Care Home: Lorraines Residential Home

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What the care home does well People told us they were encouraged to visit the service in order to familiarise themselves with the building, and to enable them to make an informed choice about their future. People told us they thought the service was "homely with a relaxed atmosphere". People said the routines were flexible and they could choose how they wished to spend their day. People told us they are "well looked after". They told us the staff team were: "friendly", "caring" and "responsive", and provided "good care and support ". People told us they were satisfied with the food provided, and they "had enough to do in the service to keep their mind active". People are supported by a stable, and trained staff team, who are dedicated to ensuring peoples needs are met to a good standard. People have opportunities to provide feedback about the service, through the quality assurance systems in place. People made many positive comments both during our discussions and in the surveys that were completed. Some of these comments include: "The staff are very good, they treat each person with care and respect. The meals are excellent, and all of my health care needs are met. We have good entertainment and activities, and we now go out which I enjoy. The staff always attend to our needs, no matter how busy they are. Our visitors are always made to feel welcome. We have a happy atmosphere now things are much better". "I feel very happy living here. This is not the first home that I have stayed in, but it is the best. I love it here, the staff are like family to me, and I get on well with the other people that live here to, we are all very happy". "The staff provide good care and are very attentive. I am very happy living here and things have improved over the last few months for the better". We found that the quantity of medicine in stock for each person was accurately recorded at the beginning of the month, and records of the disposal of medicines were kept. What has improved since the last inspection? The service had ten requirements following our last key inspection. They have made the following improvements: Each person now has a contract in place detailing their rights whilst living in this service. Each person now has a person centred care plan in place, which informs staff on the delivery of care. These are now kept under regular review. This ensures staff have access to the required information to deliver individualised care Each person has had risk assessments completed in order to monitor their mobility, pressure areas, nutrition and falls. This ensures those risks that are identified can be minimised. Improvements were made in relation to the staffing levels and additional staff have been recruited and are now on duty during peak times of activity. This ensures the staffing levels are sufficient for the dependency of the people currently living at this service. Some progress has been made in relation to arranging training for the staff team. This will ensure the health and safety of the staff, and people living in this service is promoted and safeguarded. What the care home could do better: The staff need to ensure the medication keys are stored securely, so people are not at risk. They need to ensure all records are completed to demonstrate their actions and advice received from peoples GPs. This will ensure people receive their medication as prescribed. The staff need to attend the training that has been planned or which is currently being arranged. This is to ensure they are trained in all mandatory areas in order to fulfill their roles and responsibilities. Arrangements need to be made to register the manager of this service. This is to ensure the service is managed in peoples best interests. We have made some good practice recommendations which cover a variety of areas. If addressed and responded to, these will improve outcomes for people who use this service. Key inspection report Care homes for older people Name: Address: Lorraines Residential Home 44 School Street Church Gresley Swadlincote Derbyshire DE11 9QZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Claire Williams     Date: 1 7 1 2 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 32 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 32 Information about the care home Name of care home: Address: Lorraines Residential Home 44 School Street Church Gresley Swadlincote Derbyshire DE11 9QZ 01159425840 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Parvin Riaz Khan,Mrs Abida Parveen Ashraf,Mr Inam Rehman care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 17 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Lorraines is a care home registered to provide personal care and accommodation for up to 17 people in the category of older persons. Lorraines Care Home is located in the small village of Church Gresley, South Derbyshire and is 1 mile from Swadlincote. There are 9 single rooms, and 4 double rooms available at this service. There is one lounge and a dining room for people to use. A car park and a garden area is located at the rear of the home. Care Homes for Older People Page 4 of 32 Over 65 17 0 Brief description of the care home Information about the service is provided in the Statement of Purpose and Service User Guide, which is made available to people who live in this service. People have access to the inspection report which is displayed in the foyer area. The current fees for the service are £365 to £375 per week. Items not covered in the fees include hairdressing, chiropody, toiletries, and transport. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for the service is One star. This means the people who use the service experience Adequate quality outcomes The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who use the service and their views of the service provided. This process considers the services capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This Key inspection was unannounced, and was completed in 8 hours. We were supported on this visit by a pharmacy inspector who focused on the medication practices in the service. In order to prepare for this visit we looked at all of the information that we have received since our last visit. This included any notifications from the provider, surveys, and their improvement plan. This plan told us that all of the requirements we had made previously at our last visit (which was undertaken on Care Homes for Older People Page 6 of 32 the 7th and 8th July 2009) had been addressed. During the site visit case tracking was included as part of the methodology. This involved the sampling of a total of two people representing a cross section of the care needs of individuals within the service. Their care planning, and associated care records were also examined and their private and communal facilities inspected. Discussions were also held with staff about the arrangements for their deployment, recruitment, induction, training and supervision, and records examined to support the procedures in place. Care Homes for Older People Page 7 of 32 What the care home does well: People told us they were encouraged to visit the service in order to familiarise themselves with the building, and to enable them to make an informed choice about their future. People told us they thought the service was homely with a relaxed atmosphere. People said the routines were flexible and they could choose how they wished to spend their day. People told us they are well looked after. They told us the staff team were: friendly, caring and responsive, and provided good care and support . People told us they were satisfied with the food provided, and they had enough to do in the service to keep their mind active. People are supported by a stable, and trained staff team, who are dedicated to ensuring peoples needs are met to a good standard. People have opportunities to provide feedback about the service, through the quality assurance systems in place. People made many positive comments both during our discussions and in the surveys that were completed. Some of these comments include: The staff are very good, they treat each person with care and respect. The meals are excellent, and all of my health care needs are met. We have good entertainment and activities, and we now go out which I enjoy. The staff always attend to our needs, no matter how busy they are. Our visitors are always made to feel welcome. We have a happy atmosphere now things are much better. I feel very happy living here. This is not the first home that I have stayed in, but it is the best. I love it here, the staff are like family to me, and I get on well with the other people that live here to, we are all very happy. The staff provide good care and are very attentive. I am very happy living here and things have improved over the last few months for the better. We found that the quantity of medicine in stock for each person was accurately recorded at the beginning of the month, and records of the disposal of medicines were kept. Care Homes for Older People Page 8 of 32 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 9 of 32 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 10 of 32 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 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to information, to assist them to make an informed choice about moving into this service. Evidence: People told us they have access to information about the service, and they confirmed they had been provided with an updated copy of the service user guide. The feedback we received in the surveys, also confirmed this, and people said they had sufficient information to decide if this service was right for them. We looked at the records for two people who had recently moved into the service. The records in place confirmed assessments had been undertaken and a judgement had been made to confirm that the service is able to meet peoples assessed needs. This ensures people move into a service that is right for them. People who we spoke with, told us they were encouraged to visit the service in order Care Homes for Older People Page 12 of 32 Evidence: to familarise themselves with the routines, and to meet the staff and people. One person told us: I needed somewhere for respite as I was poorly, and the doctor advised me to have a break. I rang this service, to see if they had a vacancy and they did. I had to give the staff information so they knew how to look after me. The staff were very helpful on the day I moved in and were very supportive. After being here for one day I decided I wanted to stay permanently as I liked it that much. Having respite really does give you a good insight into the way the home is run. There was evidence to support that people had agreed and signed a contract in relation to the terms and conditions of living in this service. This ensures people are aware of their rights whilst living here. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal care that people receive is based on their individual needs and preferences. However the medication practices have the potential to place people at risk. Evidence: We looked at two peoples files, and both contained an updated plan of care covering all aspects of their needs. Most areas were completed from a person centred perspective, which ensures individualised care is provided. However some areas of need require further information to ensure it is clear, about the level of support that is required from the staff team. For example under the oral care section, the plan told us the person has their own teeth, but it did not tell us if they required support to clean their own teeth. If this information is recorded it will ensure the service can meet peoples needs based on their preferences and expectations. Each care plan that we sampled contained the required risk assessments that should be undertaken to monitor peoples mobility, pressure areas, nutrition and falls. These were reviewed as required. The care records that we sampled and discussions with Care Homes for Older People Page 14 of 32 Evidence: people confirmed that contact with external health care services is routinely made. One person told us: The staff have arranged for me to have free chiropody with the NHS, which is great and saves me money. I have all of my needs seen to and the staff are very quick to call the doctor or arrange for a nurse to visit if we need it. There was evidence in the files to support that the plan of care is reviewed on a monthly basis or in response to a change in a persons needs. People told us they are consulted about their plan of care and the records seen demonstrated this, as people had signed a declaration about their plan in agreement. All of the people we spoke to and the feedback in the surveys, confirmed that people receive support which is provided in a safe, respectful and dignified manner, and our observations, supported this. People we spoke to made the following comments about the care they receive: The staff are great, they are very helpful and caring. They cannot do enough for us. The staff work very hard and they are marvelous. They are very caring and ensure we have a laugh, which is very important in my book. We had the opportunity to speak with some visitors, about their experiences and the following comments were made: The staff are really good, and they look after my relative really well. They have been great and keep us informed. My relative gets whatever they need and they always seem happy when we visit. Discussions with the staff members demonstrated that staff were able to think in a person centred way, and they had a good knowledge of how to meet peoples needs. Comments in the staff surveys, confirmed they are provided with up to date information to enable them to meet peoples needs. We looked at storage arrangements and records for medicines, and watched medicines being given to people at lunchtime. We saw that the keys to the medicine cupboards were not held personally by the member of staff on duty with responsibility for medicines. We also noticed that the medicine trolley was not locked when left unattended during the medicine round. We saw that people were approached in a polite and friendly way when offered their medicines,and that the administration record was signed immediately after the person had taken the medicine. Care Homes for Older People Page 15 of 32 Evidence: We saw that storage arrangements for controlled drugs met legal requirements. However, we found that records of the prescribing and administration of controlled drugs were not sufficiently detailed, with no explanation for alterations made in the CD register and on the medicine chart. We found that a telephone conversation with the persons doctor about changing the dose of a strong painkiller was recorded, but this had not been followed by a written instruction from the GP practice. When we looked at medicine charts we saw that the quantity of medicine in stock for each person was accurately recorded at the beginning of the month. We saw that two medicines, prescribed to be used three times a day, were being administered twice a day. The evening administration record for one of these medicines was incomplete. We found that 21 tablets of another medicine had been supplied by the pharmacy but the administration record showed 23 tablets as being given. A significant number of discontinued medicines were still being printed on medicine charts by the pharmacy, even though the service has requested for these to be removed. We found that a small number of medicines were not labeled with dose instructions. We saw that when a variable dose is prescribed the number of tablets administered to the person is recorded. However, there was no written guidance (protocol), in addition to the information on the pharmacy label, to help staff decide when medicines prescribed to be taken as required should be given. We found that three people looked after and took one of their prescribed medicines themselves. There were no records in these peoples plans to show that this was safe and best for the people concerned. Care Homes for Older People Page 16 of 32 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 this service are able to make choices about their life style. Social educational, cultural and recreational activities meet peoples expectation. Evidence: People we spoke to told us they were happy with the provision of activities provided. Comments we received include: Things have really improved, we have enough to do now. The new activities staff member is very good and arranges lots for us to do. We are doing more activities which is good to keep the mind active. We have made Christmas cards, and had trips out which is good. I am satisfied with what is available. People told us they are consulted about what activities they would like to participant in during the residents meetings which are held monthly. The activities staff member also consults each individual about their preferences. This ensures their social needs are met. People told us about a recent trip out for their Christmas meal, and they commented on how much they had enjoyed this. One person said: Care Homes for Older People Page 17 of 32 Evidence: The home was closed and we all went out for a meal. It was brilliant, the pub was all decorated and the staff were great. The meal was smashing and so tasty. I really enjoyed it, we even got presents before we left which was really nice. People also told us about a carol service they had enjoyed when the vicar visited. People said it was lovely and we all sang Christmas Carols which was really nice. The vicar who visits this service each month left a compliment in the comments book which said: The best atmosphere of the local homes, a joy to come. People told us they now receive a newsletter, which is produced every month informing them about any planned activities for the next month. People told us they liked the newsletter, and enjoy reading it. Visitors also told us they thought it was a good idea and said it very informative. We also received comments about this in the surveys: I would like to say the home seems much improved with regards to entertainment and activities. They have re-started the residents fund and we have fund-raising activities which is great. We also receive a newsletter, which we have never had before and I think this is a really good idea. I now look forward to reading it every month to see what is happening. People showed us their Christmas wreaths on their bedrooms doors, which they had made and were very proud of. Each person also had a small Christmas tree in their room, which they were supported to decorate. People told us they were able to choose how they wished to spend their day, and if this resulted in them remaining in their room, this decision was respected. We joined people for their lunch-time meal. People told us they have choices, at each meal time and observations supported this. Menus are now displayed in the lounge area for everyone to access. These include an alternative menu which people can choose an option from if they do not like the main meal available. We visited the kitchen and spoke with the catering staff who were able to show us records of peoples dietary requirements. Records demonstrated staff have undertaken the required training in order to prepare food for people. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in place ensure people have confidence to raise their concerns, and are safeguarded from harm. Evidence: During our discussions with people, and their visitors they told us they knew how to complain and said they would not hesitate to raise any issues with the staff team or manager. The feedback provided in the surveys also confirmed that people was aware of how to raise any concerns. People told us: If I was not happy I would go straight to the manager and tell her. It is so nice now to have someone we can talk to. We are now regularly consulted about things, so we can raise any issues in our meetings that we have each month. People told us they have access to the complaints procedure in the information they have been provided with. The procedure is also displayed in the service. The service has not received any complaints since our last visit and we have not referred any issues to the service. A new format for recording complaints is currently being devised, to ensure all of the required information is recorded. Care Homes for Older People Page 19 of 32 Evidence: The staff we spoke to demonstrated their awareness of both the complaints procedure and their role and responsibilities concerned with dealing with any potential abusive incidents. The staff and the records we looked at demonstrated they had received some training in these areas. This includes training provided internally in the service, and some staff have completed training in this area by completing National Vocational training. Evidence was provided to demonstrate that formal training will be arranged for the new year for all staff including the domestic and catering staff which is good practice. The service have not had any safeguarding incidents since our last visit. We was told that training is currently being sourced in relation to the Mental Capacity Act, and Deprivation of Liberty. This will ensure staff are aware and promote peoples rights to make decisions and ensure they are clear about how to safeguard people. Care Homes for Older People Page 20 of 32 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. A comfortable environment was provided for the people living in this service. Evidence: We undertook a brief tour of the building, and all areas we visited were found to be clean, comfortable, homely, warm and well lit. People we spoke to and feedback in the surveys confirmed people are encouraged to personalise their bedrooms and those visited reflected peoples preferences. People told us the building suited their needs and they confirmed they had access to equipment, which encouraged and promoted their independence. People told us: I like my room, it is just as I want it with all my things around me. It looks very festive with my Christmas tree up. I like this home and I think it is very homely as it is small and cosy. All areas seen were furnished and decorated to a satisfactory standard and all areas were well maintained. The records demonstrated that any repairs that have been identified are completed within a short timescale. A risk assessment has been completed in relation to the step at the rear entrance. Care Homes for Older People Page 21 of 32 Evidence: Action has been taken to minimise the risk of it being a trip hazard, and a sign has been displayed alert to people to this. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service are supported by staff that are safe to work with them. However this may be compromised if staff are not updated in current practices. Evidence: People we spoke to told us the staffing levels were enough to meet our needs. People said they never have to wait too long for assistance. People spoke positively about the staff team and some of the comments made include the following: The staff look after me very well I am very happy here. The staff treat me with care, respect, and dignity, I am very happy with the care I receive. The staff attend to all our needs, no matter how busy, they are. I am very happy, and content here. The staff are always friendly and helpful and very caring. They are sensitive to my needs. Discussions with the staff team confirmed that the staffing levels were sufficient to Care Homes for Older People Page 23 of 32 Evidence: enable them to deliver person centred care. They demonstrated their enthusiasm, commitment and motivation to ensuring they support people to a good standard. We looked at the staff training matrix and this demonstrated that not all of the staff have completed all of the required mandatory training. We was provided with evidence to demonstrate that training was being arranged with a training company and the acting manager was awaiting confirmation of the dates. The training matrix also demonstrated that staff have the opportunity to undertake National Vocational Training at level 2 and level 3. This will ensure people are supported by a competent and skilled workforce. We looked at two newly employed staff members files. Both staff members were recruited to work as bank staff, (so they could be called upon to cover vacant shifts). We found that majority of the required checks had been undertaken to ensure both staff members were suitable to work with vulnerable people. However we found that there was gaps in the employment history provided. Both staff members were asked to provide a revised full employment history during our visit. There was evidence to support that both staff members had completed both a service specific induction, and had been provided with the Common induction standards. This will ensure they have the skills and knowledge for their role. Care Homes for Older People Page 24 of 32 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 service is managed based on openness and respect, and consults people regularly to ensure it is meeting their needs. Evidence: An acting manager is now in place at this service. Discussions with her demonstrated her commitment, motivation, and enthusiasm to improve the service and outcomes for people. She has recently commenced a management course, and this will ensure she gains the required management skills, knowledge and qualifications to manage the service. People, their relatives and feedback provided in the surveys told us that the acting manager is doing a really good job at managing the service. She has been in this post for 5 months and people told us: the improvements are brilliant, this service is managed properly now. Comments received include some of the following: The new acting manager has been great and she has really improved things here. It Care Homes for Older People Page 25 of 32 Evidence: is so nice to be able to go to someone and talk to them in confidence, I think she has turned this place around for the better. I would like to say that the home seems much improved in all aspects. I am now kept informed about my relatives well-being and have a definite point of contact with the new manager. Both the care and medical care received is good, and the acting manager is very responsive in all areas. I think the service is now managed much better. The manager is very good, she has made lots of good changes and we have started to go out more. She has worked very hard to make many improvements to this home. We have meetings now, where we can talk about the home and suggest things to do. I feel valued and listened to, I think she is doing a really good job. The atmosphere has changed here now for the better. Things are getting back to how they used to be. I feel happy and content here and I cannot think of anywhere else I would rather be. People told us they are consulted about all aspects of the service delivery, both informally and formally at the monthly meetings they have. People said they raise any comments in this meeting and discuss anything they are not happy with or advise staff on any improvements they think could be made. We looked at the minutes of these meetings which supported these comments. This ensures the service listens and acts on peoples feedback and is committed to continually developing the service. The staff members we spoke to, told us they felt supported in their role, and we was told, things are much better now we have a manager in place. She is always available, and the office door is always open, we only have to ask for help. Staff members commented on the improvements to the service since the acting manager has been in place. The following comments were made. The new manager is working as hard as possible to everything in order. We are now doing lots of activities, and fund raising for and with the people who live here. The staff are working as a team and I think we are meeting peoples needs to a good standard Since the new manager has been in place, there have been lots of changes for the better. She has been working out of hours to get the paperwork completed. I am hoping that the home is at a turning point for the better, and the recent problems are behind us. We the staff have worked our hardest to keep the home up and running. Care Homes for Older People Page 26 of 32 Evidence: The home has a good team of staff. We now have someone to provide us with leadership and direction and who we can confide in when we need to. Since the new manager was appointed things have improved 100 . As stated previously the records we looked at demonstrated that staff members require refresher training in some of the required mandatory areas. Training is currently being sourced for this. This ensures people are supported by a trained and skilled staff team. We were informed that quality assurance surveys have been sent out and some have been returned. The findings will be analyzed, and a report will be completed and displayed for people to access. People said they were happy with the way their personal money was managed. We looked at the systems in place and these were satisfactory. A delegate of the provider undertakes monthly visits and a report is completed of their findings. This is to monitor the standards in the service and to ensure it is meeting peoples needs. The reports covers the required areas, and indicated that standards have improved over the last few months. The service have received many compliment cards and some of these comments include: I would just like to thank the staff for their kindness and understanding they show to both us the family and to our relative The family would just like to send our thanks for the love, care ,and support you gave our relative before he passed away. We really appreciate the way you looked after him and this has helped us during this emotional time. The staff so tenderly and sensitively cared for him with so much warmth we cannot thank them enough and words cannot express our gratitude. You have all been so kind and your dedication and genuine care is still a great comfort to us. Care Homes for Older People Page 27 of 32 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 32 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 9 13 The medication keys must 30/01/2010 only be accessible to staff with delegated responsibility for medicines. This is to ensure that medicines are securely stored and to protect people living in the home. 2 9 13 Risk assessments must be 29/01/2010 carried out and recorded before people are enabled to administer their own medicines. This is to ensure the health and well being of people living in the service. 3 9 13 People must receive their medicines as prescribed. This must be demonstrated by record keeping practices. This is to ensure the health and well being of people living in the service. 29/01/2010 Care Homes for Older People Page 29 of 32 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 4 30 18 All staff must complete the 31/03/2010 required Mandatory training. Evidence must be in place to demonstrate this has been undertaken. This will demonstrate that staff have the necessary skills and knowledge to undertake their duties safely. 5 31 8 Arrangements must be made to register the manager for this service. This is to ensure the service is managed in accordance with the standards and in the best interest of people that live here. 31/03/2010 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 7 9 To ensure all care plans are completed in person centred detail, to enable staff to provide individulised care. Written protocols should be prepared to guide staff as to when and why a medicine prescribed for use when required should be administered. Ask the persons doctor for written confirmation of dose changes communicated by telephone, and fully document any instructions received. Ask the pharmacy to remove discontinued medicines from printed medicine administration records and to label all medicines with full dosage instructions. Page 30 of 32 3 9 4 9 Care Homes for Older People 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 5 12 A weekly programme of activities should be devised and displayed in the service so people are aware of the activities available. This should include activities available on the days when the activities coordinator is not working. All staff who work in this service should access training in relation to safeguarding adults from abuse. New staff should not commence employment in the service until all of the required legal recruitment checks have been received and deemed satisfactory. This is to ensure staff members are suitable to work with people, and to safeguard them from any potential risks. An ongoing training programme should be in place to demonstrate that training has been planned for the staff team. Evidence should be available in staff training files to support they have completed an induction. All policies and procedures should be reviewed to ensure they reflect good practice and include any legislation changes. A report should be completed of the findings following the recent quality assurance questionnaire. This should include the action that will be taken in response to peoples comments. The report should be made available to the people that live in this service. Arrangements should be made to ensure all staff have access to refresher training in all mandatory areas. Evidence should be available to support this. This is to ensure they are working in accordance with current practices. All accidents should be recorded in the accident book. 6 7 18 27 8 28 9 10 30 33 11 33 12 38 13 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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