Care Home: Knowles Court

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What the care home does well No person moves into the home without having had his/her needs assessed and been assured that these will be met. People`s care and support needs are documented and available for the staff to follow. People`s daily life and social interests are met. Systems are in place to protect people from abuse, and support those who want to complain. People live in clean, safe and well maintained home that is suitable to their needs. The staff team are caring. The management team make sure that the health, safety and well being of people and staff is promoted and protected. What has improved since the last inspection? The work that needed to be completed in relation to the the refurbishment, redecoration and repair of the New Hall unit has been completed. In order to protect people who have agreed to pay money into the mobility fund the provider has made sure that people contributing towards it are consulted and agree about how it will be managed. A policy has been put in place setting out how the fund will be managed, what money can be used for and how it will be made equitable for the people who contribute. What the care home could do better: Ensuring that people are treated with respect and dignity; strengthening the risk assessment and care planning process, and the way that daily records are written, would enhance the work done by the staff in meeting people`s health and personal care needs. Ensuring the risk assessments clearly state what actions the staff are to take to eliminate or reduce risks would promote people`s health and welfare. Ensuring that people are supported to access relevant healthcare services would ensure that best interests are promoted. The use of recognized person cantered planning techniques would further enhance the care planning process already undertaken by the staff team. The daily records should give a clear and descriptive account of a person`s day including any care given, activities they have been involved in and any other significant information relating to their time in the home. People living on the New Hall unit would benefit from a re-assessment of their needs in order to determine what type of care provision is appropriate to meet those assessed needs. Training relating to managing violence and aggression and the use of restraint should be sourced from training providers that are accredited with the British Institute of Learning Disabilities as recommended by the Department of Health. Improvements to the specialist training offered to the staff team, and a review of the staffing levels across the site taking into account people`s needs and dependency levels, would enhance the work of the staff and improve outcomes for people.Greater emphasis should be paid by the management team to ensure that a clear sense of direction is communicated to the staff team so that improved practice in the areas of care, support and meeting needs is fostered and maintained. Key inspection report Care homes for older people Name: Address: Knowles Court 2 Bridgeway Bradford BD4 9SN     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: Tony Brindle-Wills     Date: 0 7 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Knowles Court 2 Bridgeway Bradford BD4 9SN 01274681090 01274652916 walkerdo@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd care home 146 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodate is: 146 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Dementia - Code DE(E) Learning disability - Code LD Learning disability - Code LD(E) Physical disability Code PD The residents admitted to the home for residential dementia care to be no younger than 55 years of age. Date of last inspection Brief description of the care home Knowles Court Care Home is situated in Holmewood, a residential area on the outskirts of Bradford. The home is close to local bus routes. The home is made up of five Care Homes for Older People Page 4 of 30 Over 65 30 26 90 0 30 26 0 7 Brief description of the care home individual single storey houses, which are linked by covered walkways. Newhall provides nursing care for people with learning disabilities, Headley provides residential care for older people with dementia, Fairfax provides residential care to older people and Devere and Ryecroft provide nursing care to older people. All bedrooms are single but do not have en suite facilities. Each house has a central communal area, which is used as a lounge and dining area. Each house has a satellite kitchen so that drinks and snacks can be provided between mealtimes. All have access to gardens and patio areas, and many of the bedrooms are provided with patio doors. There is a central administrative building, which houses the Matrons office, laundry, main kitchen and hairdresser?s salon. There is also a support flat where visitors could stay overnight. Information about the services provided can be obtained from the home in information packs that contain the Statement of Purpose, Service user Guide and complaints procedure. Copies are kept in every bedroom. The weekly fees for services provided in the home vary depending on whether or not the person is funded by the local authority and if they have residential or nursing needs. They range from #318.15 for local authority funded residential care to #707.84 for privately funded nursing care. Details of exact charges can be obtained from the manager. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: We visited the service and looked at the following records; care assessments and care plan files, care reviews, personnel and training records, staff meeting minutes, health and safety records. We spoke to 15 people who live at the home, and 5 relatives who were visiting Knowles Court. We also spoke to 11 members of staff who work at the home along with the registered manager. We sent surveys to people who use the service, their relatives, and professionals with an interest in the home. The comments we received included: I am very satisfied with what Knowles Court is doing for me. (Person living in the home) Care Homes for Older People Page 6 of 30 Sometimes there could be more staff on duty so that we dont have to wait to go to the toilet. (Person living in the home) I am quite happy with the staff. Overall they are wonderful. (Person living in the home) I sometimes think a few more staff would be a good idea as many of them always seem very busy, and find it difficult to stop and chat. (Person living in the home) I like the food, theres always a good choice. (Person living in the home) Theres not a lot wrong with Knowles Court. (Relative) I think the care and support being given by the home is very good. (Relative) I am very happy with the service that my relative is receiving. (Relative) I dont see the manager very often, but I do see the staff who care for my relative. (Relative) The staff are always willing to take on board ideas about how best to support people. (Professional) Sometimes the records are a little thin: more detail would be helpful so that better judgement can be made when working with people. (Professional) We sent some time observing the practice of the staff and the mood of people living at the home. We made a request for an Annual Quality Assurance Assessment (AQAA) prior to out visit, which the registered manager completed and sent back to us in time for our visit. We used this document to cross reference a variety of information and evidence we gathered while visiting the service. We have reviewed our practice when making requirements to improve national consistency Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This service is registered as a Mixed Category home. It is registered to accommodate both younger adults and older people. In the past reports concerning this service were produced using a mixed category report format. However, the Commission has done away with the mixed category report format. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Ensuring that people are treated with respect and dignity; strengthening the risk assessment and care planning process, and the way that daily records are written, would enhance the work done by the staff in meeting peoples health and personal care needs. Ensuring the risk assessments clearly state what actions the staff are to take to eliminate or reduce risks would promote peoples health and welfare. Ensuring that people are supported to access relevant healthcare services would ensure that best interests are promoted. The use of recognized person cantered planning techniques would further enhance the care planning process already undertaken by the staff team. The daily records should give a clear and descriptive account of a persons day including any care given, activities they have been involved in and any other significant information relating to their time in the home. People living on the New Hall unit would benefit from a re-assessment of their needs in order to determine what type of care provision is appropriate to meet those assessed needs. Training relating to managing violence and aggression and the use of restraint should be sourced from training providers that are accredited with the British Institute of Learning Disabilities as recommended by the Department of Health. Improvements to the specialist training offered to the staff team, and a review of the staffing levels across the site taking into account peoples needs and dependency levels, would enhance the work of the staff and improve outcomes for people. Care Homes for Older People Page 8 of 30 Greater emphasis should be paid by the management team to ensure that a clear sense of direction is communicated to the staff team so that improved practice in the areas of care, support and meeting needs is fostered and maintained. 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 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. No person moves into the home without having had his/her needs assessed and been assured that these will be met. Evidence: A discussion took place with the registered manager about what would happen if people wanted to move into the home. She explained that if someone wanted to move into the home, then she or a member of staff with experience of assessments, would visit the person, and their family or representative, and undertake an assessment of their needs. The registered manager showed us the pre-admission records of 3 people who had recently moved into the home. These records were found to contain assessments about peoples needs and desires, their health and personal care needs,and information about their life history. There were written details of how these needs should be met, and the registered manager explained that this information had been Care Homes for Older People Page 11 of 30 Evidence: gathered through meeting the person, talking to them, their family and the health and social care professionals involved in their life. Information contained within the care records confirmed that people with experience of undertaking assessments go to visit people to gather information about their on going health and personal care needs. The registered manager made it clear that if people wanted to visit the home, and meet the people and staff, then they would be able to do this. The records show that once an assessment is made, then a decision based on that information is made as to whether the service can meet that persons needs. The registered manager gave details of how a letter is sent to the person explaining the decision, and if the service can meet their needs, then arrangements are made for the person to move in. Information contained within the care records confirmed this. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ensuring that people are treated with respect and dignity; strengthening the risk assessment and care planning process, and the way that daily records are written, would enhance the work done by the staff in meeting peoples health and personal care needs. Evidence: The registered manager was able to explain the care planning process in detail, which she said includes making sure that the staff learn what is important to the person in everyday life so that they can be supported to live a fulfilling life. She added that the staff involved in the care planning process, find out what the health and safety risks are to each person by talking to them and their families, and by undertaking a risk assessment, which is documented. We looked at 12 care plan files whilst at the home. Information contained within the care plan files confirmed what registered manager had spoken about. She added that wherever possible, the person themselves, and or their family members (if appropriate) are involved in the care planning process. Again this was supported by Care Homes for Older People Page 13 of 30 Evidence: way of information contained within the care plans with peoples signatures being seen on various documents. People living at the home did not speak about the care planning process, but did say that the staff ask them about what they like to do, about what their interests are and about how they like to be supported to undertake certain activities such as washing, dressing, shopping and socializing. Staff at the home confirmed that they are involved in care planning, and were able to speak about the process in a manner that indicated that they saw it as an important part of what they do, and not just a task to be completed. Whilst on the New Hall unit, we asked if people had used any recognized person centered planning techniques when their care and support was being put together, and found evidence that one person had. The unit explained that the use of recognized person centered planning techniques would further enhance the care planning process already undertaken by the staff team. We looked at the daily records which were found to contain information about what people had been doing during the day and night. The information was seen to be factual and non-judgemental, and when decisions had been made to participate in different activities, the reasons for this had been recorded. However, the daily records belonging to people living on The New Hall unit were found to be very repetitive, and not very detailed. One staff member explained that for some people, decision making can be difficult due to their level of cognitive ability, adding that when decision are made on a persons behalf, to engage in a social activity for example, then the staff always ensure that good records are kept so that the reasons why and when decisions are made by others can be clearly demonstrated. Information contained within the daily records confirmed this. The registered manager explained that personal supported is always provided to people in private, and that routines such as the times for going to bed, having baths, meals and other activities are flexible. She added that people are encouraged to choose their own clothes and hairstyle, and where possible peoples appearance reflects their personality. Discussions with people living at the home confirmed this. Observations made on the day of the visit confirmed that on the whole staff work with people in a sensitive manner, providing flexible personal support in ways that promote peoples privacy and dignity and where possible their independence. However, it was Care Homes for Older People Page 14 of 30 Evidence: noted on one unit that when a staff member was helping someone to eat, the staff member do not speak to the person throughout the time they were helping them. Another staff member was seen to be massaging a persons hands but spent most of the time watching TV instead of interacting with the person. We also observed one staff saying in a loud voice, Ill do them, when volunteering to support a person to use the toilet. Information contained within peoples care files indicated that peoples health is monitored and any potential complications and problems are identified and dealt with at an early stage, including referral to the appropriate health-care professional. The registered manager explained that people with specific health-care needs are supported to visit a specialist, and if they are unable to make their own appointments, the staff do this on their behalf. This was supported by way of information contained peoples care plans showing when appointments had been made, the outcome, and any action that needs to be taken by the person, or the staff at the home to promote peoples health and wellbeing. Feedback from relatives indicated that they were satisfied with the way in which staff at the home support people with their health-care needs. However, we noted that one person who had received a letter relating to a routine cancer screening test, did not have any evidence in their file to show that action had been taken follow up this test. When asked about this, a staff member explained that it must have been overlooked, and that appropriate actions would be taken to support the person in this. A sample of the medications held at the home were looked at and everything was found to be in good order. The registered manager was able to explain in detail the medication policies and procedures, and these were found to be satisfactory. She explained that records are kept of all medications that are received, administered and disposed of within the home, and these systems were found to be satisfactory and ensure there is no mishandling of peoples personal medication. The records confirmed this. The staff training records show that staff have had training in the use and medication. Our observations found that people do get support and attention from staff members when they ask, or are seen to be in needs of support. However, we observed that a vast majority of the staff interactions that took place on New Hall unit were with people who were very vocal, and able to move around independently. Some of the people without verbal communication, and unable to move around due to the level of ability did not get as frequent attention from the staff, and one person was seen to Care Homes for Older People Page 15 of 30 Evidence: have no interaction for near 1.5 hours despite a staff member sitting next to them who was talking to another person. We found evidence in people care files of information relating to how they would like to be supported toward the end of their life, and what kind of funeral arrangements they would like. We also found a care plan called Expectations of Relatives that gave details of what the hopes of peoples relatives were in relation to end of life care. We expressed a concern to the registered manager that there was a need to ensure that the hopes and wishes of relatives did not override those of the person themselves, and that clear instructions must be obtained from the person about end of life issues either through discussion or the use of advocacy, and that if this was unsuccessful, then relatives views should then be taken into account. We found evidence within peoples care plan files of assessments that had identified potential risks to a persons health and welfare. We found information that gave details to staff members of how to either eliminate or reduce these risks. We found one risk assessment that stated Please do not bath this person. We expressed a concern that rather than being a request, this risk assessment should be mandatory as the person had a health condition that would mean if they became ill whilst left unattended in a bath, they could drown. A discussion took place with the unit manager on the New Hall unit regarding the needs of the people living there, and to what extent individuals had significant and complex healthcare needs that required on site nursing intervention. The unit manager explained that some of the people do require regular nursing intervention, but others do not. A look at the care plans records showed that some people living on this unit do not have significant and complex healthcare needs that require on site nursing intervention, but do have healthcare needs that could be met through access to local healthcare facilities and specialist nursing teams based in the local community. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples daily life and social interests are met. Evidence: People living at the home said they can choose when to get up, go to bed and how and where they spent their time. The manager said that links have been made with the local community. Some people go out to the Salvation Army Centre and children from a local school come in to talk to people. One person said that a vicar comes in to the home to lead worship sessions for all who want to join in and a representative from the Roman Catholic Church visits people who want to take communion. Information contained within the AQAA showed that there is an activity organiser on each of the units at the home. We spoke to one of these staff members who explained that they had received training and support to help them with their roles and that more training is planned. The registered manager explained that the people who live at the home have differing interests and preferences as to how they spend their day. One member of staff said that there are activities put on in the home, and that people do get the opportunity to go out and take part in recreational activities such as shopping, baking, meals out, Care Homes for Older People Page 17 of 30 Evidence: visits to the pub and visits to see family. The notice board was seen to give information about entertainers that visit the home from time to time. The menus were looked at, and were found to offer people a varied and balanced diet. One person said that there was always plenty to choose from, and that if they didnt like what was on the menu, then the staff would make them something different. People confirmed that they are supported to keep in touch with their families and friends, and the daily records show when family and friends visit. We spoke to a number of visitors who said that they could call in at any time, and that they were always made welcome by staff with refreshments being offered. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place to protect people from abuse, and support those who want to complain could be strengthened by staff accessing accredited training in the area of physical restraint and managing violence and aggression . Evidence: The registered manager explained that the home has a complaints procedure, which is available for all to see as it is posted in the entrance hall of the home. The procedure was seen to be satisfactory. The records show that the service has had some minor complaints within the last year which have been dealt with appropriately and to the satisfaction of the complainants. The records held by the Commission show that we have not received any complaints about this service. People who responded to our survey indicated that they knew who to speak to if they had a concern or complaint, and that they felt confident that their concern of complaint would be dealt with quickly and appropriately. One person living at the home who was spoken with said that they would speak to a staff member if they were worried about anything, and that they felt sure the staff would support them and deal with their worries properly. We found evidence to show that local advocacy services are involved with people at the home, and information about how to contact advocacy services is made available to people. Evidence contained within the records at the home showed that the registered Care Homes for Older People Page 19 of 30 Evidence: manager and unit managers make contact with the local authority Safeguarding Team as and when required. The registered manager explained that staff have had adult safeguarding training, and added that the service has a adult safeguarding policy and procedure, which is displayed within the home, given to staff, and used as a basis for staff training. She added that the organization also has a whistle blowing procedure. These policies and procedures were looked at the found to be in good order and in line with the local authority safeguarding procedures. One member of staff who was spoken with was able to talk about what they would do if they suspected or witness abuse, and their explanation was found to be in line with the policies and procedures operated by the service. The personnel records held at the home show that the Protection of Vulnerable Adults register is checked before staff are appointed to work in the home. We found that one of unit managers has been trained in managing violence and aggression and that they use their skills and knowledge to train other members of the staff team. We found that the training they had received was satisfactory but not accredited with the British Institute of Learning Disabilities as recommended by the Department of Health. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in clean, safe and well maintained home that is suitable to their needs. Evidence: The registered manager explained that the comments she regularly gets back from people living at the home, their relatives and visitors state that people see the home as being comfortable, roomy, bright, cheerful and clean. On the day of the visit, the home was found to clean and tidy, with the furnishings and fittings being seen to be of a good quality and in good working order. People living at the home said that think it is kept clean and tidy. This was confirmed on having a look around the building. Hand washing facilities were found to be located appropriately throughout the building, and the registered manager explained that laundry facilities are sited so that soiled articles and clothing are not carried through areas where food is stored and prepared. This was confirmed on having a look around the building. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the specialist training offered to the staff team, and a review of the staffing levels across the site taking into account peoples needs and dependency levels, would enhance the work of the staff and improve outcomes for people. Evidence: The registered manager explained that the comments she regularly gets back from people living at the home, their relatives and visitors state that people believe the staff team to be approachable, reliable, honest and motivated to make sure people are cared for properly. On the whole, observations made on the day supported this, with staff being seen to work sensitively with people, communicating with people effectively and showing an interest in individuals. Feedback from people who completed our survey showed that they believed the staff to be good at what they do, friendly and enthusiastic about the work they undertake. The personnel and employment records that were looked at contained good levels of information. Information contained within the records show that new starters are only confirmed into post once a satisfactory Criminal records Bureau check has been undertaken, and a check against the Protection of Vulnerable Adults register is made. Care Homes for Older People Page 22 of 30 Evidence: Feedback from people who completed our survey indicated that they believed the staff to be well trained. Staff working at the home spoke about the training they had received, giving details of scenarios that come up from time to time, and details of what they would do, how they would deal with issues, and how they could do things differently if needs be. The staff training records show that staff received good levels of training in various aspects of their work within the home. The registered manager explained that specialist training for nurses who do not have a background in learning disability is to be arranged so as to give the nurses a better awareness of the issues relating to the people with learning disabilities and sensory impairment, and the care and support they make require. Staff at the home confirmed that training in this area is to be arranged and that they were looking forward to attending it. Our observations found that on one unit several people were in bed due to illness and frailty. We found nursing and care staff rushing around from room to room dealing with care and support tasks. One person not in bed, said The staff are always busy dealing with people in their rooms, and we have to wait to be seen. Its very frustrating sometimes. When asked how often this happens, the person said everyday. One person said that at lunchtimes, the same thing happens, so many people need help and support with eating that the staff have no time to do anything else like chat or cut up you food. A relative said The staff do a wonderful job, but they are always busy. Sometimes I think another couple of pairs of hands would make a massive difference. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team make sure that the health, safety and well being of people and staff is promoted and protected, however, some aspects of service provision need improvements and proactive management input. Evidence: Information contained within the homes AQAA indicated that management systems are in place that ensure the smooth running of the home, and promote the best interests of the people living there. The records held by Commission show that the manager is registered with us. The registered manager explained that she obtains feedback from people using the service, their relatives, and other relevant parties about the services provided by way of user satisfaction questionnaires. The records of these were seen, and the feedback supplied by people was seen to be positive. She added that she has in place audit and monitoring systems for various practices within the home such as medication, money, accidents and incidents. Again, the records of these were seen, and there were found to be satisfactory. However, as previously mentioned within this report, checks on some of the care plan files held at the home Care Homes for Older People Page 24 of 30 Evidence: showed that records are generally up to date although some gaps were found in recording and some entries were not always clear. The records relating to the health and welfare of people living and working in the home were seen, and were found to be satisfactory. These included records concerning weekly alarm system tests, food hygiene control measures, infection control systems, the regulation of water temperatures and the maintenance of equipment. Staff working at the home said that the management of each unit is left to individual unit managers, and that their contact with the Registered Manager is limited. Relatives visiting the home said that their first point of contact was often the staff working on the units, and that they very rarely had contact with the Registered Manager. The Registered Manager did say that she visits the various units on the site, and that she regular meets with the unit managers and staff. Discussions with the registered manager showed that she understands the basis of person centered planning and thinking but gave the impression that translating this theory into practice in order to make a difference to the staff team or outcomes for people using the service may be difficult. We explained that having a Map of Life and a document showing who the important people in a persons life are in a care file, is only the starting point of providing person centered care and support. She agreed that work still needs to be done in order to improve outcomes for people across the site. It was pointed out to the registered manager that issues relating to the way the staff promote peoples dignity; the need to strengthen certain aspects of the risk assessment and care planning processes; and the need to provide the staff with specialist training need to be managed in a proactive and positive manner. The records held at the home show that there are not any people living at the home who is subject to a deprivation of liberty authorization. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 30 18 The registered person must make sure that all staff receive training appropriate to the needs of people living in the home. This must include all areas of health and safety related training and specialist training such as dementia, dealing with challenging behaviour and learning disabilities. 30/03/2008 Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Suitable arrangements must be in place to ensure that unnecessary risks to the health or safety of people at the home are clearly identified and so far as possible eliminated. Ensuring the risk assessments clearly state what actions the staff are to take to eliminate or reduce risks would promote peoples health and welfare. 12/12/2009 2 8 13 Suitable arrangements must 12/12/2009 be made to sure that people are supported to to receive where necessary, treatment, advice and other services from any health care professional. Ensuring that people are supported to access relevant healthcare services would ensure that best interests are promoted. Care Homes for Older People Page 27 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 27 18 Where individuals have a 12/12/2009 high level of dependency on the staff team (in relation their capacity to perform the activities of daily living for example), staffing levels must reflect the needs of those people, and suitable arrangements must be in place to ensure that staff are working in such numbers at all times to meet the assessed needs of people. Staffing levels across the site must be reviewed taking into account peoples dependency levels so as to ensure a consistent level of service is offered to all people living at the home. Details of this review is to be supplied to the Commission within the timescales given, and action taken to meet any shortfalls identified as a result of this review. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The use of recognized person centered planning techniques would further enhance the care planning process already undertaken by the staff team. The daily records should give a clear and descriptive Care Homes for Older People Page 28 of 30 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 account of a persons day including any care given, activities they have been involved in and any other significant information relating to their time in the home. 2 7 People living on the New Hall unit would benefit from a reassessment of their needs in order to determine what type of care provision is appropriate to meet those assessed needs. Training relating to managing violence and aggression and the use of restraint should be sourced from training providers that are accredited with the British Institute of Learning Disabilities as recommended by the Department of Health. Specialist training for staff working with people with a learning disability and/or sensory impairment should take place so as to give people better awareness of the issues relating to the care and support people require. Greater emphasis should be paid by the management team to ensure that a clear sense of direction is communicated to the staff team so that improved practice in the areas of care, support and meeting needs is fostered and maintained. 3 18 4 30 5 33 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. 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