Care Home: Lodge (The) Collier Row

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What the care home does well The manager communicates a clear sense of direction, and equality and diversity, human rights and person centred thinking are given a priority in this service. The ethos of the home is open and transparent and the views of residents, relatives/friends and staff are listened to and valued. The pre-admission processes for prospective residents are of a very high standard. Care is taken in the pre-assessment stage to ensure that as much information as is possible has been gathered to ensure that the home can meet the identified needs. Following on from this, the prospective resident and his/her family are invited to visit the home and spend time getting to know the home, other residents and staff. This visit can be extended to cover several day visits so that the transition into residential care is less traumatic for the person living with dementia. "A relative told us that this transition period was wonderful because it helped her mother move into the home in a happier state of being, and it also helped the family come to terms with the move." Daily life at the home is generally flexible with the wishes of residents being respected. Meals are well presented and nutritious and choices can be made with staff giving assistance at mealtimes in a sensitive way and at the speed to suit the individual. Dining rooms are attractive with appropriately laid tables. Medication systems were found to be in good order with any required PRN (as required medication) protocols being in place. The service takes all complaints seriously and outcomes are used to improve the service for residents. Training is given a high profile within the service, as are all safeguarding issues. This is important in a service catering for people who sometimes find communication difficult. The home is taking part in a project around advocacy which is being run by Age Concern Havering. To improve services for people living with dementia or mental health problems such as depression, the home pays privately for the services of a psychogeriatrican who holds a surgery at the home on a monthly basis in order to review the well-being of the resident and medication. What has improved since the last inspection? Medication systems have improved and the home complied with the requirements made at the last key inspection. Staff supervision has improved and staff are now being supervised in 1:1 sessions, groups and also by direct observation of care practices. Care plans have improved and are being reviewed on a regular basis. The registered manager has now achieved the Registered Manager`s Award, together with 2 of the senior care staff. What the care home could do better: Although staffing levels were reviewed following the last key inspection. it is still necessary to redo this as residents living with dementia require much more input and time from staff to enable them to maintain life skills and independence. However, this must not be at the expense of those residents who do not have dementia. There should be more choice around the number of baths/showers that one can have on a weekly basis. Also with improved staffing levels, staff will have more time in areas such as sitting and talking to residents, reading newspapers/magazines with them or assisting them in maintaining life skills. The revised contract to be in line with the recommendations from the Office of Fair Trading; the complaints log to be maintained in good order; the carpet joins in the corridors to be safe to prevent tripping/falls by staff and residents/visitors, and repairs to some of the lounge chairs. These were all discussed during the inspection and we were given assurances that these issues would be addressed in good time. Where residents are unable to use the emergency call system when alone in their bedrooms, the home must undertake a risk assessment and put in place alternative systems such as some assistive technology to enable staff to be alerted to reduce the risk of a fall/accident. Key inspection report Care homes for older people Name: Address: Lodge (The) Collier Row Lodge Lane Collier Row Romford Essex RM5 2ES     The quality rating for this care home is:   three star excellent 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: Sandra Parnell-Hopkinson     Date: 1 5 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Lodge (The) Collier Row Lodge Lane Collier Row Romford Essex RM5 2ES 01708732293 01708781122 patricianicoll@thelodgecarehome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Ian George Nicoll care home 63 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 63 The registered person may provide personal care and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following categories:- Old age not falling within any other category (Category OP) (no more than 63 persons) Service users with dementia who are over 65 years of age (Category DE(E)) (no more than 40 persons) Date of last inspection Brief description of the care home The Lodge is situated in Lodge Lane, which is close to Collier Row, where there are shops, cafes and restaurants. There is easy access to local towns such as Romford and Ilford. A bus stops directly outside the home. Thirty of the 62 bedrooms are ensuite, and the one double room is only used as such on request. The communal areas consist of three well-furnished lounges on the ground floor with one lounge on the first floor. There are two spacious dining rooms to cater for the differing needs and choice of the Care Homes for Older People Page 4 of 31 Over 65 40 63 0 0 Brief description of the care home residents. The home is decorated and furnished to a high standard throughout. The home caters for residents over the age of 65 and has recently changed its registration to accommodate up to 40 people with dementia. The home is one of five homes privately owned by the organisation and managed by one of the proprietors with the assistance of an experienced staff team. Personal care is provided on a 24-hour basis, with health care needs being met by visiting professionals. The home is accessible to wheelchair users. There is a well kept garden that some of the residents enjoy sitting in. Bathing and toilet facilities are suitable for the needs of older people. The residents enjoy a range of activities such as music, games, arts and crafts, gardening and entertainment. The fees per week for each resident are between £510.00 & £660. Information about the service provided is contained in the service users guide and residents welcome information pack. 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: three star excellent 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 arrived at the home at 07:45 on Monday 15th June 2009 to undertake an unannounced key inspection. The inspection took place over 9 hours on that day, with a further visit being undertaken on the evening of the 17th June 2009 to attend a relatives/residents meeting. The inspection involved talking to residents, relatives, staff, representative from Age Concern and healthcare professionals. It also included a tour of the premises, case tracking 6 residents, viewing all related and relevant documentation including staff files. Information was also taken from notifications sent to us under regulation 37 of the Care Homes Regulations and the annual quality assurance assessment (AQAA). Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Although staffing levels were reviewed following the last key inspection. it is still Care Homes for Older People Page 7 of 31 necessary to redo this as residents living with dementia require much more input and time from staff to enable them to maintain life skills and independence. However, this must not be at the expense of those residents who do not have dementia. There should be more choice around the number of baths/showers that one can have on a weekly basis. Also with improved staffing levels, staff will have more time in areas such as sitting and talking to residents, reading newspapers/magazines with them or assisting them in maintaining life skills. The revised contract to be in line with the recommendations from the Office of Fair Trading; the complaints log to be maintained in good order; the carpet joins in the corridors to be safe to prevent tripping/falls by staff and residents/visitors, and repairs to some of the lounge chairs. These were all discussed during the inspection and we were given assurances that these issues would be addressed in good time. Where residents are unable to use the emergency call system when alone in their bedrooms, the home must undertake a risk assessment and put in place alternative systems such as some assistive technology to enable staff to be alerted to reduce the risk of a fall/accident. 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 8 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 9 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives are given the information necessary to help them choose a home that will meet their needs. Evidence: A copy of the statement of purpose, service user guide and previous key inspection report were available for viewing within the home. The annual quality assurance assessment (AQAA) and discussions with the manager confirmed that the statement of purpose and service user guide are regularly reviewed, and that each resident is given a copy of the service user guide on admission to the care home. The service user guide is now available on a CD for those residents who are partially sighted. The home is progressing a service user guide in a pictorial format for those residents who may benefit from a guide in a more easily accessibly format. All prospective residents and their families are invited to visit the home prior to making a decision to move in, and can spend an enjoyable visit taking part in activities, meeting other residents and staff and enjoying a meal. During the visit the Care Homes for Older People Page 10 of 31 Evidence: pre-admission assessment is continued but in a more relaxed a informal manner. Also for those prospective residents who may find difficulty in moving into a residential home, the service will extend the admission process to cover several day visits so that the person living with dementia is less traumatised when finally moving in the home permanently. One relative told us this facility was wonderful as it enabled us as a family to slowly come to terms with the fact that my mother was having to move into residential care. Each service user and/or their family are given a contract of terms and conditions. However, this was viewed during the inspection process, and following some discussions with the manager this document will be reviewed and amended. A report has been issued by the Office of Fair Trading regarding contracts in residential/nursing homes, and it is recommended that the manager/proprietor refers to this report when making amendments to the current contract. Care Homes for Older People Page 11 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs and the principles of respect, dignity and privacy are put into practice. Evidence: From observations, discussions with some residents, relatives and staff and from viewing documentation, we are satisfied that people living at the home receive the personal and healthcare support they require. Care is delivered in a person centred way with support provided based upon the rights of dignity, equality, fairness and respect. The delivery of personal care is individual and is flexible. We were able to attend a relatives meeting which was held on the evening of the 17th June 2009 and, without exception, all of the relatives, a healthcare professional and a representative from Age Concern expressed their satisfaction with the care being provided at The Lodge. One relative said my mother has really improved since she came here, and to see her much happier and well cared for makes it easier for us as a family to deal with her having to be in a residential home. We could not have chosen a better place for her. Care Homes for Older People Page 12 of 31 Evidence: The care plans viewed were generally very comprehensive, but there are still some gaps around end of life/preferred place of care wishes. We did discuss this important area with the manager and senior care staff during the inspection, and are satisfied that progress will be made in this area. Many of the staff have undertaken training in palliative care, and we are satisfied that residents receive the care they need at the end of their life. Staff support both the family and other residents during the bereavement process, and are sensitive to the particular religious or cultural needs of the individual and families. In addition to general training around caring for frail elderly people, staff have also undertaken training in caring for older people living with dementia, and from observations much of this training is being put into practice. For example it is not important if a resident wants to keep a nightdress on all day and addressing this causes distress to that person. This may annoy the onlooker because it is not viewed as correct but causes no harm to the individual. It is more important that the independence of people living with dementia is maintained for as long as is possible, and this was generally demonstrated by staff during the inspection. All residents have access to healthcare services which include GPs, chiropodist, dentist and optician. Where necessary a district nurse will also visit the resident/s to do dressings, injections and blood sugar monitoring for diabetics. Where residents are taken to visit their GP either by a member of staff or a relative, the home has now developed a system to record the outcome of these visits, so that accurate records as to the resident/s health are kept within the home. The service also provides funding for a monthly surgery which is held at the home by a psychogeriatrician who undertakes reviews of both memory and medication, especially for those residents living with dementia. This service is very much appreciated by relatives as it has made a difference to the quality of life for their resident at The Lodge. Continence care at the home is of a good standard and there were no offensive odours noticed during the inspection visits. Risk assessments/care plans are in place for the delivery of personal care, continence care, moving and handling, nutrition and behaviour which may challenge and these are reviewed on a monthly basis. Weights are recorded and monitored. We did notice that there were no risk assessments in place for those residents who could not use the emergency call alarm system when alone in their bedrooms, and it will be a requirement that these are put into place. However, the home does use some assistive technology such as a pressure mat which is used to alert staff when one particular resident is out of bed because of the risk to Care Homes for Older People Page 13 of 31 Evidence: her falling. The use of this and other assistive technology such as mattress/cushion alarms could be used in place of the emergency call system for those resident unable to make use of this. All staff have undertaken training around infection control and we observed staff practising effective infection control procedures. We looked at the medication administration records and processes and these were found to be in good order. The requirements made at the previous key inspection had been complied with, and all PRN (as required) medications had the appropriate protocol in place. Staff who administer medication have completed a comprehensive training course which has been certified by a recognised training body. Regular audits are carried out by the manager on the medication. We did observe that daily recordings were not always reflective of the outcomes identified in the care plans. This was discussed during the first day of our inspection and by our second visit improvements had already begun to happen. It is essential that this continues as it is important information which should be used to inform the monthly reviews of the care plans. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are generally able to make choices about their life style, and are supported to maintain their life skills and cultural/recreational activities/hobbies. Evidence: Central to the homes aims and objectives is the promotion of the residents to live ordinary and meaningful lives both within the home and outside in the wider community. The home has recently purchased a new minibus and this has made access to the community much easier for residents. The home employs activity co-ordinators who are responsible for organising small/large group activities and some 1:1 sessions for those residents who choose to remain in their bedrooms. Other activities include festival celebrations, birthdays, garden fetes, and quiz evenings. Relatives are encouraged to participate in all activities, and the home is actively looking for relatives to be more involved with the residents. During the inspection we observed a musical quiz being enjoyed by many of the residents. However, residents not wishing to join in with this were observed to be left sitting in the other lounges with no staff presence. It is important that all staff recognise that the provision of activities is everyones responsibility, and that this could involve sitting and talking to residents, reading a newspaper or magazine with Care Homes for Older People Page 15 of 31 Evidence: some, taking some for a walk and possibly giving assistance to another person in tidying drawers/wardrobes in his/her bedroom. Some residents may also want to have a bath/shower more than once a week and should be given this option. To enable flexibility and choice to be meaningful, it is important that management ensures that staff are given time for this in the allocation of daily duties. This may involve a review of staffing levels or the times of day that duties are undertaken. For example, it may look nice for all beds to be made during the morning, but it may not be essential for this to happen where residents leave their rooms and spend the whole day in the lounges, and the making of these beds in the afternoon could free up time for staff to have more meaningful interactions with residents. Perhaps only the beds of those residents who spend the morning in their bedrooms, or like a rest in the afternoons, could be made in the mornings. This is just an example of where flexibility could be introduced into the daily duties of care staff. One area of good practice is that the maintenance person interacts really well with residents and this has helped one resident in particular to enjoy an improved quality of life. A monthly church service is held at the home and a priest visits fortnightly for those residents who wish to take communion or confession. There are some residents who are taken to church each week because of their wishes. All residents are encouraged to personalise their bedrooms, and we were invited by several residents to look at their bedrooms which had photographs of family members, televisions, radios and other personal items as they desired. All bedrooms seen were nicely decorated and furnished to a good standard. Where partners live in the home, the home can accommodate a joint living arrangement with one bedroom being a shared bedroom and the other a small lounge for them, if this is what they wish. Meals were observed to be well presented and nutritious. However, because many of the residents have short term memories, asking them the previous day to make a choice of what to have is not meaningful for them as many will have forgotten. Several residents told us the staff choose what we eat because my meal just appears in front of me. We did discuss this with the manager and her senior staff during the inspection and they will be looking at ways in which to enable residents to make choices on the day. Menus are being developed in a pictorial format as well as the normal written menu, and menus have now been reviewed to reflect the choices available each day. Staff were observed to be discrete and sensitive to the feelings of the person they were giving assistance to during meals, and were allowing residents time to finish their meal comfortably. Drinks and snacks are available throughout the day and night. The dining tables were well laid and appeared inviting. We were told that some of the residents help with the laying of the tables and that they enjoyed Care Homes for Older People Page 16 of 31 Evidence: doing this. Relatives and residents meetings are held and we were able to attend one such meeting during the inspection process. This particular meeting was very supportive and informative for relatives around dementia, advocacy and the Mental Capacity Act 2005, because the home had arranged for a psychogeriatrician to talk about dementia and the Mental Capacity Act 2005, and a representative from Age Concern who spoke about the advocacy project being introduced into some care homes within the London Borough of Havering, including The Lodge. We were also able to inform relatives about the Care Quality Commission and its role in ensuring the quality of life and safeguarding of vulnerable people receiving care. All of the people present at this meeting were very vocal in the praise of the service being provided at The Lodge. The home is currently developing a room where visitors can make themselves a drink whilst visiting residents. The garden areas are well maintained and there is a great deal of wildlife around which many of the residents enjoy watching. Garden furniture is in place for those residents who wish to sit outside in good weather. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service, and their relatives, are able to express their concerns and have access to a robust, effective complaints procedure. They are also protected from abuse and have their rights protected. Evidence: During conversations with some residents, relatives and staff we are satisfied that the ethos of the home is that it welcomes complaints and suggestions about the service, and that it uses these positively and learns from them to improve the quality of care to the residents. Relatives told us that the managers door is always open and I know that I can discuss any concerns that I may have. A resident told us the staff are wonderful and I can always talk to one of them and I always feel as if they are really listening to me. Copies of the complaints procedure are displayed in the home, and the home is currently developing a more simplified format for those residents who require this. The recording of complaints in a formal log does need attention and this was discussed with the manager during the inspection process. The home is also taking part in a pilot scheme being operated by Age Concern Havering around advocacy for older people. Volunteer advocates will visit the home for approximately 2 hours each month, and this will enable residents to have access to an independent person with whom they can discuss any concerns that they may have. The service has a whistleblowing policy and staff demonstrated an understanding of Care Homes for Older People Page 18 of 31 Evidence: this, and felt that they would be supported by the manager if they did need to whistleblow. One member of staff told us I would not still be working here if I didnt like it and feel supported. Policies and procedures regarding safeguarding adults are available to staff and give them clear guidance about what action should be taken. The service is clear when an incident needs to be referred to the local authority as part of the local safeguarding procedures. Currently there are no safeguarding issues at this home. All staff working within the home are fully trained in safeguarding adults, and some were able to demonstrate an understanding of what constituted restraint, and alternatives to its use would always be explored. Equipment which may be used to restrain individuals such as bed rails, recliner chairs and lap belts would only be used when absolutely necessary, and with the involvement of the residents and/or family, health/social care professionals and within a risk assessment framework. Staff recruitment procedures remain robust with the necessary interviews, references and criminal records bureau disclosures being obtained prior to employment. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables residents to live in a safe, wellmaintained and comfortable environment. With some further adjustments it could encourage people living with dementia to be more independent. Evidence: On arrival at the home at 07.45 hours we did a tour of the building, and again visited various areas during the day, and at all times found the home to be clean, well maintained and free from offensive odours. Bedrooms are of a good size and residents are encouraged to personalise their own rooms to reflect their own culture, interest and choices. There are several lounge areas and residents can choose where to sit and are free to walk around the home at their leisure. However, we were told that one of the smaller lounges, which is near to the smaller dining room, is generally occupied by those residents who require more care. Some of the lounge chairs require replacement/repair as the arms have either worn or the wicker has broken. We were told that such repair/replacement was in hand. There are two dining areas, the smaller of which is generally used by those residents who have a higher dependency need. The lounges and the dining rooms are bright and provide an inviting ambiance. Although the corridors are long there are seats located at various locations along Care Homes for Older People Page 20 of 31 Evidence: these corridors so that residents can rest if they wish. However, the home is in a square so residents can walk around and find their way back to where they started. Some of the carpet joins along the corridors require attention and we were assured during the inspection that this work is already in hand. It is essential that this work is completed quickly as it could pose a health and safety risk to residents, relatives and staff. There is some signage to help those residents living with dementia, but this does need to be further developed so that all residents can maintain as much independence as is possible in finding their way around the home, and especially in identifying their own bedroom. Some homes have done this by using primary colours to highlight doorways to toilets, bedroom doors to look like a street door with a letterbox and door knocker. Also the use of memory boxes fixed to the side of the bedroom doors, and such boxes can contain items which could be recognised by the resident. The communal bathrooms and toilets are fitted with appropriate aids and adaptations, and all toilets had toilet rolls, towels and soap. The garden areas are well maintained, and there are plans to develop a sensory garden. The kitchen and laundry areas were clean and well maintained. The home has a comprehensive fire risk assessment which is in accordance with legislation, and this has recently been viewed by the local fire service and found to be in order. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled but not always in sufficient numbers to support the people who use the service, and to support the smooth running of the service. Evidence: We spoke to some residents and relatives who told us that they have confidence in the staff, and that staff are really kind and caring. One resident told us that the girls are wonderful, nothing seems to be too much trouble, even when they are busy. We viewed the staff rota and found that staffing levels have been increased since the last key inspection. It is also essential that all staff on duty in the home, at any time, are included in the rota together with duty times and designation. Although staffing levels have been reviewed since the last key inspection, a further review is still necessary, and this on an ongoing basis, especially now that the homes registration includes dementia. People living with dementia will require much more staff input in order for them to remain motivated and retain daily living skills for as long as is possible. We discussed this with the manager and her senior staff during the inspection and have been assured that such a review will take place, and on an ongoing basis. This has also been referred to under Daily Life and Activities. Staff training is of a good standard and has included mandatory training around moving/handling, health/safety and safeguarding. Training has also included dementia Care Homes for Older People Page 22 of 31 Evidence: awareness, palliative care and the Mental Capacity Act 2005. 85 of staff have been trained to NVQ level 2 and 2 seniors have achieved the Registered Managers Award. Staff spoken to also demonstrated an understanding and awareness of equality and diversity issues. Recruitment processes are robust and in accordance with legislation. The service is endeavouring to recruit some male carers, but currently without success. Staff supervision has improved and this now includes direct observation of care practices which will benefit both staff and residents. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, and generally has effective quality assurance systems. Evidence: Since the last key inspection the registered manager has now achieved the Registered Managers Award. The gaining of this award will add to her competence and experience in running the home. The registered manager is very well supported by experienced administrative staff and senior care staff who have been trained to a high standard. The manager was able to demonstrate a clear understanding of the key principles and focus of the service and works continuously to improve services for the benefit of all of the residents. Residents enjoy an improved quality of life and there is a strong focus on equality and diversity issues and promoting human rights, especially in the areas of dignity, respect and fairness. There is a focus on person centred thinking and a strong ethos of being open and Care Homes for Older People Page 24 of 31 Evidence: transparent in all areas of the running of the home. This was confirmed from observations during the inspection and talking to residents, relatives and staff. The service pays privately for the regular surgeries undertaken by a psychogeriatrician and it is clear that this is of benefit to residents and relatives. We were told by residents, relatives and staff that Mrs. Nicoll is wonderful, she always puts the residents first and is always ready to listen. The service has sound policies and procedures which are regularly reviewed and updated in line with current thinking and practice. Through a more effective supervision regime, the manager is ensuring that staff follow the policies and procedures of the home, and that they remain positive in translating policy into practice. The home works to a clear health and safety policy and staff are aware of this and are trained to put the theory into practice. Safeguarding is given a high priority within the service with all staff undertaking the necessary training. Records are generally of a good standard and risk assessments are undertaken and in place where necessary. The manager and her staff have a good understanding of risk assessment processes which is underpinned by the promotion of independence and choice. The home has access to professional business and financial advice and has all the necessary insurance cover to enable it to fulfil any loss or legal liabilities. The home does not hold monies for residents, and any expenditure made by the home for a resident, is recovered through an invoicing system to relatives or residents. Quality monitoring systems are now in place through the mediums of internal audits, questionnaires, residents and relative meetings, staff meetings and a newsletter. The annual quality assurance assessment (AQAA), a document required by the Commission, was completed and returned in accordance with requirements. Although this document was reasonably completed, much more information could have been contained within it. It is to be hoped that the next AQAA will be much more comprehensive in its content. Maintenance records are being kept in good order with the necessary checks being undertaken within the required timescales. The manager was available throughout the inspection and is fully aware of the improvements that are required and identified in this report. We are confident that these will be complied with, and within the given timescales. Care Homes for Older People Page 25 of 31 Evidence: The home notifies the Commission of any accidents/incidents which affect residents, as required under regulation 37 of the Care Homes Regulations, and continues to work closely with the Commission. Currently there have not been any referrals under the deprivation of liberty safeguards within the Mental Capacity Act 2005. Care Homes for Older People Page 26 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 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The registered person/s shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. To ensure, as far as is possible, the safety of residents who are unable to use the emergency call system when alone in their bedrooms, a risk assessment must be in place together with the identified need for an alternative to be in place. This may involve the use of assistive technology such as mat alarms, mattress/cushion alarms. 10/07/2009 2 14 12 The registered person/s shall so far as practicable enable service users to make decisions with respect to the care they are to 10/07/2009 Care Homes for Older People Page 28 of 31 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 receive and their health and welfare. Staffing levels must be such that residents can choose when to have a bath, be able to make a meaningful choice around what to eat, and have meaningful interactions with staff especially when sitting in the lounge/alone in bedroom. 3 19 23 The registered person/s 03/07/2009 must ensure that all equipment/furnishings at the care home for use by service users or persons who work at the care home is maintained in good order. To ensure the health and safety of residents and staff all carpets/joins must be hazard free. All lounge chairs must be in a good state of repair to ensure that residents do not hurt themselves on broken wicker. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 It is recommended that the registered persons refer to the report produced by the Office of Fair Trading with respect Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations to contracts for residential care. 2 16 The registered person should ensure that the record of complaints is maintained in a good order so that a summary of such complaints could be sent to the Commission at its request. 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. 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