Care Home: Lyndhurst Care

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What the care home does well There was a good system for admitting residents into the home which included a full assessment of people`s needs, and giving them an opportunity to visit the home to see if it was a suitable place for them. This helped to make sure that staff understood what support they needed to give to people. The written care plans were also of a high standard and provided useful guidance to staff in the care and support they needed to deliver. Residents were well cared for in the home. All residents spoken with, and who completed the questionnaires, said that this was the case, and that staff were attentive and kind. One resident said they were "comfortable and well cared for". Another said that "staff listened and made the place a home". Relatives also praised the management and staff for the high quality of care given to residents and the friendly contact they had with them. One commented in the questionnaire that "staff are always friendly and cooperative" Residents had the medical care that they needed. Residents felt they had enough choices in their everyday lives and were encouraged to continue with the interests they had before going to live in the home, such as reading and going on outings. Residents spoke positively about the regular outings and other activities. There was a good choice of food for the residents and care was taken to provide suitable food for people that suited their tastes and preferences. All residents spoken with praised the food served in the home. One said that the "food was very good". The home made relatives feel welcome, and communication between them and staff in the home was good. Relatives felt that staff were approachable and that there was a friendly open atmosphere in the home. People were confident that their worries and concerns would be taken seriously through the complaints procedure. All involved with the inspection felt that the home responded well to any concerns. The home was clean, safe, well maintained, bright and pleasantly furnished, and provided comfortable communal and private accommodation for the residents. The outside areas at the back had been particualrly well developed, and provided an attractive pleasant area for residents to enjoy. Staff were well trained for their role. Most staff had the qualifications recommended for people working in a care service, and other relevant training was undertaken to further help people understand the people they cared for, such as training in looking after people with dementia, continence promotion and protection of vulnerable adults from abuse. The manager was experienced and well qualified for her roles, and had worked in the home as manager for about 21 years. She and the other people involved in the management of the home ensured that Lyndhurst was well run and in the best interests of the residents. There were thorough systems in place for assessing the quality of the services in the home that fully took into account the views of the residents, and also those of relatives and visiting professionals.Residents` money was managed safely and good records were kept to support this. The home in general was a safe place for residents and staff. What has improved since the last inspection? The requirement and recommendations made at the previous inspection had been addressed. Medication was now being stored more securely, care plans were being updated as needed and the induction training for new staff had been developed according to government guidance to ensure that staff received sufficient training to enable them to be competent and confident. In addition there had been improvements to some parts of the home including; the fire precautions, decorating and the installation of an ensuite facility in one of the bedrooms. More staff have completed relevant qualifications for those working in care services and this helped to ensure the high standard of care that residents receive in Lyndhurst. What the care home could do better: The written assessments of the risks associated with care and every day life could be improved, for example the risk from falling out of bed and the risks associated with aggressive behaviour. This is so that staff have written guidance to help them look after people safely. Some aspects of medication management could be further improved such as the records kept and instructions to staff about the administration of when required and variable dose medication. This is to ensure that all medication is given as prescribed. The unpleasant odours should be eliminated from the few areas were this was identified, to ensure the comfort and well being of the residents concerned. These matters were discussed fully with the manager and we are confident that they will be addressed Key inspection report Care homes for older people Name: Address: Lyndhurst Care 120 Manchester Old Road Middleton Manchester Greater Manchester M24 4DY     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Pat White     Date: 2 9 1 0 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 28 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 28 Information about the care home Name of care home: Address: Lyndhurst Care 120 Manchester Old Road Middleton Manchester Greater Manchester M24 4DY 01616439222 01616538060 enquiries@lyndhurstcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lyndhurst Care Limited care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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 - Code OP. The maximum number of service users who can be accommodated is: 33. Date of last inspection Brief description of the care home Lyndhurst provides care and accommodation for 33 older persons. The home is situated near to the centre of Middleton, and is close to shops, the bus terminus, pubs and leisure facilities. The home was opened in 1986 and has been extended to include purpose built rooms to the rear of the house. The home is two storey and has the provision of a passenger lift. Accommodation is provided in 29 single rooms and 2 double bedrooms. Eleven of the bedrooms have the provision of en-suite toilet facilities. There are 3 lounges and a separate dining room. The home is well maintained both internally and externally. The gardens are attractively landscaped and Care Homes for Older People Page 4 of 28 Over 65 33 0 Brief description of the care home accessible to service users. Ramped access is provided to one of the patio doors. Car parking is available to the rear and side of the home. Lyndhurst is a non - smoking home. At the time of this inspection, the weekly fees range from 372 and 387 pounds, dependent upon whether or not en-suite facilities are required. The home does not charge privately funding residents any more than those funded by the Local Authority. Additional charges are made for private chiropody and hairdressing. The provider makes information about the service available in the form of Welcome packs, which contained useful information about the home. A copy of the most recent Commission for Social Care (CSCI) inspection report is contained in the Welcome to Lyndhurst pack, which is displayed in the entrance hall. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The previous key inspection site visit for this service was in October 2006 and according to the commissions methods for inspection was not due another key inspection for 3 years. During this time 2 Annual Service Reviews (ASR) have been undertaken which indicated that there was no change to the standard of service provided. An ASR involves collecting and reviewing information about the service, including information from residents and staff and assessing whether or not the standard of service provided remains the same. This key inspection involved 2 site visits to the home on the 29th October and 5th November 2009. The purpose of this inspection was to determine again an overall assessment on the quality of the care and services in the home. This included checking important areas of life in the home that should be checked against the National Minimum Standards for Older People. Care Homes for Older People Page 6 of 28 This inspection was undertaken by looking at all the information received about the service since the last inspection, talking to residents and relatives, touring the premises, observation of life in the home, looking at residents care records and other documents and discussion with former owner, manager and deputy manager. In addition we have used written information provided by the home prior to the site visit. This includes detailed information about the home, the staff and the facilities, and is also the homes own assessment about what they need to do to improve and develop. Survey questionnaires from the commission were also sent to some residents, relatives and staff before the site visit. Of the residents who were spoken with, 5 gave their views on the home, and two relatives who were in the home at the time of the visit also spoke to us and gave their views. At the time of writing this report the commission had received completed questionnaires from 7 residents and 5 relatives and 8 members of staff. Some of the views of all these people are included in the report. Care Homes for Older People Page 7 of 28 What the care home does well: There was a good system for admitting residents into the home which included a full assessment of peoples needs, and giving them an opportunity to visit the home to see if it was a suitable place for them. This helped to make sure that staff understood what support they needed to give to people. The written care plans were also of a high standard and provided useful guidance to staff in the care and support they needed to deliver. Residents were well cared for in the home. All residents spoken with, and who completed the questionnaires, said that this was the case, and that staff were attentive and kind. One resident said they were comfortable and well cared for. Another said that staff listened and made the place a home. Relatives also praised the management and staff for the high quality of care given to residents and the friendly contact they had with them. One commented in the questionnaire that staff are always friendly and cooperative Residents had the medical care that they needed. Residents felt they had enough choices in their everyday lives and were encouraged to continue with the interests they had before going to live in the home, such as reading and going on outings. Residents spoke positively about the regular outings and other activities. There was a good choice of food for the residents and care was taken to provide suitable food for people that suited their tastes and preferences. All residents spoken with praised the food served in the home. One said that the food was very good. The home made relatives feel welcome, and communication between them and staff in the home was good. Relatives felt that staff were approachable and that there was a friendly open atmosphere in the home. People were confident that their worries and concerns would be taken seriously through the complaints procedure. All involved with the inspection felt that the home responded well to any concerns. The home was clean, safe, well maintained, bright and pleasantly furnished, and provided comfortable communal and private accommodation for the residents. The outside areas at the back had been particualrly well developed, and provided an attractive pleasant area for residents to enjoy. Staff were well trained for their role. Most staff had the qualifications recommended for people working in a care service, and other relevant training was undertaken to further help people understand the people they cared for, such as training in looking after people with dementia, continence promotion and protection of vulnerable adults from abuse. The manager was experienced and well qualified for her roles, and had worked in the home as manager for about 21 years. She and the other people involved in the management of the home ensured that Lyndhurst was well run and in the best interests of the residents. There were thorough systems in place for assessing the quality of the services in the home that fully took into account the views of the residents, and also those of relatives and visiting professionals. Care Homes for Older People Page 8 of 28 Residents money was managed safely and good records were kept to support this. The home in general was a safe place for residents and staff. 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. 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 28 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 28 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. The homes admission procedures, including the pre admission assessments and visits to the home by prospective residents and relatives, ensured that people could decide whether or not Lyndurst would be the right place for them and whether or not the home could meet peoples needs. Peoples individual needs were met in the home. Evidence: There was written information about the home (the Statement of Purpose and the Service User Guide)and this was seen in places around the home where people could have access to it. People admitted to the home were also given a welcome pack which included the documents referred to above. Although we did not fully assess these documents we were told in the information received prior to the site visit that they needed reviewing and updating, in particular with respect to recent changes in the ownership of the home, and that this would be done in the near future. It was also clear from the survey questionnaires, and discussions with people, that Care Homes for Older People Page 11 of 28 Evidence: they felt they had enough information about the home to make decisions about whether or not Lyndurst was the right place for them. Records viewed showed that a full assessment of residents needs had been undertaken prior to admission to help decide whether or not the home could meet these needs. This involved meeting prospective residents and their relatives, and inviting them to visit the home, so that people could see for themselves what Lyndhurst is like. This was confirmed by the relatives who were spoken with at the site visit. The pre admission assessment covered all the major areas of health and personal care, and a social work assessment was obtained if applicable, which helped the staff understand peoples needs. The in house assessments viewed were completed in sufficient detail to enable staff to develop a care plan. They were also person centred and included information about what people could do themselves, their preferred routines and how they would like support to be provided. The management had also begun to assess peoples mental capacity, and their abilty to make their own decisions, under new Government legislation. This should ensure that for people whose abilty to make their own decisions is impaired the right people will be involved in helping them. Residents and relatives who completed the questionnaires, and who talked to us at the site visit said that people got the right care when they needed it and that peoples individual needs were respected and met. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans contained detailed useful information about residents health and personal care, and directed staff in what support to provide. However the assessment of risks needed to be improved. Residents health was promoted and medication practices and procedures were satisfactory. Evidence: The residents records that were viewed had a detailed written care plan covering all aspects of care. These gave useful instructions to staff on what care and support was needed, and how this should be provided. Risk assessments underpinned some essential aspects of the care plan, such as the risk of pressure areas, aggression and nutrition problems. There was good written information about peoples preferences, such as preferred rising and retiring times and likes and dislikes, and a useful social profile that included peoples hobbies and religious interests. There was also evidence that the care plans were reviewed regularly and that changes in need were recorded. Residents spoken with and those who completed the questionnaires felt that they received all the care and support they needed. Care Homes for Older People Page 13 of 28 Evidence: However at the time of the site visit some of the assessments of risks were inadequate and would not give sufficient guidance to staff. For one resident with bedrails there was no written risk assessment to direct staff in their safe use (see below) and for another resident a risk assessment on aggressive behaviour did not sufficiently cover strategies to assist staff to minimise and manage this behaviour. Though there was no evidence that staff didnt know what to do in these circumstances, written guidance is necessary to help ensure that staff give residents the right support and protection. This was discussed fully with the manager who rectified these matters immediately after the site visit. We are confident that this will be a permanent improvement in the risk assessment process. Looking at records, talking to people and the responses in the completed questionnaires showed that the residents health, including mental health, was promoted. Residents had access to all the necessary health care services. All the residents who completed the commissions questionnaires said that they always had the medical attention that they needed. District nurses were involved as necessary, such as for pressure area care. At the time of the site visit bed rails were used when it was assessed that people were at risk from falling out of bed. Some concerns were identified such as the suitability of the bed rails being used; and on two beds seen there were gaps between the mattress and the bottom of the bed rail which could cause entrapment and injury. As stated above one resident did not have a risk assessment for the use of the rails. The manager agreed to urgently review this and to make any necessary changes necessary. We were subsequently informed of the action taken to rectify this and we are confident that at the time of writing this report residents were safely protected when at risk from falling out of bed. Some residents medication was checked with the records and in general we found that generally medication was managed satisfactorily. Some good practices were evident, such as the manager undertaking regular checks of the systems and assessing the competence of new members of staff, and people were encouraged and supported to administer their own medication if they so wished. Also all staff who administered medication had undertaken suitable training. We also found that the controlled drugs in the home were stored and managed safely. However we identified some matters that needed improvement. For one person who was self administering some of their medication, the supporting risk assessment to identify any risks and what support if any was required from staff was inadequate as were the instructions on the Medication Administration Record (MAR) about this. As a Care Homes for Older People Page 14 of 28 Evidence: result it was not clear whether or not this person was having this medication as prescribed. This was discussed fully with the manager and remedial action was taken immediately. There was also inadequate guidance to staff on the use of when required medication which could have meant that this was not being administered correctly. The manager had already identified this as an issue of concern in her checks, and was addressing the matter. The staff were not checking the prescriptions prior to dispensing, and therefore prescribing errors may not be identified. On the whole the homes record keeping with respect to medication was satisfactory but on some of the MARs the records of the medication received into the home had not been signed and dated and staff were not recording the doses given for variable dose medication. These matters were discussed fully with the manager who took immediate steps to rectify them. Residents spoken with said that staff treated them appropriately and with respect. Residents appreciated the fact that they could spend time in their room if they wished, and one resident enjoyed the freedom to sit in the garden and read. One resident said that all the staff were caring, considerate, friendly and helpful. Relatives also viewed staff in this way. One relative said in a questionnaire that staff were really kind. Another said that standards in the home were excellent. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents had fullfilling activities and sufficient choice in their everyday lives. The meals were varied and appetising and suited peoples needs and preferences. Evidence: Residents in discussion confirmed that routines were flexible enough to suit some of their preferences. These included a good choice of meals, choice of rising and retiring times, and support to go out. There was useful information on the care plans about some of these preferences to assist staff to give the right support. The information supplied by the home for the inspection told us that there was an activities coordinator in the home and a wide range of leisure activities, including frequent trips out. This was confirmed at the site visit through discussions with the management and residents. There were music events, crafts, quizzes, games, and regular trips out to the nearby park and shopping centre. Fireworks and supper for bonfire night was being planned at the time of our site visit. Those who completed the questionnaires felt they were satisfied with the activities in the home. Relatives spoken with at the site visit and those who completed questionnaires confirmed that visitors were made welcome in the home at any reasonable time and Care Homes for Older People Page 16 of 28 Evidence: that visits could take place in private. Visitors could also have a meal in the home if they wanted, and residents were encouraged and supported to go out with their relatives. Relatives said that communication between them and the staff in the home was good, and that they were notified of all the important events affecting their relative. They also commented on the open friendly attitude of the staff. Residents spoken with felt that they had sufficient choices in their everyday lives and felt that they were listened to and regular surveys were undertaken with residents and relatives. Regular residents meetings were also held to encourage residents to express their views and preferences. Menus showed that the food served was wholesome and varied. People could have what they wanted for breakfast including a cooked option, and there was a choice of two main cooked meals at midday. There were numerous choices for the snack meal at tea time. The chef spoken with on the day of the site visit had a good knowledge of residents likes and dislikes and dietary needs such as those who required a soft diet and those with diabetes. This showed that importance was placed on serving what people wanted and needed. Meals were discussed regularly with the residents and examples were given of providing a meal to suit individual taste. Residents spoken with praised the food. One said it was very good, and another said they got good meals. Most residents who completed the questionnaires said that they generally liked the meals. However one said they were not happy with the food. This was discussed with the manager who agreed to look into this. Care Homes for Older People Page 17 of 28 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. People knew who to speak to if they had any concerns, and residents and relatives felt confident that their concerns would be taken seriously and dealt with properly. The homes policies and procedures and staff training programme should help protect residents from abuse. Evidence: The home had a complaints procedure that was up to date and accessible to people. Records and information supplied by the home for the inspection showed that two complaints had been fully investigated and resolved within the appropriate timescale according to the homes complaints procedure. This showed that the home took peoples concerns seriously. No complaints had been made to the commission in the last 12 months. Residents and relatives spoken with said that they had no complaints, and all said they knew what to do if they were not happy with something. All the questionnaires completed by the residents and relatives agreed with these views. One of the complaints referred to above was about the attitude and behaviour of a member of staff, and had subsequently been reported to social services as an allegation of abuse. This was the correct action and resulted in safeguarding investigations and a satisfactory conclusion which would ensure people were protected. The home had policies and procedures underpinning this action, and that had therefore helped to help protect people from abuse. However these procedures required developing and updating according to more recent Government and local Care Homes for Older People Page 18 of 28 Evidence: guidance. The necessary developments were made shortly after the site visit and before this report was written so we are confident that staff had the correct guidance to follow. Staff had undertaken appropriate training in the protection of adults from abuse, and the manager had planned further training due to her concerns about the above incident. This showed that the management was determined to ensure that people in the home were as safe as possible. Care Homes for Older People Page 19 of 28 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. Lyndhurst provided comfortable well - maintained private and communal accommodation that suited residents needs. The home was clean and hygienic. Evidence: A tour of the premises showed that the areas viewed were well maintained and safe. All the communal areas and the bedrooms viewed were tastefully and comfortably furnished with a good standard of decor. The outside areas at the back of the house had been tastefully developed and made into an attractive area for residents to sit and enjoy. This included a sensory garden and a water feature. The areas viewed were free from hazards to residents. The radiators were covered to protect people from the hazards of hot surface temperatures and. The hot water in one of the toilets was hotter than the recommended range but this was rectified before the first site visit was completed, and records kept showed that water temperatures were monitored and appropriate action taken if need be. All areas of the home viewed were clean, but two bedrooms had unpleasant odours. This was discussed fully with the management who told us that this had already been identified as a problem, and told us how it was being addressed. This initially involved more thorough and frequent cleaning, and there was a noticeable improvement on the second site visit. All residents who completed the questionnaires said that the home Care Homes for Older People Page 20 of 28 Evidence: was always fresh and clean. There were suitable laundry facilities and staff had undertaken training in infection control to help prevent the spread of infections in the home. Care Homes for Older People Page 21 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient qualified and trained staff were on duty to ensure that the needs of the residents were met. Staff recruitment procedures were thorough and should help to ensure that only suitable staff worked in the home. Evidence: Discussion with staff, the residents and relatives, and observation at the time of the site visit indicated that the staffing levels in the home were suitable for meeting the needs of the residents, and were adjusted according to the residents needs. Relatives and residents said in conversation that they thought there were enough staff on duty, that they were kind and caring and treated residents properly. There was also a relatively low turn over of staff which helped to ensure a continuity of care for the residents. Staff were completing relevant qualifications and training. Information supplied by the home for the inspection and discussion with the manager and staff confirmed that the home operated a policy that all new staff without qualifications have to commit to studying for National Vocational Qualifications. This helped to ensure that the home was able to maintain a level of over 50 of carers having the right qualifications. Information supplied by the service showed that there was a rolling programme of training in moving and handling, first aid and food hygiene. This meant that all new Care Homes for Older People Page 22 of 28 Evidence: staff had the opportunity of completing this training and all staff received up dated training. Staff had also undertaken training in dementia care, training in the protection of vulnerable adults and continence promotion. The homes induction programme was in accordance with Government guidance and should ensure that new staff were confident and competent. Staff who completed the questionnaires and two staff spoken with felt that they had good training oppoprtunities, sufficient knowledge and skills to look after people, and sufficient support from the management. With respect to staff recruitment, two staff files were looked at and both showed that staff recruitment procedures were thorough and should help ensure that unsuitable people do not work in the home. Appropriate records of the recruitment process and the induction training were kept. These showed that for both members of staff whose records were viewed, the necessary checks including the criminal records bureau check and written references had been received before they had commenced work in the home. Care Homes for Older People Page 23 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed by experienced and qualified people. There were thorough systems of quality monitoring that took into account the views of residents and relatives. The health and safety of the residents and staff were promoted. Evidence: The registered manager had the relevant qualifications, skills and experience to manage the care home. She worked alongside the former owner who now is employed to run the business and premises side of the home. There was a deputy manager in post and an administrator. This team ensured the smooth and efficient running of the home which both residents and relatives benefited from. Relatives who took part in the inspection felt that the home was friendly and well run. The former owner was undertaking monthly unannounced monitoring visits and reports under the Care Homes Regulations. This helped to ensure that the management identifies areas for improvement, and reassures the commission that the home is safe and providing a high quality service to people. However this was under Care Homes for Older People Page 24 of 28 Evidence: review at the time of the site visit to ensure the most appropriate person would undertake this responsibility in the future. The home had thorough service quality monitoring systems that involved seeking the views of residents, relatives and visiting professionals and which resulted in any queries and concerns being addressed individually. People on respite care were always asked for their views on the home before they returned home. Questionnaires were used throughout the year, and those looked at on the site visit showed a high level of satisfaction with the service. It also showed that individual concerns had been addressed. Residents meetings were also held which provided another channel for the expression of resident views. It was clear through talking to people and from the responses in the commissions questionnaires that residents felt listened to, and felt that their views were taken into account. The homes own assessment of the service provided to us before the site visit was clear and detailed, and provided useful information about the service and facilities. It also identified some areas for improvement in the home. There were a number of residents for whom the home held spending money given by relatives. Suitable records were kept of money given by relatives and money spent on behalf of residents. A spot check was undertaken and it was found that the amount of cash remaining, balanced with the amount stated in the records. The home was a safe place for the residents and staff. The management told us in the information supplied for the inspection that all maintenance and servicing of installations, applicances and equipment had been carried out appropriately. Records viewed in the home confirmed this, and that there were satisfactory fire precautions. Staff were undertaking health and safety related training as indicated in the previous section and also appropriate fire safety training. The commission was notified of all incidents affecting the health and welfare of the residents, including when people died. This enables us to monitor such events and enables us to decide whether or not the home manages these events properly. Accidents were recorded appropriately, including falls, and the manager ensured that if needed specialist advice was sought to help prevent falls and protect people from injuries. Care Homes for Older People Page 25 of 28 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 28 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 8 13 Comprehensive risk 11/12/2009 assessments must be completed in writing on all risks identified such as falling out of bed, self administration of medication and aggressive behaviour to give instructions and guidance to staff. So that risks to people are satisfactory managed and eliminated or reduced. 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 9 9 Prescriptions should be checked in the home prior to dispensing to identify any prescribing errors. Suitable records should be maintained of all medication received into the home, including the date and the signature of the people checking the medicines. The home should ensure that all areas of the home including bedrooms are free from unpleasant odours. Page 27 of 28 3 26 Care Homes for Older People 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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