Care Home: Lily House

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What the care home does well Medicines are stored securely for the protection of residents, in areas which are temperature controlled to ensure the quality of medicines in use. When medicines are prescribed on a `when required` basis, care plans contain detailed guidance for staff to follow to safeguard people and ensure medicines are not used inappropriately. A person said that the food was `Excellent.` The staff continue to feel well supported by the Manager: this support has had a positive outcome for the residents` sense of well-being and has enabled the residents to exercise their choice in how they wish to live. What has improved since the last inspection? Within one of the person`s care plans we saw their individual needs were accurately identified- this validated the uniqueness of the person. There was also information to guide the staff in how to meet the person`s needs. Staff working with residents, who have mental health needs, no longer wear a uniform: this has removed some (unintentional) barriers and has, as a result, improved the residents` sense of well-being. Records made when medicines are given to people have improved and when they are given at times different to those printed on the medication record form, the actual time it is given is recorded. The requirement made about this, on our last inspection of 17th November 2009, has been met. On our inspection, on 17th November 2009, we also made a requirement that when medication is omitted, the reason for the omission must be clearly recorded. We saw on this inspection that this had improved sufficiently for us to consider the requirement has been met, but there were still a few omissions which could be improved upon. There continues to be a sustained improvement in how the home deals with any complaints that it may receive. The overall training of the staff continues to improve. The overall management of the home continues to improve resulting in a safer and happier home for people to live in. What the care home could do better: Care plans and risk assessments must be in date, detailed, accurate and drawn up, in consultation with the person, wherever possible. This is to ensure that the staff provide safe and consistent care that the person has consented to. The Manager said that this would be actioned by the home, as part of its improving quality assurance. Any changing health care needs must be closely monitored to ensure that people receive timely health care advice and treatment. The Manager agreed that this would be carried out. Suitable activities must be provided to ensure that no-one becomes bored or feels isolated. The Manager stated that there are plans to improve the range of activities. Consultation with the residents, about what they would like to eat, should be considered and the Manager agreed that this would be part of the home`s quality assurance. No action has yet been taken, since our last inspections of September and November 2009, to make sure that the garden fence is safe. The Manager agreed to take action to improve this area of the garden. Key inspection report Care homes for older people Name: Address: Lily House 143 Lynn Road Ely Cambridgeshire CB6 1DG     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: Elaine Boismier     Date: 0 6 0 1 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 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: Lily House 143 Lynn Road Ely Cambridgeshire CB6 1DG 01353666444 01353666445 lily.house@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne Boss Limited care home 44 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1. The registered person may provide the following category/ies of service only: Care home only Code PC 2. The maximum number of service users who can be accommodated is: 44 to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category Code OP Dementia Code DE Date of last inspection Brief description of the care home Lily House is situated on Lynn Road approximately one mile from the centre of Ely. It is a purpose built home that offers care for up to 44 older people, some of whom have dementia. Accommodation is provided on two floors and consists of 44 single bedrooms of which 43 of these have en-suite facilities. There are five bathrooms, one shower room and eleven additional WCs. There are lounge and dining rooms in the home and two quiet rooms. Enclosed gardens surround the home for people to visit Care Homes for Older People Page 4 of 31 Over 65 21 44 0 0 1 6 0 9 2 0 0 9 Brief description of the care home and sit. Local amenities include shops, cafes pubs, restaurants and a cinema. Current fees range from £354 to £637.50 with additional costs for toiletries, hairdressing and newspapers. Further information, about the fees, can be obtained via the home. A vacancy has arisen for a registered home manager. A copy of the inspection report is available at the home or via the CQC website at www. cqc.org.uk 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, The Care Quality Commission (CQC), carried out this unannounced key inspection (KI) on the 6th January 2010 by the Lead Inspector and on the 8th January 2010 by a Pharmacist Inspector. The total Inspectors hours for both days was 5.25 hours. Before the inspection we received surveys from seven of the residents and four from the staff. We also received a survey from a health care professional.We looked at information that we have received about the home since our last key unannounced inspection, of the 16th September 2009; this included a random unannounced inspection that took place on the 17th November 2009. During this inspection we looked around the premises and looked at some of the documentation. We case tracked three of the residents. Case tracking means speaking with some of the residents and visiting their rooms and speaking with some of the staff who were looking after them. We compared what we saw and heard with the peoples Care Homes for Older People Page 6 of 31 individual records. We also spoke with and watched other people who were not part of our case tracking. We spoke also to some of the other staff, including the Manager. For the purpose of this inspection report people who live at the home are referred to as people, person, resident or residents. 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: Care plans and risk assessments must be in date, detailed, accurate and drawn up, in consultation with the person, wherever possible. This is to ensure that the staff provide safe and consistent care that the person has consented to. The Manager said that this would be actioned by the home, as part of its improving quality assurance. Any changing health care needs must be closely monitored to ensure that people receive timely health care advice and treatment. The Manager agreed that this would Care Homes for Older People Page 8 of 31 be carried out. Suitable activities must be provided to ensure that no-one becomes bored or feels isolated. The Manager stated that there are plans to improve the range of activities. Consultation with the residents, about what they would like to eat, should be considered and the Manager agreed that this would be part of the homes quality assurance. No action has yet been taken, since our last inspections of September and November 2009, to make sure that the garden fence is safe. The Manager agreed to take action to improve this area of the garden. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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. People can be confident that there is, usually, the right amount of information, to help any prospective person in making a decision where they would like to live. People can also be confident that their needs will be assessed to ensure that the home is able to meet their needs. Evidence: The Statement of Purpose was updated to contain the change of contact details of the Care Quality Commission. This required document also contained the present situation of a vacancy for a registered manager. We received seven surveys from residents and one of these said that the person had received enough information about the home before they moved in; five of these surveys said the person could not remember if they had this information before they moved in; the remaining survey stated that the person did not have this information to help them in their decision where to live. Care Homes for Older People Page 11 of 31 Evidence: One of the people who we case tracked, told us that their relatives had visited the home, on their behalf, and had enough information, about the home, in helping them to decide that the home was a suitable place for them. Since our random unannounced inspection, of the 17th November 2009, the home has received one new admission. As part of our case tracking we looked at this persons pre-admission information: this was a detailed assessment of the persons health and social care needs, which the home had received before the person moved in. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although medication practices have improved people can not be wholly confident that all of their care needs will be met in a consistent manner, and with their permission, due to the current standard of some of the care records. Evidence: As part of our case tracking we looked at three peoples care plans and spoke with the Manager about our findings. For one person, who had mental health needs, the assessments of their care needs were directly related to their mental health condition, telling the reader how their condition affected them, including their strengths and weaknesses. For example we read how their ability to communicate with other people varied, from being able to communicate well to not being able to communicate to this standard. For another of their care plans it told us that they had a recurring medical condition which directly affected their mental health. Signs and symptoms for any deterioration in the persons physical and mental health needs were detailed for the staff to be aware of. This told us that the persons individual needs were accurately identified that validated the uniqueness of the person and that there was information to guide the staff in how to meet the persons needs. Care Homes for Older People Page 13 of 31 Evidence: For the remaining two peoples care plans we saw, as part of our case tracking, that the care plans were yet to be developed to an acceptable standard. For example we noted that for one person there was a preliminary assessment of their needs and how the staff were to meet their needs. However there was no further evolvement from this preliminary stage of care planning, although the person had lived at the home for nineteen days. We saw that the person, from their pre-admission assessment, was anxious; we saw that they were experiencing some anxiety although there was no care plan to guide the staff in how to help the person with their anxiety. We also noted that that there was a report of a fall that that they had sustained although the falls risk assessment was not completed. For the other person we saw that they had care plans to tell the staff how to meet the persons health and social needs although, and the Manager agreed with us, these care plans needed to be developed to reflect the persons unique and individual care needs. Following on from this we noted that the person had two care plans, with conflicting information, as to how often the person was to be weighed. From the record of the persons weight we, including the Manager, were unable to tell how often the person was to be weighed i.e. daily or monthly. In addition we noted that the person had a deteriorating medical condition, as this was reported in the daily records and professional visitors records: we, including the Manager, could find no care plan that contained this information to tell the staff how this persons changing health care needs could be met. We saw that one of the residents families had been actively consulted about their relatives care plans although for another person they told us that, and we found no recorded evidence for this, that no person had discussed their care needs with them, in a consultative manner. They continued to tell us that they wanted to maintain their level of independence, but with the consistent support from the staff, as the person was not wholly confident in their ability to be safe. They also told us that there was no consistent support, from the staff and we, with the Manager, found no written guidance for the staff, to tell them how to support the person in maintaining both their independence and their confidence. The Manager explained that the home had concentrated on improving the standard of care plans, belonging to the people who lived on the ground floor, and she Care Homes for Older People Page 14 of 31 Evidence: acknowledged, and agreed with us, that this work must be carried out to improve the standard of care plans, belonging to those people who lived on the first floor. We saw that the standard of personal care was good: people were wearing clean clothes and had clean hair and finger nails. As part of our case tracking we saw that people had had visits from a range of health care professionals to include specialist nurses and general practitioners. We noted that, from our examination of one of the peoples records of their weight, that they had gained, over a period of three days, a significant weight gain of 3.4 kilogrammes. According to the records the person was weighed for three days between 19th and 21st December 2009, when it was found that they had this significant increase in weight. We, including the Manager, were unable to find any record, thereafter, to indicate that the person had been weighed and, as such, their condition was not closely monitored by the home. The Manager agreed with our judgement. It was noted, however, from our examination of the persons other records, that they were seen, and treated by their doctor and a specialist nurse, thereafter, to help manage their changing medical condition. The staff, working on the ground floor, explained that the residents responded well to the staff, since the staff stopped wearing uniforms. The staff told us that some of the residents were able to remember the names of some of the staff, rather than calling them nurse and this had a positive effect on the residents sense of well-being. We saw that, when visiting the ground floor, that the residents were relaxed and interacting with each other and with the staff, in a sociable and friendly manner. Six of the seven residents surveys said that the person always or usually received the right care and support with the remaining survey stating that this was sometimes the case, with all of these seven surveys saying that the home made sure that the person always or usually got the medical care that they needed. One of the residents surveys said that the home could do better by providing More consistency in basic level of care but also added the home does well as it provides Good care most of the time. We received one survey from a healthcare professional: they considered that peoples individual health and wellbeing needs were being met and they were provided for in a manner that respected and valued the peoples dignity. We looked at the practices for the safe-handling, storage and use of medicines. Medicines are stored securely for the protection of residents. Medicines storage rooms are temperature controlled and the temperature is monitored and recorded regularly so as to ensure the quality of medicines in use. We looked at the records made when Care Homes for Older People Page 15 of 31 Evidence: medicines are received into the home, when they are given to people and when they are disposed of and these were in good order, give an audit trail of medicines in use and demonstrate that people receive the medicines prescribed for them. When medicines are given at times different to those printed on the medication record form, the actual time it is given is recorded and so the requirement made about this on our last inspection on 17th November 2009 has been met. We also made a requirement on the last inspection that where peoples medication has been omitted, the reason for this must be recorded. We saw on this inspection that this had improved but still saw some examples where the reason for the refusal was not clearly recorded. We have taken a reasonable view and consider the requirement to have been met. Some people are prescribed medication on a when required basis and care plans looked at contain detailed guidance for staff on the use of such medicines which will safeguard people and ensure the medication is not used inappropriately. We saw the staff knocking on peoples doors before they entered and we saw the staff interact with the residents in a kind and caring manner. One of the people, who we case tracked, said that some of the staff were Very nice. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that there are opportunities to live an adequate social life, although this must be developed further to ensure that people do not become bored or isolated. Evidence: There was a range of views about the activities as three of the residents surveys said that always or usually suitable activities were provided that the person could take part in whereas the remaining four residents surveys said that sometimes this was the case. Two of these surveys provided additional comments that said the home could do better to Provide more activities and (To) let me go out for walks more (and some entertainment/concerts). As part of our case tracking we asked one of the people about the activities: they told us that they were often bored as there were no suitable activities provided for them (this person had significant difficulties with their sight). Another person, who was not part of our case tracking, found that they were unable to talk with other residents, due to communication difficulties, and this gave them a sense of isolation. When visiting the ground floor we saw that some of the people were looking at the Care Homes for Older People Page 17 of 31 Evidence: daily newspapers which had been provided and another person was arranging the table linen. According to the staff they encourage this person to help with putting their personal laundry away; helping with giving out drinks to other residents and helping with setting the dining tables for meals. According to the Manager arrangements have been made for some of the staff to attend training in what are and how to provide residents with meaningful activities. Other arrangements are in place, some based on suggestions from the staff, to improve the standard of activities within the home. According to peoples care records the home had received entertainers over the Christmas period and, prior to this, Bonfire Night was enjoyed by a large number of the residents; the Manager told us that hot-dogs were served as part of the firework celebrations. The record of activities was examined and evidence indicated that residents enjoyed a visit by a pat dog, had had manicures and that 1:1 activity sessions were also provided. We saw that peoples rooms were provided with personal items such as furniture, pictures, photographs and ornaments. We saw, and this was also confirmed by the Manager and the staff, some of the people were allowed to stay in bed and get up when they chose to. One of the people, who we case tracked, told us that at one time they were made to get out of bed, in the morning, when they considered it was too early for them. They said that this had now changed; they got out of bed when they wanted to. This told us that the peoples individual choices, of how they wish to live, were valued and respected. We saw people receiving their guests and this was also confirmed from our examination of peoples care records and from the visitors signing in book. According to the records, of one of the people who we case tracked, they spent Christmas Day at their relatives home. Five of the seven residents surveys said the person always or usually liked their meals with the remaining two surveys saying that sometimes this was the case. One of these surveys added the home could do better by having More variety in the food although another of these surveys said that the food was Excellent. When speaking with some of the people we received a range of views about the food: one person said that the food was Excellent whereas another person told us the food lacked variety and relied on their relatives to bring more interesting food in for them Care Homes for Older People Page 18 of 31 Evidence: to eat. We looked at the menus and there was a range of food available, mainly of a traditional English range, such as sausages in gravy, breaded cod, cottage pie and ham and egg. There was a range of desserts with also alternative choices of, for example, yoghurts and ice cream. The Manager told us that a cooked breakfast was available on request although she believed this information was not currently known to the residents. One of the people, who was part of our case tracking, said that they had often requested a bacon sandwich instead of their main meal, but their request was never responded to. They told us, however, that they had made a special request for their breakfast, and this request was honored; the person said that they thoroughly enjoyed eating it. The Manager stated that she would consider asking peoples views about the food and what they would like to have on the menu. Care Homes for Older People Page 19 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. People can be confident that there concerns will be listened to and action taken to resolve these. People can also be confident that they are safe from the risk of harm. Evidence: Three of the residents surveys said the person knew who to speak to if they were unhappy about something; two of these surveys said that the person did not know who to speak to if they were unhappy about something; the remaining two surveys were not completed in this section of the questionnaire. One of the people, who was part of our case tracking, knew that they could speak with the Manager if they were not happy about something. They told us that they had a need to do this and was satisfied with how the Manager dealt with their concern. We looked at the record of complaints and we were satisfied that the improvement noted at our random unannounced inspection, of 17th November 2009, was sustained. The record indicated that the home was active in responding to a complaint and this response was done in a listening manner. We attended an ongoing safeguarding meeting, in December 2009, when representatives of the home and registered provider, were present. We considered that there was full co-operation, from these representatives, to ensure the safety and well-being of the residents. Care Homes for Older People Page 20 of 31 Evidence: Although the registered provider had the expectation that 100 of the staff would have attended safeguarding training, by the 24th November 2009, the homes current Training Statistics indicated that 94 of the staff have attended this training: the Manager said that this was because two members the staff were yet to attend this training. We asked two members of the staff what they would do if they witnessed or suspected any abuse against any of the residents and they were able to tell us, confidently, what they would do. We were satisfied with their response. We also asked them about their knowledge of abuse, as they had said they had attended safeguarding training: we were confident that, from their responses, that they were competent in safeguarding awareness. Since our last inspection, of the 17th November 2009, we have received no concerns of any delays in reporting safeguarding issues by the home, indicating that the improvement noted at our inspection of November 2009, has been sustained. Care Homes for Older People Page 21 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. People live in a generally safe and comfortable home. Evidence: One of the people, who was not part of our case tracking, told us that they enjoyed walking around the garden when the weather was warmer. At the last key unannounced inspection, of the 16th September 2009, we noted that some of the garden fence was unsafe and we expected action to be taken, by the home, to make sure this was safe from the risk of harm to any person visiting the garden. We noted that no action had yet been taken and we reminded the Manager of this outstanding action. She agreed that this would be made safer for when people were able to visit the gardens, once the weather became warmer. We noted, from one of the records of a person who we case tracked, that they had replacement flooring in their bedroom-telling us that there is an ongoing refurbishment programme. This was also demonstrated as we found other areas of the home were generally well-maintained (see also Standard 38 of this report that notes an exception of this) and the staff, working on the ground floor, told us that, with the improvement the management of the home, there was a more homely feel about Lily House. As part of our case tracking we visited one of the three peoples bedrooms, including Care Homes for Older People Page 22 of 31 Evidence: their en-suite facilities: there were adaptations to include a raised toilet seat, so that they could use the toilet with ease, and grab rails to help them safely, and independently, get on and off the toilet. They also showed us that they had easy access to their call bell, should they have the need to call for assistance from the staff. The majority (6) of the residents surveys said that the home was always or usually clean and fresh. We found no offensive odours when we looked around the home. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they are safely cared for by a sufficient number of trained and well recruited staff. Evidence: All of the completed residents surveys said that the staff were always or usually available when the person needed them. Three of the four staff surveys said that there was enough staff on duty to meet the individual needs of the people. The remaining survey said that this was never the case as Staffing levels could be much better and indicated that some of the staff were working long hours and these were on consecutive days, without having a break from duty. As a result of these comments, we spoke with the Manager while we looked at the staff roster for weeks commencing 30th November 2009 and 6th December 2009. Evidence indicated that only one of the staff chose to work long hours, as suggested by the staff survey. According to the Manager this is closely monitored. The Manager also told us that no agency staff have been used since October 2009, thereby reducing the risk of inconsistent care being provided to the residents from staff unfamiliar to the home. According to the Manager there is active recruitment to replace staff who have left their employment. We saw the staff working in an unhurried manner and this allowed people to choose how they wanted to spend their day, such as staying in bed. Care Homes for Older People Page 24 of 31 Evidence: People should be in safe hands as, according to the Manager, the home currently has 59 of the staff with a National Vocational Qualification, level 2 or equivalent, in care. We examined two of the staff files and found that all the required information, such as employment history, two written references and criminal record bureau checks, was available within these files. This tells us that the recruitment procedure ensures people are safe as they are cared for by suitable staff. According to the current Training Statistics staff have attended training in, for example, dementia awareness (66 ), infection control (47 ), care planning (217 ) and nutrition (86 ). The staff who we spoke with said that there are training opportunities made available for them to attend. The Manager provided information about forthcoming training, to include nutrition and health and safety. Due to the improved standards of care provided to the residents, since our last key unannounced inspection of 16th September 2009, there is evidence that the training and ongoing training of staff has generally improved the outcomes for the residents health, welfare and safety, although the training in care planning documentation may need to be re-considered in the light of our findings, as reported under Standard 7 of this inspection report. Care Homes for Older People Page 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they live in a home that has, overall, improved, in its standard of management although it is too early for people to say that the current quality assurance is robust enough to sustain such improvements. Evidence: The staff surveys said that the person felt supported by the Manager with one of these surveys adding The home does well now we have a new Manager. She is very supportive and easygoing. The staff we spoke with said that they had noticed an improved change in the management of the home, since our last key unannounced inspection of 16th September 2009. We noted the improved overall management of the home, at our random unannounced inspection of November 2009 and we found that this improvement continues. This is indicative also of the improved overall star rating of the home: in September Care Homes for Older People Page 26 of 31 Evidence: 2009 we rated the home to have 0 stars i.e. poor quality outcomes for the residents; we have now rated the home to provide adequate quality outcomes for the people i.e. 1 star. In August 2008 we considered that the home was providing excellent outcomes for people although by September 2009, when we next inspected the service we found that the standard of care and standard of management had posed serious risks to the health, welfare and safety of the residents. The registered provider agreed with our findings and we considered that the quality assurance of the home had failed to protect the residents. In November 2009 and at this inspection, of January 2010, we have noted improvements in the overall management of the home. However, we need to have confidence that the existing quality assurance maintains a sustainability of these improvements. We discussed this with the Manager who completely agreed with our judgement. Copies of the visits for November and December 2009, carried out by a representative of the registered provider, were seen and views of staff, visitors and residents were recorded. Also noted were audits of records such as staff training and records of peoples personal allowances. We looked at how the home manages peoples personal allowances: we did this as part of our case tracking methodology. We saw that the home keeps records of receipts of items paid for, the cost for these and this information, complete with reference numbers, are maintained on a data base and provided a clear audit trail. The staff we spoke with said that they had attended training in fire safety and moving and handling. From the examination of the current staff Training Statistics 91 of staff have attended training in fire safety; 91 of staff have attended a fire drill; 100 of staff have attended food hygiene and 88 of staff have attended training in safe moving and handling. The Manager said that there are arrangements in place to improve any percentages that are less than 100 . During both of our inspections of September and November 2009 we noted that two of the fire doors were not closing: we saw that there was an email requisition made for these doors to be replaced. We saw another door, a sluice door on Grace unit was also failing to close to: we informed the Manager about this. Fire alarms and emergency lights were recorded as checked on a weekly basis. During Care Homes for Older People Page 27 of 31 Evidence: the tour of the premises we also noted that hoists were next due an inspection by January 2010. At our last inspection, of November 2009, we noted that there was a lack of safe-keeping of a bottle of hazardous cleaning fluid. At this inspection we did not find any such fluids kept in an unsafe manner. Care Homes for Older People Page 28 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 29 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 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). 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