Care Home: Langdale Residential Care Home

What the care home does well During our visit the atmosphere at the home was warm and welcoming. From discussions with people and from comments made people are confident and contented about the service they receive. People told us:- " staff are very good." "You only have to ask to get attention." " The food is very good." "We are well looked after". During our visit we saw that staff was very caring. Staff appeared to provide people with a good standard of care and have understanding of their care and support needs. Each person before moving into the home have their care and support needs assessed, this ensures that their needs can be met at the home. The home`s Quality audit gives people and their relatives an opportunity to have their say about the running of the home and any issues which affect the people living there. The food is good and people are provided with a choice, and their dietary needs are met. What has improved since the last inspection? This is the first key inspection since the registration of the new provider. What the care home could do better: Staff records must be available in the home for inspection. This would ensure that the home is following the requirements. The call system must not be able to be cancelled at the staff panel, but only at the point of call. This would ensure that people are safe. The stair lift must be in good working order at all times. This is to make sure people are safe at all times and have access at all times to their rooms on the first floor. We have made these recommendations: The home`s Statement of purpose and service user guide should give people information of other services that they may need to use and information how people can access the inspection reports. The home written information should provide people with information about other agencies and a copy of the most recent inspection report. The pre-assessment information should be more detailed. This will make sure that information in the document is clear as to where the assessment took place, who was involved in the process, what if any specialist arrangement for the admission are required and what people can do for themselves. People readmitted on respite care to the home should also have an assessment of their needs reassessed before each respite stay. This will makes sure that the home can continue to meet their needs. Documentation should show that people and/or their representative has been involved in drawing up and reviewing the care plans. This means that people can have a say on how they receive their care and support. The assessment documentation should show that people and or their representative had been involved in their assessment process. Care plans should be individualised and person centred so they reflect the wishes, choice and support people want to get with their health, personal and social care. An agreement and care plan should be in place for the use of bed safety rails. This would ensure that people and or their representatives and GPs are in agreement with the use of safety rails and people are not put at risk. The CQC guidance for safe handling of medicine and the RPS guidance for care homes should be available in the home, to ensure that all medications are ordered, recorded and stored appropriately. A signed agreement should be in place for people to agree to have their medication administered by the home or for them to self medicate. This will ensure that people`s rights and choice is respected. Supporting written guidance for assessment used to carry out dependency and risk of pressure sore assessment should be kept in people`s care plan. This will help make sure that people who are at risk get the care needed at the appropriate time with the involvement of any agency. People, who spend time in their bedrooms, should have access to social activities. This would ensure that they do not get bored. People should have a nutritional risk assessment carried out to ensure they are not at risk of malnutrition. The provider should provide the CQC with information on what steps they are going to take when the kitchen is being refurbished. To ensure that the home is working within the guidance for safe handling of food. Some consideration should be given for all bedrooms to have liquid soap and hand drying facilities. To ensure infection control is not compromised. The provider must send us a programme of refurbishment and replacement. This would ensure that people live in an environment which is well maintained. People should have a pieces of lockable furniture in their room, for private storage and medication if they self medicate. Chairs and carpet in the lounge identified should be cleaned. Bath panels and wooden toilet seats showing signs of wear should be replaced. Bathroom windows should have blinds or curtains fitted. The bedroom with the curtain that needed replacing or re-hanging should be carried out. So that people`s privacy and dignity are not compromised. Staff should have dementia training. This would ensure that they can meet the needs of people with dementia living in the home. The provider should ensure that visits are made in accordance with regulation 26. This is to make sure that they know that the home is continually been run in the best interest of people. Key inspection report Care homes for older people Name: Address: Langdale Residential Care Home 23 Bierley Lane Bradford W Yorkshire BD4 6AB     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: Valerie Francis     Date: 0 6 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Langdale Residential Care Home 23 Bierley Lane Bradford W Yorkshire BD4 6AB 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Michael Chander Shekher Kainth Name of registered manager (if applicable) Miss Linda Ann Buttle Type of registration: Number of places registered: care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 19 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP (maximum number of places: 13) Service users with Dementia - Code DE (maximum number of places: 6). Date of last inspection Brief description of the care home The home is now owned by a new provider, who was registered on the 21 October 2009. Langdale is a detached property that provides accommodation for nineteen people of Care Homes for Older People Page 4 of 34 Over 65 0 13 6 0 Brief description of the care home pensionable age. The majority are elderly although a small number may also have mental health needs or a physical disability. There are two separate lounges and a separate dining room and the bedrooms are located on three floors and most are accessible by stair lifts for those less mobile. This is a non-smoking building .The building is set in its own grounds opposite Bierley church. It is one minute from the Bradford ring road and near to bus routes to Bradford, Leeds and Halifax. There are parking places to the front and rear of the property. The large garden provides a pleasant outdoor space and there is also a small patio accessed from one of the lounge rooms. Care Homes for Older People Page 5 of 34 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: This was the homes first inspection. The visit was unannounced made by one inspector who was at the home from 10:30 am until 17:30 pm on the 6th April 2010. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there, and in accordance with the requirements. Before the inspection the accumulated evidence about the home was reviewed. This included looking at any reported incidents and complaints. A number of documents were looked at during the visit. All areas of the home were inspected. Time was also spent talking to people and staff. Before the visit the manager was Care Homes for Older People Page 6 of 34 asked to complete an Annual Quality Assurance Assessment (AQAA) to provide additional information. This is a self assessment of the service provided; information from this is included in this report. We sent surveys to the home before the inspection to give people and staff the opportunity to tell us about the service. Seven people and six staff returned completed surveys. Comments received have been included in the body of this report. The daily rates of fees are fifty one pounds and thirty two pence to fifty six pounds and eighty pence. This does not include hairdressing, chiropody, taxis to appointments and luxury toiletries. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Staff records must be available in the home for inspection. This would ensure that the home is following the requirements. The call system must not be able to be cancelled at the staff panel, but only at the point of call. This would ensure that people are safe. The stair lift must be in good working order at all times. This is to make sure people are safe at all times and have access at all times to their rooms on the first floor. We have made these recommendations: The homes Statement of purpose and service user guide should give people information of other services that they may need to use and information how people can access the inspection reports. The home written information should provide people with information about other agencies and a copy of the most recent inspection report. The pre-assessment information should be more detailed. This will make sure that information in the document is clear as to where the assessment took place, who was involved in the process, what if any specialist arrangement for the admission are required and what people can do for themselves. People readmitted on respite care to the home should also have an assessment of their needs reassessed before each respite stay. This will makes sure that the home can continue to meet their needs. Documentation should show that people and/or their representative has been involved in drawing up and reviewing the care plans. This means that people can have a say on how they receive their care and support. The assessment documentation should show that people and or their representative Care Homes for Older People Page 8 of 34 had been involved in their assessment process. Care plans should be individualised and person centred so they reflect the wishes, choice and support people want to get with their health, personal and social care. An agreement and care plan should be in place for the use of bed safety rails. This would ensure that people and or their representatives and GPs are in agreement with the use of safety rails and people are not put at risk. The CQC guidance for safe handling of medicine and the RPS guidance for care homes should be available in the home, to ensure that all medications are ordered, recorded and stored appropriately. A signed agreement should be in place for people to agree to have their medication administered by the home or for them to self medicate. This will ensure that peoples rights and choice is respected. Supporting written guidance for assessment used to carry out dependency and risk of pressure sore assessment should be kept in peoples care plan. This will help make sure that people who are at risk get the care needed at the appropriate time with the involvement of any agency. People, who spend time in their bedrooms, should have access to social activities. This would ensure that they do not get bored. People should have a nutritional risk assessment carried out to ensure they are not at risk of malnutrition. The provider should provide the CQC with information on what steps they are going to take when the kitchen is being refurbished. To ensure that the home is working within the guidance for safe handling of food. Some consideration should be given for all bedrooms to have liquid soap and hand drying facilities. To ensure infection control is not compromised. The provider must send us a programme of refurbishment and replacement. This would ensure that people live in an environment which is well maintained. People should have a pieces of lockable furniture in their room, for private storage and medication if they self medicate. Chairs and carpet in the lounge identified should be cleaned. Bath panels and wooden toilet seats showing signs of wear should be replaced. Bathroom windows should have blinds or curtains fitted. The bedroom with the curtain that needed replacing or re-hanging should be carried out. So that peoples privacy and dignity are not compromised. Staff should have dementia training. This would ensure that they can meet the needs of people with dementia living in the home. The provider should ensure that visits are made in accordance with regulation 26. This is to make sure that they know that the home is continually been run in the best interest of people. Care Homes for Older People Page 9 of 34 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wanting to use the service at the home are given the information they need to choose a home that can meet their needs. An assessment of needs is carried out before a placement at the home is offered. Evidence: We looked at the Statement Of Purpose and Service User Guide which is given to people wanting to use the service. However, we found additional information was needed on how people could access any other agencies and the recent inspection report about the home. People told us that they had received enough information to help them decide if the home was the right place for them. They also told us that they had been given written information about the homes terms and conditions. This sets out what services are offered and the fees. Care Homes for Older People Page 12 of 34 Evidence: The home told us in the AQAA that all people wanting to move into the home are assessed by the manager or the trainee manager, and they also ensure that they get enough information from the referring agency. We looked at the assessment information for one person who was recently admitted to the home. The home had obtained a copy of the social workers assessment details prior to the persons admission. The home had also carried out a pre-assessment of the persons care and support needs. Although we found that there was some good information about personal care needs and memory impairment; additional information was needed about what the person could do for themselves and who had been involved in the assessment process. This would show us that a full assessment had taken place before admission and people and or their representative had been in involved in the process. We noted that people using the home for respite care dont have their needs reassessed on each admission. This is necessary to make sure that there are no change in needs and the home can still meet the persons care needs. We spoke to people during our visit and they all indicated that they were happy with the care and attention they receive at the home. Care Homes for Older People Page 13 of 34 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. Peoples health and care needs are generally met. However, this could be compromised by poor recording. Evidence: The manager told us that each person had a care plan that is tailored around their individual care and support needs. We were also told and we saw that there were several people who had some elements of dementia. However, we did not see any care plan that reflected how these individual specialist care are being met. Although we found that people were provided with the care that met their needs this was not reflected in the three care plans we looked at. This could result in some elements of peoples care and support needs been missed. For example, there were three people who were cared for in bed and needed regular personal care from staff. However, this was not reflected in their care plans. Care Homes for Older People Page 14 of 34 Evidence: There was evidence that various risk assessments are carried out for moving and handling, falls prevention and pressure area damage. However, there was no guidance for staff to follow that would give them the action they must take when a particular score is made, so that the appropriate action can be taken. Several people had bed safety rails in place; the manager said these are checked daily to make sure that they are safe for use. However, there was no agreement or care plan in place, to make sure that people and or their representative and GPs are in agreement for the use of bed safety rails. Generally many of the care plans and assessments are reviewed regularly and with the involvement of health and social care professionals. This helps to ensure that all the appropriate professionals have an input into the care planning. Overall, we found that care plans needed to be person centred reflecting peoples preferences and choices. This would ensure that people get the care they want and how they want it to be delivered. People who returned surveys all indicated that they had no concerns about the care they received. People we spoke to at the visit said they were happy with the care and the support they get and said staff were very helpful. A hoist for moving and handling people had recently been purchased, staff told us that this is very well received by the team, as it is a help to them with the moving and handling of some people. We ask the managers how peoples medications were ordered, the information given suggested that the home were not performing this task in accordance with the Royal Pharmaceutical Society Guidance (RPS) for care homes. We looked at how medication was stored in the home and found that medications were stored in two separate areas, one of which was a locked walking cupboard. The keys for the medication cupboards are kept by the senior care worker who is in charge of administering medication on their shift. The walking cupboard was also used by staff to store their personal belongings when they are at work. Injections were stored in an unlocked fridge accessible to other staff. These matters Care Homes for Older People Page 15 of 34 Evidence: were discussed with the manager who said they would look at alternative storage for staff belongings and a more safe way of storing injections. There were no written information or agreements in place that would indicate that people had agreed that the home would administer their medication or they could self medicate. The recording of control drugs was discussed with the manager after finding that Morphine sulphate was recorded on the MAR (Medication administration Record) sheet, the manager said this had been discussed with the pharmacy and it was alright because of the low dosage. Only staff who have had training by the manager and the pharmacy in safe handling of medication can administer medicines. Care Homes for Older People Page 16 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples access to activities is limited but improving. Meals served meet the needs of people living in the home. Evidence: In the AQAA the home told us that what they could do better is: find out more information about peoples religion, carry out any arranged activities that would simulate and also encourage people to join in activities, get ideas from them on what they want to do and arrange more trips out. We did not see any evidence in any care plans to show that peoples social care need were being assessed. This was discussed with the manager who said that activities was one of the areas they had started working on and they had been in touch with the local church to visit the home. The manager also said peoples relatives and friends are encouraged to visit and take their relatives out. The home had started to put an activity file in place for each person, each will have a log how people spent their day. The manager said peoples life history would also be Care Homes for Older People Page 17 of 34 Evidence: placed in these files. So that staff has some background information about the person and their life before they move into the home. The home told us that plans are in place for trips out to local places of interest. Some people in their surveys indicated that the home always arrange activities that they could take part in if they wanted. During our visit we saw that time was spent with groups of people in the communal room playing board games, some people who chose not to take part in activities sat quietly listening. Although it was evident that people could go back to their rooms when they wish,we found that bedroom windows were still open in the late afternoon and bedrooms were cold. The manager immediately asked staff to close these windows. During our visit we observed meal times, we saw that lunch was a cook meal and a hot pudding. Staff was seen assisting people in a friendly way, offering assistance discreetly when needed. People in bed and who needed a soft diet was given their food in a consistency that was suitable for them. Meals and drinks for people in bed were recorded and monitored, we were told any supplement to/with meals are given. Some people were given extra drinks and snacks to supplement their food. During our discussion with staff it was apparent that both care and kitchen staff knew peoples like and dislikes and those who needed additional calories. All staff have had basic food hygiene training. We spoke to the catering staff who have recently undertaken a course on nutrition and it was apparent from discussion that they knew how to meet people nutritional needs. There was no records in peoples file to show that a nutritional risk assessment had been carried out, to make sure that people were not at risk of Malnutrition. However, we did see that people have weekly or monthly weight checks. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to express their concerns and have access to an effective complaints procedure. There are safeguarding procedure in place to protect people from abuse. Evidence: The home told us in the AQAA the complaints procedure is displayed in the home accessible to people, their visitors and staff. The homes information which is given to people also contains a copy of the procedure. The home has a system in place to record complaint, allegations and complements The home told us that they had not had any complaint since their registration. The CQC has not received any complaint or safeguarding issues about the home. In the surveys everyone indicated that there was someone they could speak to formally if they were not happy. Five people indicated that they knew how to make a complaint. Six staff returned surveys; all indicated that they knew what to do if someone have concerns about the home. We were told and saw records that staff have had training on safeguarding adults, to make sure that they know what to do in the event of a safeguarding matter. We spoke to staff who were able to describe the different types of abuse and were Care Homes for Older People Page 19 of 34 Evidence: clear about reporting safeguarding (abuse) issues, and whistle blowing. The home management team had recently undertaken Protection Of Vulnerable Adults (POVA) training so that they know what to do if they had to make a referral of a staff member to POVA regarding any allegation of abuse. The home told us in the AQAA what they want to improve in the next twelve months is for staff to have more training on POVA, research any other methods on how people can raise concerns and opinion within the home. The home had recently put a suggestion box in place, which was on a table next to the visitors signing book. This gives people, visitors and staff the opportunity to make their views known. Care Homes for Older People Page 20 of 34 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. There is on going maintenance to the home to provide people with a safe, comfortable and pleasant place for people to live. Evidence: The home is situated in a residential area near Bradford Bierley ring road. Since registration the new provider has started some refurbishment of the premises inside and outside. For instance, the front perimeter wall is being raise and electronic gates are to be fitted. The home have two shared rooms one is on the first floor which was occupied the other is on the lower ground floor in a self contained flat which has a bathroom and sitting area. The home offers people two sitting areas and a dinning room. People have the opportunity to sit in an area that suited them. There is one designated dining room which was recently redecorated, the size of the room appeared to be suitable for the number of people living in the home. People we spoke to and those who returned surveys told us that they liked their rooms and they were able to bring with them some of the things that remind them of their Care Homes for Older People Page 21 of 34 Evidence: life before they moved into the home. People had taken the opportunity to personalised their bedrooms with furniture, pictures and ornaments they brought with them from their own home. However, they did not have a pieces of lockable furniture in their rooms. This is to ensure that they can store private and personal items securely. People told us that their rooms were clean and that the home was clean and fresh. A domestic staff has now been employed, working six days 9am to 4pm. Some cleaning is carried out during the by night and day staff at the weekend. Although during our visit we found that the home was clean, tidy and generally most of the home was free from unpleasant smells; we found that two bedrooms had an odour of stale urine, these were identified to the manager. It was noted that some of the electric vents needed cleaning and many area such as ceilings had cobwebs. The chairs in the sitting room identified to the manager were dirty and needed cleaning. The carpet in one of the sitting rooms had areas that were almost threadbare and dirty in areas in front of the easy chairs. We also found that several areas needed attention, for example vanity units in bedrooms, wooden tables in sitting rooms, wooden bath panels, toilet seat were showing signs of wear and tear or was broken and windows in bathrooms and toilets had no privacy blinds or curtains fitted. In communal bathrooms and toilets there were hand washing and drying facilities. However, there were none in peoples bedrooms; to make sure that infection control is adhered to at all times. Staff have completed infection control training and we saw no evidence of breaches of infection control. We saw staff wearing protective clothing to carry out food handling and personal care. Laundry is undertaken by the care staff. People did not raise any concerns about the way their clothing were laundered. We noted that the homes nurse call system in place, could be cancelled at the staff Care Homes for Older People Page 22 of 34 Evidence: panel and at the point of call, this system could put people at risk if their call was switch off at the staff panel. We also noted that not all people had an extension lead to the call point in their room that they could use if they wanted to get help from staff. The home had been given two stars following a visit from the Environmental Health Inspector and recommendations were made. The manager said these had been completed. We were also told that there was a plan in place for the kitchen to be refurbished with new equipment, the provider said he had contacted environmental health office for guidance. All our findings was relayed back to the registered manager and the provider who said a programme of replacement and redecoration would be drawn up and a copy would be sent to the CQC. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited in a safe way and are provided with training so they can do their jobs well and keep people safe. Evidence: The home have a stable staff team many of whom have worked there for over over ten years. The manager told us that staffing arrangement had been changed; so that it benefited people and there are now a minimum of three care staff available to people for the day. The manager and or the trainee manager is also available in the morning. During the night there are two staff and a manager on call. Three staff and others spoken to on the day of our visit said that sometimes there was enough staff to meet peoples needs. The home have over 50 of their staff who have an (NVQ) National Vocational Qualification level two or three, with others undertaking the course for NVQ Level 2. In the AQAA the home told us we follow a strict recruitment process. All potential staff have to provide two references, have clear (CRB) Criminal Bureau and (POVA) Protection of Vulnerable Adult first checks before starting employment. Care Homes for Older People Page 24 of 34 Evidence: We looked at three staff file and found that two people had information that showed that all required pre-employment checks had taken place. However, one staff file had no information about their recruitment and selection process such as a CRB and POVA first checks had been carried out, or what training they had received. The manager told us that this person was transfered from another home, that was owned by the provider and their employment file was there . Staff told us in surveys and in our discussion with them that the home had carried out checks such as CRB and references before they started work. It was apparent from discussions with the manager that she was committed to have a well trained staff team. Training records seen showed that there was ongoing training and development for staff which covers topics such as moving and handling, infection control, safe handling of medication. The training Matrix is kept up to date to help the manager identify courses that needs updating and which staff needed training updates, so that the courses can be arranged. There were regular meetings with staff to discuss work. Although the home had several people who use their service with dementia, only some staff have had training that would help them in the care of people with dementia. People who we spoke to and those who returned surveys were complementary about the staff. Their comments included staff are very good and very patient. Staff said: All residents are looked after well, the home is clean and tidy, staff get along well with peoples families when they visit. All residents are cared for at a high standard. We work closely with Doctors and District Nurses. We care for the residents to meet their daily needs, making them feel safe and cared for. One person said We could improve on communication when it come to members of staff and the different shifts, to improve working as a team. This staff also said what the home could do better is: communicate more about residents recent needs, if anything changes I would like to be informed more promptly Care Homes for Older People Page 25 of 34 Evidence: and in detail. Care Homes for Older People Page 26 of 34 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. Although the home is generally managed in the interest of the people who live there, further improvement is needed to be made to make sure that people are not at risk. Evidence: In the AQAA the home told us that the new registered manager has worked at the home for many years and therefore knew people and their families. The manager said she and the trainee manager is available to people, their relatives and staff. The manager has completed NVQ 4 and LMCS (Leadership and Management for Care Services) courses. The manager is supported by the trainee manager and three senior care workers. The trainee manager has started NVQ 4 and plans are in place for her to start LMCS in September 2010. There was only one report to show that the provider carries out regular monthly visits Care Homes for Older People Page 27 of 34 Evidence: to the home; to make sure that the home is been managed for the best interest of people. From discussion with staff it was apparent that they found the management team accessible and approachable. Staff spoken to said that they felt there was a good team relationship throughout the home, which they felt benefited the people they cared for. There is a system in place for staff to have six weekly one to one supervision and six monthly appraisals. We were told by staff that staff meetings are held but not as regular as they should. In the AQAA we were also told that there is a commitments to equal opportunity and they ensure this is done in the recruitment of staff and people wanting to use the service. The manager said that no group meetings are held with people. However, peoples views are sought through one to one discussion with them. We were told that a meeting had been held with relatives and the provider, this was said to be well attended and there is a possibility of these meetings being held on a regular basis, to get the views of peoples representatives. The manager said that there is a quality audit system in place, to get the views of people who use the service, relatives and staff. Since registration the home has distributed questionnaires to people, staff, and relatives. We were told when the outcome of the information is completed this would be displayed in the home on the notice board and a copy sent to the CQC. The manager said they plan to include health and social care professionals who visit the home. The home have a variety of policies and procedures which are readily available to staff. We looked at the system in place for the safe handling of peoples money, the manager said when possible peoples family or a solicitor handle their finance. Some peoples personal allowance and any money given by relatives or solicitors for peoples use is held by the home. Each person have a cash book record of all Care Homes for Older People Page 28 of 34 Evidence: transaction made by or on behalf of the person, receipts are numbered which correspond with the transactions, these are initial by one of the managers. The provider said that in future all transaction will be signed by two members of staff. We saw that all equipments in the home that needed regular checks, have had all the required health and safety checks carried out in the required timescales. During our visit, the stairlift had stop working for a short time, we were told that this was a regular occurrence. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 34 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 29 19 There must be evidence 31/05/2010 available to the manager and in the home that all proper recruitment checks have been carried out before staff start work. This is to makes sure people are protected from abuse. 2 38 12 The call system must not be able to be cancelled at the staff panel, but only at the point of call. This would ensure that people are not put at risk. 14/06/2010 3 38 16 The stairlift must be well maintained. This would ensure that it is safe for people to use. 30/05/2010 Care Homes for Older People Page 31 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The home written information should provide people with information about other agencies and a copy of the most recent inspection report. The pre-assessment information should be more detailed. This will make sure that information in the document is clear about where the assessment took place, who was involved in the process, what if any specialist arrangement for the admission are required and what people can do for themselves. People readmitted on respite care to the home should also have an assessment of their needs reassessed before each respite stay. This will makes sure that the home can meet their needs at all times. 2 3 3 7 Documentation should show that people and/or their representative has been involved in drawing up and reviewing the care plans. This mean that people can have a say on how they receive their care and support. 4 7 Care plans should be individualised and person centred so they reflect the wishes, choice and support people want to get with their health, personal and social care. An agreement and care plan should be in place for the use of bed safety rails. This would ensure that people and or their representative and GPs are in agreement with the use of safety rails and people are not put at risk. The CQC guidance for safe handling of medicine and the RPS guidance for care homes should be available in the home, to ensure that all medications are ordered, recorded and stored appropriately. A signed agreement should be in place for people to agree to have their medication administered by the home or for them to self medicate. This will ensure that peoples rights and choice is respected. Supporting written guidance for assessment used to carry out dependency and risk of pressure sore assessment should be kept in peoples care plan. This will help to make sure that people who are at risk get 5 9 6 9 7 9 Care Homes for Older People Page 32 of 34 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 the care needed at the appropriate time and the involvement of any agency. 8 12 People who spend time in their bedrooms, should have access to social activities. This would ensure that they do not get bored. People should have a nutritional risk assessment carried out to ensure they are not at risk of malnutrition. Some consideration should be given for all bedrooms to have liquid soap and hand drying facilities. To ensure infection control is not compromised. The provider should provide the CQC with information on what steps are going to be taken when the kitchen is being replaced. To ensure that the home is working within the guidance for safe handling of food. The provider must send us a programme of refurbishment and replacement. This would ensure that people live in an environment which is well maintained. Staff should have dementia training. So that they can meet the needs of people with dementia living in the home. The provider should ensure that visits are made in accordance with regulation 26. This is to make sure that they know that the home is continually run in the best interest of people. 9 10 15 19 11 19 12 19 13 14 30 38 Care Homes for Older People Page 33 of 34 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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