Care Home: Keldgate Manor

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What the care home does well People have a thorough care needs assessment before any decision is made about their admission to the home. Managers always visit prospective residents as part of the admission process. People tell us that their privacy and dignity is respected by staff, and there is evidence that independence is promoted and supported. Meal provision at the home is good - people have a three course meal at lunchtime and there is a variety of choices recorded on daily menus. People with a poor appetite are prescribed food supplements. Visitors are made welcome at the home and people are encouraged to take part in a variety of activities. The home is well maintained and is decorated and furnished in a homely way. There is ample access to sunlight and there are extensive gardens for people to enjoy. The home is clean and there are no unpleasant odours. Staff observe good hygiene practices that reduce the risk of cross infection. There are sufficient staff on duty to meet the needs of the people living at the home. Staff receive good induction training and are then offered various training opportunities to ensure that their practice is kept up to date. Money kept at the home on behalf of people who live there is held securely. What has improved since the last inspection? There is now a photograph of each person held with their care planning documentation and care plans include information about a person`s previous lifestyle, life history, present lifestyle and likes/dislikes. Medication procedures and practices are now robust; medication is stored correctly and recorded accurately. This protects people living at the home from the risk of harm. There are risk assessments in place for the use of bedrails that meet the Medicines and Health Care Regulatory Agency (MHRA) guidelines. Regular safety checks are made on any bed rails that are in use. Most staff have now had training on safeguarding adults from abuse and the remaining staff are booked on training courses. This ensures that staff know what to do should they witness an incident or poor practice. All substances that could be hazardous to health are now stored in locked cupboards this protects people living at the home from the risk of harm. Recruitment practices have improved; staff do not commence work at the home until two references and a Protection of Vulnerable Adults (POVA) first check have been received. This ensures that only people considered suitable to work with vulnerable people are being employed. The Care Quality Commission are now being informed appropriately of any accidents or incidents that occur at the home, as well as any safeguarding alerts that have been made to the local authority. This enables us to monitor that the appropriate people are being informed of accidents and incidents that could affect the well-being of the people living at the home. The maintenance issues raised at the time of the last key inspection have been addressed; hand washing facilities for staff are satisfactory, a window opening restrictor has been fitted and the parquet flooring has been repaired. There is a training and development plan that records the training achievements and the future training booked for staff. This evidences that staff have undertaken training that equips them with the skills and knowledge needed to support the people living at the home and assists the manager to identify the need for refresher training. National Vocational Qualification (NVQ) achievement is high for all groups of staff. Quality surveys are now distributed to relatives and health and social care professionals as well as people living at the home. The information received in quality surveys is collated and the information is displayed on the home`s notice board. This informs people of any action that is going to be taken by the home as a result of the comments they have received. The roles of managers are clearly defined and there are monitoring systems in place to ensure that policies, procedures and practices are being followed by staff. What the care home could do better: Satisfactory care plans are in place but they need to be personalised for each individual living at the home. The home intend to use new care planning documentation that they showed to us on the day of the site visit. Risk assessments should be recorded separately so that they can be reviewed and updated individually, and so that each risk assessment is clear for staff to read in care planning documentation. Care plans are reviewed on a regular basis but there is a complex system in place to update staff about any changes made to a person`s care needs. There needs to be a simple and quick system in place to keep staff informed of any changes made to care plans to ensure that staff are always working with up to date information. Verbal references must not be accepted and any references received by post or by email should be dated to evidence that they have been received before a new employee starts towork at the home. Key inspection report Care homes for older people Name: Address: Keldgate Manor Keldgate Beverley East Yorkshire HU17 8HU     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: Diane Wilkinson     Date: 1 4 0 1 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 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Keldgate Manor Keldgate Beverley East Yorkshire HU17 8HU 01482882418 01482882098 kme@mail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Keldgate Manor Estates Limited care home 35 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 Keldgate Manor is a care home that is operated by a privately owned family company. The home is an eighteenth century property that has been adapted and extended to provide accommodation and care for 35 older people, including those with dementia related conditions. It is situated in the market town of Beverley in the East Riding of Yorkshire and is close to the town centre. The home stands in an acre of land that has mature trees, flowerbeds and a large ornamental pond. Accommodation is located over three floors - communal accommodation is provided in two quiet lounges, a large lounge and dining room/lounge - some rooms overlook the large garden. Private accommodation is provided in 23 single rooms and six shared rooms. The home is close to public transport facilities and is easily accessed via car; car Care Homes for Older People Page 4 of 33 Over 65 35 35 0 0 0 1 0 9 2 0 0 9 Brief description of the care home parking space is available at the rear of the property. Information about the home is provided to people living at the home and others in the Statement of Purpose and Service Users guide; both documents are available from the manager. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection report is based on information received by the Care Quality Commission (CQC) since the last key inspection of the home on the 1st September 2009, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day; it began at 10.15 am and ended at 4.30 pm. On the day of the site visit the inspector spoke on a one to one basis with the registered person, other managers at the home and a senior carer as well as chatting to people living at the home. Inspection of the premises and close examination of a range of documentation, including two care plans, were also undertaken. The registered person submitted information about the service prior to the previous key inspection of the home on the 1st September 2009 by completing and returning an Annual Quality Assurance Assessment (AQAA) form. They were not asked to complete an AQAA form on this occasion. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Care Homes for Older People Page 6 of 33 As part of the inspection process we sent survey forms to some of the people living at the home; seven were returned. Comments were mainly positive, such as, my mothers room is always spotless and her appearance immaculate and meals are usually very good. Other anonymised comments are included throughout the report. The current fee for residential care at the home is from £362.04 to £410.02 per week. At the end of this site visit feedback was given to the registered person and other managers on our findings, including requirements and recommendations that would be made in the key inspection report. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? There is now a photograph of each person held with their care planning documentation and care plans include information about a persons previous lifestyle, life history, present lifestyle and likes/dislikes. Medication procedures and practices are now robust; medication is stored correctly and recorded accurately. This protects people living at the home from the risk of harm. There are risk assessments in place for the use of bedrails that meet the Medicines and Health Care Regulatory Agency (MHRA) guidelines. Regular safety checks are made on any bed rails that are in use. Most staff have now had training on safeguarding adults from abuse and the remaining staff are booked on training courses. This ensures that staff know what to do should they witness an incident or poor practice. All substances that could be hazardous to health are now stored in locked cupboards this protects people living at the home from the risk of harm. Recruitment practices have improved; staff do not commence work at the home until two references and a Protection of Vulnerable Adults (POVA) first check have been Care Homes for Older People Page 8 of 33 received. This ensures that only people considered suitable to work with vulnerable people are being employed. The Care Quality Commission are now being informed appropriately of any accidents or incidents that occur at the home, as well as any safeguarding alerts that have been made to the local authority. This enables us to monitor that the appropriate people are being informed of accidents and incidents that could affect the well-being of the people living at the home. The maintenance issues raised at the time of the last key inspection have been addressed; hand washing facilities for staff are satisfactory, a window opening restrictor has been fitted and the parquet flooring has been repaired. There is a training and development plan that records the training achievements and the future training booked for staff. This evidences that staff have undertaken training that equips them with the skills and knowledge needed to support the people living at the home and assists the manager to identify the need for refresher training. National Vocational Qualification (NVQ) achievement is high for all groups of staff. Quality surveys are now distributed to relatives and health and social care professionals as well as people living at the home. The information received in quality surveys is collated and the information is displayed on the homes notice board. This informs people of any action that is going to be taken by the home as a result of the comments they have received. The roles of managers are clearly defined and there are monitoring systems in place to ensure that policies, procedures and practices are being followed by staff. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 9 of 33 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 10 of 33 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 11 of 33 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. We looked at outcomes for Standard 3. Standard 6 was not assessed as there is no intermediate care provision at the home. People have a full care needs assessment prior to their admission to the home and are only offered a place if it is considered that their individual needs can be met. Evidence: We examined the care records for two people living at the home. They both included a care needs assessment that had been completed prior to their admission to the home. The assessment is thorough and covers all aspects of a persons physical, emotional and social care needs. There is also a record of where the assessment has taken place, i.e. at the hospital, at another care home or at the persons own home. Risk assessments are completed at the time of a persons admission to the home and these include a general risk assessment as well as more individual risk assessments Care Homes for Older People Page 12 of 33 Evidence: specific to the person concerned. This informs staff of a persons individual care needs from the time of their admission. The registered persons told us that, on occasions, they do decide that a persons needs cannot be met by the home, for example, if they feel that admitting a person to the home would be detrimental to the other people living there. We noted that community care assessments and care plans are obtained from the local authority when they are commissioning a placement at the home. This information, along with information obtained from relatives and others and information gathered at the time of the initial assessment, is used to develop an individual plan of care for the new resident. We received seven surveys from people living at the home - six people told us that they received enough information prior to their admission to the home to help them with their decision making. Care Homes for Older People Page 13 of 33 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. We looked at outcomes for Standards 7, 8, 9 and 10. Care plans are in place to guide staff and make sure that peoples needs can be met. However, these need to be simplified and to be more person centred. A persons privacy and dignity is respected by staff. Medication practices are now robust and ensure that people living at the home are protected from the risk of harm. Evidence: One person living at the home had been assisted by a relative to complete a survey. They told us, my mothers life has been prolonged because of the good care she receives. Individual care plans have been developed using information gathered at the time of the initial assessment and, whenever possible, have been agreed by the person concerned or a relative. Care plans included a photograph of the person concerned and set out in detail the action that needs to be taken by care staff to ensure that all Care Homes for Older People Page 14 of 33 Evidence: aspects of the persons health, personal and social care needs are met. For example, care plans record information about the assistance needed with bathing, such as, needs prompting to wash - one member of staff to assist. The current care planning system in use at the home is based on one standard care plan that is adapted for each individual living at the home. Although care plans do include the recommended information, they are not as person centred as they could be. Also, information in care plans is not always easy to find. The home should start to use a more person-centred approach to care planning and we are aware that they intend to use the new format that they showed to the inspector on the day of the site visit. This will be stored in a ring binder with dividers for each section so that information is easy for staff to locate. Care plans are reviewed on a monthly basis. Each team of staff meets every month to discuss the current needs of the people they are responsible for. The leaders of each team then meet and this is followed by a full staff meeting - this is when staff are told about changes to care plans. The responsible person told us that, from the date of this site visit, she intends to record any changes on a white board so that staff can be informed of these changes immediately. This system is quite complex and time consuming and the documentation in the new care planning format should assist the home to develop a quick and simple way to update care plans and to inform staff accordingly. It is important that staff are working with up to date information at all times to ensure that a persons current care needs are met. Each care plan is accompanied by a general risk assessment that includes details about mobility needs and the risk of falls for that person. Additional risk assessments that are individual to the person concerned, such as, ensure safety whilst walking up and down the stairs and assist to light cigarettes are also undertaken. All identified risks for an individual are recorded on one form and the registered person was advised to record one risk assessment per form. This would enable each risk assessment to be reviewed individually and updated as necessary. The use of one form per risk assessment also highlights each risk associated with the individual concerned for care staff. Again, this type of risk assessment is included in the new care planning format that the home intend to introduce. We noted that there are now risk assessments in place for any bed rails in use by people living at the home. A laminated notice entitled, safe use of bedrails is displayed in all bedrooms where people use a bed rail and bed rails are checked for safety every month. The advice circulated by the Medicines and Health Care Regulatory Agency (MHRA) is being used at the home, although we recommend that Care Homes for Older People Page 15 of 33 Evidence: weekly checks of bed rails would futher promote safety. We received seven surveys from people living at the home. Most people told us that they receive the care and support they need, and everyone told us that they receive the medical care they need. We saw evidence that appropriate pressure care equipment and equipment to promote continence is provided for people. There is evidence in care plans that appropriate referrals are made to health care professionals and that people have optical, hearing and chiropody appointments. A record is kept of a persons food and fluid intake where this has been identified as an area of concern. We were told that people are weighed regularly as part of nutritional screening but we did not find these records in all care plans. Although the home undertake a brief nutritional risk assessment, they do not currently use the MUST malnutrition tool. They now have a copy of this information and intend to include a MUST assessment in each individual plan of care. At the last key inspection we made a number of requirements about the administration of medication and these have all been addressed. We observed the administration of medication at lunchtime. The medication trolley is stored in the treatment room when not in use - each mealtime the blister packs for that occasion are placed in the trolley and taken to the dining room; blister packs are colour coded by the pharmacist to reduce the risk of errors being made. We saw that the person responsible for the administration of medication asks discreetly if people require their as required medication. If this is not needed, the correct code is used on medication administration record (MAR) sheets. We noted that any handwritten entries on MAR sheets had been signed by two members of staff, that the amount of medication received from the pharmacist is recorded and that there were no gaps in recording. MAR sheets are accompanied by an information sheet that records the persons name, a photograph, their date of birth, their room number and any allergies - this helps to reduce the risk of errors being made. There is also a list of sample signatures for staff who have had medication training and have responsiblity for this task - this assists in monitoring medication records for accuracy. The medications fridge is kept in the managers office - this is only used to store medication, mainly antibiotics and insulin, and is kept locked at all times. There is also a fridge in the dining room that is used to store food supplements - we noted that all of the food supplements were labelled and that this fridge is also locked. Catering staff Care Homes for Older People Page 16 of 33 Evidence: check fridge temperatures daily and keep appropriate records. The storage arrangements for controlled drugs were satisfactory. There is a new controlled drugs book in use; a sample of drugs held in the cabinet were checked against records and were found to be accurate. The arrangements for recording any changes in Warferin levels following the results of blood tests undertaken by district nurses were also seen to be satisfactory. The medication administration record book also includes information for staff on homely remedies. We noted that if people take homely remedies or food supplements, these are also recorded on MAR sheets; this is good practice. We observed that staff respect the privacy and dignity of people living at the home and care plans record how assistance should be given with personal care in the least intrusive way. A persons preferred name is used by staff and it is evident that people always wear their own clothes. People have access to a telephone so that they can keep in touch with family and friends. Most people have a single room so are able to see visitors and health care professionals in private, and there are various areas of the home where private meetings can be held. People accommodated in shared rooms have been provided with a screen to promote privacy. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 12, 13, 14 and 15. People are able to choose how to spend their day and various activities are provided for people to participate in if they choose. Visitors are made welcome at the home and meal provision is good. Evidence: Care plans record details of a persons life history, personal history, present lifestyle, their hobbies and interests and their likes/dislikes. People are able to choose where to spend their day, where to take their meals and whether to take part in available activities. Daily diary sheets record any activities that a person has participated in, any visitors seen and any trips out of the home. We noted that care plans included a record of all activities undertaken by individuals living at the home. On the afternoon of this site visit we observed that people were encouraged to take part in a chair exercise session led by a member of staff. Seven people living at the home returned a survey. When asked, Does the home Care Homes for Older People Page 18 of 33 Evidence: arrange activities that you can take part in?, four people responded always and three people responded sometimes. There are extensive gardens to the rear of the property with seating provided for people living at the home and their visitors. A small allotment area has been created to try to encourage people to take part in gardening activities, and the home has purchased some chickens both to stimulate interest and to supply fresh eggs. Most people have single rooms so are able to see visitors and care professionals in private, and there are also private areas of the home where people can meet with family and friends. We saw that visitors were in and out of the home throughout the day and that they were made welcome by staff. One person visited over lunchtime to assist their relative with eating their meal, as it had been identified that this was the best way to encourage this person to eat and drink. We saw information in the home about advocacy, Deprivation of Liberty, safeguarding adults and funding of residential care; this enables people to access this information without having to ask for advice and promotes privacy and independence. We noted that best interest meetings had been held to assist people living at the home with decision making when they lacked the capacity to do this for themselves. People are able to bring small items of furniture, photographs, pictures and ornaments with them from their own home so that their bedrooms are personalised. Meal provision at the home is good - one person told us in a survey, meals are usually very good. A three course lunch is provided with a choice of main meal and dessert the choices on the day of the site visit were belly pork and stuffing or chicken and leek pie, follwed by ginger sponge and custard or a yoghurt. There was also a choice of meals recorded for tea-time; these are recorded on a daily menu that is displayed in the dining room. We were told that kitchen staff talk to people each morning about the choices on offer that day. We observed the serving of lunch and noted that meals are presented in an attractive manner and that people were offered both a cold drink and a drink of tea. Food supplements (including Calogen and Ensure) are provided for some people as well as meals to suit people with diabetes. We observed that some people were served their meal on a plate that made eating easier for them, that people were given sufficient time to eat and that people were offered appropriate assistance with eating and drinking. We were told that key workers discuss the menu choices with people living at the home and that menus are adjusted by catering staff based on this Care Homes for Older People Page 19 of 33 Evidence: feedback. We received seven surveys from people living at the home and people told us that they like the meals. One relative told us, my mother has lived at Keldgate Manor for approximately five years and over that time she has been very well fed and cared for. Care Homes for Older People Page 20 of 33 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. We looked at outcomes for Standards 16 and 18. People tell us that they know who to speak to if they have any concerns and there are policies and procedures in place on how to make a complaint. Staff have now undertaken training on safeguarding adults from abuse and recruitment practices are robust - this protects people living at the home from the risk of harm. Evidence: There is a complaints log in place and we noted that information is displayed in the home to inform people about the complaints procedure. The manager told us that there have been no complaints made to the home since the last key inspection and records at the home support this. We received seven surveys from people living at the home - they all told us that there was someone they could speak to informally if they were not happy. Five of these people told us that they also knew how to make a formal complaint. There are policies and procedures in place that are designed to protect people from the risk of harm, including safeguarding adults from abuse and whistle blowing. The home has recently made some appropriate safeguarding adults referrals to the local authority for their consideration - they were advised to send a copy of any safeguarding alerts made to the local authority to the Care Quality Commission (CQC). Care Homes for Older People Page 21 of 33 Evidence: At the last inspection we were told that staff had undertaken training on safeguarding adults from abuse but this information was not recorded on the training and development plan. Since that time, most staff have attended refresher training on this topic and this information was recorded on the training and development plan, including the dates that each member of staff attended this training - this assists the registered person with arranging refresher training. People are now recruited using robust policies and procedures and this protects people living at the home from the risk of harm - only people considered safe to work with vulnerable people are employed by the home. Care Homes for Older People Page 22 of 33 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. We looked at outcomes for Standards 19 and 26. The home is generally well maintained and the gardens provide an attractive space for people to use and enjoy; it is maintained in a clean and hygienic condition. Evidence: A handyman is employed at the home and he was present on the day of the site visit undertaking routine maintenance of the premises. The home was generally well maintained. At the last key inspection we noted that some areas needed improvement and we received information from the home shortly after the inspection to inform us that this work had been undertaken. On the day of this site visit we were able to confirm this the parquet flooring has been repaired, the glass in a cabinet has been repaired, a corridor carpet has been replaced and a window has been fitted with an opening restrictor. The grounds are extensive and are kept tidy, safe, attractive and accessible to people living at the home. There is a large conservatory across the rear of the premises that is used as a lounge and dining room - this provides a view of the garden area and gives people ample access to sunlight. Care Homes for Older People Page 23 of 33 Evidence: Due to the very cold weather at the time of this site visit some people had been provided with free standing heaters in their bedroom. Risk assessments had been undertaken to ensure that these had only been provided in rooms where this was considered to be safe for the person concerned. The home was clean and hygienic on the day of the site visit and no unpleasant odours were detected. A relative told us, my mothers room is always spotless and her appearance is immaculate. Laundry facilities are suitable for the needs of the people living at the home and we noted that hand washing facilities for staff in the laundry room are now satisfactory and promote good hygiene practices. Disinfecting hand gel is placed at entrances to the home along with polite notices about precautions for swine flu and diarrhoea outbreaks; this is good practice. Records evidence that staff have had training on infection control. We saw that all cleaning materials are now stored in locked cupboards to meet the Control of Substances Hazardous to Health (COSHH) regulations. Care Homes for Older People Page 24 of 33 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. We looked at outcomes for Standards 27, 28, 29 and 30. There are sufficient staff on duty to meet the needs of the people living at the home. Staff receive appropriate induction and on-going training and NVQ achievement is good. Recruitment practices have improved and only people considered safe to work with vulnerable people are employed. Evidence: We noted that the staff rotas recorded the role of each person on shift each day and that the staff recorded on the rota were actually on duty. Domestic and catering staff are employed in addition to care staff; there are three full time cooks, three full time domestic assistants and a kitchen assistant. This allows care staff to concentrate on care duties as all other tasks are undertaken by ancillary staff, which helps to alleviate the risk of cross infection. Records evidence that there are enough staff on duty to meet the needs of the people living at the home and we noted that staff are well supported by the management team, who live on the premises. Nine care staff have achieved NVQ Level 2 in Care and some are working towards NVQ Level 3 in Care. Only three staff have not achieved a NVQ qualification, and two of these staff members are working towards this award. Managers are working towards NVQ Level 4 in Care and/or the team leaders award. Care Homes for Older People Page 25 of 33 Evidence: In addition to this, domestic staff are undertaking NVQ Level 2 in Housekeeping and catering staff are working towards NVQ Level 3 awards; this is good practice. We examined the records for two new members of staff. Both had completed application forms (accompanied by CVs) that recorded their qualifications and training, their current employment, a criminal conviction declaration and the names of two referees. Each person had two references in place but in one instance a reference addressed to to whom it may concern had been accepted. We noted that the home had contacted the referee to verify the details of the reference and that these details had been recorded on the reference. Two references had been sent to the home via email and neither were dated. However, we noted that all of these references were from the people recorded as referees on application forms. We advised the registered persons that they should write to each referee requesting a reference and that these letters should be retained, so that they can then be reconciled with the references received from referees, and that all references should be dated. The registered person showed us a copy of the new reference request letter - they had recorded that verbal references could no longer be accepted by the home. Protection of Vulnerable Adults (POVA) first checks had been received prior to the new employees commencing work at the home and Criminal Records Bureau (CRB) checks were received shortly after they had commenced work. The registered persons showed us an employment check list that they have developed for future use. This will record the date the Independent Safeguarding Authority (ISA) Adult First check has been applied for, the date that ISA/CRB checks have been received, the dates that both written references have been received and the persons start date. Staff commence induction training when their POVA first check has been received and the dates that staff have worked under supervision whilst waiting for their CRB check to arrive are clearly recorded. These records include details of the duties undertaken by the new employee and comments from the manager about their progress. People undertake some training sessions during their induction period such as health and safety, fire safety and infection control. We were told (and records evidenced) that one persons induction training and shadowing continued after their CRB clearance had been received i.e. until they were deemed competent by senior staff. We checked the training records for a further two members of staff and noted that individual training records are held for each member of staff - these record the training achievements and the training needs of the person concerned. Care Homes for Older People Page 26 of 33 Evidence: Individual training information is transferred to a training and development plan. This records that most staff have undertaken training on safeguarding adults from abuse, hand hygiene, dementia care, infection control, COSHH and care of people with stroke. All staff have undertaken training on fire safety and a small number of staff have attended training on the deprivation of liberty and epilepsy awareness. The training plan also records NVQ achievements, planned training and when refresher training is needed. Training planned for February 2010 includes moving and handling, risk assessment, COSHH and epilepsy awareness. All staff are to have refresher training on fire safety in March and September and hand hygiene in June. Care Homes for Older People Page 27 of 33 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. We looked at outcomes for Standards 31, 33, 35 and 38. The home is well managed; health and safety systems in place at the home are now being monitored consistently, and people living at the home and staff are protected from harm as far as is possible. Peoples money is held securely and quality assurance systems have been expanded to ensure that people have the opportunity to express their opinion about the service being provided. Evidence: The registered manager is a qualified nurse and has the skills, qualifications and experience to manage the home. Managers at the home keep their practice up to date by attending training sessions and by accessing the internet, including the CQC website. At the last key inspection we highlighted that some policies and procedures were not been adhered to. The registered person told us in an improvement plan how they Care Homes for Older People Page 28 of 33 Evidence: intended to address these shortfalls and immediately took action to improve management systems at the home - they acknowledged that they had not been monitoring that the systems in place were being followed by staff. At this inspection we found that monitoring systems had been developed and these were being used consistently; recruitment practices and medication policies and practices had both improved. Improvements have also been made to the quality assurance system in place at the home. Surveys are now distributed to relatives and health and social care professionals as well as to people living at the home. These are distributed throughout the year rather than at six monthly or annual intervals. Results of surveys are collated and this information is displayed on the homes notice board. Staff meetings are held on a regular basis. Each team (including catering and housekeeping staff) have a meeting every month, and the leader of each team then attends a team leader meeting where all issues are discussed. Residents meetings are held and key workers spend time each week with people living at the home. Most people are assisted by a family member to manage their financial affairs but monies are held on behalf of some people living at the home. A sample of these monies and associated records were checked at the last key inspection and were found to be accurate. We saw that receipts are obtained for newspapers, hairdressing and chiropody. We examined some of the health and safety documentation at the home. An annual fire test took place in October 2009 and we noted that weekly in-house fire tests take place consistently; fire drills take place every six months at the same time as fire safety training. The handyman checks water temperatures in bedrooms and bathrooms each month and, in addition to this, staff check water temperatures each time they assist people with washing or bathing and alert managers if there are any problems - this reduces the risk of scalding for people living at the home. There are gas safety and electrical installation certificates in place and stair lifts, hoists and portable appliances have been tested. Since the last key inspection the CQC are being informed of any accidents or incidents that affect the well-being of a person living at the home, and we noted that accidents and incidents are also recorded in individual care plans. Care Homes for Older People Page 29 of 33 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 30 of 33 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 The home must proceed with their plans to make care plans more personalised. This is needed to ensure that the individual needs and wishes of people are clearly recorded, and that these are met by staff working at the home. 28/03/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The current systems in place for reviewing and updating care plans should be simplified to ensure that staff are informed of any changes quickly and are always working with up to date information. It would be good practice to record each risk associated with an individual on a separate form so that all risk areas are highlighted for staff, and to allow each identified area of risk to be reviewed and amended individually. We recommend that the home completes a MUST malnutrition assessment for each person living at the Page 31 of 33 2 7 3 8 Care Homes for Older People 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 home. 4 18 The Care Quality Commission should be informed of any safeguarding alerts that have been sent to the local authority for their consideration. Verbal references should not be accepted as evidence of a persons suitability for employment. References should be requested by and returned to the registered persons, and should be dated to evidence that they were received prior to the person commencing work at the home. 5 29 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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