Care Home: Kimberley Residential Home

What the care home does well Since the last inspection, the service has improved the environment and some aspects of care practices which have benefited residents living there. Feedback and observation by inspectors at this and previous site visits has shown that staff supported residents in a sensitive and respectful manner. Improved staffing levels have helped staff effectiveness in this regard and examples of improving care practices was noted. The home provides a consistent range of activities for residents. The evidence was that the owner is committed to working towards a more person centred approach to care and this is particularly evident in this area. What has improved since the last inspection? Since the last inspection, the home has made improvements to the environment and care practices which have benefited residents. Residents may now be more confident that a suitable care plan will be put in place for them as soon as they commence residency and that their future support will be reviewed regularly. Staffing levels have improved since last inspection. Feedback from staff, observation by inspectors at the site visit and rotas seen evidenced that residents now benefit from consistently better staffing levels to enable their assessed needs to be met. Improvements have been made in staff training to support the staff competencies needed to meet resident`s needs. The home now has a rolling schedule of training in place, although all staff have yet to benefit from this. The report outlines what the home could do better to improve this area of service to vulnerable people. Feedback from residents, relatives and observation by the inspectors on the day of the site visit showed that residents benefit from a range of activities in the home which are now consistently available. The home now has two dedicated activity co coordinators who together with care staff facilitate a range of activities that residents find stimulating. Requirements made in relation to the environment have now been met and residents now benefit from bedrooms that are decorated to a good standard. Subject to risk assessment bedroom doors now have door locks for the benefit of resident`s privacy and in most cases have appropriate equipment and facilities to meet people`s needs in a dignified manner. Laundry facilities have improved in that the home has two new washing machines with appropriate sluice facilities and two new dryers. The laundry area has been redecorated and has appropriate flooring and a new sink. What the care home could do better: Although the home has improved the training of staff, discussions with staff, the provider and training records seen showed that a considerable minority of staff still have significant gaps in regard to mandatory training. This was particularly noted in regard to night staff which remains a cause for concern. The home could do more to evidence that the quality of training staff are receiving is sufficient and that the person facilitating the training is qualified to do so. Resident`s health and safety would be better protected if the home ensured that a dedicated person was in charge at nights as well as during waking hours. Residents safety would be better protected if the home ensured that all staff particularly night staff had appropriate safe guarding training and that the home ensured that staff understand and follow the home`s safeguarding policies and procedures. Resident`s individual needs would be better met by more detailed care plans that reflect their assessed health and care needs. Resident`s health and safety would be better protected if detailed risk assessments were in place in all cases. Resident`s health and safety would be better protected by ensuring that identified health and medication needs of residents are consistently monitored and records are kept up to date and accurate. The home needs to do more to evidence that were residents are in shared rooms they have agreed to do so and that their needs are conducive to sharing, particularly in regards to upholding the person`s dignity. Resident`s safety would be better protected if a system was in place to ensure that hot water outlets in residents rooms was at a consistently safe temperature that would avoid the risk of scolding. Residents would benefit from a staff team that had supervision and team meetings on a regular basis. Athough the laundry room and equipment have been significantly improved the laundry room is very small. The home is now considering developing another room for laundry sorting. This would contribute to good practice procedures in terms of making infection control easier for staff to follow. Feedback from relatives and staff showed that residents do not have access to community activities unless their relatives can facilitate this. The homes intention to provide a person centred approach to activities would be much improved if community access was incorporated into the range of options already available to people. More could be done to improve the range of food options available for residents at the tea time meal. Key inspection report Care homes for older people Name: Address: Kimberley Residential Home 40 Mickleburgh Hill Herne Bay Kent CT6 6DT     The quality rating for this care home is:   one star adequate 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: Eamonn Kelly     Date: 2 9 0 3 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Kimberley Residential Home 40 Mickleburgh Hill Herne Bay Kent CT6 6DT 01227374568 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): home@kimberley-care.com C. & P. Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 36. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE). Date of last inspection Brief description of the care home The service provides support and accommodation for up to 36 older people who have dementia. The premises are close to town centre amenities, to the sea-side and to public transport services. The brochure states that seven of the bedrooms have an en-suite facility; 26 single bedrooms and 5 shared bedrooms are located on the ground and first floors. Care Homes for Older People Page 4 of 32 Over 65 0 0 Brief description of the care home A passenger lift assists access to the first floor. On-street car parking is available. Residents, staff and visitors have access to a garden. The current fees, as outlined in the brochure, begin at £460 a week for permanent private residents and £505 a week for respite care residents. Weekly fees for Local Authority funded residents are £413. This includes a top-up of about £17 a week and this sum is redeemed from the resident by the Local Authority where they are able to do so. The brochure states that there are additional charges. In addition to our weekly fee, extra charge is made for private physiotherapy, newspapers, toiletries, chiropody and hairdressing. This list is not exhaustive: if you require an indication of price for a service or item do not hesitate to ask. The website www.kimberley-care.com includes a reference to possible further additional charges: these are stated as being Transport, escorting to appointments and hospital visits. Prospective residents and their advocates are entitled to a copy of a written guide (Statement of Purpose and Service Users Guide) to the service to enable them to make a decision about entering residential care and choosing a residential home that suited their health and social care needs. This is available on request from the owner or manager. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 Star. This means that people who use the service experience adequate quality outcomes. The site visit to the service was carried out on 29th March 2010 between 10.30am and 5.30pm by Jo Griffiths, regulatory inspector, and Andrea Leverett, local area manager. The registered manager was not present but the owner, Mr Post, facilitated the inspection with support from Mrs Post and members of the care staff. Prior to the inspection visit, information received about the service since the last key inspection was examined. This included notifications, updates from the Local Authority adult protection coordinator and the homes action plan. Care Homes for Older People Page 6 of 32 The provider was not asked to complete a further Annual Quality Assurance Assessment (AQAA) on this occasion. During the inspection visit, we visited most parts of the premises and checked a number of records and documents used for the running of the service. Three residents, four staff, a health professsional and three relatives provided feedback on the day. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Although the home has improved the training of staff, discussions with staff, the Care Homes for Older People Page 8 of 32 provider and training records seen showed that a considerable minority of staff still have significant gaps in regard to mandatory training. This was particularly noted in regard to night staff which remains a cause for concern. The home could do more to evidence that the quality of training staff are receiving is sufficient and that the person facilitating the training is qualified to do so. Residents health and safety would be better protected if the home ensured that a dedicated person was in charge at nights as well as during waking hours. Residents safety would be better protected if the home ensured that all staff particularly night staff had appropriate safe guarding training and that the home ensured that staff understand and follow the homes safeguarding policies and procedures. Residents individual needs would be better met by more detailed care plans that reflect their assessed health and care needs. Residents health and safety would be better protected if detailed risk assessments were in place in all cases. Residents health and safety would be better protected by ensuring that identified health and medication needs of residents are consistently monitored and records are kept up to date and accurate. The home needs to do more to evidence that were residents are in shared rooms they have agreed to do so and that their needs are conducive to sharing, particularly in regards to upholding the persons dignity. Residents safety would be better protected if a system was in place to ensure that hot water outlets in residents rooms was at a consistently safe temperature that would avoid the risk of scolding. Residents would benefit from a staff team that had supervision and team meetings on a regular basis. Athough the laundry room and equipment have been significantly improved the laundry room is very small. The home is now considering developing another room for laundry sorting. This would contribute to good practice procedures in terms of making infection control easier for staff to follow. Feedback from relatives and staff showed that residents do not have access to community activities unless their relatives can facilitate this. The homes intention to provide a person centred approach to activities would be much improved if community access was incorporated into the range of options already available to people. More could be done to improve the range of food options available for residents at the tea time meal. 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 32 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 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not always have a sufficiently detailed assessment of their needs to ensure an informed care plan is in place. Evidence: We were given a new draft Statement of Purpose which contained the information required to enable prospective residents to make an informed decision when choosing a home. The statement now needs to be updated to include information regarding the new management structure within the home. Together with Local Authority assessments where appropriate, the home undertakes its own assessments of prospective residents before a place is offered. A sample of the homes own assessments were seen and although they consistently included basic information more could be done to inform care plans, for example, in relation to Care Homes for Older People Page 12 of 32 Evidence: personal, likes and dislikes and preferences in terms of day to day living. The assessments did not explore residents wishes in terms of frequency of bathing and contained little information regarding food preferences. Although on the whole risk assessments were in place they did not always have sufficient detail to inform the services care plans. Residents now benefit from having care plans in place before they take up residency in the home. Although these plans included basic information they need to be improved to ensure preferences in terms of day to day living are fully recorded. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although all residents benefit from having a care plan, these do not always contribute fully enough towards ensuring their assessed needs are met. More needs to be done to ensure that recording and reporting procedures ensure peoples health needs are always met. Residents are consulted on their preferences in some areas but peoples choices need to be taken more fully into consideration regarding their daily routines and their personal care. The privacy and dignity of people using the service is mostly upheld but improvements are needed in some areas. Evidence: As stated previously, care plans were in place that included basic information to guide staff practice. However more could be done to ensure that basic care needs are reflected in more detail. For example one persons care plan stated Two carers to Care Homes for Older People Page 14 of 32 Evidence: assist with all aspects. This did not describe how this personal care should be undertaken. Residents preferences in terms of day to day living were also not always reflected in the plans. Risk assessments were on the whole in place but again did not provide sufficient detail to guide staff practice. For example one persons moving and handling assessment in the action required section only stated Carer to assist. Many residents files seen included bedrail permissions forms which had not been completed and no risk assessments were in place for those residents files seen where bedrails were in place. Medication administration records were inspected and on the whole were seen to be completed to a good standard and staff were observed administering medication in an appropriate and sensitive manner. However we were told by the owner that one residents medication had been reviewed and changed but medication records and health records did not evidence this. Staff spoken to were not sure if medication had changed or not. Training records showed that medication administration training was provided to some staff. The home does not keep a record of medication signatures and so we could not sufficiently evidence that staff who administer medication have been trained. The provider was informed that it is a requirement to keep a staff signature record. In addition, more needs to be done to ensure that health needs are appropriately monitored and recorded. For example, one residents care notes evidenced that they had lost significant weight and the GP had advised weekly weight monitoring. Records were seen to show that weight monitoring had started in January but no records were in place for March and no explanation was recorded as to why this had stopped. Evidence was seen to show that on the whole residents had access to appropriate health care including access to GP, community nurses, chiropody, CPNs and psychiatrists. In addition evidence was seen to show that residents had access to regular eye examinations. However, little evidence was seen to show that residents had regular dental checks and care plans gave little information regarding oral hygiene. Care Homes for Older People Page 15 of 32 Evidence: It was also noted that some residents with a diagnoses of diabetes were paying for their own chiropody care when this should be free to them on the NHS. The provider was advised to evidence that the home are supporting residents with diabetes to access NHS chiropody were appropriate. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered person ensures that systems are in place for monitoring whether individuals recreational needs are met and whether residents are appropriately occupied during the day. On the whole, routines in the home promote and respect individuals choice although improvements to assessment and care planning would further improve this. People are supported to receive visitors when they wish to and to maintain contact. Evidence: The home offers a range of activities and now benefits from two activity coordinators each day with an activities plan in place. Records are kept to evidence residents participation in activities. These include art, seed planting, cooking, bingo, feeding birds and 1 to 1 work with residents recording their own personal histories. The service also benefits from an external entertainer on a fortnightly basis. Care Homes for Older People Page 17 of 32 Evidence: Time is also taken to work with residents in their own rooms and include activities such as hand massage, making cards and nail care. The home organises activities around themes such as Easter and St Patricks day. The activities take into account peoples dementia and the home has a date and menu board on display. The registered provider stated that the service is committed to moving towards a more person centred way of working. The homes programme of activities showed that residents were being supported in this way. However, feedback from relatives and staff showed that residents do not have access to community activities unless their relatives can facilitate this. The homes intention to provide a person centred approach to activities would be much improved if community access was incorporated into the range of options already available to people. As stated previously, more could be done to promote personal choice and ensure residents preferences are taken into consideration if care plans and assessments contained more detail in this regard. Several relatives were seen visiting people on the day of the site visit and feedback from them evidenced that they are encouraged to visit at any reasonable time. All relatives spoken to were happy with the care provided and felt that staff communicated with them and shared information appropriatly. Care staff were seen supporting residents in a sensitive and dignified manner. Feedback from staff showed that the improved staffing levels gave them more time to spend with residents and get to know them better. One member of staff stated that: Now that we have more time to spend with residents we are finding things out about them that we did not know and its really good. Observation of the lunch-time meal and feedback from relatives evidenced that although the lunch time meal is freshly cooked and varied the tea time meal could be improved. The owner stated that he was aware of this and the home was planning to review tea time menus. Evidence was seen to show that residents benefit from having appropriate eating and drinking utensils in keeping with their needs and food served takes into account Care Homes for Older People Page 18 of 32 Evidence: individual dietary needs in terms of content and consistancy. Staff were observed supporting people to eat in a sensitive and dignified manner which contributed towards the creation of a relaxed and congenial atmosphere during this time. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives are supported to make complaints if they need to and can be confident that their complaint will be listened to and acted upon. Residents in the home are at risk of harm and abuse due to a lack of understanding of and compliance with safeguarding procedures. Evidence: Records seen showed that the home has an appropriate complaints procedure in place. Relatives spoken to thought that their concerns would be listened to and acted upon. In addition, the home uses questionnaires to get feedback from residents, relatives and health professionals. The service is currently subject to an adult protection investigation. Although it is cooperating with the investigation, information received shows that adult protection policies and procedures were not followed appropriately. In addition, training records seen showed that a significant minority of staff have still not received adult protection training. This includes a particularly high number of night staff, which is when the incident currently under investigation happened. A requirement has been made regarding this in this report. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well decorated and furnished home with sufficient bathroom facilities. Most individuals have bedrooms that meet their needs but some residents in shared rooms may not have their privacy and dignity fully respected. Residents have unrestricted access to the gardens which are secure and appropriately maintained. The home is clean and mostly free from offensive odours . People using the service are at risk from a lack of systems in place for checking water temperatures in the home. Evidence: Since the last inspection, the service has made improvements to the environment which have benefited residents. A number of bedrooms have been refurbished and decorated. Improvements have been made to protect residents dignity and privacy. For example, residents (subject to recorded risk assessments) were able to have a key to their Care Homes for Older People Page 21 of 32 Evidence: bedroom doors. Glass panels on bedroom doors and walls leading to the landing have been filled in or have curtains in line with residents wishes. Shared rooms now have appropriate curtains in place around beds and the sink areas. However the home was not able to evidence that residents in shared bedrooms have chosen to share and that their needs are conducive to sharing particularly in regards to upholding the persons dignity. Bedroom water outlets need to be risk assessed to ensure that water temperatures are appropriate and safe. The homes laundry equipment and room have been upgraded. The home is now considering developing another room for laundry sorting. Storage around the home has been improved and further improvements are planned. On the whole the home was free from offensive odours and cleaned to a good standard. Communal spaces are large and decorated to a good standard. The home has adequate dining space to meet peoples needs. The garden was seen to be suitable for residents needs. Further improvements are planned both inside and outside the premises. The evidence was that there were good improvements made since the previous inspection. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by sufficient numbers of staff to meet their needs but lack of staff training is putting their safety at risk. Residents are protected by the homes recruitment practices and procedures. Evidence: Staffing levels have improved since the last inspection. This has had a demonstrable benefit for residents. Observation on the day of the site visit, records seen and discussion with staff evidenced that the home now has consistently good levels of staffing to meet peoples needs. The homes Statement of Purpose stated that it maintains staffing levels in line with peoples needs but aims to have five care staff on each shift not including the manager and domestic staff. Rotas seen evidenced that these staffing levels are being adhered to. As discussed elsewhere in this report, staff were seen supporting residents in a respectful and dignified manner and feedback from relatives was very positive about staff. Care Homes for Older People Page 23 of 32 Evidence: A sample of staff files was inspected. These showed that Criminal Records Checks were undertaken and appropriate references and employment history and application forms were in place. Training records seen and discussions with staff showed that a range of training was provided including moving and handling, challenging behaviour, dementia, nutrition, pressure care, adult protection, first aid, infection control and medication administration. Staff training has improved since the last inspection but more improvements are needed to ensure that all staff have appropriate training to meet residents needs. Significant gaps were noted in the areas of adult protection training and dementia. A lack of training for new staff is concerning. For example, some staff that have been employed in the home since November 2009 still do not have adult protection, moving and handling, first aid, dementia, fire safety and challenging behaviour training. Given the complex needs of residents, the registered provider was advised that this must be addressed without delay. This was particularly evident in relation to nighttime staffing where there is a lack of training in safe guarding. A sample of staff rotas seen showed that on several occasions only one out of five care staff on duty at night had AP training and on at least one occasion none of the staff working had this. This puts vulnerable residents at risk. On the whole staff undergo Skills for Care induction training but this was not confirmed by staff in all cases. It was noted that some of the courses undertaken by staff relied on watching DVDs and discussions with the owner evidenced that the home could not be confident that one of the homes trainers was qualified to deliver training in areas such as moving and handling and adult protection. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. On the whole, the home is run in the best interests of residents but more improvements are needed in the homes management and monitoring systems to ensure the quality of care and safety of all residents. Evidence: The registered manager was not present at the site visit and we were informed that the manager was resigning from her post. The owner stated that the manager had contributed considerably to the improvements that had been made since the last inspection and he was sorry to see her go. Since the visit the home now has a new manager and deputy manager in place. Feedback from relatives and professionals also evidenced that the manager endeavoured to run the home in the best interests of residents. Comments from staff included: Things have changed since December. Most things have got a lot better. The amount of staff has greatly improved. Communication is Care Homes for Older People Page 25 of 32 Evidence: better and residents are being put first. However, as stated elsewere in this report, further improvements are still needed to ensure residents receive a good quality and safe service at all times. Discussions with staff evidenced that they do not always receive appropriate supervision and several staff said that they had never been to a staff meeting. One member of staff had been employed in the home for ten months and received her first supervision in February this year. Lack of staff supervision and training particularly for night staff are putting residents at risk. In addition, discussion with the provider and rotas seen showed that the home does not have a named person in charge at nights. The owner was advised to address the lack of leadership in the home which is leading to inconsistent approaches to care and putting residents at risk. The service must ensure that a named person is in charge of the home at all times and that this is indicated on the homes staffing rota. Feedback from staff also showed that they do not have a staff handover between shifts and are not given specific time to read care plans. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that care plans are detailed in respect of residents health and social care needs and that these are reviewed at appropriate intervals. Care plans are necessary to identify the support needs of residents and to ensure that these needs are reviewed regularly and addressed. 01/06/2010 2 8 13 The registered person must ensure that were necessary detailed risk assessments are in place for all service users and that these are regularly reviewed. This is to identify all the care needs of residents and the issues that care staff must be aware of so that they can provide planned support. When such support needs to be changed, the risks 01/06/2010 Care Homes for Older People Page 28 of 32 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 associated with the new support must be identified and known to all staff. 3 8 13 The registered person must ensure that identified health and medication needs of residents are properly monitored and actions recorded. This is necessary for the protection of vulnerable people and for staff to be properly supported in this aspect of their work. 4 10 14 The registered person must 01/06/2010 ensure that the procedure for admissions to shared rooms is reviewed. The procedure must include evidence that prospective residents have chosen to share and that the shared accommodation is conducive to upholding their dignity and privacy. The accommodation for residents must be appropriate to their health and current disposition. One aspect of this is that there must be evidence that prospective residents and/or their advocate has agreed that the accommodation in a 01/06/2010 Care Homes for Older People Page 29 of 32 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 shared bedroom is deemed acceptable. 5 18 13 The registered person must ensure that all staff are appropriately trained in and understand and follow Adult Protection procedures. All members of staff must receive support and ongoing training in being able to understand the need for safe guarding vulnerable people. 6 19 13 The registered person must 17/05/2010 risk assess hot water outlets in bedrooms and ensure they are safe for residents use. This is necessary for the safety of residents. 7 30 18 The registered person must ensure that all staff receive appropriate mandatory training and that the home can evidence that this has been done. This is necessary both for resident safety and staff efficiency and competence. 8 36 18 The registered person must ensure that staff receive supervision at appropriate intervals. In the absence of the registered manager, a 01/06/2010 15/06/2010 01/06/2010 Care Homes for Older People Page 30 of 32 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 named person must be in charge of the home at all times. This is for the safety of residents and for the benefit of staff providing support to highly vulnerable 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 1 2 12 15 It is recommended that the service enables residents to access their local community if they wish to do so. It is recommended that the service reviews menus for the tea-time meal to ensure a variety of options are available that are in keeping with residents wishes. Care Homes for Older People Page 31 of 32 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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