Care Home: Little Oldway

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What the care home does well Little Oldway is set in spacious attractive grounds, which are close to the local stately home `Oldway Mansion`. People living there are able to enjoy the gardens and other facilities offered by Oldway Mansion with the support of the staff at the home. The manager and owners have shown a clear commitment to ensure that staff receive regular mandatory training and have access to training that increases their knowledge of the disease`s and problems facing older people. The staff team continue to appear to be knowledgeable, friendly and supportive to the people they are caring for a Little Oldway. People who live at Little Oldway commented that staff are really kind and helpful towards them and nothing they ask seems too much trouble. What has improved since the last inspection? The Requirements made at our random inspection had been met. These related to the use of bed guards and fire safety. A new stair lift has been fitted to the small upper staircase and a new hoist has been purchased. Redecoration and replacement of worn carpets has continued. This shows that people benefit from a pleasant home environment that is able to meet their care needs. Mental Capacity assessments have been introduced for people identified as at risk and staff have received Mental Capacity Act training. Risk assessments for manual handling and self medication have been improved. This should ensure Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 that staff continue to be up to date with current best practice for care of older people. Staffing levels have increased to meet the increased overall dependency of the people at Little Oldway. This shows that the management respond to the needs of the people living there and arrange staffing to meet their needs. What the care home could do better: No Requirements have been made at this inspection. The owners have continued to improve the way the home is managed and run and have built on good practice. Some Recommendations have been made which should enable the service to show further year on year improvements once completed. Key inspection report CARE HOMES FOR OLDER PEOPLE Little Oldway Little Oldway Torquay Road Paignton Devon TQ3 2TD Lead Inspector Rachel Proctor Key Unannounced Inspection 6th August 2009 09:30 DS0000018389.V376826.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 2 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 Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Little Oldway Address Little Oldway Torquay Road Paignton Devon TQ3 2TD 01803 527156 01803 663670 littleoldway@btconnect.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Barry Michael Privett Mrs Jacqueline Ann Privett Manager post vacant Mrs Jacqueline Ann Privett Care Home 35 Category(ies) of Dementia - over 65 years of age (35), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (35), Old age, not falling within any other category (35), Physical disability over 65 years of age (35) Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th August 2007 Brief Description of the Service: Little Oldway is a large, listed building, which provides accommodation for up to 35 service users on two levels. The home is surrounded by a large, level attractive garden, and is adjacent to Oldway Mansion and its grounds. The home provides personal care for elderly service users with or without a physical and/or mental health frailty. The statement of purpose is available in the office of the home and each person has a copy of the service users’ guide in their individual room. The fee range on 06.08.09 was stated as from £302 to £480. We were told the fee charged depended on the care needs of the individual and the way funding is agreed. Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall rating for this service has been judged as Good, this means that people using the service experience good quality outcomes. This was an unannounced key inspection, which took place on the 6th August 2009 between 9:30 am and 4:30 pm. Besides the information gathered from the visit to the home information obtained since the last inspection of Little Oldway in August 2007 has been included in this report. Selected people had their care followed, this included looking at the way their plan of care was recorded and speaking to them about the service they were receiving. The manager provided information for the inspection prior to the visit to the home. This gave information about how Little Oldway was meeting the Care Standards. People living at Little Oldway, their relatives and staff working at home were spoken with as part of this inspection. A tour of the home was completed and some records were inspected. What the service does well: Little Oldway is set in spacious attractive grounds, which are close to the local stately home ‘Oldway Mansion’. People living there are able to enjoy the gardens and other facilities offered by Oldway Mansion with the support of the staff at the home. The manager and owners have shown a clear commitment to ensure that staff receive regular mandatory training and have access to training that increases their knowledge of the disease’s and problems facing older people. The staff team continue to appear to be knowledgeable, friendly and supportive to the people they are caring for a Little Oldway. People who live at Little Oldway commented that staff are really kind and helpful towards them and nothing they ask seems too much trouble. What has improved since the last inspection? The Requirements made at our random inspection had been met. These related to the use of bed guards and fire safety. A new stair lift has been fitted to the small upper staircase and a new hoist has been purchased. Redecoration and replacement of worn carpets has continued. This shows that people benefit from a pleasant home environment that is able to meet their care needs. Mental Capacity assessments have been introduced for people identified as at risk and staff have received Mental Capacity Act training. Risk assessments for manual handling and self medication have been improved. This should ensure Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 6 that staff continue to be up to date with current best practice for care of older people. Staffing levels have increased to meet the increased overall dependency of the people at Little Oldway. This shows that the management respond to the needs of the people living there and arrange staffing to meet their needs. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3, 6. People using the 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 living at Little Oldway have access to information that enables them to know if the home can meet their needs. The information provided was clear and easily available to them or their relatives. The way people have their care needs assessed and recorded should ensure that they receive the care they need. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) provided by the manager stated what had improved in the last 12 months and the plans for the next 12 months. This stated that assessment packs had been redesigned and preprepared for prospective new people. An example of this was seen in use during the inspection. The assessment template provided sufficient prompts to ensure the persons care needs were fully identified at assessment. Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 9 The statement of purpose and service users guide were easily available for the people who live at Little Oldway. The manager had stated in the AQAA that she plans to up date the statement of purpose in the next 12 months. Each person living in the home had their own copy of the service user’s guide in their individual room. The deputy manager advised that where possible people and/or their relatives are encouraged to visit the home prior to their admission. People spoken with confirmed that they were given the opportunity to meet staff and/or visit the home prior to their admission. One person spoken with said that they had been able to visit the home prior to the admission with their relative and that help them choose the home. Another person spoken with said they had stayed at the home for a short stay before deciding to move in permanently. They also said that staff were friendly, helpful and informative about the services provided at the home. One person admitted to the home recently had their care followed. The pre admission assessment was clearly recorded and provided information about the persons care needs. Copies of the care manager’s assessment were also being kept with the persons care plan information. One person admitted two days earlier had basic care plan information and the care manager care plan assessment in place. The deputy manager advised that they were working with the person to develop a plan of care that would meet their needs. Little Oldway does not provide intermediate care but does offer short stay placements when beds are available. In addition to this they offer limited day care places for people. Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People using the 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 way care plan information was recorded for individual people living at Little Oldway should ensure they receive the health and personal care they need. Staff understand the needs of the people they care for. Medication practices in the home mostly meet the required standards, this should ensure that people receive the medication they need from staff who understand. People living at Little Oldway are treated with respected by the staff team who care for them. The things that are important to them are taken into account when their care is planned. EVIDENCE: At the time of this inspection thirty people were living at Little Oldway. Since our last key inspection in August 2007 a new care planning system has been put in place. This was a pre prepared template which provided space for care Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 11 planning, risk assessments and professional visits from the multi-disciplinary team, which included the persons GP. A system for reviewing the care plan each month was also provided. The manager had introduced a care programme for people, which was being kept in their individual rooms. The AQAA provided by the manager gave information about what changes had been made to improve the service provided for people living at Little Oldway. These included restructuring the key worker system and introducing mental capacity assessments. An example of a mental capacity assessment was seen during the inspection. The deputy manager advised that these had been developed following training. The deputy manager advised that they also had a system for managing people with behaviour that challenged the system. Three people had their care followed as part of this inspection. Each person had a plan of care in place, which showed how staff should meet their needs. Risk assessments were an integral part of the care planning assessments seen during the inspection. Where risk of falls or nutritional risk had been identified plans of care had been put in place to address the identified risk. A falls register was being kept, which recorded falls for individual people and enabled the manager to analyse the number, time and place people fell. The deputy manager advised this had enabled them to reduce the risk of falls. One person whose care was followed had chosen to move into Little Oldway. They said staff are always very helpful and they liked the food. They said they were meeting friends outside the home later that day. A risk assessment had been recorded, which showed that the person was safe to go out independently. They said the manager had spoken to them about the care they needed when they came into the home. They explained how they managed their own medication; a lockable cupboard had been provided for them to store their medication in. The care plan had a risk assessment for self medication completed, which the person had signed. The care plan was signed and dated by the person and the member of staff who had written the care plan. Another person whose care was followed told us they felt very lucky to be at Little Oldway. They said they had been admitted to the home when they had been unwell. Although they had visited the home prior to this and decided that if they needed to live in a residential home they would like to move into Little Oldway. They said they liked the room they had at Little Oldway and enjoyed the food. They told us they liked to spend time in their room but joined other in the dining room for meals. Their plan of care had a record of GP visits and the involvement of the multi disciplinary team in their care. This identified that they had periods of depression. Staff spoken with were knowledgeable about the persons care and what helped them to feel less depressed. One person who had lived at the home for several years had their care followed. They were spoken with in their own room with a family member present. They said they could not fault the care they had a Little Oldway. They said staff had arranged for them to go to hospital when they became unwell Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 12 and had difficulty breathing. The relative commented that the quick action of the staff at Little Oldway had saved their relatives life. The person had a plan of care in place which showed they had been re-assessed and their care plan up dated with changes to their care. Risk assessments had been completed for nutrition, pressure sore risk and manual handling. The person was unable to go out independently or manage their own medication; risk assessments had been completed and recorded with their care planning information. The person had had a few falls at the beginning of the year and as a result of this a different room with a non slip floor covering and en-suit had been organised in discussion with the person, their family and the home manager. The person said they liked the new room and found it easier to walk on the none slip floor than the carpet they had in their previous room. This shows that people are consulted about their care needs and changes made to improve their care management when needed. Medication practice in the home was reviewed with the deputy manager. A new blister pack dispensing system had been introduced and the storage changed to a larger space. The cupboard being used had shelving for medication and a medication trolley being stored. The medication trolley could be tethered to the wall when not in use. Controlled drug medication was being stored in the trolley and not in a separate lockable space. The controlled drug book had been completed correctly for the one person whose medication was checked. The medication records of the three people whose care was followed were viewed. These had been signed and recorded as expected and medication storage was safe. Medication being given out during lunch was being given by a carer who observed the person taking the medication and completed the record after each person had received their lunch time medication. A medication returns book was being kept. This recorded medication returned to the pharmacy when it was no longer required by the person. This had been signed by the staff member completing the returns book. Staff observed speaking to the people they were caring for were doing so in a friendly helpful manner. During the lunch time period one person was repeatedly getting up form the table before they had had their lunch. The staff spoke to the person telling them their lunch was almost ready each time and encouraged them to sit down. Some times walking with the person around the dining room before helping them to sit down again. Another person was heard to ask a member of staff the same question several times. The member of staff responded to the person in the same positive friendly way each time they asked. People told us the staff are very helpful and friendly towards them and nothing is too much trouble. This shows that staff value people they care for as individuals and treat them with respect. Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People using the 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 information recorded for people’s social care included the activities they enjoy or prefer to take part in. However because of the varying needs of the people at Little Oldway, the number of planned external activities had been reduced. This may mean that not all the people living at Little Oldway have access to the activities that stimulate and interest them. Meal times are a pleasant experience for the people who live at Little Oldway. Meals are attractively presented and provide for the nutritional need of those who live there. EVIDENCE: When the inspection started music was playing in the large lounge only a few people were using the lounge at that time. The owner advised that the dependency of the people living at Little Oldway had changed and not as many wanted to or were able to spend time in the lounge. One person spoken with in their own room said there were not as many activities as there used to be. They acknowledged that people weren’t always able to take part. Another Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 14 person spoken with said they liked to be doing things and had helped out in the past helped. The deputy manager advised that they had asked the person to help folding napkins and do some filing of paperwork that did not contain personal information about people. They also advised that they used to attend an art class but this had closed for the summer, which meant they did not spend as much time out side the home as they did. The art class was due to restart in September. It was unclear from the care plan how activities had been planed or organised that this person would enjoy when the art class had stopped. An activity book was being completed by staff which showed the activities they had organised and who had taken part. These included memory games, which the deputy manager advised people seemed to enjoy doing. In addition to this an outside organisation was providing activities once a fortnight. A record showed that they had arranged to have animals brought to the home for people to look at and touch. These include a dog, rabbits and an owl. One person spoken with said they enjoyed the animals as they used to have a pet themselves. There are two lounges and a conservatory within the home; those people who dont want to take part in activities are able to go to a small lounge or conservatory. One person was using the small lounge during the inspection as they liked to smoke and this had been designated a smoking lounge. The way the environment is set out with three communal lounge areas and a diningroom allows people to choose where they wish to sit. Each of the individual peoples rooms entered had been personalised with items of their choice. Visitors were coming and going during the inspection, they were seeing their relatives/friends in the privacy of their own rooms or one of the communal areas in the home. The statement of purpose and service uses guide available in each person’s room gives information about the homes policy on maintaining relatives and friends involvement. The mealtime observed during the inspection was unhurried with people eating their meals at their own pace. People were given the opportunity to have second helpings if they wished. The staff assisting the people who needed help to cut their food were doing this in a friendly supportive way. They were observed asking the people if they needed help before giving it. Very little wastage was seen at the lunchtime meal. Those people asked said the food was always good. One person commented that if you don’t like what’s on offer they will find an alternative for you that you do. The varied menu supplied showed that the nutritional content of meals provided for people at the home had been taken into account. The cook working during the inspection said food was always cooked using fresh produce and people’s likes and dislikes are taken into account. The people whose care was followed had a nutritional risk assessment completed and a record of their weight was being kept. Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. People using the 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 people who live at Little Oldway can have confidence that any concerns they raise will be dealt with sensitively by a staff team who understand them and have their best interests at heart. EVIDENCE: The Commission has been made aware of three complaints in the last twelve months one of these was referred to the adult protection team. A random inspection was carried out to follow up one complaint. As a result of this inspection two Requirements and three good practice Recommendations were made. The Requirements related to the risk assessment and use of bed guards. At this inspection clear information was provided for the use and risk management for people who had been assessed for bed guards. The second Requirement related to fire safety of the home. The fire authority has carried out a check of the premises and has confirmed the home meets fire safety guidelines. The Care Trust had provided a low profiling bed for one person. The person was being cared for in bed and a mattress had been placed on the floor next to the bed. The bed guard was not in use. The deputy manager advised that they had consulted the health teams who had provided them with equipment and information which meant the person did not need to use bed guards. This information was recorded in their care plan. The manager provided information for the Commission, which showed she had acted in the Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 16 best interests of the people living at Little Oldway. A record of concerns raised was being kept this showed the actions taken as a result of the concerns raised. The AQAA (Annual Quality Assurance Assessment) showed that all the complaints received had been dealt with in 28 days. Each person has a copy of the complaints procedure with the service users guide provided in each person’s room. The people spoken to during the inspection said the staff deal with any concerns they have in a sensitive way. Those asked said their concerns were taken seriously, staff were approachable and they knew who to speak to if they had any concerns. The deputy manager advised that they were continuing to use the adult protection-training programme used at the time of the last inspection. This gives staff the opportunity to read course material and answer set questions, which test their learning. The deputy manager advised that in addition to this she intended to seek an external trainer for adult protection to ensure staff had good understanding of the issues. The recruitment process and procedures in place protect the people living at Little Oldway from unsuitable staff. Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. People using the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes management have continued to improve and up date the homes décor. This should ensure that the people who live at Little Oldway continue to have a pleasant, clean fresh and homely place to live in that is able to meet their needs. EVIDENCE: A tour of the home was completed as part of this inspection. Several areas in the home had been redecorated since the last inspection. Some rooms had new flooring fitted. One room had a carpet that was rucked close to the entrance to the room; this could pose a trip hazard for the person or staff entering the room. The owner advised that they were replacing carpets as part of the refurbishment of the home. There were two areas where damp had damaged the paper and paintwork. The owner advised that there had been a Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 18 problem with a blocked gutter, which had been resolved and the areas would be repainted or papered once they had dried out. The maintenance man was working in the home during the inspection they said that they carried out maintenance tasks that staff and the owners had identified needed doing. The home was fresh and clean in all areas that the people who live there have access to. Individual peoples rooms entered during an inspection had been personalised with items of their choice. One relative commented that the cleaners make sure their relative’s room was clean and fresh for them. Another relative commented that the home was always fresh and clean when they visited. The gardens surrounding the home continue to be attractively presented, with a variety of flowering summer plants for people to enjoy. Several of the people living at Little Oldway and their relatives commented how much they liked the gardens around the home. Environmental risk assessments are completed for the home, these were available during the inspection. The AQAA information indicated over the last 12 months maintenance has continued within the home both internally and externally. An additional stair rider has been fitted to one of the stair cases, pressure relieving equipment has been purchased for some people who required this and new hoist purchased. Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. People using the 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 commitment of the homes management team to ensure staff have qualifications in care should ensure that people who live at Little Oldway are in safe hands at all times. The recruitment practices in place at Little Oldway should protect people from unsuitable staff. The people who live at Little Oldway can have confidence that the staff team who care for them have access to training that will help them understand their care needs. EVIDENCE: The deputy manager provided a duty rota, which showed the number of staff on duty and in which capacity they were employed for each shift. This showed that more staff were on duty at peak times. The deputy manager advised that the number of staff on duty had been reviewed to meet the increased care needs of the current people living at Little Oldway. The duty rota showed that more staff were available each day to care for people. The staff observed and people living at the home spoken with during the inspection demonstrated that sufficient staff were available on duty. Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 20 In addition to the care staff the home also employs ancillary staff, which includes domestic staff that carry out cleaning and laundry, cooks and a maintenance man. The maintenance man was spoken with during the inspection. He advised that he works to a book, which staff and the owner’s record maintenance tasks that need doing. This record was seen during the inspection, this had been signed off as tasks were completed. The deputy manager provided a list of staff who were in progress of completing an NVQ (National Vocational Qualification) in care or had already achieved this with the AQAA. This showed that of the 22 permanent care staff employed 10 had achieved an NVQ level 2 or above. This information showed that the home had maintained almost 50 of its staff with NVQ level 2 or above. The deputy manager confirmed that the home’s management team are still committed to ensuring staff receive the training they need new staff would be working towards this award. The AQAA showed that 9 staff had left in the last 12 months. Staff spoken with during the inspection said they had good access to training that helped them do their job well. Three staff files were viewed during the inspection. This showed that staff had the necessary pre-employment checks completed prior to starting work. This included a completed application form, references and police checks. The staff files viewed also contained a contract, which included a statement of the terms and conditions of employment. The deputy manager advised that new training pack, which followed the skills for care guidelines for the induction of new staff were being used. Examples of the induction records were available for inspection. The training information provided by the deputy manager showed that staff have access to training that enables them to do their job. A list of mandatory training completed by staff in the last 12 months was provided for inspection. Mandatory training included fire safety, manual handling and protection of vulnerable adults. The deputy manager advised that all senior staff had completed medication management training. The home caters for people who suffer with dementia. The deputy manager advised that staff had completed dementia care training using a distance learning training pack. The training packs used by staff were discussed with the deputy manager. She advised that a new training pack relating to the implementation of the Mental Capacity Act had been introduced. She also commented that she and the manager continue to seek advice from the Alzheimer’s disease society. She also confirmed that the community psychiatric nurses who provided support for some of the people living at Little Oldway had been helpful supporting her and the staff at the home to care for people with dementia. The deputy manager advised that personal profiles for people are completed as part of their care planning process. These enable the staff to understand the person and know what interests them. Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38, People using the 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 new manager has continued to improve the way care is delivered and directed for the people who live at Little Oldway. The homes management team seek the views of people who use their service. However the results of a recent quality audit had not been made available to the people who live at Little Oldway or the Commission. EVIDENCE: A deputy manager has been appointed to support the manager since our last inspection. The owner advised that both the deputy and manager work four days a week and they share the management tasks. The manager has been in Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 22 post for two years, however she has not yet registered with the Commission. The owner has remained in day to day contact with the home and continues to support the manager on a daily basis. She advised she would be putting forward this manager for registration with the Commission. The manager has experience working in a senior position in an older Persons care home. She has kept herself up to date with care practices by accessing relevant training. Observation during the visit to the home showed there continues to be clear lines of accountability with in the home. Senior carers who take responsibility for the shifts they cover were supporting the deputy manager during the inspection. The deputy manager advised that questionnaires had been sent out to family and people who live at Little Oldway to give them the opportunity to comment on the services they provide. Some completed quality audit forms were seen during the inspection. The deputy manager advised that as a result of the feed back received in the questionnaires some changes had been made. One person spoken with in their own room said they were able to speak to the manager and make suggestions to improve the activities provided. However the results of the quality audits had still not been analysed and had not been made available for the people who live at Little Oldway or the Commission. Policies and procedures are in place, which were easily available for staff. The Annual Quality Assurance Assessment (AQAA) confirmed that these had been reviewed. The Requirements made at the last inspection have been met. The fire officer has confirmed that the fire prevention systems meet required safety standards. The multi disciplinary team had provided assessments and advice for one person who had used bed guards. As a result of this the person had been provided with a low profiling bed and the bed guards were no longer being used. Risk assessments and information about the assessments were recorded in the persons care plan. The deputy manager confirmed that the district nurse team are always asked for advice regarding the use of bed guards for people in the home. The deputy manager advised that they dont routinely keep valuables on behalf of people living at Little Oldway. The deputy manager confirmed that people are still billed on a monthly basis for things they purchase, such as newspapers, chiropody and toiletries. The records of money being held for safekeeping for one person living at home were viewed. Records and receipts of expenditures were being kept for this person. Evidence that staff had received health and safety training, which included manual handling, fire safety, food hygiene and first aid, was provided. Copies of certificates staff had received for training completed were available with their staff files. The staff spoken with during the inspection confirmed that they had received the mandatory training they needed. Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 23 The AQAA confirmed that supervision was in place for all staff. Records of supervision for staff were being kept these showed that staff receive regular supervision with their line manager. The deputy manager advised that the training and devolvement needs of staff are discussed at supervision meetings and training organised if this is agreed with the staff member. The accident records were available for inspection. The deputy manager advised that they keep a record of falls and accidents for individual’s people that enable them to look at trends. A system for reporting injuries, diseases and dangerous occurrences regulations (RIDDOR) 1985 is in place. The deputy manager was aware of her responsibilities in relation to reporting through the system. The fire log book had a record of monthly fire alarm checks however fire extinguishers and safety lighting had not been checked since May 2009. Records showed they had been completed monthly prior to this. The deputy manager confirmed that this would be completed as soon as possible. A record of staff fire training was provided. The AQAA did not confirm that the home has had an electrical circuit check with in the last five years. The owner had advised that the wiring in the home had been checked recently following problems with damp. However a record of this was not requested during the inspection. One person spoken with during the inspection who had recently been admitted to the home said they would like a lock on their room as sometimes people living in the home come into their room. A risk assessment process was in place to identify if a person could safely have a key to their room. The deputy manager advised that the person would be risk assessed for provisions of a lock to their room. Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 3 Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP12 Good Practice Recommendations Separate secure storage should be provided for controlled drugs. The manager should consider providing more activities for people who live at Little Oldway who are more able to participate. The planned redecoration of individual rooms and replacement of worn carpets should continue. The new manager should complete the commission’s fit person processes The results of quality audits should be available for the service users and the Commission. The fire log book should be kept up to date and show that DS0000018389.V376826.R01.S.doc Version 5.2 Page 26 3 4 5. 6 OP19 OP31 OP33 OP38 Little Oldway fire safety systems have been checked at least monthly. The registered person should provided information with the Annual Quality Assurance Assessment that confirms electrical safety checks for the wiring in the home has been completed in the last five years. Little Oldway DS0000018389.V376826.R01.S.doc Version 5.2 Page 27 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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