Care Home: Lyme Valley House Care Home

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What the care home does well People living at the home told us that - `The staff are very obliging and are always willing to help`. `The food is good`. Visitors and relatives told us `We have no complaints, Dad is very well looked after, we can visit at all times and we are always made welcome. The new staff group are all very friendly and helpful. Dad goes out to the pub each week and enjoys this`. ``I have peace of mind that Mum is ok, the environment is not brilliant and could do with upgrading but mum is settled here`. What has improved since the last inspection? A new treatment room is now in operation for the safe storage of the medications and a dedicated space for community health care professionals to use when they visit. Improvements have been made to the procedures for the safe administration of medications, with staff receiving training and updates. Further amendments to working practice are needed to ensure that there is a robust working system. Complaints, grumbles and compliments books are available in a communal area for people to use should they so wish. What the care home could do better: The service user guide should contain details of the weekly fees for the service. The care plans should be discussed and agreed with the person whenever possible and/or their representative. Risk assessments should be completed when a person has been identified as being at risk of harm. This will ensure that staff have the information of how they can help with reducing the risk to the person. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. Improvements should be made to improving the mealtime experience to make it a more social and pleasing part of the day. For the continuing safety and protection of people living at the home staff should continue to have regular updates and training in the protection of vulnerable adults. For the effective control of the spread of infections and for general hand hygiene purposes, liquid soap and paper towels should be provided in all communal areas and where personal care is provided. The recruitment procedures should be robust to ensure that all information is obtained before a person starts to work at the home. Domestic staff should be employed in sufficient numbers to ensure the home is kept in a clean and hygienic state. Systems should be adopted to ensure that there is sufficient evidence available at the home to demonstrate that the service complies with all the health and safety legislations applicable to a social care service. Key inspection report Care homes for older people Name: Address: Lyme Valley House Care Home 115 London Road Newcastle under Lyme Staffordshire ST5 7HL     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: Joy Hoelzel     Date: 0 9 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 29 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 29 Information about the care home Name of care home: Address: Lyme Valley House Care Home 115 London Road Newcastle under Lyme Staffordshire ST5 7HL 01782633407 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ravinder Singh Thiara Name of registered manager (if applicable) Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Age: Dementia (DE) age 55 and above Physical Disability (PD) age 55 and above The maximum number of service users who can be accommodated is: 26 The registered person may provide the following category 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 (OP) 26 Dementia (DE) 26 Physical disability (PD) 26 Date of last inspection Brief description of the care home Lyme Valley House Care Home is a large, Victorian house that has been extended to provide accommodation for a total of 26 people over 55 years of age. The home Care Homes for Older People Page 4 of 29 Over 65 0 26 0 26 0 26 2 7 1 1 2 0 0 9 Brief description of the care home provides a service to people with dementia and people with a physical disability. The home is privately owned. The home is situated on a corner plot, fronting the main A34 road. There are small gardens to the front and side of the property. To the rear there is a large secure, paved patio area with raised flowerbeds; there are also car-parking facilities on site. There are a selection of communal sitting and dining areas on the ground floor. A selection of single and double occupancy bedrooms are situated on both floors. There is a passenger lift for ease of access to the first floor rooms. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have recently been revised and are readily available. The service user guide does not include information on the current level of fees for the service. The reader may wish to obtain more up to date information from the care service. Care Quality Commission reports for this service are available from the provider or can be obtained from www.cqc.org.uk Care Homes for Older People Page 5 of 29 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 home did not know that we would be visiting to inspect the service. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the home. Some people were unable to fully comment about their experience of life at the home. Observations were made of how they spent the day and of the interactions offered by staff in an attempt to obtain an overview of how they may be feeling. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting Care Homes for Older People Page 6 of 29 outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The acting care manager completed this document in march 2010 and returned it to us. Comments from the AQAA are included within this inspection report. We asked for our Have Your Say, surveys, to be distributed to people living in, working in and visiting the home. Five were returned from people living in the home (all indicated that they had help to complete the form) and seven were completed by members of staff. The responses and comments are included in this report. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The service user guide should contain details of the weekly fees for the service. The care plans should be discussed and agreed with the person whenever possible and/or their representative. Risk assessments should be completed when a person has been identified as being at risk of harm. This will ensure that staff have the information of how they can help with reducing the risk to the person. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. Improvements should be made to improving the mealtime experience to make it a more social and pleasing part of the day. For the continuing safety and protection of people living at the home staff should continue to have regular updates and training in the protection of vulnerable adults. For the effective control of the spread of infections and for general hand hygiene purposes, liquid soap and paper towels should be provided in all communal areas and where personal care is provided. The recruitment procedures should be robust to ensure that all information is obtained before a person starts to work at the home. Domestic staff should be employed in sufficient numbers to ensure the home is kept in Care Homes for Older People Page 8 of 29 a clean and hygienic state. Systems should be adopted to ensure that there is sufficient evidence available at the home to demonstrate that the service complies with all the health and safety legislations applicable to a social care service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 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. Admissions are not made to the home, until a full needs assessment has been undertaken. This tells the home all about the person and the support they need. Evidence: Information on the home is provided in two documents. The statement of purpose, which sets out what the service offers and the service user guide which offers more information when a person decides to move in. Both documents have been reviewed recently and are available directly from the home. The service user guide offered information on what is and what is not included in the weekly fees, with people being advised to contact the home directly for the actual fee level. To comply with the regulations and to give people full information and details of the service, the weekly fees should be specified in the service information document. Information in the AQAA with regard to the way the service deals with referrals from people who are thinking about residing in the home, records Care Homes for Older People Page 11 of 29 Evidence: All prospective residents are assessed before a decision on admission is made. A full and comprehensive assessment is compiled prior to admission and family members, carers, and social workers are all encouraged to be present where possible. This assessment enables us to compile a care plan that is person centred and individual. We offer introductory visits to prospective residents as this we feel helps with the transition period and makes it less traumatic. We looked at the case file of the person who recently moved into the home. The contents in the file confirmed that information had been sought regarding this persons needs prior to them moving in. Information had been gathered from various sources and the service had completed a full assessment of the persons needs. This person told us that they were very satisfied with the service and care provided and had made the decision to stay permanently. A family member of this person confirmed a satisfaction with the service and told us that they had peace of mind now their relative is safe with someone to look after and care for her. Other case files looked at included a pre admission assessment by the home in addition to social worker reviews and assessments from other health and social care settings. This gathering of information ensures that the service can be confident of meeting a persons care needs. The home does not provide an intermediate care service. Care Homes for Older People Page 12 of 29 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. People who use this service can be assured that the management are aware of the gaps in the recording of important information and the plans they have to deal with it. Evidence: Information recorded in the AQAA tells us All care plans are now person centred and all staff have been made aware of the importance of this. The link worker /key worker system has recently being implemented. Once improved this will ensure that all residents are supported using a person centred approach. The care plans are currently stored in an area within the main kitchen. The acting care manager explaining that storage space within the home is very limited. They went on to explain that staff do not access the main area of the kitchen but we did observe staff regularly going into the kitchen area. We selected three case files to look at in depth, with other files looked at briefly to Care Homes for Older People Page 13 of 29 Evidence: follow up any observations made during the inspection. We saw that one person and their representative had been consulted and had agreed with the plan of care. An assessment had been completed of each persons care needs; a specific plan of care had been completed for each identified need. For example one person has very poor mobility, through the plan of care, staff are instructed on the equipment needed to assist with transfers. We observed staff explaining this procedure to the person and appeared very competent with using the equipment and undertaking the manoeuvre. This person looked very relaxed and comfortable throughout the transfer. The three plans that we looked at contained a care plan for helping people with their personal hygiene and grooming. Staff were very quick to attend when a persons personal hygiene became compromised. Staff told us that they do not record the care provided or personal care interventions on a daily basis, but the information is verbally passed on at the regular shift hand overs. Without documenting this information it is possible that the care will not be carried out consistently or in the way the person prefers. A person who completed our survey on behalf of their family member living at the home, made an additional comment in regard to the personal care provided and the lack of communication between the staff and the change over of shifts. Residents hands are not washed after using the toilet, sometimes the hands and finger nails are left dirty. There seems to be a lack of communication between staff at the change over of shifts... they dont talk to relatives over issues with their family member. Staff who completed our survey told us that they could be better by- Improving the dialogue between senior care staff and carers with regards information on some residents. Information recorded in the plans identified that two people had a history of falls. We did not see a falls risk assessment or any information that would help reduce the risk of the person falling and being injured. The acting care manager told us that the plans are being regularly reviewed and updated. A member of the senior care staff has been allocated the responsibility for checking the plans. This should ensure that staff have the information needed to enable them to support people to meet their health and social needs. The AQAA informs us of the recent improvements made - In the last twelve months we have introduced a brand new medication / treatment room, which is now fully Care Homes for Older People Page 14 of 29 Evidence: operational. This room is equipped with all items required by both ourselves and District Nurses. We also have a new and improved medication policy that all staff are aware of. All senior staff are now fully trained through Lloyds chemist in the safe handling and administrating of medication. We saw that the prescribed medications are safely stored in the treatment room. Staff explained the procedures and we looked at the medication administration records (MAR) for a selection of people. We saw that some of the MAR had not been fully completed when it was necessary to hand write the charts. Some people at the home have been prescribed medications that are to be taken on an as required basis. Staff told us that there are no written protocols or instructions for what triggers the medications to be given or for how often it can be given. We advised that protocols for all as required medications should be available for reference. We saw that the MAR is completed when the as required medications are given. We discussed the administration of creams and lotions; the care staff apply and administers these preparations. These external medicines are kept in the treatment room with staff collecting the creams to administer. These preparations that may have short shelf lives upon opening were not being dated so there may be a risk that some residents are given out of date medication. We advised a member of staff to contact the supplying pharmacy to request that prescribing labels are attached to both inner and outer packaging of some medications in particular inhalers. We saw that staff were very patient, understanding and caring. They assisted people with care needs in a discreet and respectful way; they explained what they were going to do before actually starting the task. Thereby putting the person at ease and alleviating any stress that the person may be feeling. To ensure that a persons privacy and dignity is upheld it would be useful to have vacant/engaged signage on toilet and bathroom doors. Care Homes for Older People Page 15 of 29 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 using the service are given the opportunity to take part in activities both within the home and in the community Evidence: The AQAA tells us of the social and leisure activities provided - We now have an activities co-ordinator, who works very closely with our residents. She has just completed a life story for our residents which now complete are used for reminiscing sessions both in groups and with individual residents. Our activities co-ordinator ensures that all residents are given the opportunity for stimulation through leisure and recreational activities both inside and outside the home. Information is recorded in the care plans of the activities enjoyed by each person. One person went to the local library where a group of people spent time reminiscing about the old days. One person told us how much they enjoy the regular visits to the local pub where they can enjoy half a pint of beer. Other people, it is recorded, like to play dominoes, bingo, listen to music or watch the television. On the day of this inspection the home was very lively; people were interacting with each other, participating in group activities. One person became increasingly restless, a member of staff was very Care Homes for Older People Page 16 of 29 Evidence: attentive offering the person activity options and spending one to one time with them. Two out of the five people who completed our survey told us that there was always something arranged for them to take part in. People commented that they thought the activities had recently improved. Throughout the day we saw that many people were visiting the home. People told us that they were satisfied with the visiting arrangements and could call at any time. They told us that the staff are friendly, pleasant and welcoming. The main front door is locked for security reasons. Staff answer the door and allow entry. No other doors within the building are locked with the exception of the treatment room and kitchen. People have free access to areas within the home. The rear garden has recently been renovated (with further improvements planned), it is a secure area for people to use if they so wish. Meals are planned using a four weekly rotational menu. People told us that they enjoy the meals and that they have enough to eat. The dining areas were partially completed prior to the midday meal being served. Although the people appeared to be enjoying the meal it did not appear to be a pleasing social occasion, but rather mundane and task orientated. We spoke with the acting care manager about our observations; they agreed that with a little more effort meals and mealtimes could be a more enjoyable experience. Care Homes for Older People Page 17 of 29 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. If people have concerns with their care, they or people close to them know how to complain. Evidence: The AQAA tells us that - We have implemented new complaints policies and procedures, and have introduced a complaints book, grumbles book and a compliments book. All staff, relatives and residents are aware of the location of these and how to use them. We also have a suggestion box in our hospitality lounge, again all know where it is situated and how to use it. We saw the complaints procedure and comment books in the hospitality lounge. A recent comment in the compliment book Mum is settled and comfortable during such a short period, management and staff are dedicated in their work. They provide everything possible to provide an individual service. All five people indicated in our survey that they had someone to speak with informally if they had any concerns. All five people told us that they know how to make a formal complaint. The AQAA records that during the past twelve months the service has received four complaints all of which were responded to within the time frames. No referrals have been made to the inter agency adult protection team or in regard to the deprivation of Care Homes for Older People Page 18 of 29 Evidence: liberty safeguards. We, the commission have received six anonymous complaints regarding the service. On each occasion we have contacted the owner of the service for them to investigate using their own procedures. We have received responses and explanations from the owners following each complaint and the actions that have been taken. The acting care manager confirmed that training in abuse awareness and safe guarding vulnerable people is ongoing. There is a facility for the service to safe keep small amounts of a persons money. Separate records are maintained for each person and the money is stored individually in a locked safe. Individual lockable cash boxes are available if a person wishes to have one in their personal room. Care Homes for Older People Page 19 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that meets the specific needs of the people who live there, but there is room for improvement. Evidence: The AQAA records - We provide a very homely environment that is safe, clean and hygienic. In the last twelve months we have erected a new wall in the rear garden, ensuring our residents safety at all times. It goes on to tell us the plans for the next twelve months- We plan to allocate more funds into the maintenance budget to allow internal areas of the home to be decorated and to continue with the rolling improvements programme. Comments recorded in our surveys included - It would be good to see a general revamp of the home, to brighten the home up a little. People living at the home told us that they were generally satisfied with their accommodation. Visitors told us that the environment, communal and private areas, could be improved. During the tour of the premises we saw that most areas of the home are looking very tired and in need of upgrading and redecoration. Some furniture in use looks old and worn out. The bedroom furniture provided by the service is of varying quality, Care Homes for Older People Page 20 of 29 Evidence: condition and age. The acting manager informed us that the improvement plan for the environment is currently with the owners of the premises but confirmed that all areas are being considered for improvement. We asked for a copy of the improvement plan to be forwarded to us. We saw one or two areas that may potentially be a risk to people. For example a commode in one of the bedrooms had the rubber protectors missing from the feet of the chair. Not all areas have been supplied with suitable hand wash facilities for effective hand washing and for infection control purposes. There is no signage on the entry to the conservatory that is currently being used as the dedicated smoking area. The door was open and as such it could be unpleasant for some people with the smell of smoke. We saw that there are no privacy indicators on the toilet and bathroom doors. There is a potential that someones privacy and dignity could be compromised when using the facilities. We saw that only a few bedrooms have been provided with a locking facility on the door. All bedroom doors should be fitted with a suitable lock to ensure that people have a true choice of whether to lock their door or not. The laundry is sited in an unused toilet and is extremely cramped. The acting manager explained the plan for improvements to be made to the area but again confirmed a lack of suitable space. One person completed our survey and made an additional commented that More care could be taken when dealing with laundry as lots of clothing is being ruined and shrunk, which is expensive to replace. Care Homes for Older People Page 21 of 29 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 are satisfied that the care they receive will meet their needs. Evidence: People completing our survey told us The staff are very obliging and are always willing to help. Staff should respond quicker when asked to do something. People living at the home told us that the staff were helpful and that they were satisfied with the care provided. The care staff were extremely busy throughout the day as they were attending to the laundry, household cleaning, recreational activities, offering and serving refreshments in addition to their care duties. The acting manager explained the recent appointment of a person to attend to the cleaning and laundry but was unable to confirm an actual start date. The AQAA tells us that of the thirteen permanent care staff, nine have gained a National Vocational Qualification in care at level 2. A member of staff confirmed they had completed the level 2 training and was looking forward to working towards a level 3 qualification. Care Homes for Older People Page 22 of 29 Evidence: We sampled the personnel files of staff, working in various positions within the home. The acting manager is currently checking all files to ensure that all relevant information has been obtained for the people working at the home. We found that some pieces of information were missing and advised the acting manager to ensure a full employment history is obtained with any gaps discussed with the person and recorded in the file. All seven staff who completed our survey indicated that the necessary checks, (criminal records bureau, and references) had been carried out prior to them starting working at the home. The acting manager confirmed that staff training is up to date. There are plans for continuing the mandatory and specialist topic area training for all staff throughout the year. We spoke with staff on duty regarding the care provided, the training opportunities and how they generally feel the home is operating. They told us - We provide good standards of care, we have had safe guarding training and the care plans have been reviewed and updated. The home is more organised, there have been improvements in the treatment room and the procedures for administering medication. We have sufficient staff but need a cleaner but on the whole much improved service. Care Homes for Older People Page 23 of 29 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 using this service can be assured that the management are developing ways to improve the service. Evidence: There has been a change to the management arrangements of the service since the last main inspection in June 2009. A new person has been recruited and is currently working as the acting care manager. A formal application for the position of registered manager has been forwarded to us for consideration. The acting care manager completed the AQAA in March 2010; it contains clear, relevant information that is supported by a range of evidence. The AQAA lets us know about changes they have made and where they still need to make improvements. It shows clearly how they are going to do this. Staff and visitors told us of the improvements that have been made to the service since the arrival of the new manager. They told us that the acting manager was Care Homes for Older People Page 24 of 29 Evidence: approachable and willing to listen to suggestions. The acting manager told us of the quality assurance and monitoring systems that the service has for checking that the home operates as it states it does. The acting manager described the ways that the systems will be expanded to obtain the views of people with an interest in the service. The owner of the home visits at regular intervals, the reports of the monthly visits were not available. It is recommended that a copy of the report is sent to the acting manager and available for inspection upon request. There is a facility for the service to safe keep small amounts of a persons money. Separate records are maintained for each person and the money is stored individually in a locked safe. The service documents offer information on the maximum amounts that the home will be responsible and accountable for. We looked at the records for monitoring the health and safety of the building and the equipment. We saw that the fire alarm is being tested each week, but the fire risk assessment for the premises is out of date. We advised the acting manager to contact the local fire safety officer for advice. The acting manager explained that the owners hold many of the routine testing certificates and that they are not kept at the service. Therefore it was not possible to establish if all the required health and safety tests had been carried out or if the home is complying with the relevant legislations. Care Homes for Older People Page 25 of 29 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 26 of 29 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 29 19 The audit of all the staff personnel files of people working at the home must be completed with action taken. This will ensure that people living at the home are supported by suitable people. 03/05/2010 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 1 The service user guide should include details of the weekly fees for the service. This will offer people additional information when they are deciding to move into the home. When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative. Any identified risks should be clearly assessed with details of the action staff are to take to reduce the risk. Protocols and details of the as required medications should be available for staff reference. This will ensure that people Page 27 of 29 2 7 3 4 8 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 are offered and given medications as they require them. 5 9 The service should make sure that all medications are supplied with a suitable prescribing label. This will ensure that staff have full details of the medication and when it is to be administered. External medications (creams/ointments) that have short shelf lives upon opening should be dated and discarded within the guidelines. Mar charts that are handwritten should be fully completed to include full details of the person and their prescribed medications. The charts should then be checked for accuracy. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. Improvements should be made to improving the mealtime experience to make it a more social and pleasing part of the day. For the continuing safety and protection of people living at the home staff should continue to have regular updates and training in the protection of vulnerable adults. All bedroom doors should be provided with a suitable locking facility, to ensure that people have a true choice of whether they wish to secure their room when they are out. The equipment provided by the home must be in good order and safe to use. For the effective control of the spread of infections and for general hand hygiene purposes, liquid soap and paper towels should be provided in all communal areas and where personal care is provided. Domestic staff should be employed in sufficient numbers to ensure the home is kept in a clean and hygienic state Systems should be adopted to ensure that there is sufficient evidence available at the home to demonstrate that the service complies with all the health and safety legislations applicable to a social care service. 6 9 7 9 8 10 9 15 10 18 11 24 12 13 24 26 14 15 27 38 Care Homes for Older People Page 28 of 29 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. 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