Care Home: Katherine Lowe House

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What the care home does well People living in the home generally felt very well cared for. One person said staff were kind, another that they were brilliant and a relative described staff as devoted. We saw staff being warm, caring, considerate and helpful. People enjoyed good food, with choices, including hot ones, always available. Visitors felt they were made very welcome by friendly and helpful staff. All staff received good training and were well supported by the management team (who who described as approachable and always willing to listen). What has improved since the last inspection? All staff were now being polite and respectful, and made sure everybody received the help they needed or asked for. Health records were now clearer, helping to keep people well. We were now being told of any serious accidents and incidents in the home, allowing us to confirm the manager and staff were taking the right action to keep people well and safe. Mealtimes had improved. Changes to staff break times now made sure enough staff were on duty to help and medication was now given either before or after to avoid interupting the meal. Major redecoration work was currently being carried out, with the whole home benefting greatly. The local authority had kept numbers of people living in the home low so disruption was kept to a minimum. Improvements in fire safety meant everyone in the building was now safer. What the care home could do better: Improvements in care and medicine records would make sure staff have the guidance they need to look after people and there is accurate information about medicines being taken. There was still not enough social activities going on to keep people living in the home (especially those people with confusion) busy and stimulated. Whilst recruitment of new staff was generally done very well, some practices needed to improve to make sure people living in the home were safe. A lot of agency staff worked in the home. This meant people living there did not benefit from a permanent, stable staff team. Key inspection report Care homes for older people Name: Address: Katherine Lowe House Barton Road Urmston Manchester M41 7NL     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: Sarah Tomlinson     Date: 2 2 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 30 Information about the care home Name of care home: Address: Katherine Lowe House Barton Road Urmston Manchester M41 7NL 01617482844 01617475377 Rose.hargreaves@trafford.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Trafford Metropolitan Borough Council Name of registered manager (if applicable) Mrs Rosemarie Hargreaves Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Dementia - Code DE. The maximum number of service users who can be accommodated is: 45. Date of last inspection Brief description of the care home Katherine Lowe House is a local authority care home, owned and run by Trafford Social Services. It is registered with us (the Care Quality Commission) to provide specialist care for up to 45 older people who may have confusion (dementia). The home is a purpose built, 3 storey building with 2 lifts. It is divided into 8 separate Care Homes for Older People Page 4 of 30 45 0 Over 65 0 45 Brief description of the care home units, each with their own small lounge/dining room (with a kitchenette). Derrymore and Tatton units are on the ground floor; Blenheim, Balmoral, Dunham and Windsor on the 1st floor; and Sandringham and Woburn on the 2nd floor. There is a communal smoke room on the 1st floor. There are 37 single and 4 double bedrooms. All have wash hand basins (there are no en-suite facilities). There is 1 assisted and 1 unassisted bathroom on both the 1st and 2nd floors, and 2 assisted bathrooms on the ground floor. There is parking to the side of the home and an enclosed garden at the rear, overlooked by mature trees. The home is situated on a main road, immediately by Davyhulme Circle roundabout in Urmston. Local shops and bus stops are very close and in easy walking distance. The current weekly fees are £417.48 (hairdressing and toiletries are extra). A copy of our latest inspection report is kept in the homes entrance, with a summary on each unit. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Our inspection visit, which the home was not told about beforehand, took place over 1 day (lasting 11 hours) and was carried out by 1 inspector. (References to we and our mean the Care Quality Commission). During our visit we spent time watching how staff cared for people. We also talked with 6 people living in the home and with 2 relatives. A further 5 other relatives returned surveys that we had sent out before our visit. The views from these are also included in this report. We also looked around parts of the building and at some paperwork and talked with the manager, care staff and the cook. We have also used information from an Annual Quality Assurance Assessment form (AQAA). The manager has to complete this each year. It includes information about what they think they do well, what they would like to do better and what they have Care Homes for Older People Page 6 of 30 improved upon since our last visit. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 30 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will have their needs properly assessed before deciding to move in, so both they and the manager and staff team know in advance what their needs are and that they can be met. Evidence: At the time of our visit, 27 people lived in the home, with 18 vacancies. Places were provided on a long term, permanent basis (with no respite, intermediate or day care). Although the home could choose to offer all 45 of its places for people with confusion, it currently provided only 21 places for people with such specialist care needs. The home used to allocate bedrooms (with nearby lounges) according to need, with people who had greater confusion living in different parts of the home to people who were more mentally able. This had now changed and people of all abilities lived together across the home. At times during our inspection we observed the behaviour of more confused people irritating those who were more able. Care Homes for Older People Page 11 of 30 Evidence: Apart from several emergency, short term admissions over the Christmas period, no new people had moved into the home since our last inspection. This was due to a freeze on admissions. Initially in place because of uncertainty regarding the homes future, this had continued due to the major programme of redecoration work planned (which was now underway). Once this was completed the home planned to reopen to admissions, with the aim of returning to its full occupancy level of 45 people. The moving in process (which often involves leaving the family home where a person has lived for many years) can be overwhelming for some. The manager confirmed returning the home to full occupancy would be staggered so staff would have the time to offer support and to help new people settle in and adjust. The existing formal preassessment process would continue to apply. A new person would only be offered a place after the manager had obtained up to date, comprehensive assessment information and carried out an assessment visit to confirm the persons needs and wishes. The prospective new person and their family would then be invited to look around the home. Good practice was noted, as the manager was planning for this visit to include staying for a meal (plus an overnight stay if desired). This would enable the person to test out the home, helping them make an informed choice about whether it was right for them. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in health records and in care practices meant people living in the home received good, respectful care. However, occasional gaps in some records needed addressing to support this. Evidence: Due to their confusion, many people living in the home were unable to tell us what it was like to live there. However, we spent time watching how staff cared for people; we were able to speak with some people who told us their views; and we also received feedback from relatives. People living in the home were generally very positive about staff. One said they were kind, another that they were brilliant. At our last inspection we had seen mixed practice, with some staff being dismissive and disrespectful, and some basic care not provided. At this inspection, we saw no such poor practice. Staff were caring, friendly, patient and polite, and people living in the home appeared clean and were neatly and appropriately dressed. We did discuss staff fingernails with regard to keeping them short and not wearing artifical nails (to support hand hygiene and reduce the risk of Care Homes for Older People Page 13 of 30 Evidence: causing skin tears). Permanent staff had an excellent understanding of the help and support people living in the home needed and how they liked this to be given. Relatives also consistently confirmed people were well cared for. One relative commented how staff worked with dedication and respect. Another wrote staff were truely wonderful and devoted. However, several relatives were concerned about the high number of agency staff and how as a result, communication and care had at times suffered. We looked at the care files of 3 people living in the home. At our last inspection care files had generally been in good order, although some supporting records had not been clear (regarding daily care provided; monitoring of food intake; and health appointments attended). Changes had since been made to more clearly show this information. A further major change was planned with the introduction of a new care recording system. With regard to current care files, care plans and risk assessments were up to date and generally in good order. We were concerned an established serious risk issue for one person had not been documented. Although known by staff, there was no information about it in their file and no agreement about how to reduce or manage it. A more minor omission was the absence of guidance for staff for a person who frequently suffered with anxiety. There was helpful information about what triggered their anxiety, but no details about how staff should support them when it happened (e.g. what helped/didnt help). We looked at how medicines were handled. Suitable arrangements were in place. Only senior staff, who had received certificated training, administered medicines. Good practice was noted, as there was a specimin list of their initials (to identify who administered any given medicine). There was generally a clear audit trail of medicines entering the home, being administered and any unused medicines being returned to the pharmacist. Good practice was noted, as separate administration records were used for creams. This ensured accurate records as the person who applied the cream was the person signing the administration record. However, we found one persons controlled drugs (supplied by the district nurse) had not been entered into the CD register and consequently not disposed of. We also found some inaccuracies in the medicine administration records. There were gaps where a medicine had been given but not signed for, and two occasions when a persons medicine had been signed as being given when it had not been. Medicines were stored safely. The home had increased the number of medicines trolleys from 3 to 8 and secured these in the dining area of each unit. We discussed Care Homes for Older People Page 14 of 30 Evidence: whilst this improved access for staff, the trolleys were very noticable in what was otherwise a domestic setting. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was still not enough meaningful stimulation provided. This meant the social needs of people living in the home, particuarly the specialist needs of people with confusion, were not being met. Evidence: Care staff organised and carried out social activities. These took place in the afternoon, with a different activity in each lounge (ranging from games/puzzles, manicures, art, media group to bingo and physical games). Two people we spoke said they did not like the activities provided and chose not to join in. Each units daily activity was displayed on a noticeboad in its dining area. We discussed who these noticeboards were for, as some information was difficult to read and staff information was also displayed. A hairdresser also visited twice a week and Roman Catholic and Church of England services were provided. Good practice was noted, as staff supported several people to collect their daily newspaper from a nearby shop. In good weather people enjoyed sitting out in the enclosed garden and in the summer outings were organised. Most people living in the home were dependant on staff for social stimulation. As noted at our last inspection, we were again concerned not enough was being provided. Care Homes for Older People Page 16 of 30 Evidence: Most people sat in the communal lounges during the day. The televisions in these were on through-out the morning of our inspection, although they were often not watched. Staff explained they were too busy (e.g. making beds, doing the laundry) to carry out social activities in the morning. Three relatives felt there was a need for more stimulating activities (rather than just the televison, said one). We looked at the daily activity records for 3 people who had confusion. Entries were often not made and when they were, they showed no meaningful stimulation. For example, 2 people had only 4 and 6 entries respectively over the last 3 week period, all of which just said watching tv. A third person had 5 entries saying dozing in chair; 2 saying sat in lounge and only 1 described an actual activity (did a little physio). As well as formal, organised activities, we also discussed the benefits of developing more informal, domestic ones, plus having reminiscence memorabilia around the home. Care records had brief details of peoples personal backgrounds. Good practice was noted, as the manager was developing this further with new life story booklets. When completed, these would have much more detail, helping staff know more about a persons life and provide starting points for new activities and/or reminiscence work. Visitors felt they were made very welcome. Three relatives said how friendly and helpful staff were. Good practice was noted, as relatives were encouraged to personalise peoples bedrooms (e.g. with pictures and ornaments). With regard to how people were helped to make choices, individual preferences about what time people liked to get up and go to bed were now being documented. Regarding food choices, likes and dislikes were known by care and catering staff. People were also asked on a daily basis what they would like to eat. Good practice was noted, as 2 hot choices were provided at both lunch and tea time, with records showing alternatives were frequently provided. Three people said the food was good. A weekly menu was displayed on noticeboards in the dining areas. We discussed displaying a daily rather than a weekly menu and in larger print would be a more helpful. We joined people for lunch in one unit and observed some of lunch in another. Tables looked attractive and there was a calm and relaxed atmosphere, with people given plenty of time to enjoy their food. At our last inspection we had been concerned people were brought too early for their meals resulting in a long wait until food was served. A complaint had also since been made about not enough staff around to help at mealtimes. This complaint had been upheld, with staff break times now been Care Homes for Older People Page 17 of 30 Evidence: reorganised to ensure people received the help they needed. We discussed providing seating for staff so they could sit beside a person needing help. Good practice was noted, as the manager planned for staff to start eating with people as part of their duties (enabling them to assist discreetly and make meals a more social occasion). Special dietary needs were catered for, with low sugar and pureed meals provided. We discussed how the latter were currently served, as although pureed foods had previously been served separately (maintaining taste, texture and appearance), they were now mixed together. Fresh fruit continued to be offered on a daily basis. With regard to staff training, the new cook was due to renew her food hygiene certificate and care staff confirmed they were trained in the management of choking. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home were generally very well protected from abuse or harm. However, this was put at risk by some recruitment practices. The new recording system for informal complaints may also deter people from raising concerns. Evidence: Information about how to make a complaint was usually displayed around the home. This had temporarily been taken down due to the redecoration work. People living in the home and relatives confirmed they knew how to complain. At our last inspection we had advised informal as well as formal complaints should be recorded (to provide an audit trail showing how all concerns were taken seriously and acted on). Staff were now asking people if they wanted to complete a form when making an informal complaint. None had chosen to do so. We discussed most people would probably not wish to formalise an informal complaint and asking them to do so may also deter them from raising other future concerns. We discussed staff could instead separately complete a record of informal issues raised. With regard to formal complaints, none had been received by us since our last inspection. As noted one (upheld) complaint, regarding the lack of staff assistance at mealtimes, had been received by the home. Action had been taken to put things right and prevent it happening again. Care Homes for Older People Page 19 of 30 Evidence: With regard to safeguarding alerts, staff were now correctly informing us of any safeguarding referrals they made. There had been several minor incidents between people living at the home, but no instances of abuse had been found. Good practice was noted, as all staff (including domestic and catering staff) completed very comprehensive abuse awareness training. We discussed the need to improve some staff recruitment practices. We found gaps in 2 peoples employment histories had not been explored and more suitable referees for 2 people not requested. We discussed the new Deprivation of Liberty Safeguards, which include a new legal role and responsibilities for care home managers. Good practice was noted, as the manager had attended training about the new safeguards (which apply particularly to people with confusion). Management staff confirmed no person living in the home was currently being deprived of their liberty. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Extensive refurbishment work was greatly improving the building, with people benefiting from a better decorated home and improved access to the garden. Evidence: At our last inspection we had been concerned the home was still badly in need of redecoration. The decision to upgrade the building had been on hold during the local authoritys review of its older peoples services. This was now completed and funds had been allocated for the homes refurbishment. Work had started several weeks ago. All areas including communal rooms, hallways and bedrooms were being redecorated; the flooring on the middle floor was being replaced; and a new exit into the garden from Derrymore lounge created. Where possible, people had been involved in chosing the colour schemes for their bedrooms. Good practice was noted, as wallpaper continued being used to help make the building more homely and comfortable. As a result of the redecoration work the building was now bright, welcoming, attractive and comfortable. Domestic style furniture continued to be used (including domestic units to discreetly store continence products in toilets) and wallpaper borders in bathrooms to help them seem more homely. With regard to how the home maximised peoples independence, there was a wide Care Homes for Older People Page 21 of 30 Evidence: range of aids and adaptations. These included fingerguards on all doors; handrails on both sides of the wide corridors with heavy fire doors held open automatically; lowered light switches and raised electric sockets; dining chairs with glide rails and arm rests; and easy to use locks on bedroom doors. There were also assisted bathrooms, and toilets had grab rails and lowered wash hand basins and mirrors. There were 2 rise and fall beds. Hoists and bed rails were available if needed, with the latter only used after a formal assessment from the local authoritys moving and handling assessor. We discussed adaptations made to meet the specialist needs of people living in the home with confusion. With regard to the current refurbishment work, the manager had been advised to have door frames and doors in contrasting colours. Most doors already had identifying signs. We discussed the height of bedroom name plates as these were very high and therefore not useful as a memory aid for most people. The manager was planning to personalise bedroom doors with further items. We also discussed having domestic style single day-to-view calendars in lounge or dining areas. Good practice was noted, as the manager planned to display a photo rota in each lounge, helping people (and their visitors) know who was on duty. We identified two repair issues during our visit - the permanent gazebo/sun canopy in the garden was broken (the manager confirmed this was repaired the day after our vist); and the carpet in Derrymore lounge was marked with cigarette burns and needed replacing. There were fluorescent lights in some of the dining areas. We discussed consideration should be given in the future to replacing these with more domestic lighting (more in keeping with the rest of the lounge/dining room decor). Raised beds in the garden would also allow people get involved in gardening, particularly if they used a wheelchair. The home was very clean and tidy. This was confirmed as usual by several visitors. One relative had told us about a constant smell of urine. However, we found communal areas smelt fresh. Good hand hygiene was generally maintained with liquid soap, paper towels and pedal operated bins in toilets and bathrooms. However, there was no liquid soap or paper towels for staff to use in peoples bedrooms. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The high use of agency staff meant people living in the home did not benefit from a stable and consistent staff team, and put at risk the staff teams ability to meet peoples needs (especially those with confusion). Evidence: The care staff team consisted of the manager, residential officers (who acted in a deputy manager role), senior carers and carers. Good practice was noted however, as communication within the staff team was supported as all day shifts overlapped, enabling handovers to take place. However, night and day shifts did not, with only an informal system in place to pass on information. During our inspection, enough staff were on duty to meet most of the needs of people living in the home. However, as noted peoples social care needs were not being properly met. As also noted, staffing levels were being maintained with high use of agency staff. The manager was aware this was not conducive to continuity of care and tried to lessen the impact by requesting the same agency staff. After previous difficulties with some agency staff, permanent staff were also encouraged to raise any concerns about an agency staff as soon as possible. Also, an induction file had been put together for new agency staff to read through at the start of their first shift. Such use of agency staff was due to a high number of vacancies (1 senior and 6 day Care Homes for Older People Page 23 of 30 Evidence: carer posts) and high sickness levels. Regarding the former, the manager was not able to fill these due to a recruitment freeze. The manager was hoping vacancies may be filled through redeployment but this had not been confirmed and no date had been given when this may occur. With regard to the latter, this was now being more actively managed and was reducing. The impact of the staffing situation was also lessened due to the homes reduced occupancy. However, as soon as the refurbishment finished the home was to open to admissions again. We discussed night staffing levels, which consisted of 2 waking night staff, plus an officer sleeping in. This was the usual level (existing before the reduced occupancy) and we had concerns about its adequacy when the home returned to full occupancy. Following a review of job roles last year, the manager was also waiting for changes to staff duties and hoped this would bring about positive changes. For example, replacing the sleep-in staff member with a 3rd waking night carer; laundry and bed making tasks taken from care staff; and the appointment of an activities co-ordinator. However, these changes had not been confirmed and no date had been given for their implementation. We looked at 3 recruitment files of new staff who had been employed prior to the recruitment freeze. These were generally in good order, with appropriate checks, proof of identity and interview records in place. However, as noted, we were concerned satisfactory information had not been obtained to confirm applicants suitability. The manager was aware of the new forthcoming additonal legal requirement for staff to be registered with the Independent Safeguarding Authority. Staff received a good range of mandatory training, including moving and handling, fire safety, equality and diversity, and health and safety. Service specific training was also provided with dementia care and challenging behaviour courses. We discussed about developing this further, with on site training to meet the needs of people living in the home (e.g. Parkinsons; learning disabilities; alcohol misuse; and anxiety training). New staff completed a practical induction checklist and the Skills for Care induction workbook. With regard to NVQ, good practice was noted, as the manager confirmed 85 of staff had at least the level 2 award. The local authoritys commitment to staff development was demonstrated by senior carers being supported to achieve the level 3 award and officers the level 4 award. However, agency staff also need to be included in the homes NVQ numbers. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and staff working there benefited from a well managed home, with improvements in fire safety practices and procedures keeping them safer. Evidence: The manager of the home was Rose Hargreaves, who had been registered with us since 2003. Mrs Hargeaves had over 20 years experience of managing older peoples care homes and had an NVQ level 4 award in care and the Registered Managers award. She updated her skills, knowledge and competence and now exceeded the qualifications we expected of a manager by recently achieving an NVQ level 5 award in leadership and management. With regard to how staff were supported, new carers worked alongside existing staff for their first few shifts and had regular, formal probationary review meetings. Existing staff were supported by regular, individual supervison meetings. The manager worked hard to ensure all staff (including night and agency staff), were kept up to date about changes in the home and general information sharing. Team meetings had been tried Care Homes for Older People Page 25 of 30 Evidence: but as they were not well attended (despite staff being paid for their time and meetings held at different times), the manager currently spoke to staff in small groups during their shift. Staff confirmed they got to know what was going on and consistently said they felt very well supported by the management team who they said were approachable and always willing to listen. With regard to how the home monitored the quality of its service, the manager had confirmed the monthly quality monitoring visits we require were carried out by a senior manager within Social Services. As noted, formal complaints were also responded to with remedial action taken. The views of relatives were sought via focus groups and annual anonymous satisfaction surveys. The manager was currently reviewing the survey questions to gather more useful information. We advised feedback from other involved groups and people should also be sought (e.g. district nurse teams; social work and community mental health teams; GP practices; chiropody/podiatry service; pharmacy). With regard to safe working practices, accident records were being completed appropriately and we were now being informed of serious accidents. We discussed developing a system to provide an overview of all accidents in the home, allowing the manager to identify any patterns and ensure remedial action was taken. Money was only held on behalf of one person living in the home. This was kept safely, with clear transaction records. At our last inspection we had concerns about fire safety, with some automatic fire doors not closing properly and poor procedures to ensure staff safety in an emergency. A range of improvements had since been made. As noted, there was a new induction file to guide agency staff visting the home for the first time. Agency staff also took part in fire drills; new weekly checks had been introduced to ensure all fire doors were closing safely into their rebates; and all recommendations from the local authority fire safety officer had now been completed. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must contain 30/07/2010 details of serious risk issues, including the agreements reached about how these will be managed. To provide guidance to staff. 2 9 13 Medication administration records must be completed accurately. To show medicines can be accounted for and people are being given them as prescribed. 30/07/2010 3 12 16 More frequent and a better range of social activities must be provided. To meet the social needs of people living in the home, particularly those with confusion. 30/09/2010 4 18 19 Satisfactory references must 30/06/2010 be sought and any gaps in employment explored. Care Homes for Older People Page 28 of 30 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 To protect people living in the home. 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 16 The system for recording informal complaints should be reviewed again (so useful information is available for audit purposes, whilst also not deterring people from raising their concerns). To support hand hygiene, liquid soap and paper towels should be provided for staff in bedrooms. To ensure night time care needs will be met, the adequacy of night time staffing levels should be monitored as the number of people living in the home increases. The high use of agency staff should stop as soon as possible to enable people living in the home (particulalry those with confusion) to receive better continuity of care. To develop the homes quality assurance system, feedback should be sought from as many community stakeholders as possible. 2 3 26 27 4 27 5 33 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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