Care Home: Longview

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What the care home does well The Manager and staff had attended training to give them a better understanding of the needs of those who have Dementia. There is clear evidence around the building of this training being put into practice and the home has items to look at and become involved in, which helps with stimulation. Areas around the home have also been decorated individually, taking into considerations colour schemes, which also helps with orientation. The Manager has introduced a number of new ideas to help residents have some autonomy and independence whilst living at the home. A trolley has been introduced which sells sweets and personal items to the residents. This allows them to have some autonomy on buying personal items such as razors, shampoo, bubble bath etc. They also sell sweets, which also allows independence to those residents who have mobility problems and would be unable to go out and buy their own. Choice has been provided in the meals and desserts offered at the home. A dessert trolley has been introduced, which offers residents at least 4 choices each meal time. The home has a busy feeling, with animal and birds being part of the environment. A raised garden has been introduced to help those with mobility problems who may want to take part in this opportunity. Complaints made to the home are well recorded, issues are investigated and outcomes reached. What has improved since the last inspection? There were only two requirements made at the last inspection. These were around updates for training and ensuring that gaps in applications forms are discussed and recorded. From documentation seen and evidence gathered these requirements have been met, although some updates are still required for staff training. As previously stated the Manager has introduced new ideas to the home, which offer the residents choice, independence, stimulation and helps to make Longview their own home. What the care home could do better: No requirements have been made at this inspection. There were only minor issues raised in this inspection regarding odour control and ensuring boxes of medication are dated when open. Generally it was felt the the home was well run and that the residents were happy with the care and service they received. Key inspection report Care homes for older people Name: Address: Longview Little Gypps Road Canvey Island Essex SS8 8HG     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: Sharon Lacey     Date: 3 0 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Longview Little Gypps Road Canvey Island Essex SS8 8HG 01268682906 01268510155 longview@runwoodhomes.co.uk www.runwoodhomecare.com Runwood Homes Plc Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Helen Joyce Cottee Type of registration: Number of places registered: care home 65 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Longview is registered to provide care and accommodation for 65 older people. Thirtytwo beds are registered for residents with dementia and three beds are reserved for residents on a short stay placement. One part of the site is used to provide day care. Longview is a 2-storey building and is nearby to local shops and community amenities. The home has access to local bus routes. All bedrooms are single occupancy and most have en suite facilities. The home has a courtyard garden/patio area and other grassed areas surround the building. There are adequate parking facilities to the front of the home. The range of fees is £382.62 and £409.92, depending on the service required and Care Homes for Older People Page 4 of 30 Over 65 0 65 65 0 Brief description of the care home dependency. There are additional charges for toiletries, hairdressing, newspapers and personal items. Copies of the homes Statement of Purpose and Service Users Guide were available in the main entrance hallway. Care Homes for Older People Page 5 of 30 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: The Last Key Inspection to Longview took place on the 28th April 2008. This Key inspection was in the form of an unannounced inspection and took place over eight hours. All the Key Standards were inspected, but evidence was also gained on some of the other National Minimum Standards. A tour of Longview was completed and an inspection of relevant records and documentation took place. Areas looked at included information given to residents before being admitted, information gained when residents first come into the home, how information is given to staff on the care residents may require, the facilities and the environment of the home, and any complaints or safeguarding issues that may have been received since the last inspection. Also staffing and management of the home were inspected. An Annual Quality Assurance Assessment (AQAA) was sent to us. The AQAA is a self assessment, which is required by law and identifies how the service feel outcomes are being met for the people using the service. The AQAA submitted provided information Care Homes for Older People Page 6 of 30 on how the service had improved over the last 12 months and what improvements they still hoped to make. During a tour of the home a number of residents were spoken with about their life experiences at Longview. Some of the residents approached were unable to express their thoughts or feelings, so they were observed during the day interacting with staff and visitors. Questionnaires were sent out to residents and relatives, information from those returned have been included in this report. Most staff members on duty were spoken with informally during the visit to the home and any feedback has been included as part of the report. Staff questionnaires were also distributed and information from those returned has been included. At the end of the day the findings of the inspection on the home were discussed with the Manager and advice and guidance was given. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 30 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents will be provided with information about Longview and the services it provides. Residents who move into the home will have their care needs assessed to ensure these can be met. Evidence: Copies of the Service User Guide and Statement of Purpose were available in the foyer of the home. These contained specific information about the home and advised prospective residents of the services provided, the fees and also the facilities available. On viewing both documents it was felt that these were very informative and contained all the information required. Both documents had also recently been reviewed. The Manager confirmed that these documents would be given to prospective residents when they viewed the home or when an assessment was completed. Copies could also be found in each of the residents bedrooms. Those residents who returned questionnaires confirmed that they had received enough information about the home before they moved in. Care Homes for Older People Page 11 of 30 Evidence: It was confirmed with the Manager that admissions are not made to the home until a full needs assessment has been undertaken. It was established that all new residents would be visited before they were admitted, to help ensure their care needs can be met. The Care Team Managers or the Manager would complete the assessment, but they had recently gained a new Deputy Manager and it was hoped that she would also take on this role. The assessment form consisted of a set form, which had a tick box in place and provided a score on dependency. Three files were viewed and all contained a fully completed form, which helped to identifying the persons individual assessed needs. Prospective residents are given the opportunity to spend time in the home and details of trial periods could be found in the Service User Guide. These are arranged to provide an opportunity for prospective residents and families to visit Longview and assess the quality/facilities and the suitability of the home before they move in. This is to help them come to a decision as to whether or not residential care is the most appropriate option for them. Residents are provided with Contracts and details could be found in the Service User Guide. Two files were viewed and both contained a Contract, which included details of the room number and the fees. Those who returned their questionnaires confirmed that they had received a Contract. To ensure staff can meet the needs of the residents living at Longview, all staff are provided with training. From the training documents seen this showed that the staff are well trained and able to meet their residents care needs. Staff had received specialist training in dementia care and individually and collectively had the skills and experience to deliver the services and care that the Home provides. The certificate of Registration had been placed on the wall in the foyer and this was noted to be correct. There were also details of the service user Charter of Rights and Mission and Values of the home. Guidance could also be found regarding organisations that may be able to assist or help relatives or residents whilst living at the home. The home does not provide intermediate care, but does have six beds which are often used for convalescence for those who have been in hospital. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their health, personal and social care needs will be met. Each will have an individual plan of care and they will receive the care they need. Evidence: The Service User Guide contained guidance on care plans, which included what they were, how often they were reviewed and how individual residents would be involved in this process. Three resident files were viewed and these contained details of the care required and also guidance to staff on how this was to be provided. These files also had resident profiles, which contained personal details, details of next of kin, GP, social worker, marital status and date of birth. There were also Social History forms, which had details of the persons likes and dislikes, family history and what hobbies they may have an interesting in; which would assist with any activities organised. Night care plans were also in place, which identified care needs and any assistance each individual may require during the night. Other documentation included continence assessments, mental health and nutritional assessments. Documentation seen showed that care plans were person centered and had been agreed with the individual or their relative. Those who returned their questionnaires confirmed that Care Homes for Older People Page 13 of 30 Evidence: they received the support and care needed, with one resident adding they are here if you need them. During the inspection their was evidence that health care professionals were visiting individuals to provide them with care. The home has an identified nurse who visits regularly and works well with the staff to identify residents health care needs and provide assistance when needed. The multidisciplinary review form on each residents file provided details of district nurse visits, GP visits, hospital visits and interaction with other healthcare professionals. All three residents who returned their questionnaires stated that they always received the medical support they needed. Longview have written policies and procedures in connection to the recording, storage, handling and administration of medication. A Senior staff member was accompanied and observed whilst administering residents medication. The home uses a monitored dosage system, which helps to assist in the safe storage and administration of medication. All medications is kept in a lockable cabinet. Medication record sheets had been used to record any medication administered. On viewing these it was noted that there were no anomalies and all had been correctly completed. The home also had update forms in place for any changes to individuals medication and this helped to ensure that the care staff were aware of any new requirements. There were also PRN medication guidance and medication profiles, which provided details on the medication, what it was for and how many times it was to be administered. Files contained photos of the residents to help staff identify those who needed medication. Fridge temperatures had been regularly checked. It was noted that room numbers had been put on boxes of medication for easy identification, but not all bottles or packets have been dated when opened. The documentation used to record controlled drugs had been completed correctly and contained the signatures of two staff. The staff member spoken with advised that medication audits are completed twice a week by the night staff. She added that medication training is also updated yearly. On the day of the inspection there was evidence that staff were treating residents with dignity and respect and providing appropriate care. Staff were observed speaking with residents to ensure they were provided with choice were possible and that there wishes were taken into consideration. The Manager stated that residents are able to stay at Longview for as long as the staff are able to provide the care they require. Guidance could be found in the foyer in the form of a an information pack, which provides relatives and residents with guidance around bereavement and services they may require. It was noted that details of the persons wishes with regard to death was also part of the Personal Details form and Care Homes for Older People Page 14 of 30 Evidence: these had been completed on the resident files viewed. The Manager stated that some staff had requested further training in connection to bereavement and she was looking into the possibility of arranging this. Care Homes for Older People Page 15 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents living at Longview will be able to participate in a full and stimulating variety of activities, which are also relevant to those who may have dementia. Meals offered will provide choice and will also be nutritional. Evidence: The Service User Guide contained details of the homes visiting policy, which states it encourages and welcomes visitors between 9.00 am and 9.00pm. It adds that visitors can call outside these times, but arrangements need to be made with staff. There was evidence of visitors coming and going during the day and some were spoken to with regard to their experience of the home. There is a visitors book in the foyer for people to sign when they arrive and leave the Home. There is a visitors room so that residents can see their relatives privately if they wish. The Manager is in the process of developing a tea room, which will allow visitors to make their own tea and provide another private space for them to use. There are also small areas around the home for relatives and residents to sit and chat. Three Activity Co-ordinators are employed for approximately 40 hours a week to support the social activities within the home. On the day of the inspection residents were observed doing Easter crafts and many had made an Easter bonnet, which they Care Homes for Older People Page 16 of 30 Evidence: were waiting to be judged. There was also an Easter raffle for residents to take part in. The home belongs to NAPA and had also won the Runwood Homes Best Activities Trophy for 2009. The home had introduced a trolley service, which sells sweets and personal items to residents twice a week. This provides the residents with an opportunity to be independent with regards to buying personal items such as soap, shampoo, bubble bath and sweets and chocolate. A weekly activities programme had been produced, which was very colourful and advised the residents of any activities that were to take place each day. On the one viewed this included bingo, Easter cards, Easter bonnet making, pat the rabbit, chitchat, choice of film, the sweet trolley, film of the day, hot cross buns and residents choice. The Manager had also produced a newsletter, which provided residents with details of raffle, residents birthdays and staff birthdays, the Easter bonnet competition, race morning, nail painting and hand massage, a craft morning, a trip to the lake, a St Georges Day tea party and a trip to the shops. The Manager advised that they now have the use of a minibus, which they hoped to use for more trips out. Whilst touring the home the walls were busy with pictures, textured boards, hats and handbags and jigsaws which the residents had been involved producing. These helped to provide a stimulating environment for the residents. There was also a wall which had a painted tree and residents were involved in doing art work to reflect the four seasons. This was bright and colourful and a good visual aid as residents went to and from the dining room. Written records had been completed each day by the Activity Coordinators on what activities the individual residents had been involved in. It was felt that the evidence available for this National Minimum Standard was outstanding and the Manager had tried to ensure that the environment was stimulating and relevant for those residents who may have some from of dementia. The hairdresser comes to the home twice a week and there are also manicures available. Residents confirmed that the hairdresser calls and that many of them use the service. It was noted whilst touring the home at lunchtime that the dining room was pleasant and there were tablecloths, flowers on the table, menus on the table providing information with regards to breakfast, lunch, tea and supper. One resident advised there is a cooked breakfast on Monday, Wednesday and Fridays. There is a menu on a whiteboard in the dining room, which provided residents with details of what is on offer with regard to the meals for the day. There were also details of meals and mealtimes in the Service User Guide. Residents were heard being offered choice by Care Homes for Older People Page 17 of 30 Evidence: staff with regard to food and drinks. Some residents chose to stay in their rooms during the morning and also at lunchtime to eat their meals. The Manager had recently introduced a dessert trolley, and today the choice was peaches and cream, sultana cake and custard, fruit, or yoghurts. On discussion with the Cook she stated that since the dessert trolley was introduced, she had found that the residents were eating more food and there had been less waste and that the food orders made each week had changed. At the last inspection it was noted that there were not any sauces or condiments on the table. The new Manager has now arranged for sauce sachets to be placed on each residents table, which also ensures they have a choice. Residents spoken with confirmed that tea, coffee and biscuits were served during the day. Residents were complimentary with regard to the food served at Longview. When looking at the homes catering survey, which was completed in October 2009 comments included I like roast dinners, I am always fill up, I like most things, I am happy with the menu, I like the cakes and sweets, I like it all and sometimes the food is not very hot. On viewing the kitchen there was a good stock of food and selections of frozen meat. The Cook advised that there is a delivery of food weekly and fresh vegetables are delivered twice weekly. The Cook advised that she assures the residents have at least one or two fresh vegetables a day. Longview had scored four stars and were rated as good for Castle Point Councils Scores on the Doors and awarded the Gold Award for the Healthy Eating. Care Homes for Older People Page 18 of 30 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 can be confident that any concerns or complaints will be listened to, investigated and acted upon. They can also be confident that they will be kept safe and that staff have a good understanding of safeguarding practice. Evidence: The complaints procedure is supplied to everyone as part of the Service User Guide. This includes details of the CQC address, the procedure, and also any timescales. The complaints procedure was also on display on the wall in the foyer. The home had a complaints file and this was viewed. There were clear evidence of complaints, investigations and outcomes of each of the complaints received. There was a set form, which had space to record details of the name of the complainant, details of the complaint, the investigation and also the outcome. Each complaint on file had been well recorded, had a full investigation and included copies of letters of apologies and details of the outcome. The Manager explained that she has an open door policy and is happy to speak to residents, staff and relatives if they have concerns. From documentation seen and observation it was felt that the home welcomed complaints and suggestions about the service. On discussion with the Manager she was able to show that they have learnt from the complaints received and had used this to improve their service. Questionnaires showed that residents have a clear understanding of how to make a complaint and what action will be taken. Care Homes for Older People Page 19 of 30 Evidence: There are policies and procedures in place to assist with the safeguarding of vulnerable adults. The Manager is clear when an incident needs to be referred to the Local Authority as part of the safeguarding procedures and evidence of this practice has been gained by the CQC over the last 12 months. From viewing the training matrix it was clear that all staff had received safeguarding training. Staff spoken with had a good understanding of both Whistleblowing and Safeguarding vulnerable adults. Guidance on the procedure used to safeguard service users finances was found in the Service User Guide. There were also details of an advocacy service in the Service User Guide and guidance in the foyer, for any relatives of residents who may need this. Postal votes are made available to the residents, but the Manager stated that at present only two residents take have taken up this offer. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home will live in an environment that is appropriate to their needs, especially if they have dementia. They will live in a home that is clean, tidy and pleasant. Evidence: A tour of the premises was undertaken. Since the last Key inspection the Manager had organised the redecoration of parts of the home and introduced new colour schemes in each of the corridors; this is to help the residents identify the area of the home in which they live. The home employs a full-time maintenance person, who was awarded the maintenance persons quality award in October 2008. There is a maintenance book for staff to write any areas of concern regarding maintenance and this had been dated when the work had been completed. On the day of the inspection the maintenance man was painting the stairwell in the foyer. The Manager had used the environment in the home to meet the needs of those residents who have dementia. There were boards with different textures around the walls, handbags and hats for residents to use, jigsaws framed on the walls that residents and staff had been involved in putting together, an Avery of birds in the foyer (which many of the residents enjoyed sitting by), two rabbits in the garden that residents assist in caring for and they are also in the process of developing raised flowerbeds, so that residents can assist in the garden area. It was a pleasant Care Homes for Older People Page 21 of 30 Evidence: environment to be in, with lots to look at and suitable for a stated purpose, which is a home for those residents with dementia. The furniture was of good quality, but carpets were in the process of being renewed in the hall ways and it was noted that in some areas the joints had started to come apart. This was brought to the Managers attention and a risk assessment was completed. The maintenance man also arranged to place tape over the gaps to ensure residents safety. The lighting is sufficient in the lounge areas and many lights were on sensors to help reduce electricity usage and also assist those residents who are unable to turn lights on or off. The home had the use of hoists, handrails, pressure mattresses and the signage around the home was good and aided orientation. Residents had specialist equipment required to assist with their mobility etc. Generally the residents live in safe and comfortable surroundings. There were details in the Service User Guide with regard to personalising rooms and what each resident could bring in with them. Bedrooms were well decorated with coordinating bedding and curtains and these had been personalised with ornaments, pictures and other personal possessions. Each resident had a plaque on their bedroom door with their name and an individual picture to help them recognise their room and assist orientation around the home. Toilets and bathrooms around the building had been individually decorated and were bright, colourful and added items of interest for residents to look at and assist with stimulation. The Manager was advised that any mirrors or glass items would need to be made safe. All bedrooms have ensuite facilities and there are no shared rooms. From training documentation viewed all staff have completed infection control training. Alcohol hand gel could be found in the foyer for visitors to use. It was noted that paper towels and liquid soap were available in bathrooms and toilets. On discussion with the Manager it was established that there were odour control systems in place and it was noted that all rooms were clean and tidy. Odour control was fairly good, but the front lounge had a strong smell of urine. This was brought to the Managers attention. One domestic spoken with confirmed that there were sufficient cleaning materials and also stated that she had received all her training and was up-to-date. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that they will be cared for by competent and experienced staff. Evidence: Staffing rotas were viewed and these contained details of the staff members name, job title, and dates and time worked. The Manager confirmed that there are eight care staff on duty in the morning and two Care Team Managers and seven care staff in the afternoon and two Care Team Managers. Three night staff and one Care Team Manager are on duty at night. The Manager is supernumerary to the numbers and there is a Deputy Manager who works during the week and also some weekends. There is also an administrator, laundry staff, domestic staff, Cook, Cooks assistant, maintenance man and three Activity Coordinators. Five staff returned questionnaires and of these two stated they always had enough time to meet the assessed needs of the residents, whilst three stated they usually did. There is a recruitment policy and procedure, but this was not viewed during this inspection. It was confirmed that the Manager and Deputy Manager would complete any interviews for new staff. The gathering of recruitment information is the responsibility of the homes Administrator and it was noted that the files viewed contained a checklist to assist the Administrator in being aware of what information had been received back. The files of two recently recruited staff were viewed and Care Homes for Older People Page 23 of 30 Evidence: these contained an application form, proof of identity, details of criminal offences, two written references, a full employment history, a POVA first check, a signed Contract, interview questionnaire and a health medical. It was established that only one staff member had their CRB back, but the Manager confirmed that the other had been requested and due to this she was working under supervision. On speaking to the staff member in question she confirmed that she was being supervised and did not provide care on her own. The Manager confirmed that the induction provided to staff is in line with Skills for Care guidance and that all new staff had completed this. There is also an in-house induction and evidence seen on files viewed showed that this had been completed on only one of the new staff members files. Runwood Homes has its own training department. Mandatory training is updated yearly and consists of moving and handling, safeguarding, first aid, dementia, health and safety, fire awareness, infection control and food hygiene. Fire safety is updated every six months. Further training is also on offer and includes challenging behaviour, pressure care, care plan training, death and dying, yesterday, today and tomorrow and activity-based care. The Manager provided a completed training matrix, which provided evidence of when training had been completed and when updates were required. Training records are kept on staff files and of the files viewed all contained copies of training certificates. The training matrix showed that all staff had completed safeguarding training, first aid (22 require updates), moved and handling (one requires an update), dementia (four require updates), health and safety, food hygiene (seven require updates), fire awareness (six require an update) and infection control. All five staff who returned questionnaires confirmed that they had been offered training that was relevant to their role, with one adding staff have enough training to support the needs of residents. From the documentation and feedback from staff it was established that the staff at Longview have the skills and experience to provide the care required. The Manager confirmed that NVQ training is provided to staff and when looking at NVQ matrix it was clear that 13 staff had completed their NVQ 2 training and 21 were presently doing this. Feedback from one staff members questionnaire confirmed they encourage staff to obtain NVQ training. The home is still working towards having at least 50 of their staff to be NVQ trained. Care Homes for Older People Page 24 of 30 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. People live in a home that is run and managed efficiently and effectively. Residents 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 her responsibilities fully. Evidence: The Registered Manager at Longview is qualified, competent and experienced to run the home and to meet its stated purpose and aims and objectives. She has a least two years experience in senior management and has a relevant qualification, which consists of the Registered Managers award. The Manager regularly updates her training and is at present attending a Managing Peoples course, which consists of one year of training. She has also completed a dementia course, and there is clear evidence around the home of this being put into practice. The Manager tries to ensure that there is an open, positive atmosphere within the home. She holds a surgery on the first Thursday of every month until 8.00PM for any relatives or friends who may wish to speak to her. Staff who returned questionnaires Care Homes for Older People Page 25 of 30 Evidence: confirmed that they received support with one adding it has a great environment, we get a lot of support from our manager. During the inspection staff were observed in general conversation with the residents and incorporating them in parts of the day-today activities, one residents added that there was a happy atmosphere. There are a number of quality assurance systems in place to help monitor the home and the quality of the service it provides. Details of the quality assurance system could be found in the Service User Guide and it stated that the home is audited yearly and residents and relatives would be requested to complete questionnaires to gain their views on the service. An internal quality report is also completed, which is quiet comprehensive and highlights areas the home needs to improve. Relatives meetings occur monthly and documentation viewed showed that these had occurred, who had attended and minutes of the meetings. The home has achieved the Investors in People Award and their next assessment is in 2011. Essex County Council also completed an annual contract monitoring visit. Regular supervision is provided to staff in the form of observations, appraisals and one-to-one meetings. The Manager had produced a supervision matrix. The matrix showed that supervision had occurred in November, December, January, February and March and during this time staff had been seen at least three or four times. Regular staff meetings had been held and minutes were made available. Two staff files were viewed and these contained documentation that one to one supervision, observations and appraisals had taken place over the last 12 months. There are systems in place to assist with safeguarding residents finances and guidance could be found in the Service User Guide. Regular audits are completed by head office and when viewing residents documents there was evidence when this had occurred. Three resident financial records were checked and these were all found to be correct. Due to Longview being part of a larger organisation there are systems in place with regard to the management of the business. Regular audits are completed and there are financial procedures in place including annual accounts. There was a certificate of insurance, which was valid until 19/08/10. Individual records and home records were found to be secure, up-to-date and good order. There were separate files for both staff and service users and generally the records kept at the home were of a good quality. Documentation was provided to show that regular safety checks had been completed on the home. There was evidence of a fire plan, certificates in place for bathing hoists, Care Homes for Older People Page 26 of 30 Evidence: emergency lighting, fire protection, PAT testing and gas. The maintenance man was also responsible for certain checks within the home for safety and on viewing documentation it showed that weekly fire alarm checks, water temperatures, safety checks and emergency lighting checks had been regularly completed. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 9 26 28 It is recommended that staff date boxes and bottles of medication when opened. Ensure all areas of the home have odour control in place. Recommend you continue to work towards 50 of your staff achieving their NVQ qualifications. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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