Care Home: Kingsclear Nursing And Residential Home

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What the care home does well Generally the home continues to provide a good service to the service users living at the home. Service users lifestyles matched their needs and preferences and where possible they are able to maintain contact with family, friends and the local community. Service users are able to make choices in accordance with their abilities and are provided with a balanced diet in pleasant dinning rooms. The documentation of individual care plans is easy to read, gives the reader a full picture of the service users` likes and dislikes, communication needs, risk assessments and care needs and exactly what the carers did with and for the service user over any twenty-four hour period. The home has a satisfactory complaints policy and procedure and training in place that evidenced that service users and relatives concerns are listened to and acted upon.Robust Safeguarding adults policies are in place to protect the service users from abuse. Observations of care staff interaction with residents indicated that residents are treated with dignity and respect. It was also observed that great care was taken in respect of the residents` personal belongings. Currently, all carers undertaking National Vocational Qualification have Equality and Diversity as part of their course work. What has improved since the last inspection? The home has appointed a Senior Clinical Nurse to address care delivery and staff personal development through robust supervision and training. The home has also increased the Activities Coordinator`s hours to one full time and one part time coordinator. The catering team meets with all new service users to individually to discuss personal, cultural or religious preferences in diet. A residents forum and committee has been developed. What the care home could do better: The Responsible individual must ensure the building is kept in good construction and decorative order to meet the needs of the service users and to maintain health and safety of all living and visiting the home. The Responsible Individual must ensure sufficient numbers of staff with suitable qualification are on duty at all times to meet the assessed and agreed needs of the service users. Key inspection report Care homes for older people Name: Address: Kingsclear Nursing And Residential Home Park Road Camberley Surrey GU15 2LN     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: Mavis Clahar     Date: 0 6 0 7 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 29 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 29 Information about the care home Name of care home: Address: Kingsclear Nursing And Residential Home Park Road Camberley Surrey GU15 2LN 0127621211 01276691228 admin@caringhomes.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Kingsclear House Limited Name of registered manager (if applicable) Mr Michael Farmer Type of registration: Number of places registered: care home 72 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 72 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia (DE) Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Kingsclear Nursing and Residential Home is a care home providing nursing and personal care for older people from the age of 60 years. Service provision includes permanent, convalescence and respite care. Care Homes for Older People Page 4 of 29 Over 65 0 72 0 72 0 72 Brief description of the care home The home is part of a group of seven care homes in Surrey operated by Caring Homes Limited. These homes are part of a wider network of care homes, specialist centres and independent hospitals in England and Scotland operated by the same organisation. The home is located in a quiet residential area convenient for Camberley town and all community facilities. The building is a large, detached Edwardian house that has been extended over the years. The original architectural features of the main house have been tastefully combined with the modern, purpose built facilities. The home is set in 4 acres of landscaped grounds and has ample car parking facilities. Bedroom and communal facilities are on two floors, accessible by stairs and passenger lifts. For operational purposes the home is divided into five living units though service users have choice of where they sit during the day. Most bedrooms are single occupancy and ten have en-suite facilities. There are five lounges also a large dining room on the ground floor; a number of combined lounge/dining areas are also available on all floors. The accommodation includes a spacious conservatory, also an activities room and hair dressing/therapy room. All areas of the home are wheelchair accessible and provision includes suitable assisted toilet and bathing facilities. A full time registered nurse-manager is responsible for the day-to-day management of the home. For current information on fees please contact the home manager. Care Homes for Older People Page 5 of 29 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: The last Key Inspection on this service was carried out on 31st January 2008. The service also received an Annual Service Review on 30th January 2009. For information regarding the fees at this home please refer to the manager of the home. This unannounced site visit, which forms part of the key inspection to be undertaken by the Care Quality Commission, (CQC) was undertaken by Mrs Mavis Clahar on the 6th July 2009 and lasted for eight hours and thirty minutes; commencing at 09:00 hours and concluding at 17:30 hours. Also assisting on this inspection visit was an Expert by Experience. This is a person who either has a shared experience of using services or understands how people in this service communicate. They visited the home with us to help us get a picture of what it is like to live in or use the service. This is important because the views and experiences of the people who use the service are Care Homes for Older People Page 6 of 29 central to helping us make a judgement about the quality of the care being delivered in the home. The registered Individual Mrs Wendy Lowther was present and Mr Michael Farmer manager of the home assisted on this inspection. The CQC Inspecting for Better Lives (IBL) involves an Annual Quality Assurance Assessment (AQAA) to be completed by the service, which includes information from a variety of sources. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process. This document was received by CQC (us) and is referred to throughout the report. The comments received via the pre inspection questionnaires sent to twelve service users, five members of staff and one visiting professional are also included in this report. The home has been without a registered manager for some time and the manager has very recently being interviewed by CQC for the vacant post of registered manager for the home. This manager has been in post since September 2008. The majority of the service users spoken to were able to express their thoughts and feelings about the care they receive and the food served to them. The information contained in this report was gathered mainly from observation by the inspectors, speaking with a number of service users, with the manager and Operations manager and deputy manager and with care staff. Further information was gathered from records kept at the home. The first part of the inspection was spent discussing and agreeing the inspection process with the manager, followed by a tour of the home, which included time spent in discussion with service users, care workers and the Chef. The manager and staff are aware of the Laws regarding equality and diversity and this was reflected in the staff mix. Service users in this home are multi racial and reflect the population of the area in which the home is situated. All records sampled were up to date with care plans being signed by the service users or by relatives. Two requirements under Environment and Staffing were made on this visit. Please refer to the requirements page at the back of the report for more and fuller information regarding these requirements. The final part of the inspection was spent giving feedback to the manager , deputy manager and operation manager about the findings of this visit. We would like to thank all the service users, visiting professional and care staff for taking time to complete and return the pre inspection questionnaires. Thanks also to the service users, staff and visitors who took time out of their busy schedule to speak with us and for making the visit so productive and pleasant on the day. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 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. Prospective service users and their relatives have the information needed to choose a home, which will meet their needs and service users are being assessed to ensure the home is capable to meet the needs of the service users prior to being admitted into the home. Evidence: The AQAA informs residents and relatives annual quality service questionnaires show an overall score of 70 satisfaction with the choice of home. This is up by 5 from last year. The home provides service users guide in suitable format for service users. Review of service users documents demonstrated the home has a policy and procedure on admission and discharge of service users. This was supported in discussion with the manager who informed us no service user will be admitted into the home without first being assessed in their environment either by himself or his deputy who are both skilled in the art of assessing the care needs of service users. The admission policy informs service users must have an assessment prior to being Care Homes for Older People Page 10 of 29 Evidence: admitted into the home. Re admission assessment following discharge from hospital is also carried out to ensure the home is still able to meet the needs of the service users. Review of a random sample of service users files including two recently admitted service user, demonstrated that pre admission assessments are being carried out and relatives were being involved in the assessment process. The home provides respite and short stay placement care. Twelve completed surveys were returned by service users.eleven said they had received enough information to make a decision before moving into the home. One said they had not received enough information. Nine said they were given information about the homes terms and condition, two said they were not given any information and one said they did not know if they were given any information. Care Homes for Older People Page 11 of 29 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. Service users receive effective personal and healthcare support using a person centred approach with support provided based on the rights of dignity, equality, fairness, autonomy and respect. The home fully respects the rights of the individual in the areas of healthcare and medication. Staff members are very alert to changes in mood, behaviour and general wellbeing and fully understand how they should respond and take action. Evidence: The randomly selected care plans were clear, identifying potential and actual risks to service users and detailing how these risks would be managed. The daily work sheet along with discussion with service users and care workers demonstrated that service users care needs are fully met. The service user or relative signed the care plans to indicate their involvement in deciding what care they received. It was evidenced that care staff undertaking the development and monthly review of the care plans also signed and dated them. Information contained in the homes Annual Quality Assurance Assessment (AQAA) informs each care plan is written in a manner which each client and staff member can understand and follow to ensure the needs of the service users Care Homes for Older People Page 12 of 29 Evidence: are met. Personal discussions on the day of the visit with service users revealed that they were involved in the assessment of their care needs. All service users are registered with a local General Practitioner (GP) of their choice and visits are recorded, with access to specialist health care professionals through their GP practise as required and these visits are also recorded in the service users folder. Service users are offered access to chiropody service and weekly hairdressing facilities are available at a cost to the service users. In discussion with the manager, the deputy manager of the home and care workers they were extremely proud of the high standard of care they provided to all service users in the home. This was supported by the service users spoken to and by the review of the many letters of thanks received by the home. Care staff identified as capable to administer medication are requested to leave a sample of their signature which is dated, in the medication trolley. All service users have a recent photograph included in their personal folder and medication record, to reduce the risk of mistakes happening during medication administration. We were told that some service users on the day of the site visit were assessed as capable to self medicate. This aspect of medication management was supported in discussion with the manager, and by reviewing the homes policy on self-medication in the service users medication folder. Medication records were checked and found to be correct as documented on the Medication Administration Record (MAR) sheet. Review of the homes record of receipt and disposal of medication was satisfactory, dated and signed.We saw relatives on the day of the visit. Most residents and visitors spoken to were happy with the level of care at the Home. One relation said, The nursing care is alright. One visitor said, If there is a problem, the Manager will sort it out. All staff seen were calm, reassuring and kind with some humour to residents. One visitor said, Overall, the staff are fairly kind people, although there are not enough on occasion when under pressure. One resident pointing to a nurse walking through said, Thats a nice girl. Another said, The staff are lovely. One resident said, The staff are wonderful. They need a medal. And the nurses-were really spoilt. One new member of staff observed had a cheery manner with residents and knew their names. One resident in her room was on a large oxygen machine and wished there were more smaller oxygen units available so that she could move around the Home more often. One visitor complained to the laundry during the inspection that their relations personal apron had disappeared, and the laundry lady resolved this. One resident said ,I wish they [staff] did not put me in a hot bath. I can bath myself. She also said, Sometimes the staff ignore people,they have their favourites. One resident in a wheelchair said that when they were in the hall, the call bell [near a wall] is too far away. Care Homes for Older People Page 13 of 29 Evidence: We observed that care workers wore name badges to enable visitors and service users with memory impairment to be sure of whom they are speaking with. We observed Service users being treated in a friendly but respectful manner by care workers. Service users spoken to rate the personal care they receive as very good. Service users unanimously said, We are treated with respect. They said the staff team are friendly and they attend all appointments accompanied either by staff or if their relative decides to accompany them. In discussion with service users they told us that they are treated with respect and dignity, and that they are able to make their own choice. They further told us they can see many improvements in the home as a result of having a new manager. One service user told us I am very happy here. Everything is so nice. I have my own room; I can have as much privacy as I want and I can can second helpings if I want. not that I ever ask only if it is ice cream being served. Another service user said We have good staff here; they do not ill treat me. I have help to choose my own clothing every day. Twelve completed service users questionnaires were returned. Seven said they received the care and support they need . Three said usually and Two said sometimes. Care Homes for Older People Page 14 of 29 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. Service users lifestyles matched their needs and preferences and where possible they are able to maintain contact with family, friends and the local community. Service users are able to make choices in accordance with their abilities and are provided with a balanced diet in pleasant dinning rooms. Evidence: The home ensures the activity staff along with outside entertainers manage the activities programme for the service users. The Manager and staff in agreement with the service users and their relatives provide a range of activities based on the individual assessed and agreed needs, including their preferences, cultural beliefs and customs. The AQAA informs us that wherever possible relatives are encouraged to participate in the planning and carrying out of service users activities. Activities provided are age appropriate and include board game,various crafts, knitting, reminiscence therapy, sing-a-long, scrabble, quiz afternoons, bingo and a wide range of board games. The home also provides outside visiting entertainers to the home to provide extra activities for the service users. We were told the home has good contact with religious denominations and Holy Communion is provided for all service users who would like to participate. In discussion with service users we were told the home respects those service users who wish not to participate in an activity on any given Care Homes for Older People Page 15 of 29 Evidence: day. A record of each service users daily activity is kept by the activity co-ordinator. Activities are brought to those service users who are unable or unwilling to join the big group. Service users told us visiting is open, and that they can entertain their guests in their bedrooms in private or in the spacious communal areas of the home. We observed that a variety of fresh fruits were made available for service users and their visitors in the home. Six of the service users spoken to said they had choice in their clothing and sometimes they receive help from their key worker. On the day of inspection all service users were dressed appropriately for the weather.We were told the Chef who has been at the home for a long time operates from a four-week menu and there is always a choice of three hot meals per day at mid-day, or salad at mid-day or the service user can choose their own food e.g. omelet etc. One service user told us there is always a choice of two hot dishes for the evening meal, or we can choose to have sandwiches filled with our own choice. Morning coffee and afternoon tea is served daily and our visitors are also our guests are served the same as us. We observed jugs of fruit juices and squash with glasses were placed in the lounges whilst service users were present, and staff was seen offering drinks to service users. There were ample amount of fresh fruit, available in the home in the lounges and dining rooms so that service users could help themselves if they wished.The inspector did not sample the lunch, but service users said the food was very good, tasty and the right amount. The inspector observed the presentation of the food was done in a way to stimulate appetite. A choice of squash or fruit juices were served with lunch, which was served in the dinning room unless a service user requested to have their meal in their bedroom. We observed care workers interacting in a friendly but dignified manner with service users . Care Homes for Older People Page 16 of 29 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. The home has a satisfactory complaints policy and procedure and training in place that evidenced that servic users and relatives concerns are listened to and acted upon.Robust Safeguarding adults policies are in place to protect the service users from abuse. Evidence: Three safeguarding matters have been investigated by the local safeguarding team; two have been resolved and one is on-going at the time of the site visit. Twelve complaints were logged at the home since the last inspection and 70 of these have been resolved within the twenty-eight days period. The manager told us he and the deputy manager of the home are in touch with service users on a daily basis and issues raised are dealt with immediately; this prevents any need for service users to complain. Service users spoken to said they have no need to complain, as they are able to discuss everything with the manager or deputy. In discussion with the manager we were told all records of service users complaints were logged with their outcome as this would demonstrate the management of the home is open and transparent.The care workers were aware of the homes policy and procedure on Safeguarding Adults and felt secure in the knowledge that if they had to use the whistle blowing procedure they would be supported. It was observed that the homes guest information notice board situated in reception contained a complaints procedure and policy, whistle blowing policy, statement of purpose and a recent copy of the last CSCI and CQC inspection report for the benefit of all visitors to the home. The home Care Homes for Older People Page 17 of 29 Evidence: has received a number of complimentary letters and cards from relatives of service users, commenting in a positive way about the care their relatives received at the home. A random sample of care workers training record demonstrated that care workers are being trained to undertake the duties of meeting the service users assessed needs, thereby protecting them from abuse. We were told all staff have criminal records checked prior to commencing employment. Staff are aware of the procedure for responding to suspicion or evidence of abuse or neglect. The policies and practises of the home ensure that physical and verbal aggression by service users are understood and dealt with appropriately. The home does not become involved with service users finance. We observed that the manager has commenced keeping a record of all falls in the home. In discussion with the manager we were told this is being done to see if there is a pattern to falls and the result will enable the staff team to be more able to prevent falls occurring in the future. Twelve completed service users surveys were returned. Nine said they knew how to make a complaint. Three said they did not know how to make a complaint. Care Homes for Older People Page 18 of 29 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. The physical design and layout of the home enables service users to live in a safe and comfortable environment, which encourages independence, and protect their privacy and dignity. Any risks identified are being managed appropriately Evidence: The management and staff encourage service users to see the home as their own home. It presents as a comfortable, attractive old building, which has all the specialist adaptations, needed to meet the service users needs. It was observed that call bells were left within reach of each service users and service users said the bells are answered promptly. We also observed service users safety is promoted and there is suitable protection for the part of the home that is being used for service users diagnosed with dementia. The home has attractive, secure secluded gardens. which are well maintained and there is good access to the gardens from various parts of the home. Some service users told the inspectors that they try to go out daily weather permitting to enjoy the gardens. The inspector noted that adverse weather would not stop service users enjoying the garden, as the windows are low enough especially in the dining room to allow service users to view the gardens from their chairs. It was noted that service users were able to personalise their bedrooms with small items of furniture, paintings on the wall and many family photographs. Generally, the home presents as clean, safe, pleasant, hygienic and tidy. There was a strong smell of urine in one sitting room. However when pointed out to the manager and staff they said Care Homes for Older People Page 19 of 29 Evidence: they could not smell it. Two bedrooms were particularly odorous and we discussed ways in which the home could get rid of the smell or even minimise it. The manager informed us they have got this particular problem under discussion and that he was waiting on the company to make the necessary alterations to the flooring of one room and they were in discussion with the continence nurse about the other bedroom. One visitor complained of the smell in her relations room and said that her children and grandchildren didnt like to visit because of it. The visitor also remarked, After sitting in the Day-Centre we had to change all our clothes when we got home because of the smell. We have never sat in there again. Random review of care workers training record demonstrated they have had training in infection control and this was evident in the storage of waste and the cleanliness of the sluice.. The AQAA informs us staff are trained on the safe disposal of clinical waste and are provided with protective clothing to minimise the risk of spreading infection. We observed staff wearing disposable gloves and aprons whilst undertaking tasks during the visit. We observed great care is taken by caring staff when caring for service users who are being barrier nursed. Twelve completed surveys were returned from service users. Six said the home is always fresh and clean. Six said the home is usually fresh and clean. Care Homes for Older People Page 20 of 29 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. Staff in the home are trained, skilled and are not always in sufficient numbers to fulfil the aims of the home and meet the changing needs of the service users. The training arrangements are robust and the recruitment procedure satisfactory ensuring service users are protected. Evidence: The staff rota demonstrated the number and grade of staff on duty to provide care and attention to service users for any twentyfour hour period was suitable to meet the assessed care needs of the service user according to the manager. However, during dinner time it became apparent that there were not enough staff available to help those service users in one dining room who needed help with feeding. In the larger diningroom on the ground floor at the beginning of lunch there were only one or two members of staff and the service users were kept waiting to have something to drink beforehand and for their meals to be served. The Manager and a member of staff explained that the Home is in the process of improving lunch times for the service users by having two of the five units together to help the social side of the meal and staff have not yet fully grasped the idea of helping service users from each others units. Near the end of lunch at twelve fortyfive p.m. there was only one member of staff looking after 13 service users. Another dining area for more able service users had one member of staff for 12 service users. A service users remarked the carer seems to cope very well. Another replied, shes truly wonderful. After lunch the Care Homes for Older People Page 21 of 29 Evidence: trousers of a service user who was in the ground floor TV room were very wet and it was the Deputy Manager passing through who alerted a carer in another area to wash and change the service user.This was done promptly by two carers.One service user said that they had to wait sometimes for the call bell to be answered and added, they never have enough people, some go upstairs and then are not available. But it has got better since the new Manager arrived. Another service user said that she had to wait half an hour and longer sometimes.The service user said, definitely, there is never enough staff at any time of day and night. At night there is one nurse and one carer for seventeen service users. We observed that a few call bells which went off during the inspection were answered within five minutes. One visitor told us, there are only two carers and a nurse on duty to get ten people up in the mornings, that means washed (three baths a day), toileted and dressed. This takes about ten to fifteen minutes a time. They also said, overall the staff cope very well. One member of staff said that it is very busy in the mornings and wished the night staff could help more beforehand, but understood that the service users choice of getting up times have to be respected. Another member of staff said that they seldom had their two fifteen minute breaks during the day during a twelve hour shift, but had half an hour at lunch. One nurse said, it is a big problem, there is not enough time to help service users all the time.A requirement was made to ensure the home provide enough carers to meet the agreeed needs of the service users.The home has a programme of planned training in place and all members of staff have an individual training record. The AQAA informs just under 50 of care workers have attained the National Vocation Qualification at Level 2 (NVQ L2) or above. Care workers are encouraged and enabled to undertake developmental training as well as the mandatory training. All newly appointed staff undertakes the Skills for Care Common Induction programme.The home ensures that staff undertakes the mandatory training with yearly updates as necessary to maintain their competency to fulfil their duties.This was evidenced through discussion with the care workers, the training manager and review of carers training records. All members of staff spoken with said that their training was adequate for their tasks and was very much ongoing. This was supported in the staff questionnaires returned to us. One member of staff who had been at the Home for less than eight weeks had already had manual handling training and some electronic,training. The staff member said that they felt they had adequate training to date but was always learning on the job. This staff member stated that when dealing with service users with dementia, qualities should include giving reassurance and to have humour when appropriate. Another member of staff who had been in the home for a short time informed us that they uses distraction tactics if a service users is worried about something. Another care staff who had been at the Home for under a year said that they had done the moving and handling course, fire and customer service courses, and pressure area care. They also said, if they needed to take blood Care Homes for Older People Page 22 of 29 Evidence: or a female catheter changed, they would get help from one of the other units.The AQAA informs staff turnover at the home is medium to high.In discussion with the manager we were told this is a result of foreign carers returning to their own country after a stay in Britain.The AQAA informs all care workers are Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checked prior to commencing employment, and they are in receipt of terms and conditions of employment, as evidenced in their randomly selected files, which contained the information required under care Homes Regulations 2001 Schedule 2. One recently employed carers file did not contain full work history and a requirement was made to rectify this. However, the manager emailed the information to us the next day and before completion of this report. We observed supervision records were up to date during random sampling of care workers files. Documented evidence indicated that the home ensures that care workers receives the mandatory training with yearly updates as necessary to maintain their competency to fulfil their duties.This was evidenced through discussion with care workers. In discussion with the manager he explained that attracting suitable staff was proving quite difficult but he would rather wait for the right person for the job than to take on someone who was totally unsuitable. He further informs us he ensures all staff are able to speak and understand the English language before offering them employment as a carer. We observed a calm atmosphere in the Home and no evidence observed of staff or service user being rushed. We observed a carer taking two service users down to lunch in the lift (one in a wheelchair) in a calm manner. Although one service user was distressed at the time, the carer spoke very kindly and reassuredly to both service users and did not rush them to move into the lift. It was noted that footplates were not used on the wheelchair, but the carer explained that this particular service user hated to use them. The carer reminded the service user to lift their feet as she pushed the chair forwards. We observed a member of staff taking a service user to the lavatory and the staff member did this in an unrushed manner. We also observed service users in the main dining area were not rushed in eating their meal. Staff walked in an unhurried manner.Several service users and some visitors told us that they could not easily understand some of the foreign staff. We also found two members of staff difficult to understand. One service user said, it is very difficult to understand some of them (the staff). Sometimes when they say the menu options quickly, I cant understand them. One service user told us, the foreign staff are quite nice, they have good manners. Another service user said, I have no problem understanding the staff. Twelve completed service users questionnaires were returned. Two said staff are always available when you need them, eight said usually and two said sometimes. Four said staff always listen and act on what they say; five said usually and two said sometimes . One said dont know. Five completed staff questionnaires were returned and all staff were satisfied with the checks the home did prior to their commencing work and were also satisfied with the training provided for Care Homes for Older People Page 23 of 29 Evidence: them. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the experience to run the home and works to continuously improve services and provide an increased quality of life for the service users. There is a strong ethos of being transparent and open in all areas of running the home and the views of service users and their relatives are actively sought.Service users financial interests are safeguarded and the health, safety and welfare of service users and staff are protected and promoted by the homes policies and procedures. Evidence: The AQAA informs us that the manager has demonstrated that he has kept himself updated on issues relating to care of the service users and staff in his charge. He is registered for the Leadership and Management In Care Services (this replaces the Registered managers Award course) distant learning, and has recently being interviewed for the registered managers position by CQC. He informed us he has had verbal confirmation that he will be registered. This was confirmed with Registration division. He is also a Registered Mental Health Nurse with many years experience of caring for the elderly both in the NHS and in the private sector. In discussion with the Care Homes for Older People Page 25 of 29 Evidence: manager it was evident both the manager and the deputy manager are knowledgeable about the care needs of the service users and the training needs of the care workers to meet these identified needs. There are clear lines of accountability within the home, each member of staff spoken to on the day of inspection aware of their role and responsibilities. We were told that the majority of the service users are capable to be fully involved in the running of the home, and their relatives are encouraged to be as involved as their time allows them to be. We were told the service users of the home are treated as part of a large family and meetings are held at regular intervals to allow service users, their relatives, carers, registered manager, Chef and the deputy manager to discuss issues pertaining to the smooth running of the home. Every one is then able to contribute to the running of the home, whether it is to change the four weekly menus or to replace major items in the home. One service user explained that this approach is preferable by all concern parties as any occurrence in the home affects us all.The home does not become involved in service users finance. The relatives manages all their finance. Good records are kept with receipts for any expenditure.Review of documented records demonstrated that health and safety checks are routinely carried out at the home. All equipment examined on the day was properly maintained. The AQAA informs that fire drills, fire alarm, and water temperature were regularly checked and records kept verifying this. Random sample of care workers training files demonstrated that up to date and relevant training were carried out by care workers to protect service users health, welfare and safety. Throughout the service there is a highly evolved understanding of the equality and diversity needs of the individual service users. Care workers are confident in delivering high quality outcomes for service users in the areas of age, sexuality, gender, disability race and belief. Care workers are knowledgeable about issues relating to race and equality and diversity, they are able at the moment to put this knowledge into practise, as the current service users are of a mixture of race and culture. Random checking of policies revealed that the homes policies are updated recently. Care Homes for Older People Page 26 of 29 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 29 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 19 23 Repair the ceiling in the nurses room and in the vestibule between Lower meadow and Willard Repair the ceiling in the nurses room and in the vestibule between Lower meadow and Willard 16/10/2009 2 27 18 Ensure that all times 28/08/2009 suitable numbers of staff are on duty to ensure the needs of the service users are met. To ensure identified needs of the service users are met at all times 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 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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