Care Home: Kew House

What the care home does well The staff group have been successful in developing good relationships with people who use the service in the short time the home has been operating. People who use the service made positive comments about the way they were supported and the approach of the staff group. Comments included; `I am very happy with the carers`, `the staff are wonderful`, `the service is excellent`, `staff here have a very good attitude` and `people are very helpful here`. One person informed us that they had not wanted to move into the service but now they `love it here` and would not want to move anywhere else. We found staff to have a very good understanding of the individual needs and strengths of the people they were supporting. Staff worked to provide individualised care, providing the support individuals needed at the times they wished. We observed staff supporting people in a discreet and sensitive manner. People who use the service also commented on how well they felt the deputy manager had taken on the main management role in the service in the absence of the Registered Manager. Staff informed us that they felt well supported by the management of the home and the organisation. People who use the service described the food provided as `excellent` or `good`. Individuals told us they were always offered choices, that the food was well presented and served and that there was `always` plenty to eat. One person commented that at times they felt there was too much food. We observed management consulting with people who use the service on a day to day basis and through regular meetings. The management are working with the people who use the service to ensure that the service is developed in the way they want. The record of complaints showed that staff were taking action to improve the service for individuals and were taking note of all concerns raised. This is a new, purpose built service which has been finished to a high standard. People who use the service told us they were very happy with their individual rooms and the communal facilities available. Care is being taken to provide a stimulating environment for those people living with dementia which is in line with current good practise. Advice has been sought from a specialist in this area and the organisation has allocated funds to support this. Staff are being provided with good opportunities for training which assists in ensuring that people who use the service are supported by a well informed staff group. The organisation has booked places on more advanced training courses in dementia care for a number of staff in the service. What has improved since the last inspection? This is the first inspection of this service. What the care home could do better: In order to ensure that staff can continue to provide individualised care as the service expands further work should be carried out on care planning. Care plans should provide clear information on the strengths, needs and wishes of each person along with information on how staff will be meeting these. More detail on individuals needs and wishes will assist in providing support at the right levels and in the appropriate way for the person. Evaluations should include information on what has worked well for the person along with any changes. Where actions are needed consideration should be given to allocating named members of staff and clear timescales to ensure that things are not left undone. The main area where people who use the service felt there could be improvements was in activities. Individuals told us they were `bored` at times, and that `time hangs`. As staff are working with and being led by what people who use the service are saying they want there is bound to be a gap between finding out what individuals as well as the larger group would like and meeting these wishes. The employment of an activities coordinator should assist in developing this area of the service. Further consideration should be given to how the meal time experience could be improved and how meal times are going to be managed as the service expands and includes more people who are living with dementia. Although some information is sought on the past history and life experiences of people who use the service consideration should be given as to how this can be expanded. This may be of particular importance for people who may be experiencing difficulties with their memory. As noted previously this is a new building and it is common for difficulties only to become apparent once people start living in the service. The main issue during our visits was a problem for people using the service having easy access to the main reception and front door area. The internal door being too heavy for may people to open. We were informed that the organisation were looking into how this problem could be solved. A medication profile should be compiled and maintained for each person. This document should provide a record of all medication with dates of when medication was commenced and discontinued and by whom. The record of complaints should include the views of the person raising the complaint on the outcome. Consideration could also be given to making the complaints process more easily accessible so that anyone making a complaint can have a clear understanding of how their complaint will be dealt with and by whom. To assist in safeguarding people who use the service a full employment history needs to be provided by all staff as part of the recruitment process along with satisfactory explanations for any gaps in employment. Care will need to be taken to make sure that people who use the service do not feel that staff are at times so busy that they are reluctant to ask for support or advice from them. The management of the service should ensure that they make regular checks on records, particularly those concerning health and safety and finances. Key inspection report Care homes for older people Name: Address: Kew House 58 Spencer Hill Road Wimbledon Surrey SW19 4EL     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: Elizabeth OReilly     Date: 0 3 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) 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 30 Information about the care home Name of care home: Address: Kew House 58 Spencer Hill Road Wimbledon Surrey SW19 4EL 02089710190 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hallmark Healthcare (Wimbledon) Limited Name of registered manager (if applicable) Mr Peter Donkin Type of registration: Number of places registered: care home 81 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The Maximum number of service uses who can be accommodated is 81 The registered person may proved the following category of service only: Care Home with Nursing - Code N 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 maximum number of places 35 Dementia Code DE maximum number of places 45 whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (Maximum number of places: 35) Dementia - Code DE (Maximum number of places: 46) Date of last inspection 0 0 Over 65 46 35 Care Homes for Older People Page 4 of 30 Brief description of the care home Kew House is a purpose built service completed in 2009 for up to 81 older people. The service is split into four units providing care and support for older people in residential and nursing units and for those people living with dementia in nursing and residential units. Each person is provided with their own room with en suite facilities. The service is close to the entertainment, shopping and transport facilities of Wimbledon. Fees for this service range from £850 to £1300 per week. 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: This unannounced inspection was carried out by one Regulation Inspector on the 27th November and the 3rd December 2009. At the time of this visit eleven people were using the service the majority of whom had lived in the service for only a short time. The inspector had the opportunity to speak with seven people who were using the service, two visitors, five members of staff and the deputy manager. We looked at a sample of the records the service is required to keep. The deputy manager completed an Annual Quality Assurance Assessment (AQAA) for the service. This document includes information on how the service is meeting national minimum standards and plans for improvements over the next twelve months. The document also provides some statistical information on the service. We have used information from all of the above sources as well as our own Care Homes for Older People Page 6 of 30 observations to reach the judgements made in this report. It should be noted that this is the first inspection of the service. The home has been judged to provide good outcomes for people using the service. This is the maximum star rating which can be awarded for a new service. 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: In order to ensure that staff can continue to provide individualised care as the service expands further work should be carried out on care planning. Care plans should provide clear information on the strengths, needs and wishes of each person along with Care Homes for Older People Page 8 of 30 information on how staff will be meeting these. More detail on individuals needs and wishes will assist in providing support at the right levels and in the appropriate way for the person. Evaluations should include information on what has worked well for the person along with any changes. Where actions are needed consideration should be given to allocating named members of staff and clear timescales to ensure that things are not left undone. The main area where people who use the service felt there could be improvements was in activities. Individuals told us they were bored at times, and that time hangs. As staff are working with and being led by what people who use the service are saying they want there is bound to be a gap between finding out what individuals as well as the larger group would like and meeting these wishes. The employment of an activities coordinator should assist in developing this area of the service. Further consideration should be given to how the meal time experience could be improved and how meal times are going to be managed as the service expands and includes more people who are living with dementia. Although some information is sought on the past history and life experiences of people who use the service consideration should be given as to how this can be expanded. This may be of particular importance for people who may be experiencing difficulties with their memory. As noted previously this is a new building and it is common for difficulties only to become apparent once people start living in the service. The main issue during our visits was a problem for people using the service having easy access to the main reception and front door area. The internal door being too heavy for may people to open. We were informed that the organisation were looking into how this problem could be solved. A medication profile should be compiled and maintained for each person. This document should provide a record of all medication with dates of when medication was commenced and discontinued and by whom. The record of complaints should include the views of the person raising the complaint on the outcome. Consideration could also be given to making the complaints process more easily accessible so that anyone making a complaint can have a clear understanding of how their complaint will be dealt with and by whom. To assist in safeguarding people who use the service a full employment history needs to be provided by all staff as part of the recruitment process along with satisfactory explanations for any gaps in employment. Care will need to be taken to make sure that people who use the service do not feel that staff are at times so busy that they are reluctant to ask for support or advice from them. The management of the service should ensure that they make regular checks on records, particularly those concerning health and safety and finances. Care Homes for Older People Page 9 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 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 11 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 who use this service are provided with information on what they can expect from the service. Individuals told us they had enough information to make the decision about moving in. Pre admission assessments ensure that the service can meet individual needs. Evidence: The service has produced its own Service User Guide and Statement of Purpose which were seen to be available in the service. These documents provide information on what people can expect from the service. The management informed us, through their own assessment of the service, that these documents are provided to each person who moves into the home. This was confirmed by people we spoke to during our visits. We noted that space has been left in the documents to add the views of people who use the service which will be added when the home is more established. This will Care Homes for Older People Page 12 of 30 Evidence: provide further information for people who are considering moving in. People who are considering moving into the home are provided with opportunities to visit and individuals are encouraged to try out the service before making any judgement about moving in permanently. The service has produced a checklist to compare the facilities in Kew House to other services they may visit. Individual assessments are carried out for each person by the manager or the deputy manager. This assists in ensuring that the service can meet individual needs and provides information for staff so that they are aware of the main strengths and needs of each person from day one of their stay. The pre admission assessments used could provide more detail on how people would like to be supported and more detail on their social needs and wishes. The Service User Guide could provide more detail on how any complaint or concern about the service will be dealt with. This service does not provide intermediate care. Care Homes for Older People Page 13 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. People who use this service are provided with the support they need in the way they wish. Further work should be done on providing more detailed care plans to assist in maintaining consistency in care as the number of people using the service increases. The health care needs of people using this service are met. Evidence: We looked at a sample of the care plans produced by the service. During the first few weeks of each persons stay staff assess in detail various areas of the support needed by each person. This information, along with that which was gathered through the pre admission assessment, is then used to complete an individual care plan. The service is still in the development stage of care planning. The plans we saw included some information on how individuals would like their support provided along with personal preferences. We saw that staff have recorded how many pillows people prefer, whether they would like lights left on, their door open or closed at night, the times and how individuals would like to be woken in the mornings. Staff have also added some details of how people like to be supported with their personal care such Care Homes for Older People Page 14 of 30 Evidence: as daily showers and early morning tea. This information assists in providing personalised and consistent support. The service management told us through their own assessment of the service that care plans reflect the individual preferences of individuals in relation to the care they receive. We found staff have gone some way to achieving this. However more detail in the care planning will assist in providing more person centred support. This could include at what time individuals prefer a bath or shower, what toiletries they like, whether they prefer to take their time over a bath and how individuals like to present themselves. Staff had in some instances recorded where particular areas of support were needed but did not always follow this up with how this would be provided. For example it was noted that one person becomes anxious at certain times of the day but no information was available on how staff should assist the person. Staff were seen to have been given good instructions on specifying what has or has not worked in relation to memory loss for one person. However staff had recorded that the person was confused an disorientated at times. Senior staff will need to monitor how staff are completing evaluations to make sure there is a clear understanding of what is expected of them. In one instance it had been recorded that staff needed to choose the clothing for one person. No further instructions were available on how this person may be supported to make their own choices or what they may like to wear. Information such as whether this person likes to wear make up, what type, how they prefer their hair dressed and whether they use perfume and what type they prefer may also be useful to staff to support the person to present themselves as they might wish. Additional training on dementia care should assist staff in understanding how to support people and that making judgements on the behaviour of individuals is not always useful. Despite the gaps in the recorded information discussions with staff did indicate that they were well aware of the individual preferences of the people they were supporting and as there were few people using the service at this time it was clear that people were receiving the support they wanted at the time they wished. However care will need to be taken as the service expands and better, person centred records could assist in providing consistency of care. Staff are working on introducing more personalised information by requesting people who use the service provide information on what is important for them and to them. Care Homes for Older People Page 15 of 30 Evidence: To assist in the development of care planning consideration could be given to staff bringing a care plan to staff hand overs on a rotating basis and for individual care plans to be discussed as part of one to one staff supervision. This may assist in keeping care plans up to date, involving all staff and keeping care plans in mind for staff. Consideration could also be given to more involvement of care staff in the care planning process. Staff complete daily notes for each person and these generally included good details but staff need to make sure they do not make judgements. We found instances where staff had on a number of occasions described someone as wandering and in one instance had described a room as smelly. Neither of these judgements are helpful in providing support for individuals. We found individual risk assessments in place which assist in ensuring people who use the service are supported in an appropriate manner to lead the lives they wish. The health care needs of individuals were seen to be met. Referrals are made to other health care professionals when needed and individuals are supported to attend appointments within or outside the service. People who use the service told us that they could see their own GP when they wanted and in private. Individuals told us that staff would arrange appointments for them with opticians, dentist and chiropodist. Staff were seen to keep a record of health care appointments. In one instance staff had recorded an appointment had been due but did not record any outcome. People who use this service can keep the services of their own GP or be registered with a local GP practise. We looked at a the recording and storage of medication. We found medication was well managed. Records were up to date and accurate. Consideration should be given to producing a medication profile for each person. This record should include all the medication each person is prescribed the date commenced, where possible, date discontinued and by whom. Records indicated how people would like to be addressed and we observed individual staff members using the persons preferred name when providing support. We observed staff offering support and advice in a considerate and discreet manner. The privacy of individuals was seen to be respected and maintained. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are working with people who use the service to develop and provide appropriate social activities. Visitors feel welcome in the home and good facilities are available for individuals to spend time with their friends or relatives. People who use the service told us the quantity and quality of food on offer is very good. Evidence: We found that staff are working with people who use the service to develop social activities within the home. Staff are also investigating what activities individuals may like to be involved in in the local community. The service has advertised for an activities coordinator and care is being taken to recruit the appropriate person to further develop this areas of the service. Senior staff were planning to purchase a number of items relating to activities following meetings with people who use the service which ensures that the service provides what individuals want. Individuals had requested a better range of magazines and newspapers to be available in the lounge areas. The deputy manager agreed that these would be provided. People who use the service informed us that they were involved in setting up a library, book and film club. The organisation has provided a specific budget to purchase interactive items for the dementia care units. We found Care Homes for Older People Page 17 of 30 Evidence: that work had already begun on one of these units to provide a good environment for people with dementia. The sample of records we looked at included monthly and three monthly evaluations of activities. However these were not being used consistently. In one instance it had been noted that the person had expressed an interest in cooking and care staff would be asking the catering staff for ingredients for baking. However the daily activities plan for this person did not include baking or cooking. Where individuals have express an interest in a particular activity considerations should be given to allocating a named member of staff to support the person along with clear timescales. This could assist in ensuring that individual interests continue to be supported and that action is taken to assist people to who may wish to try out new activities. Senior staff informed us that they would be having discussions with the chef about how people who use the service can become involved in the kitchen if they wish. A hairdresser visits the service on a regular basis and the home has a purpose built salon on the ground floor. A separate well equipped therapy room is also available on the ground floor. Various therapies can be booked and a list of the therapies on offer along with the costs are on display. The service has a cinema area in one of the lounges on the first floor which is fitted with a large drop down screen and projector. We observed a number of individuals enjoying an afternoon film during our visits. Arrangements can be made to attend local places of worship or for visits to the service from representatives of local religious groups. Arrangements had been made with a local Church choir to visit the service for carols at Christmas. We found some records contained basic life history information. This type of information can assist in supporting people to maintain interests and provide staff with some insight into individual previous life experiences. However these were not completed in each file seen. Consideration should be given to looking for wider contacts for information if there is no close next of kin and to developing more detailed life story books particularly for those people who are living with dementia. We had the opportunity to speak with two visitors to the service. They informed us that they were always made to feel welcome by the staff and could visit at any time. Facilities are available for visitors to meet in private with their relative or friend. We observed one person who uses the service asking if a friend could join them for Christmas dinner and this was immediately agreed. Care Homes for Older People Page 18 of 30 Evidence: People who use the service made very positive comments about the food provided. We found menus contained a good variety of meals and people were seen to be given good opportunities to make informed choices in both food and drinks. Meals were seen to be well presented and served. Individuals informed us that they always had sufficient to eat and could ask for a snack at any time. As the service develops consideration could be given to protected meal times which would allow more staff from across the service to be involved in supporting people and making meal times more of a social event. Consideration could also be given to presenting food in serving dishes which could allow for more choice in portion size and assist in maintaining independence. Snacks and fruit could be made more available throughout the home particularly for those people with dementia who may prefer taking small snacks rather than sitting through a full meal time. Considerations should be given to staff joining with people who use the service at meal times in the dementia care units. Care Homes for Older People Page 19 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 who use this service felt confident that they would be listened to if they had any concerns or complaints. Records showed that actions were taken when concerns were raised. Staff are provided with training which ensures they understand their personal responsibilities in reporting any allegations or suspicions of abuse. Evidence: People who use the service told us that they would speak to senior staff if they had any complaints or concerns. The organisation has in place a complaints procedure. We looked at the record of complaints held and we saw that staff were recording complaints, even those regarding relatively minor issues. This shows that staff are listening to people and taking action to remedy any concerns they may have. The recording of outcomes should include the outcomes for the person raising the concern or complaint, were they satisfied with the investigation and or results? Consideration could be given to making the complaints procedure easier to access around the service. Records showed that all staff who provide direct care have been provided with training on safeguarding people. Plans are in place for all staff who work in the service to receive this training. The service is looking to include their staff in the training on safeguarding provided by the local authority. This training will assist in ensuring that all staff have a clear understanding of the role and responsibilities in reporting any suspicions or allegations of abuse to the appropriate person. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are provided with a comfortable and well equipped environment which is finished to a high standard. Staff are working to ensure that furnishings and the general environment meets the needs and preferences of the people who use the service. Specialist advice has been sought in relation to making the environment comfortable and stimulating for people who are living with dementia. Evidence: The service is purpose built and only recently opened. The home has been finished to a high standard with good quality furnishings and fittings. People who use the service told us they were happy with their individual rooms and the communal areas available to them. Two people we spoke to felt they either could do with a different item of furniture or had brought to the home an item which was not appropriately placed. Consideration could be given to checking with people a short time after they have moved in to make sure they are happy with the way their room is set out and that they have all they need. Communal areas of the home include lounges and dining rooms on each floor. One large room on the first floor is furnished with a cinema. On the ground floor a celebration room is available which includes a sitting and dining area which can be used when families or friends visit and for small special occasions. A well equipped and finished hairdressing salon with adjacent coffee lounge is also available on the ground Care Homes for Older People Page 21 of 30 Evidence: floor. We saw that coffee was available throughout the day and night. A spa room is also available. At the time of these visits people who use the service and staff were planning on setting up a library in a quiet room on the first floor. People who use the service are provided with their own room with en suite shower and toilet tactilities. Staff are taking considerable care to develop the environment to meet the needs of the people using the service. In the yet to be opened dementia care unit on the ground floor corridors have been furnished with hats, dresses and a variety of items which people can interact with. Memory boxes have been fitted into which individuals can place personal items and or items which may aid their memory. A specialist in dementia care has visited the service and provided advice on the environment. The organisation has provided a budget to obtain more items of interest for people who are living with dementia. The deputy manager informed us that people who use the service would have their own choice about what was fitted to their individual door such as a door bell or knocker. Staff were also looking to improve the main bathrooms in the dementia care units which people with dementia may find intimidating. At the time of these visits concerns were being raised by staff and people who use the service about the entrance to the home. People who use the service were experiencing some difficulty in opening the main internal door which is very heavy. This was being addressed by the organisation. The service is also planning to test out sensor pads which will activate lights in the en suite bathroom when someone gets out of bed at night and will alert staff after a short time if there is no further movement. All areas of the service we saw were clean, fresh and free from odour. Two people who use the service described the standard of cleaning as excellent. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have been successful in developing good relationships with people living in the home. The organisation has provided good training opportunities for staff which assists in ensuring that they are up to date with current good practise. The more advanced training on dementia care should ensure that the service provides good standards in this area. Evidence: We received positive comments from individuals on the approach and standard of support they received from staff. We looked at the record of staff training. Systems are in place for all staff to take part in an induction training programme. Staff we spoke to confirmed that they had completed this training. Staff informed us that they had also take part in training on moving and handling, first aid, abuse awareness, dementia care, health and safety and basic food hygiene. The majority of care staff have been enrolled on National Vocational Training in care level two. As this service will be providing dementia care in two of their units all staff including ancillary staff should be provided with training on dementia care as well as safeguarding people. We were informed by senior staff that places had already been booked on more advanced dementia care training for senior staff. Care Homes for Older People Page 23 of 30 Evidence: We looked at the staff rota and staff confirmed that during the day there is always at least one qualified nurse on duty and three carers. At night one qualified member of staff and one carer are available. As the majority of the service is not operational at the moment these staffing levels are sufficient to meet the needs of the present group of people living in the home. However in talking to people who use the service we found they were given the impression that staff were at times very busy and pushed to get things done. Although we are aware that staff are working to a high standard management should look at the way the service is operating and how staff are approaching individuals to make sure that people who use the service and not reluctant to ask for support when they think staff are too busy. This will be of particular importance as the numbers of people using the service increase. The organisation is continuing to recruit staff to make sure they have sufficient staff to meet the needs of an increasing number of people moving into the service. We looked at a sample of staff files. These were found to be in good order with records of the appropriate checks having been carried out before staff start work in the service. However not all files contained a full employment history. To assist in ensuring the safety of people who use the service a full employment history along with adequate explanations for any gaps in employment needs to be in recorded. The management of the service were found to have a clear vision of the standards they expect from staff and were seen to take prompt action when staff have not met these standards. 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 who use this service are consulted on the day to day operation and future development of the home. Systems for the safekeeping of valuables and cash have been improved. Regular checks are carried out on the building and equipment to ensure the health and safety of people who use the service, staff and visitors. Systems for the regular monitoring of health and safety checks and valuables and cash held in the home should now be in place. Evidence: The registered manager has the experience and knowledge to run a service of this type. At the time of this inspection the registered manager was not available in the service. The deputy manager was running the home. People who use the service made positive comments about the manager and how the deputy manager was working to manage the service in his absence. People who use the service were seen to be consulted on how the service operates through regular resident meetings. During these visits the inspector had the Care Homes for Older People Page 25 of 30 Evidence: opportunity to sit in on one residents meeting. Individuals were asked by the deputy manager what they were happy with and what they felt could be improved. One person who uses the service had produced their own written comments on the service, copies of which were distributed to the group for discussion. We found management were listening to the views of individuals and working to adapt the service to meet their needs and wishes. Individuals were asked what activity equipment they would like to see in the service as it was acknowledged that this was an area which needed to be further developed. The organisation has its own quality assurance and monitoring systems which, at this early stage in the service development have not been fully implemented. However follow up letters are sent to every person who has stayed in the service for respite care to seek their opinions on the experience. We looked at a sample of the records kept on money held on behalf of people who use the service. The recording systems were not robust and were in need of review. This was carried out within a short time following our visit and improved security systems are now in place. The management of the service should ensure that they carry out a regular audit of money held in the service. We looked at a sample of the health and safety checks carried out on the building and equipment. Checks were seen to be done but should be more detailed. During the course of this inspection additional checks were made to ensure that all staff, including those who work at night were familiar with the actions to be taken should the fire alarms be activated. The record of fire drills should include the names of all of those who attended along with response times. This will assist in ensuring that all staff take part in random unannounced fire drills on a regular basis. 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Consideration should be given to providing more detail in the Service User Guide on how any complaint or concern will be dealt with. Consideration should be given to expanding pre admission assessment documentation to capture more detail on the social needs and wishes of people moving into the service. Evaluations made by staff should be monitored by senior staff to ensure that there is a clear understanding of what is expected from these evaluations. Staff should be reminded that recording their own judgements on the behaviour of individuals is not always useful. Where is has been identified that individuals may have difficulty in making choices staff should be provided with information on how they can support people to make choices along with information on what individuals may prefer. Where areas of need have been identified care plans should provide information for staff on how these needs might be met. Page 28 of 30 2 3 3 7 4 7 5 7 6 7 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 7 7 Further work should be carried out to ensure that care plans include details of how individuals would prefer their support and care to be provided. Systems to regularly discuss individual care plans should be developed. Medication profiles should be produced for each person which include the date any medication is commenced or discontinued along with details of who prescribed any medication. Consideration should be given to developing more detailed and more easily accessible life story information particularly for those people who are living with dementia. To ensure that prompt action is taken to support individuals to continue with their own interests and or try out new activities consideration should be given to allocating named staff to support the person along with clear timescales. To further develop meal times particularly in the dementia care units consideration should be given to protected meal times, how meals are presented, the availability of snacks and to staff joining with people who use the service at meal times. The record of complaints should include the outcomes for the person raising any concern or complaint. A full employment history should be kept on record for all staff along with adequate explanations for any gaps in employment to assist in safeguarding people who use the service. Senior staff should ensure that regular checks are carried out on the records kept in the service particularly those relating to health and safety and money or valuables held in the home. The record of fire drills should include the names of all those involved and response times to ensure that all staff take part in regular fire drills. 8 8 9 12 10 12 11 15 12 13 16 29 14 37 15 38 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. 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). 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