL 01213577574 01213579425 bhellend@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sandwell Metropolitan Borough Council Name of registered manager (if applicable) Ms Tracey Elizabeth Lewis Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home John Dando is located in Great Barr, close to the Birmingham/Sandwell border. It is situated in a residential area, a school, community centre, library, pub and small shops are all close by. Bus routes are available locally enabling access to other local areas and facilities. The home is owned and managed by Sandwell Council. The home comprises of two floors, providing thirty-nine single bedrooms. Internally the home is divided into four sections or units. Three sections or units are on the ground floor and one big section/ unit on the first floor. All of these different sections/ units have their own toilets, an assisted bathroom, lounge, dining and individual resident accommodation. There is one main laundry. The main kitchen prepares, cooks and serves all food for the individual units within the home. The home is registered with Care Homes for Older People Page 4 of 32 care home 39 Over 65 20 19 0 0 Brief description of the care home the Commission for Social Care Inspection ( CSCI) to provide personal care to a maximum of 39 older people. Twenty of these places are allocated to service users who have a diagnosis of dementia, Nineteen to older people who do not have other needs. The fees for this home are not currently available in the Statement of Purpose and the home should be contacted for details. Additional charges apply for the following; toiletries, newspapers, dry cleaning , the hairdresser and private chiropody. Care Homes for Older People Page 5 of 32 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: In making a judgment about John Dando we reviewed all the information we have received about the home over the period since the last key inspection. This included formal notifications the home has sent us as to incidents affecting the well being of individuals, the Annual Quality Assurance Assessment (AQAA) completed by the acting manager, and questionnaires completed by individuals living at the home and others. We also visited the service on two occasions (initially on an unannounced basis) to look at records (relating to care and management), talk to individuals living at the home as well as management and staff. We also toured the building. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Whilst there has been improvement in respect of care planning more care needs to be taken to ensure that information recorded is accurate and reflects individuals current needs and how care is provided. The potential range of fees for the service need to be made available in the homes statement of purpose. There is still some scope to improve some specific recording in respect of medication management and there is a need to ensure the contracted pharmacist carries out regular audits. There is scope to improve the frequency of activities and stimulation available to individuals living at the home. Records of monies for individuals coming to the home for short stays need to be better Care Homes for Older People Page 7 of 32 documented. Night staff need more regular involvement in fire drills. 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 set out 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 8 of 32 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 9 of 32 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. Individuals who may be looking to live at John Dando, and their representatives, are able to access sufficient information so as to decide as to whether the home is able to meet their needs. Evidence: The acting manager has told us in the annual quality assurance assessment (AQAA) that the home provides prospective individuals moving into the home with a statement of purpose and residents guide that provides a range of information on the home. This we saw was the case when we visited the home, with copies of the same freely available and people we spoke to told us they had been given booklets at the point of admission or prior to this. We saw that some effort has been made to make the residents guide more user friendly with the use of images to break up written information. The information contained within the document covers that which we would expect to find such as the aims of the home, information about staffing, meals, Care Homes for Older People Page 10 of 32 Evidence: visiting arrangements and such like. The only gap in the information available in the statement of purpose and service users guide was the current range of potential fees for the service, this so that people know what it could possibly cost them. We have been told that copies of this information can be made available in other languages if needed. We received 9 comment cards from people living at the home and seven told us they had enough information before moving into the home, six said they had received a contract and 3 spoke of their relatives visiting the home prior to their admission to check it out on their behalf. From sight of assessments completed on four individuals living in the home we saw that assessments of their needs were robust and drew information from other sources at the point of admission and through an on going review process. A number of beds within the home are allocated to respite and short term stays and in cases individuals may have had prior involvement with the home. We saw from case files sampled that the assessment process is applied to short term stays as would be the case for a permanent admission unless emergency input is required. In cases of the latter reviews are held shortly after admission. We did have some limited comment from staff via comment card that the information as to temporary admissions could be better, although from records we saw for those whose care we tracked there was sufficient information available to compile formative care plans. We noted that it is the homes policy to hold 72 hour reviews (after admission) where this is necessary for such as emergency admission, where there may not have been time for staff to have carried out a full assessment. Care Homes for Older People Page 11 of 32 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. People receive effective personal care that reflects their individual needs and access to health services is timely and appropriate. Care is provided in a way that respects the individual although care planning could in cases be more accurate. Evidence: We saw that the home has developed its approach to care planning with the introduction of pictorial care plans, this an easier to understand version of the more detailed care plans that staff complete to run alongside these. The easy read plan covers personal care, diet, senses, health, sleep and sexuality. The main written care plan was seen to build on the detail within this to include reference to such as communication where we saw clear information as to how staff could communicate, with involvement of such as relatives, observation of non verbal cues and such like. Observation of staff indicated that they did follow up on the latter. We saw that care plans are supported by detailed risk assessments, which with some exceptions (see below) reflected detail in the care plans. Care Homes for Older People Page 12 of 32 Evidence: Overall the care objectives for individuals in the four care plans we checked are clear and from discussion with some individuals matched what they told us, although we did note that the detail relating to personal requirements for social stimulation could be better. We also noted that there are areas where recording could be better examples including; moving and handling instructions that did not fully match how staff transferred an individual (documentation stating that they were unable to weight bear). We saw staff encourage independence when they encouraged the transfer of this individual with verbal encouragement. We also saw that a care plan for a diabetic did not carry detail as to the actions staff should take if there was an instance of hypo or hyper glaecemia. We have seen that the management have identified the need for staff to improve recording, and the acting manager is looking at developing care plans further so as to encompass social care needs in greater detail. Some of the staff told us about the dementia care mapping training they had attended, and incorporation of this into the homes assessments and care planning would be seen as a positive step in building on the strengths of the homes dementia care service, this to utilize the skills and knowledge that staff have learned. Discussion with individuals living at the home identified satisfaction with the quality of personal care that they received. 7 out of 9 people that responded to our comment cards stated they received the care and support they needed, this included medical support. None said they did not receive this support. Comments we received include the following: staff do their very best to help and act to what we like, staff are always here to help and are always been quite courteous and understanding and district nurse always come in time, the staff members are lovely to look after us. This reflected our observation of the staff where we saw that they encouraged and supported individuals in an appropriate and timely manner, showing respect and consideration in regard to their individual abilities. We saw that records in respect of individuals involvement with health care services showed appropriate and timely access. We saw that the home has an efficient medication policy that is supported by procedures and practice. Based on review of the requirements relating to medication we made at the time of the last inspection there has been a noted improvement in this area. We found better recording and storage in place although there are areas where improvement is still needed. We saw that there was omission in booking a controlled drug in (although we did see evidence of the number received but not in the controlled drugs book) and care plans did in one instance not reference the need to take medication prior to food (although staff spoken to were aware of this need). We also Care Homes for Older People Page 13 of 32 Evidence: noted that there has been no audit of the homes medication systems by the contracted pharmacist since early in 2007, this well overdue. The manager in discussion was clear as to the training needs for staff and showed us evidence of targeting input so as to provide this input, this including dementia care, medication and nutrition. Care Homes for Older People Page 14 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social, educational, cultural and recreational activities sometimes meet the expectations of individuals although staff do promote individuals choices about their day to day life. People are usually satisfied with the choice of foods available to them. Evidence: People we spoke to at the home told us that they liked their life there and assessments/care plans that we looked at identified individuals personal preferences (including such as religion, likes dislikes etc) although people in the comment cards said that activities were only usually available (7 out of 9 received). This has been identified as an area that needs development by senior management in their monthly visit reports. Comments we received about activities in comment cards included such as activities not like it used to be, activities not happened for 4 months. We did see staff offering some activities during our visits however, this something we saw people enjoying. People we spoke to during the visits to the home said that the activities available were acceptable but commented about the lack of bingo. What does need to be considered is the fact that many of the people living at the home have dementia, and therefore need more support to participate in meaningful day to day activities. We also received comment from staff indicating that activities could be Care Homes for Older People Page 15 of 32 Evidence: better, staffing levels a possible factor as one member of staff on a unit (with a floater between units) is insufficient to allow them time to actively encourage individual stimulation. Based on records of activities as recorded by staff this shows these do not take place on a daily basis. There was little evidence to show that staff document individual activities people are involved with. As stated previously there is also a need to focus on what stimulation is appropriate for the individual in their care plans. In discussion with the acting manager she made us aware that the she is fully aware of these issues and is keen to address them, with suggestions made including the possible employment of an activities organizer. The homes procedures highlight how the home will involve relatives and significant others in the life of the individual and they are actively encouraged to support people through admission to the home and in their day to day life. We saw that there are facilities available for visitors to make themselves drinks and space is available for visitors to meet with individuals living at the home in privacy. We noted that the views of carers and others are considered within the homes assessment processes and reviews of care. The homes statement of purpose contains information for people to read on advocacy and the acting manager saw one of the areas for development the promotion of rights for all individuals. We discussed the possible impact of the deprivation of liberty safeguards and a number of staff have attended training. The acting manager was aware of the challenges this may present when considering safety against the need to encourage self determination. People told us that they usually enjoy the food provided by the home and we saw that people are offered a choice, these documented by staff. We saw the meals as they were served, these plated up by the staff that work on the units the people live on. These meals looked appetizing and we saw that staff took the time to offer alternatives that people liked. Individual plans detail the specific requirements of people in respect of how their food is presented and we were told by some people how this was followed into practice, for instance provision of soft diets. We saw from observation that staff are available to assist individuals as needed at meal times. We also saw that the home has attained a Five for life award. The home has a set menu that has been formulated by the local authorities catering service, and the acting manager did discuss her wish to adapt this further to reflect local flavors. We saw from residents meetings that the menu is a matter that is discussed so as to gain peoples views of the foods offered to them, with changes made to reflect these comments. We noted that time is taken to make meal times special by the staff paying attention to such as the laying of tables, these well presented and having flowers to aid this Care Homes for Older People Page 16 of 32 Evidence: presentation. Care Homes for Older People Page 17 of 32 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. People who use the service tell us that staff listen and respond to what they say, this assisted by access to a robust and effective complaints procedure. Staff awareness as to how to protect people has improved. Evidence: We saw that the home has a robust complaints procedure with information available in the homes foyer in leaflet and poster format, this also available in a number of languages. Out of the 9 responses we received to our comment cards 8 stated that staff listened to, and acted upon what they said. Only 5 said they knew how to complain though, 4 stating they did not, only one saying they did not know who to speak to. Whilst the home as stated did have complaints information available in the reception area, access to this for individuals living at the home was in cases limited due to the locked key padded doors. It was suggested to the acting manager that complaint information in each unit may assist peoples access to it. Individuals we spoke to all said that they had no complaints, and if they did they would speak to staff or relatives. We saw that the home had policies and procedures available in respect of safeguarding adults and the staff we spoke to had a good understanding of what they should do if such issues arose. Based on recent practice the staff understanding has improved with incidents relating to aggression between individuals now been referred as safeguarding Care Homes for Older People Page 18 of 32 Evidence: alerts, this indicating that recent training for staff in adult protection has proved effective. We have noted that the staff have understood the need to notify us of any issues that have the potential for affecting an individuals wellbeing. Discussion with the acting manager showed us that she has an excellent understanding of safeguarding and she spoke of ways in which she wanted to promote this, through staff supervision, meetings with residents and such like. In addition we were told by the acting manager that she wishes to promote deprivation of liberty safeguards due to the mental frailty of some of the individuals living at the home, and one of the issues identified was to review the use of locked doors and how this impacted on decision making. Care Homes for Older People Page 19 of 32 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. People that live in the home have access to a safe and well maintained environment that provides for their needs and has facilities for the promotion of independence. Evidence: John Dando is a large detached purpose built home that has been open a number of years. There have been efforts made to break down the living units to a more manageable and homely size, this meaning there are a number of wings on the ground floor (this accommodating the service for individuals with dementia) and a space on the first floor for the continuing care and respite units. There is also a daycare unit separated from the main living areas, although the space this offers is useful when it can be used for social events outside of daycare hours. We were made aware by the acting manager that there are plans to develop the unit so as to offer intermediate care in conjunction with the health authority, with the possibility that the daycare provision at the home may cease. It was stated more definite proposals will be forwarded to us as needed. From a tour of the building we saw that the environment is reasonable maintained and there have been efforts to brighten parts of the home with items of interest (such as pictures completed by people living at the home) these making interesting focal points. It was therefore disappointing to see that some of the lounge/dining areas on the Care Homes for Older People Page 20 of 32 Evidence: ground floor presented as quite bland. This was in contrast to such as the hairdressing room which has been decorated to resemble a hairdressers shop, this down to the sign outside the door. We saw a number of bedrooms and these were decorated to a reasonable standard and a number showed evidence of people having their own personal possessions within them. We saw that the home also has an attractive, enclosed garden area which is easily accessible from the ground floor, this containing such as raised flower beds, tree ornaments and benches. There are a number of areas where people can sit for privacy and a further area has been created in the sun lounge, where individuals can sit and relax away from the main living area. We noted that there is also a designated smoking area for individuals should they wish to smoke. From a tour of the building we saw that it was generally well maintained and from sight of servicing documentation, safety checks (some carried out by the homes handyman) and records of repairs we saw that equipment and the fabric of the building was kept to a safe standard. We saw that the home has numerous adaptations in place including floor level showers, hoists, adapted baths, handrails in corridors, adapted toilets and such like. This allows individuals to have a choice of facility that suits there individual choice and abilities. From our tour of the building we noted that it was clean throughout and there was no evidence of any unpleasant odours. We saw in bathrooms that there was liquid soap and paper towels readily available as well as personal protective wear for staff (i.e single use latex gloves). The home now has hand wash signs on display in numerous toilets/bathrooms, these a timely reminder for all that use them. We saw that the laundry was exceptionally clean at the time we saw it and cleaning records relating to this area we saw to be well maintained. A sink for hand wash purposes has now been fitted in the laundry. The availability of dedicated laundry staff is advantageous, and discussion with one of the laundry staff indicated that they are knowledgeable as to what they needed to do to promote infection control. There is still an issue in respect of staff receiving infection control training, this a matter the acting manager was aware of, showing us evidence of training booked. Outcomes do indicate that infection control is well managed however, this view supported by 7 people living at the home telling us in questionnaires that the home is always fresh and clean ( this out of a total of 9). Care Homes for Older People Page 21 of 32 Care Homes for Older People Page 22 of 32 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. People tell us that staff are available to support their care needs and they have confidence in the staff. The management are pro-active in identifying staff training needs so as to promote staff skills and knowledge. Evidence: When visiting the home we examined the staffing rotas and found these to be accurate based on the staff we saw on duty at the time of our visits. Staff are allocated to specific areas in the home, for example there is usually one member of staff allocated to each wing on the ground floor (dementia care units) with a floating member of staff at times. There are separate staff allocated to the continuing care and respite units on the first floor. There are a number of ancillary staff including domestics, laundry assistants and catering staff, this meaning care staff are involved with direct care during daytime hours. The care staff are supported by the additional senior staff who carry out tasks such as administration of medication and when needed will become involved in care tasks. Comments we received from people using the service indicated that staff are available when needed. Out of 9 responses to our comment cards 8 stated that staff are available when needed with comments such as I would like to say that I get as much Care Homes for Older People Page 23 of 32 Evidence: attention as the staff can give me, We shout and staff come running in a nice way. People we spoke to the day of our visits also told us that staff are available when needed for such as assisting to the toilet. Comments we received from staff varied however with comment such as staffing is not always correct to fulfill the residents needs as we maybe short staffed on some shifts, Sometimes we could do with more staff, because if you want to interact with service users 2 carers are not enough and If we need to go off the floor for anything the other person has to do the caring, we need a floater to relieve the other person. Discussion with the acting manager did show that there are some staff vacancies, and the home has had to hold these open due to redeployment of staff from other local authority homes that are closing. We have been informed that these posts will soon all be filled and issues in respect of having to employ such as agency staff to fill gaps in staffing levels will continue to lessen. There is however indication that whilst people are satisfied with the level of care consideration does need to be given to allowing sufficient planned time for staff to interact with people outside of the times they are providing direct care to raise the levels of stimulation available, this of critical importance for those people with dementia. We have looked at the homes recruitment procedures and found that these are robust, although due to the home not having employed any outside staff since the time of the last inspection we had limited evidence of recent recruitment practice. Based on discussion with the acting manager we are aware that she is knowledgeable as to the process that should be followed so as to protect vulnerable adults. Based on the homes training records we saw that there are gaps in provision of training, discussion with the acting manager indicating that she was fully aware of these and was targeting training courses to fill these gaps. The courses identified for initial booking including accredited dementia care training, infection control, health and safety, nutrition (for catering staff) and medication ( this for care staff, we saw that most seniors, managers held accredited training). The homes training records indicated that there are gaps in core areas of training such as moving and handling, food hygiene and first aid. We also noted that this indicates a drop in the number of staff with a vocational qualification (NVQ 2) to below 50 . This conflicts with the information we saw in the AQAA and following discussion with the acting manager we have been told that the training records that we saw are inaccurate, and we have been informed that these have been updated since our visit. The acting manager verbally confirmed what she said in the AQAA that nearly all care staff hold an NVQ level 2 in care and the necessary mandatory training. From observation of the staff during the course of our visits we did see that they had a Care Homes for Older People Page 24 of 32 Evidence: positive approach to the people living at the home, and the way they interacted was respectful and appropriate. This view was supported by comments that we received from people living at John Dando. Care Homes for Older People Page 25 of 32 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 of the home is supported by a strong management structure and effective quality systems that are assisting with the identification of how to improve outcomes for individuals living at the home. Evidence: The home currently has an acting manager that is experienced and suitably qualified whilst the registered manager is on extended leave. She is supported by an experienced senior team. The acting managers supervision is overseen by senior managers who have extensive experience of management in the social care sector, with regular management visits seen to be undertaken to monitor the quality of service provision. Areas of responsibility are delegated to seniors within the management team, and discussion with those on duty showed a clear understanding of the areas each had responsibility for. The management team also has administrative support from a Care Homes for Older People Page 26 of 32 Evidence: clerical support worker based at the home. The home has been accredited by ISOQAR in respect of its quality assurance system, this to ISO 9002. We saw that the home uses a range of methods to ensure that peoples views are gained this through meetings, individual reviews and questionnaires. The home also has set systems in place for quality monitoring of systems, these sampled by us and generally seen to be up to date. Discussion with the acting manager did show that she had a good understanding of where the home needed to develop, these areas mirroring those we found such as staff training, record keeping, improving activities and such like. Based on the what the manager told us, and the fact that there has been improvement in the service since the last inspection we are confident that these areas will be addressed in reasonable timescales. In addition the acting manager was looking at how the service needs to develop to meet the challenges of its proposed development to providing intermediate care, this fitting in with the overarching aim of the provider to target provision of more specialist services. We saw that the home has good procedures in place for the safeguarding of individuals monies and valuables but on checking the monies for four individuals we did find some discrepancies in recording for those in temporary accommodation. We did verify that the monies in safekeeping and any expenditure was accurate, although the audit trail for this could be clearer, this due to the fact that records of monies that are kept for permanent residents are not kept for those on temporary stays. The keeping of such would be advised as those we saw for permanent residents are accurate, well recorded and easy to track. We saw that inventories of individuals property are routinely maintained and reviewed. Overall we saw that the home has good systems in place to monitor the providers health and safety requirements, with this supported by the home having achieved a GOLD award in respect of food safety from Environmental Health. There are routinely implemented safety checks on the building and equipment carried out by the handyman and we saw robust monitoring of accidents is carried out, this not indicating any particular trends from those we sampled. There are however issues in respect of staff training in core areas such as first aid, food hygiene and moving and handling based on the training matrix which we believe to be inaccurate, this meaning gaps in training provision are not as extensive as first thought. Discussion with the acting manager since the visit to the home indicated that the training records have now been updated and were inaccurate at the time of our visit, and the only area of training in safe working practice necessary is infection control (as we saw was planned). Care Homes for Older People Page 27 of 32 Evidence: We also noted that fire drills, based on records kept by the home, has not been provided to the majority of night staff in the last six months. This would seem to be due to the fact that these drills are carried out by the handyman who only works during the daytime. Care Homes for Older People Page 28 of 32 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 29 of 32 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 1 1 To provide information in the Statement of Purpose as to the possible costs to the individual for residency at the home. To ensure that there are no inconsistencies between information in care plans and risk assessments and staff practices. To ensure that care plans for diabetics carry detail as to what staff need to do in the event an individual has a hyper or hypo glaecemic episode. To develop the homes care plans and assessments in accordance with dementia care mapping. To ensure that controlled medication is documented in the controlled drugs book on receipt. To ensure that the contracted pharmacist carries out regular audits on the homes systems for control of medication. To ensure that there is clear instruction in care plans or similar in respect of ensuring medication is given as prescribed (for example before food). 2 7 3 8 4 5 6 8 9 9 7 9 Care Homes for Older People Page 30 of 32 8 12 To better identify in care plans individuals specific and chosen pastimes and social needs so as to promote individual activity. To promote the development of activities relating to dementia care and consider the employment of an activities co-ordinator. To ensure that easy to track records are in use to record any monies temporary residents have in the home. To ensure all night staff have regular involvement in fire drills. 9 12 10 11 35 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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