Care Home: Magnolia House

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What the care home does well People have a full care needs assessment prior to their admission to the home and are only offered a place if it is felt their care needs can be met. People have care plans in place that are personalised, that are usually kept up to date and that have been agreed by them. Meal provision at the home is good and there is a choice of meal at each mealtime. There is an activities coordinator employed at the home and they provide regular activities for people to take part in. Visitors are made welcome at the home. People are provided with information about independent advocacy services and advocates have been used to help people with decision making. The home has extensive landscaped gardens with garden furniture so that people are able to sit outside and enjoy the fresh air. People are provided with information about how to express concerns and make a complaint, and complaints made are dealt with professionally. There is a quality assurance system in place that gives people living and working at the home the opportunity to comment on how well the service is being operated, and to make suggestions about how to improve the service. Health and safety systems promote the well-being of people living at the home, as well as those working at the home and visiting the home. What has improved since the last inspection? There are now risk assessments in place for all bed rails in use at the home and there are safety checks to ensure that they remain safe during use. Medical attention is now sought quickly for people who have had an accident or injury at the home. The areas requiring maintenance that were idenfitied at the last key inspection have been actioned. No unauthorised means are used to hold open fire doors; any doors that may need to be left open are now held open by door guards that are attached to the fire alarm system. People are now supported by sufficient numbers of both care staff and ancillary staff. The home now records the dates that people commence work at the home and when references and CRB/ISA first checks are received; this provides an audit trail to monitor safe recruitment. The Care Quality Commission are now informed of all accidents or incidents involving people living at the home, including those where people require medical attention. Management monitoring systems have improved but further improvements need to be made for monitoring medication policies, procedures and practices, the safe recruitment of staff and the provision of regular training programmes. What the care home could do better: Forms in care plans that are intended to monitor specific health care needs must be used consistently to be effective. Medication policies, procedures and practices must improve to ensure that people always receive their prescribed medication. There is a lack of evidence that all staff would know what action to take should they observe poor practice or an incident of abuse. People do not always have induction training within 6 weeks of commencing work at the home. There is a training and development plan in place but this evidences that some staff have not had basic training and that many refresher training courses are overdue. There is no record of the supervision arrangements in place for staff when they start work following receipt of an ISA first check but before their CRB clearance is received. Key inspection report Care homes for older people Name: Address: Magnolia House 42 Hull Road Cottingham Hull East Yorkshire HU16 4PX     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: Diane Wilkinson     Date: 0 6 0 5 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 33 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 33 Information about the care home Name of care home: Address: Magnolia House 42 Hull Road Cottingham Hull East Yorkshire HU16 4PX 01482845038 01482848271 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Park Lane Healthcare (Magnolia House) Limited Name of registered manager (if applicable) Mrs Susan Bottomley Type of registration: Number of places registered: care home 88 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is:88 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 neds on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP-maximum number of places 88 Dementia CodeDE, maximum number of places 88 Date of last inspection Brief description of the care home Magnolia House is a care home that is operated by Park Lane Healthcare Limited, a privately owned company. The home has been adapted and extended to provide Care Homes for Older People Page 4 of 33 Over 65 0 88 88 0 0 8 0 9 2 0 0 9 Brief description of the care home accommodation and care for up to 88 older people, including those with dementia related conditions. It is situated in Cottingham, close to the border between the East Riding of Yorkshire and the city of Hull. The home stands in extensive landscaped grounds that include mature trees, flowerbeds and various seating areas. Private and communal accommodation is located over two floors, both in the east wing and the west wing. All bedrooms are now single and many of these have en-suite facilities. There are various lounge and dining areas, some overlooking the landscaped gardens. All areas of the home, including the garden, are accessible to people living at the home via the provision of passenger lifts and ramps. The home is on a bus route and is easily accessed via road; there is ample car parking space for visitors and staff. Information about the home is provided to people living at the home and others in the statement of purpose and service users guide. Care Homes for Older People Page 5 of 33 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: This inspection report is based on information received by the Care Quality Commission (CQC) since the last key inspection of the home on the 8th September 2009, including information gathered during a site visit to the home. The unannounced site visit was undertaken by two inspectors over one day; it began at 9.30 am and ended at 6.00 pm. On the day of the site visit inspectors spoke on a one to one basis with people living at the home, managers and staff. Inspection of the premises and close examination of a range of documentation, including six care plans, were also undertaken. The registered manager submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Care Homes for Older People Page 6 of 33 As part of the inspection process we sent survey forms to ten people living at the home and ten members of staff; two were returned by people living at the home and three were returned by staff. Responses in surveys and comments from discussions with people on the day of the site visit were mainly positive, for example, good and plentiful food - meals in room if needed and the home creates a homely atmosphere for the residents. At the end of this site visit feedback was given to the registered manager, assistant manager and one of the directors of the company, including requirements and recommendations that would be made in the key inspection report. The manager told us that the current cost for residential care is from £369.75 to £575 per week. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at signigicant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? There are now risk assessments in place for all bed rails in use at the home and there are safety checks to ensure that they remain safe during use. Medical attention is now sought quickly for people who have had an accident or injury at the home. The areas requiring maintenance that were idenfitied at the last key inspection have been actioned. No unauthorised means are used to hold open fire doors; any doors that may need to be left open are now held open by door guards that are attached to the fire alarm system. People are now supported by sufficient numbers of both care staff and ancillary staff. The home now records the dates that people commence work at the home and when references and CRB/ISA first checks are received; this provides an audit trail to monitor safe recruitment. Care Homes for Older People Page 8 of 33 The Care Quality Commission are now informed of all accidents or incidents involving people living at the home, including those where people require medical attention. Management monitoring systems have improved but further improvements need to be made for monitoring medication policies, procedures and practices, the safe recruitment of staff and the provision of regular training programmes. 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 33 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 33 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. We looked at outcomes for Standard 3. Standard 6 was not assessed as there is no intermediate care provision at the home. People have their care needs assessed prior to any agreement being reached about admission and are only offered a place at the home if it is felt that their needs can be met. Evidence: We checked the care plans for six people living at the home. Some care plans included an initial enquiry form and all included an initial assessment sheet that records brief details about the prospective resident, including a list of their currrent prescribed medication and the reason it is taken, a body map and a personal profile (including information on any illnesses). The information on the assessment form is reviewed monthly. Care Homes for Older People Page 11 of 33 Evidence: We saw that, when the service is commissioned by a local authority, a copy of the community care assessment and care plan produced by them is obtained by the home. This information is used along with the homes own assessment to begin to formulate an individual plan of care. The care records are divided into the following sections: falls and maintaining a safe environment, mobility, physical needs, mental health, self medication, communication, pressure care, eating and drinking, elimination, personal hygiene, sleeping and leisure/interests. Each section then includes an assessment, a care plan and any relevant supporting information such as pressure care assessments, behavioural assessments and a falls risk assessment. On the day of the site visit the manager and assistant manager went out to assess someone who had made enquiries via Social Services about admission to the home. They expressed concerns about this persons situation and it was apparent that they would not agree to someone moving to Magnolia House if they felt it was not the right place for them. The manager recorded in the AQAA form that the home intends to provide people with a written decision when they have undertaken a care needs assessment to inform them whether they believe their needs can be met by the home. Care Homes for Older People Page 12 of 33 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. We looked at outcomes for Standards 7, 8, 9 and 10. People have care plans in place that reflect their current care needs but some documentation is not used consistently and this could result in their health care needs not being met. More care needs to be taken to ensure that medication is administered accurately to ensure that people receive their prescribed medication. Evidence: We saw that five of the six care plans we checked included a photograph of the person concerned; the care plan with no photograph was for someone who had been admitted to the home during the last three months. Each section of the care plan includes supporting information about the persons individual care needs, such as, cannot walk long distances, assistance with shower 1 carer needed and bathing - hoist needed and clear explanation. Care plans should be expanded further to include more personalised information about areas like dressing and bathing. For example, there should be a record of whether people need Care Homes for Older People Page 13 of 33 Evidence: assistance to get washed or dried, whether they like bubble bath in the bath water and whether they like to be left alone in the bathroom or not. We noted that people have signed a form to agree to the content of their care plan. Managers told us that they have not yet attended training on personalisation but that they have obtained copies of patient passports and will be completing these for people living at the home in due course. These documents are a summary of a persons capabilities, wishes, likes and dislikes and are intended to be taken to hospital with people to help medical staff understand the support they need. These should be in place as soon as possible. We saw that care plans, assessments and risk assessments are reviewed each month although one persons reviews had ceased in December 2009 when the review form was full. In most instances, an annual review of the care plan takes place. This is organised by a local authority when they commission the placement and by the home when the person is privately funded. Care plans are updated as a result of monthly and annual reviews; this ensures that staff are working with up to date information about the people living at the home to enable their care needs to be met. Both people living at the home told us in surveys that they get the medical care they need. One person added, I feel that the staff do really well in looking after us. Care plans evidence that a persons health care needs are met but we did observe that some monitoring charts were not used consistently. For example, one person had a food and fluid chart in place and there were several days when no entry had been made. Another persons care plan recorded that they had received advice from a dietician that food additiives were to be used with meals. Staff told us that they no longer gave this person the additives but there is no record of why this is the case, and managers told us that this person was still prescribed food additives. We noted that some people had stool charts in place when dietary intake was not an area of concern. This inconsistent recording was an area of concern at the last key inspection. There are risk assessments in place for the use of bed rails and we saw evidence of safety checks undertaken by the homes handyman. One persons daily records gave details of an accident when they tried to climb over their bed rail; this information is not reflected in the persons care plan. We observed medication being administered on both wings of the home and noted that the person responsible for administering morning medication was still undertaking this task at 11.05 am. The time that medication is administered at lunchtimes would need to be adjusted if this is normal practice. Care Homes for Older People Page 14 of 33 Evidence: Medication cabinets are stored in a locked cupboard within another room and only senior carers have a key to the cupboard. However, on the day of the site visit one of the senior carers left the trolley keys on top of the trolley, the blister packs out on the work top and the door of the medication room open when they took medication to someone living at the home. This is unsafe practice as it leaves medication accessible to other people living at the home. Controlled drugs are stored securely; records seen and balances of drugs held were checked and were found to be accurate. Medication administration record (MAR) charts were checked. One of the MAR charts we examined was not accompanied by a photograph of the person concerned - a photograph is needed to assist staff with identification and to reduce the risk of errors being made. We saw that the code M is used on some MAR charts. We were told that this is when medication is given to someone who wishes to take the medication in their own time. This practice is supported by a risk assessment that records that the person is capable of taking their own medication and that staff rely on confirmation from the person concerned that they have taken it. Managers told us that these risk assessments are reviewed monthly. We suggested that the risk assessments should be more robust, for example, to include that people should only be handed medication in their own room to reduce the risk of someone else taking the medication in error. There were some errors in recording on MAR charts. In some instances medication records had been signed to indicate that the person had taken their medication but the medication was still in the blister pack. In other instances MAR charts recorded that medication had been refused but the medication was not in the blister pack; this may have led to some people being given their medication again, resulting in an overdose. The manager told us that they have recently transferred to another pharmacy and that days are no longer recorded on the blister pack. The manager told us that they would contact the pharmacist to request that the days are printed on the blister packs to help reduce the risk of errors being made. The deputy manager contacted us following the day of the site visit to inform us that they had done a full medication audit and that the actual number of tablets in blister packs was correct. One MAR chart did not record the correct balance of medication carried over from the previous month and when checked, the number of tablets left in the blister pack did not tally with medication records. This provides a lack of evidence that people have taken their prescribed medication. The manager recorded on the AQAA form that staff who have had medication training Care Homes for Older People Page 15 of 33 Evidence: are monitored periodically by a senior staff member to ensure that their practice remains safe; this is good practice. Staff training records indicate that some staff have had training on the administration of medication but we recommend that clearer records are kept to evidence that all staff who are responsible for the administration of medication have completed this training. On the day of the site visit we observed that staff spoke to people sensitively and that their privacy and dignity is respected. Everyone living at the home has a single room so they are able to see visitors and health care professionals in their own room. There are also areas of the home where people could have private meetings. Care Homes for Older People Page 16 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 12, 13, 14 and 15. People were seen to have visitors throughout the day, routines are flexible and meal provision is good, but individual records are not kept of how people spend their day. This results in a less than complete picture of the support provided for each person living at the home. Evidence: We saw that routines of daily living are flexible - people are able to spend their day in their own room or in one of the lounges and can choose where to take their meals. Care plans include information about a persons personal history, previous lifestyle and their interests. Two surveys were returned by people living at the home and they told us that the home does arrange activities that they can take part in. There is an activities coordinator employed each day who works three days in one wing of the home and two days in the other. Activities undertaken are recorded in the activity book; this indicates that people take part in a variety of activities including exercise to music, floor games, reminiscence and hand massages. These records are individual but this information is not cross referenced to care plans. Care Homes for Older People Page 17 of 33 Evidence: We saw that visitors were in and out of the home throughout the day and that they appeared to have a good rapport with the managers and staff on duty. Because care plans do not record how people have spent their day, which activities they have taken part in or if they have had any visitors, there is an incomplete picture of the support provided for people living at the home. There is a hairdressing salon at the home and we saw information on the notice board about when the hairdresser visits the home. We also saw that information was displayed about church services, a forthcoming clothes party and about a theatre production, although there was no information to suggest that the home would be arranging an outing to the theatre. As at the last inspection, we noted that key worker one to one time frequently consists of time spent with people undertaking personal care tasks rather than social time; individual time that is spent with people should reflect their hobbies and interests as recorded in their care plan. We saw that there was some information displayed about advocacy services and we are aware that advocates have been sought for people to assist them with decision making. However, we were concerned that some information in care plans indicated that decisions had been made about people without consultation with them or others involved in their care. On one occasion the heads of shift had decided that chairs should be removed from a persons room as it appeared that they had falls when trying to get from their bed to a chair. The managers confirmed that no-one else had been consulted about this decision. We were told that people had been assisted to vote; the day of the site visit was also the day of the General Election. However, some people did tell us that they would have liked to vote, which indicated that they had not had the opportunity to do so. We observed the serving of lunch and noted that some people were brought into the dining room about 30 minutes before lunch was due to be served. People did not complain about having to wait and we appreciate that this may be unavoidable due to the large number of meals that need to be served each day. Some staff took meals on a tray to people who prefer to eat their meals in their own room. One person told us in a survey, good and plentiful food - meals in room if needed. There is a menu on display and we observed that people were offered a choice of meal Care Homes for Older People Page 18 of 33 Evidence: at lunchtime. We saw that people were offered one to one assistance with eating their meal when this was needed and that this was done sensitively by staff. The manager told us that they have had some complaints about food not being served hot and that they are addressing this by purchasing new equipment that will keep food hot whilst it is being served. The manager recorded in the AQAA form that no staff have had training on malnutrition and assistance with eating and we would recommend that this be arranged. However, most staff have had training on basic food hygiene. Care Homes for Older People Page 19 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 16 and 18. People are protected by the policies and procedures in place on making a complaint but not all staff have had training on safeguarding adults from abuse so there is insufficient evidence that all staff would react appropriately if they observed poor practice. Evidence: We saw that the complaints procedure is displayed within the home and the manager told us in the AQAA form that there is also a copy in each bedroom. People living at the home told us that they know who to speak to if they have any concerns and that they know how to make a formal complaint. Staff told us in surveys that they know what to do if someone expresses concerns. We examined the complaints log and noted that this records the date that the complaint was made, details of the complaint and any action taken by the home. There was one occasion when the person did not receive a response within the agreed 28-day timescale but on all other occasions the response was appropriate and timely. On some occasions the manager had recorded that the complainant was happy with the outcome of the investigation. The manager has undertaken the managers awareness training on safeguarding Care Homes for Older People Page 20 of 33 Evidence: adults from abuse and approximately 50 of staff have undertaken this training. We would expect the home to ensure that all staff have undertaken this training so that they can be confident that staff know how to recognise good and poor practice, and know what action to take should they observe an incident or any poor practice. A requirement was made at the last key inspection that medical advice must be sought immediately following accidents at the home. A further incident occurred when a member of staff dressed a skin tear rather than seeking medical advice immediately. This resulted in a safeguarding referral being made to the local authority. There have been no more incidents since that time and we are now assured that staff at the home understand that they must seek medical advice immediately following any accidents or incidents involving people living at the home. Care Homes for Older People Page 21 of 33 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. We looked at outcomes for Standards 19 and 26. People live in a home that is well decorated and well furnished and that is maintained in a hygienic and safe condition. They have ample access to sunlight and they and their visitors have the use of an attractive garden. Evidence: We toured both wings of the home on the day of the site visit. The home was found to be clean, tidy, well decorated and furnished and well maintained. Staff record any jobs or repairs that they identify and then the handyman records when these repairs have been completed. Three surveys were returned by staff and when asked what the home does well, one person commented, The home creates a homely atmosphere for the residents. The repairs identified in the last key inspection report had been actioned and we saw that there were no wooden wedges used to hold open fire doors; door opening devices that are attached to the fire alarm system are fitted where needed. We saw evidence that bed rails are checked for safety on a regular basis by the homes handyman. The home has a large lounge/conservatory at the rear of the property that overlooks the extensive landscaped gardens; this offers people ample access to sunlight. Some Care Homes for Older People Page 22 of 33 Evidence: bedrooms also overlook the garden. Garden furniture is provided so that people can sit outside in the warmer weather. Two people living at the home returned a survey and they told us that the home is usually fresh and clean. One person added, The cleaners do well and always make me satisfied in the cleanliness of my room. The manager recorded in the AQAA form that 35 staff have undertaken training on infection control. We saw that staff follow good hygiene practices and that disinfecting gel is available throughout the home, including at the front door. Laundry facilities were found to be satisfactory and one of the directors of the company told us about their plans to improve laundry facilities at the home. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 27, 28, 29 and 30. People are cared for by sufficient numbers of staff. However, care is compromised by recruitment practices that are not robust and by insufficient evidence that all staff have received training in core topics. Evidence: We checked the staff rotas for both wings of the home. These evidence that there are sufficient care staff on duty to support the people living at the home. Ancillary staff are employed in sufficient numbers and this leaves care staff to concentrate on care duties; this also reduces the risk of cross infection. The manager recorded in the AQAA form that over 50 of care staff have now achieved National Vocational Qualification (NVQ) Level 2 in Care. We examined the recruitment records for five members of staff. All of these employees had appropriate application forms in place that recorded their employment history and the name of two referees. The home had obtained two written references prior to them commencing work at the home but in two instances the carer had commenced work prior to the Protection of Vulnerable Adults (POVA) first check being Care Homes for Older People Page 24 of 33 Evidence: obtained. Managers contacted us following the day of the key inspection to say that they had checked time sheets at the home and these people had attended the home to undertake training and not to commence work. We advised that this should be made clear in staff records to avoid any confusion in the future. The Criminal Records Bureau (CRB) check for one of these people did not arrive for another four months and there is no evidence of the supervision arrangements in place whilst they were waiting for CRB clearance; this is also the case for the other staff members whose records we examined. Staff who commence work at the home following receipt of a POVA or Independent Safeguarding Authority (ISA) first check but prior to CRB clearance must work under supervision, and these supervision arrangements need to be recorded. One persons records evidenced that they commenced work at the home in November 2009 but their induction training was dated 8/4/10. Managers told us that, because they have not been able to ascertain whether all staff have undertaken induction training, they made the decision that all staff should undertake this training again. They told us that this had been an enourmous task but had been worthwhile, as it had boosted staff morale. Although managers assured us that all staff have now undertaken or are undertaking induction training, the training and development plan does not record this information (although some individual staff files do). In future, there must be evidence that people have had induction training within six weeks of commencing work to ensure that they have the skills and knowledge needed to support the people they care for. We were told that the home has introduced a new induction pack for staff who have been promoted to senior carer or who commence work at the home at this level. This was seen on the day of the site visit and was found to be an effective training pack. We examined the training and development plan in place at the home; this records the date that people complete training and when refresher training is due. Staff undertake training on core topics such as health and safety, food hygiene, first aid, infection control, fire safety and dementia awareness. However, the training and developoment plan recorded that some staff had not undertaken any training on fire safety, safeguarding adults from abuse and manual handling and we noted that some refresher training was overdue. One person had not done moving and handling training since 2004 and others had not done fire training since 2003 and 2005. This lack of staff training could leave people living at the home at risk of harm. Care Homes for Older People Page 25 of 33 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. We looked at outcomes for Standards 31, 33, 35 and 38. The home is managed in the best interests of the people who live there although some monitoring systems need to improve to ensure that policies, procedures and practices are followed by staff. Evidence: The manager told us that she is undertaking National Vocational Qualification Level 4 in Management and that she has completed six units. She keeps her practice up to date by attending some in-house training alongside staff and by meeting with other managers from the organisation to discuss developments in the care sector and current legislation. Some progress has been made via monitoring systems to ensure that staff are following the policies and procedures in place at the home. Good progress has been made on ensuring satisfactory staffing levels and in developing new care plans but Care Homes for Older People Page 26 of 33 Evidence: some mistakes are still being made when recording in care plans, in the administration of medication and in recruitment practices. Monitoring of these systems must be more robust. We noted that quality monitoring systems at the home are well developed. The quality assurance folder includes a quality assurance plan for 2010, reports from other regulators, reports from the homes health and safety enforcement officer and information recorded by the responsible individual when undertaking visits to the home under Regulation 26 of the Care Standards Act 2000. Regular audits take place at the home. The most recent one was on the standard of meals provided. Information in returned surveys had been collated and an action plan produced - we saw that this was displayed in the home on the day of the site visit, and that it included information on the action that had been taken to deal with the issues raised; this is good practice. We also saw action plans that had been put together following previous audits and surveys. A resident and relatives meeting was held in April 2010 and we saw in the minutes of the meeting that people were reminded that there is a suggestion box in place for both people living at the home and others to use. Meetings are also held for staff, including meetings specifically for senior staff and ancillary staff. Minutes of these meetings are signed by all staff to evidence that they are aware of the issues discussed. On the day of the site visit a review of someones care plan was taking place - we noted that several family members, care management staff and a staff member from the home attended. We saw that sufficient time and effort had been put into this by staff working at the home. The manager told us that no monies are held on behalf of people living at the home. The home pays for items such as chiropody and hairdressing and money owed to the home is added to monthly residential fee accounts. The exception to this is when the home holds a clothes party; money is handed to the home by relatives and is held in the homes safe until the day of the event. We examined a selection of health and safety documentation including in-house fire records. We saw that weekly tests of the fire alarm system take place consistently and that regular fire drills are held. The fire alarm system and fire fighting equipment had been serviced by a qualified contractor. Care Homes for Older People Page 27 of 33 Evidence: There is evidence that portable appliances, lifts and hoists, gas appliances and systems and the electrical installation had all been serviced within the last 12 months. Water temperatures are tested in-house by the handyman on a regular basis to reduce the risk of scalding for people living at the home, and a test to detect Legionella in the water system has also taken place. We noted that the Care Quality Commission are now informed of all accidents and incidents that affect the well-being of people living at the home. Care Homes for Older People Page 28 of 33 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 29 of 33 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 12 Any forms included in care plans that are intended to monitor health care needs must be completed consistently. This is needed to provide staff with up to date information and to evidence that health care needs are being met. 11/06/2010 2 9 13 Medication administration records must be accompanied by a photograph of the person concerned. This is needed to help staff with identification and to reduce the risk of errors being made. 11/06/2010 3 9 13 Medication must be stored securely at all times i.e. in a locked trolley or cupboard. 11/06/2010 Care Homes for Older People Page 30 of 33 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 This is to ensure that medication is not accessible to other people living at the home or others. 4 9 13 More care must be taken with recording on MAR charts. This is needed to ensure that people receive their prescribed medication. 5 29 19 There must be evidence that 11/06/2010 people who commence work following receipt of a ISA first check work under supervision. Staff cannot work unsupervised until the home has evidence that they have no criminal convictions that could prevent them working with vulnerable people. 6 31 12 Monitoring systems in place 31/07/2010 at the home designed to ensure that policies, procedures and practices are being followed by staff must be more robust. This is needed to ensure that mistakes are not made in care planning, the administration of medication and in staff recruitment. 11/06/2010 Care Homes for Older People Page 31 of 33 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 7 Care records and medication records should include a photograph of the person concerned to assist new staff with identification and to reduce the risk of medication errors being made. A photograph also helps the emergency services should someone go missing from the home. This was a recommendation at the last key inspection. The home should continue with their plans to produce patient passports for each person living at the home. The risk assessments used to evidence that people are able to take their medication in their own time after it has been handed to them by staff should be more robust. Staff should ensure that there are suitable gaps left between the times that medication is administered. It would be more beneficial to people living at the home for key workers to spend social time with them undertaking activities that reflect their hobbies and interests rather than completing personal care tasks. This was a recommendation at the last key inspection. Care records should include information about how people have spent their day so that there is a full picture of the care provided to each person living at the home. This was a recommendation at the last key inspection. There should be a record of how decisions have been reached that affect a persons day to day care, including consultation with relevant others. Staff should have training on assistance with eating and malnutrition so that they can provide appropriate support to people living at the home. All staff working at the home should have received some training on safeguarding adults from abuse to ensure that they know how to recognise good and poor practice, and know what action to take should they observe poor practice. In future, there should be evidence that induction training undertaken by staff has been completed within 6 weeks of them commencing work at the home. 2 3 8 9 4 5 9 12 6 12 7 14 8 15 9 18 10 30 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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