Care Home: Lathbury Manor Residential Home For The Elderly

Similar services:

• The Maypole Nursing Centre
• The Briars
• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home

What the care home does well There are effective assessment and care planning procedures in place which ensure that people`s health, social and personal care needs are met. The meal provision is good offering choice and variety and catering for any special dietary needs. There is a satisfactory complaints policy and complaints are taken seriously and acted upon appropriately. The home has a friendly, caring inclusive atmosphere in which people feel confident that they are very well cared for and their right to privacy and dignity is upheld at all times; this was clearly evidenced during the inspection. The home provides a relaxed friendly atmosphere, with a high standard of cleanliness throughout. There is range of daily activities provided for users of the service, which are tailored around their needs, likes and dislikes which they can partake on a one to one basis or in a group setting if they require. The home is well managed and the quality of care for users of the service is monitored regularly by the organization. What has improved since the last inspection? Since the last inspection the home has undergone some refurbishment and redecoration to meet with the previous requirements made and to add to the comfort for those using the service. The kitchen has been refurbished; new kitchen cupboards and worktops have been fitted, with one remaining to be fitted to the central island which has been purchased and delivered and is to be fitted in the next couple of weeks. Further improvements have been made to the laundry which has been made larger, thereby improving the working conditions for staff. The the floor and walls have been tiled and a racking system is now in place to provide for the storage of peoples clothing. All that remains to be done is the ceiling which is in progress. What the care home could do better: As is required by the Care Home Regulations 2001, a full employment history must be gained when recruiting new members of staff. Key inspection report Care homes for older people Name: Address: Lathbury Manor Residential Home For The Elderly Lathbury Nr Newport Pagnell Bucks MK16 8JX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Handscombe     Date: 1 3 0 8 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 31 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 31 Information about the care home Name of care home: Address: Lathbury Manor Residential Home For The Elderly Lathbury Nr Newport Pagnell Bucks MK16 8JX 01908615245 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: broadwaylathbury@btconnect.com Mrs Gillian Elaine Broadway,Mr Edward Nigel Broadway care home 23 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 to be accommodated is 23 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care need on admission to the home are within the following category: Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Lathbury Manor is an attractive old house with listed building status. It is conveniently situated on a main road to Northampton, just north of Newport Pagnell. There is a landscaped garden and car parking to the rear of the property. Residents bedrooms and the communal rooms of the house have been comfortably furnished and pleasantly decorated. The home is registered to provide care for twenty-three residents. Care Homes for Older People Page 4 of 31 Over 65 0 23 23 0 1 1 0 8 2 0 0 8 Brief description of the care home Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection, which took place over one day. The visit took place on the 12th and 13th August 2009. The purpose of the visit was to see how the home is meeting the National Minimum Standards. Prior to our visit we sent the registered manager a number of surveys to be distributed to service users, staff members and visiting health and social care professionals in order to ascertain their views upon the service and the care provided. At the time of writing this report we have received completed questionnaires from four service users, four staff, four health and social care professionals and five relatives, any further completed surveys we receive will be considered as part of the Commissions ongoing regulatory responsibilities for registered services. All services are required to supply us with a completed Annual Quality Assurance Assessment (AQAA), which enables them to evaluate the quality of their service and Care Homes for Older People Page 6 of 31 forward to ourselves when asked. This initially helps us to prioritize the order of the inspection and identify areas that require more attention during the inspection process Results of this inspection report are derived from feedback gained from the service users, discussions with staff during the visit and responses to questionnaires sent out prior to this visit, viewing service users records held within the home, viewing policies and procedures, staff personnel files, general observation throughout the visit, along with information provided to us within the AQAA and any other information that the Commission has received about the service in order to gain an understanding of how the service meet the service users needs, and how it impacts upon their lives. We looked at how well the home was meeting the key standards set by the government and have in this report made judgments about the standard of the service. Comments received from service users during the inspection process include: the food here is very nice I enjoy it here, its not a bad place to be Ive never had to make a complaint The staff are very caring Comments from relatives include: My mother enjoys the meals at the home - I am often present at meal times. The food is of the highest standard and with a choice of main meals. Meals can be eaten away from the dining room if the resident wishes. The quality of staff employed is generally of a very high standard and my mother relates well to them The rooms are kept immaculate and bedrooms spotless, all of a very high standard at all times Fees for this service start from £495.00 per week. Service users are expected to pay extra for personal items such as newspapers, toiletries, hairdressing and chiropody. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 31 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 31 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 31 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. The homes statement of purpose and service users guide provide prospective service users with detailed information of the services provided. Assessment and care planning processes ensure that service users and their relatives can be confident that care needs are fully identified and can be met by caring competent staff. Evidence: The information provided in the statement of purpose and service users guide assists prospective users of the service to decide whether the home is able to meet their specific care needs. The information is provided in large format for those who require and although still in its infancy, the home is in the process of producing the information in picture format too. Prior to moving into the home, an assessment of the individuals health, social and personal care needs are assessed and discussed with them and any other persons involved in their care such as their relatives and health care professionals to ensure Care Homes for Older People Page 11 of 31 Evidence: that the service can meet their needs appropriately and ensure that appropriate equipment and services are in place. Where an assessment has been undertaken by Social Services, the home also carries out its own care needs assessments with the service user. Prospective service users and/or their Representatives are encouraged to visit the home to meet with fellow users of the service, meet with staff members and gain a feel of the home prior to making a decision as to whether the home is suitable for both their accommodation and care needs. The home does not offer intermediate care, therefore standard six does not apply. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the home are being met. The care plans are person-centred to include peoples preferences in how they wish the care to be provided and promote their overall well-being. Evidence: Each user of the service has an individual personalised care plan in which they and/or their relatives have been consulted with, which is regularly reviewed and updated accordingly. As part of the inspection process we chose to view four service users files, all of which gave a good all round picture of the individuals needs and contained detailed instructions for staff to follow to ensure that their needs are fully met. In addition to the detailed care plan, each user has a plaque in their room detailing their specific needs in relation to their personal care; these are kept in a plastic wall file with non confidential information on the front, which details moving and handling procedures, any equipment to be used and creams to be applied. More personal confidential information is found on the back of the document which details information such as the individuals capabilities, what they need specific help with and personal information about their continence needs etc. The information on the plaque Care Homes for Older People Page 13 of 31 Evidence: provides a useful reference tool for staff which is used in conjunction with the more detailed care plan. It is reviewed and updated on a monthly basis in consultation with the service user. The care plans inspected focused on peoples individual strengths and preferences covering areas such as medical needs, personal care, social skills and leisure, personal hygiene, mobility, food and diet, communication and any special care needs. Each file viewed contained evidence of regular reviews being undertaken and care plans updated where peoples needs change. During the last inspection in August 2008, there were some failures around the recording of pressure sores, their treatment and the resulting outcomes for which a requirement was made to ensure the promotion of tissue viability and the prevention of pressure sores. During this visit it was noted that improvements had been made and appropriate recording was being done with details of district nurse input being recorded along with the treatment given. Likewise another area for which a requirement was made was in relation to the lack of a protocol being in place to provide staff with specific guidelines in relation to a service users medical condition. During this visit we noted that actions had been taken to meet the requirement; advice had been sought from relevant health care professionals, appropriate monitoring processes had been put into place and a protocol had been drawn up with the input of the service users GP who had signed the document, which detailed what actions the staff were to take in the event of any seizures. Suitable arrangements are in place for meeting the health care needs of those using the service. The home has good working relationships with the local GPs and community health services and accesses them when appropriate. Records of contact with health care professionals, including GPs, District Nurses, Community Psychiatrist Nurses, chiropodist and other health care services are maintained and detailed in the service users care plans. Feedback gained from Health and Social Care Professionals who completed surveys was very positive. All those who responded inform us that peoples social and health care needs are properly monitored, reviewed and met by the service; that the staff seek advice and act on it to meet peoples individual needs and improve their well-being. As part of the inspection process we looked at the medication systems within the home. People who wish to maintain responsibility for their own medication are enabled to do so within a risk management process, although at the time of this visit no service users were self-administering their own medication. Senior care staff are responsible for administering service users medication which is provided by a local Care Homes for Older People Page 14 of 31 Evidence: pharmacy in a monitored dosage system. The senior staff have all undertaken a distance by learning medication course and received training by the supplying pharmacy to ensure that they have the knowledge, skills and competency to undertake the role safely. Recently a key night worker has been trained to ensure that that an appropriately trained member of staff can administer medications during the night if required. Service users prescribed creams are applied by all care staff. There are systems in place for the receipt and returns of medication and a monthly medication audit is undertaken. It was noted that the medication trolley, although locked and stored in a locked room, was not securely affixed to the wall as required because the fixture had broken. In discussion with the senior carer it was acknowledged that this had been reported and were awaiting the maintenance person to address this. We were assured that this would be dealt with to ensure the safety of peoples prescribed medication. We inspected the medication administration records of those service users who were being case tracked all of which were in good order; there were no gaps to suggest that people were not being given their medication as prescribed and an appropriate coding system was in use to explain the reason if medication had not been administered. Handwritten entries were seen to be signed by two members of staff where this was evident. There was one anomaly found in which there was seven nutritional drinks being stored which were out of date, three of whose expiry date was December 2008. The senior carer acted upon the findings immediately and removed them to ensure the health safety and welfare of those using the service. Feedback from residents indicated that the staff treat them with respect and supported their privacy and dignity at all times. The ethos of the care provision at Lathbury Manor is service user centred and staff were observed to treat the service users with respect and dignity at all times. Appropriate terms of address are used, and attention is given to maintaining social contacts with relatives and keeping them up to date with important issues affecting their relatives. Care Homes for Older People Page 15 of 31 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. Contact with family, friends and the local community is encouraged and support is given where required. A varied programme of activities satisfies the recreational interests of the residents. The food provided in the home is of good quality, freshly prepared and cooked on the premises, offers choice and meets the dietary needs of those using the service. Evidence: Discussions with service users was generally very positive acknowledging that the lifestyle experienced at Lathbury Manor matches their expectations and enables them to exercise choice and control over their lives. There is a varied programme of activities, which is co-ordinated by a senior carer, providing a range of stimulating, therapeutic, activities for those who wish to partake which are based upon the service users likes and dislikes. Daily activities are offered both in groups and on a one to one basis, according to peoples needs and wishes, which include various kinds of quizzes, exercises, art and craft, flower arranging, cooking, reminiscence sessions and sing-a-longs. The service have a quiet room Care Homes for Older People Page 16 of 31 Evidence: equipped with sensory equipment for those who prefer to spend some quiet time relaxing and engaging in relaxing sensory experiences using sound, lighting and aromatherapy facilities. The home endeavors to provide parties and arranges outside entertainers to provide in house entertainment, throughout the year, to which family members are welcome to attend. Service users are supported to attend religious services at the local church if they require and the local vicar visits the home once a fortnight and will provide communion for those who require. People who use the service are provided with good quality food which is freshly cooked on the premises and are offered a choice. Special diets are available to meet individual health and cultural needs. The cook always endeavors to take individual tastes into account and discusses their requirements. The dining environment is relaxed and comfortable and residents are able to enjoy their lunch at their own pace. Assistance is given by the staff to ensure that family links and friendships outside the home are maintained and records are kept of any contacts made. One user of the service informed us of how the home has supported him/her to attend a local club once a week to enable him/her to socialise and maintain contact with friends. Family and friends know they can visit the home at any time and those spoken to during this visit tell us that they are always made welcome and enjoy visiting. Service users are able to entertain them in their own bedrooms or in the communal areas of the home and meals can be provided for visitors who visit during mealtimes if required. As part of our inspection process we viewed the kitchen which was found to be well organised and kept to a clean standard of hygiene; food stocks were good and all relevant checks were being maintained and documented. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure with evidence that residents feel their views are listened to and acted upon. Evidence: Discussions with service users and the feedback gained through surveys sent out to other users of the service, family members and visitors to the home, informed us that they were confident about approaching management and staff about any concerns or complaints that they might have. They described the management and staff as being very approachable, helpful and friendly. The complaints procedure was available at the home and is included in the service users guide. The home encourages people to raise any concerns, complaint and suggestions, which it records along with any necessary actions taken to investigate and address issues. The complaints book was viewed during this visit and it was noted that of the four complaints received since the last inspection, all were acted upon and dealt with appropriately, in line with their complaints procedure and in a timely manner. We viewed the complaints policy given to users of the service and noted that the Commissions contact details had not been updated and information about the the stages and timescales were not included. However this was acted upon immediately and amendments made and by the second day of the inspection, each user of the service had been provided with an updated copy. The home has safeguarding systems in place to protect service users; the Care Homes for Older People Page 18 of 31 Evidence: safeguarding of vulnerable adults is taken seriously, any allegations are dealt with appropriately and in line with the local multi agency procedures and staff members. Staff and management are aware of the need to protect service users from abuse and neglect and all have undergone training in these issues. Staff members are aware of the homes whistle blowing policy, which encourages staff to speak out about any suspicions or allegations of abuse or neglect. Each member of staff spoken to during this visit assured us that they would have no hesitation in approaching the manager should the need arise. Information provided to us in the completed Annual Quality Assurance Assessment (AQAA) informs that the service itself has not had any safeguarding referrals or investigations during the last 12 months, and we at the Commission have not been alerted to any such referrals or investigations. The home facilitates access to an independent advocate if the need should arise details of which are accessible within the home to residents and their families. Care Homes for Older People Page 19 of 31 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. The service have maintained the environment to ensure the safety of the people living in the home. Evidence: Lathbury Manor is an attractive old house, with listed building status which has retained many of its original features. It is set in one acre of grounds in the small village of Lathbury. The home is registered to accommodate 23 residents. There is car parking to the rear of the property. The home has a redecoration and refurbishment plan in place. Since the last inspection the kitchen has been refurbished and a new worktop has been purchased for the worktop island in the middle of the kitchen, which we are informed is to be fitted in the next couple of weeks. We are informed that there has been a delay in attending to replacing this particular worktop as the one recently delivered was a glass top which the home had not ordered and was unsuitable for their needs. Further improvements have been made to the laundry room which has been made larger, the floor and walls tiled and a racking system with individual drawers is now in place for the storage of peoples clothing. The refurbishment of the laundry is near completion with some final work to the ceiling being finished. The homes laundry facilities are, located well away from areas of food preparation and contained the appropriate washing machines with the specified programming to meet disinfections standards. Care Homes for Older People Page 20 of 31 Evidence: There are infection control policies and procedures in place and the staff were observed to be washing their hands and wearing appropriate protective clothing. Further improvements that have been undertaken includes redecorating the lounges and purchasing new chairs, redecorating and replacing furniture and carpets in some bedrooms and redecorating a bathroom. Further plans are in place to paint the outside of the building, refurbish a further 4 bedrooms and redecorate and carpet the office. Sufficient washing, bathing and WC facilities are available for service users use, which contain grab rails, and any specialist equipment required to ensure maximisation of their independence. It was noted that not all communal facilities had appropriate washing facilities in place some of which did not contain paper towels and soap dispensers; a requirement has been made within this report to ensure these be provided to prevent the spread of cross infection. Feedback from a health care professional, who visits the home, reiterated our finding in which he/she told us I personally would like to have better hand washing facilities within the home from an infection control perspective, this has been requested previously. requirement has been made within this report to ensure Discussions with service users informed the inspector that they were happy with their bedrooms and their surroundings, that the home is kept to a high standard of cleanliness at all times. Service users are encouraged to bring personal possessions with them, many of which were seen to be on view in their bedrooms. A recent environmental health inspection has been undertaken in which the home was awarded a commendable 4 stars. During both days of the inspection, the home presented as clean, pleasant and hygienic, which service users inform us is usually the case. Care Homes for Older People Page 21 of 31 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. The staff team are provided with a good range of training, ongoing support and supervision to ensure they have the relevant skills and knowledge to enable them to deliver the care safely and competently. Evidence: The staffing levels on both days of the inspection were sufficient to meet the needs of those using the service. However feedback from one completed survey informs us that at weekends staff cover is always at a minimum and my mother has to wait to get help toileting or getting to bed longer than normal, it is recommended that the registered manager reviews the staffing levels to ensure appropriate cover is provided at weekends during the busier periods of the day. We chose to look at four staff personnel files at random, two of who had been recruited since the previous inspection undertaken in August 2008 and two longer standing member of staff, to ensure that robust recruitment procedures are in place and to ensure that staff are provided with appropriate training to ensure that those using the service are protected by the homes recruitment procedures and that staff have the skills, support and knowledge to undertake their roles competently. Whilst viewing the staff members personnel files, it was evident that there are serious failings in the recruitment practices taking place within the home, thereby placing those using the service at a potential risk of harm. Care Homes for Older People Page 22 of 31 Evidence: Whilst inspecting the two newer member of staffs files it was noted that there are serious failings in the recruitment procedures taking place in the home, which do not serve to protect those using the service. There was an absence of a relevant CRB (Criminal Bureau) disclosure or POVA first check having been undertaken for one member of staff to ensure their suitability to work with older vulnerable people. The member of staff had begun working at the home without a PovaFirst check being undertaken and on a previous CRB disclosure which did not relate to working at Lathbury Manor. A CRB application had been applied for eleven days after she began working at the home and had not yet been received. The member of staff who was overseeing the management of the service, whilst the manager was on leave, took immediate steps to ensure that this particular carer was removed from her duties immediately and would not return to work at the home until appropriate the appropriate checks had been undertaken and clearances received to ensure the health safety and welfare of those using the service. Actions were taken to ensure that the staffing levels were not affected and that peoples needs would be met with appropriate staffing levels. In discussion with the registered manager, by telephone that evening, it was explained that she thought that CRB disclosures were portable and explained that the staff member was being shadowed until her new CRB clearance was gained. The second member of staff who was also recruited since the last inspection had also begun working without appropriate checks being undertaken to ensure his/her suitability to work with vulnerable adults. There was no evidence of a PovaFirst check having been undertaken and the CRB disclosure on file was issued five and a half weeks after the carer began working at the home. The practice of employing staff to work at the home without having undertaken checks to ensure that they are suitable to work with vulnerable adults and ensure that those using the service are in safe hands at all times does not act in the service users best interests and places their health, safety and welfare at potential risk of harm. A requirement has been made within this report to ensure that appropriate checks and clearances are obtained before a member of staff is employed to work at the home and the registered manager update her knowledge to ensure that a robust recruitment procedure is in place to protect the health, safety and welfare of those using the service. All newly appointed members of staff undergo induction training upon appointment to their posts and shadow experienced staff until both parties feel confident in undertaking the role unsupervised. Records are kept of staff training and show that staff receive the training needed to meet the needs of people living at Lathbury Manor; they are provided with mandatory training, offered ongoing training and encouraged to undertake the National Vocational Qualification (NVQ) in Care, which equips them to meet the assessed needs of the residents within the home and allows Care Homes for Older People Page 23 of 31 Evidence: for their personal development. Information provided to us in the completed AQAA informs us that of the 19 permanent care staff eleven have obtained their NVQ qualifications at level 2 or above in care with a further four presently working towards it, which is commendable. Records confirm that staff have regular supervision and appraisals and that staff meetings are held. Staff confirmed that they had regular supervision and also the opportunity to discuss any concerns with the management team. Staff have a clear understanding of their roles and responsibilities and demonstrate a good sense of team work. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is qualified and has the experience to run the home competently. Evidence: The registered manager is experienced, knowledgeable, has the required qualifications and competence to manage the home. She generally displays a good sound knowledge of matters related to the management and running of the care home for older people but needs to ensure that the service users best interests are promoted through a more robust recruitment procedure to ensure they are in safe hands at all times. Residents and staff spoke in complimentary terms about her management ability and the support she gives. The management approach of the home creates an open, positive, transparent and inclusive atmosphere. . Care Homes for Older People Page 25 of 31 Evidence: The home has a health and safety policy statement and provides training for staff on safety topics such as moving and handling residents and fire safety training. As part of the inspection process we discussed health and safety issues and saw appropriate maintenance records relating to maintaining a safe environment for residents. Regular safety checks are undertaken relating to fire safety and infectious diseases and regular servicing and maintenance of equipment, all of which were seen to be documented appropriately. We viewed the last inspection report by the fire officer undertaken in January 2008 in which there were some deficiencies found in relation to testing the fire alarm on a weekly basis, the testing of the emergency lighting and the fire detection system on an annual basis and the homes fire risk assessment failed to address that a fire door within the home was held open by a door guard device. We were informed that all the deficiencies have now been dealt with. Likewise an environmental health inspection was undertaken in January 2008, who made a recommendation in relation to ensuring to take and record food temperatures, which has since their visit, been acted upon appropriately. All accidents, injuries and incidents of illness or communicable disease are recorded and reported accordingly. As part of the inspection process, we chose to view the accidents and incidents log and found a good standard of recording detailing the actions that had been taken as a result of any such incidences. The home engages regularly with users of the service to gain feedback on various aspects of the service it provides; this is undertaken on both an informal and formal basis through feedback and questionnaires on various aspects of the service and the care provided. Evidence was held within staff personnel files to inform us that care staff receive formal supervision at least six times and this was also verified whilst speaking to staff during this visit. We are informed that they also receive an annual appraisal of their work in which they can discuss their performance, any areas of concern and plan for any future training and development needs. Generally the health, safety and welfare of those using the service and the staff delivering the care are protected, however there are some poor procedures that need addressing in relation to the recruitment procedure and ensuring the safety of those using the service, which have been mentioned within this report and for which requirements have been made (see sections headed staffing and environment). Care Homes for Older People Page 26 of 31 Evidence: The home sent us their annual quality assurance assessment (AQAA) when we asked for it. It was clear and gave us all the information we asked for. The AQAA contains clear, relevant information that is supported by a wide range of evidence and informs of areas in which they plan to make improvements over the next 12 months. The home deals with a number of diverse care needs and there is a commitment to ensure that all clients, however diverse their needs may be, receive a person-centered package of care which meets their needs appropriately. Care Homes for Older People Page 27 of 31 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 28 of 31 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 20 13 In the interests of people 23/10/2009 using the service suitable arrangements must be made to provide paper towels and soap dispensers in the communal hand washing facilities. To prevent the spread of infection. All required recruitment 30/09/2009 checks are to be undertaken and received back before staff start working with service users This is to ensure that only suitable persons are employed and users of the service are in safe hands at all times. 2 29 19 Care Homes for Older People Page 29 of 31 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 27 Review the staffing levels to ensure appropriate cover is provided at weekends during the busier periods of the day. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!