Care Home: Mandeville Grange

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What the care home does well Service users and visitors who we spoke to were positive about the care offered at Mandeville Grange. Comments included: "this home is like a 5 star hotel." "The food provided is very good." "I would recommend this home to anyone looking for a home." Staff who we spoke to and and those who returned a survey said they enjoyed working at the home. Written comments included: "the home looks after the residents to a high standard. It tries to make them feel comfortable and helps the residents with any questions and worries." "The home always has a lovely happy family atmosphere" A health care respondent to the Commission`s survey said the following: "the staff communicate well respond to suggestions of management change for patients." The home provides individualised activities to enable service users to enjoy a full and stimulating lifestyle to meet their diverse needs. There are systems in place to ensure that the home is clean, pleasant, hygienic and the environment is appropriately maintained. Aids and adaptations are in place to promote independence. There are complaints policies and procedures in place and information is available to service users about local advocacy services. Staff have received training in the safeguarding of vulnerable adults and those spoken to said that they would report any concerns they had about service users` safety. What has improved since the last inspection? The home`s admission procedure has improved. No service user is admitted to the home unless they have been assessed by a senior member of staff using the revised pre-admission assessment form that informs the care plan. People are not admitted until the manager and senior members of staff are confident that the home can meet their identified needs and any appropriate equipment that maybe required is in place. Service users` care plans are now kept under regular review or as and when needs change. Those identified at risk have plans in place detailing how risks would be managed. The home has an ongoing programme for redecoration and refurbishment. One of the bathrooms has been converted into a wet room to promote service users` dignity and independence. The training matrix has been further developed and is more comprehensive detailing staff`s training needs and when updates are required. A named nurse system has been introduced to ensure accountability with the provision of care. What the care home could do better: Information recorded in the care plan documentation must be explicit, factual and free from jargons.This is to ensure that it is fit for purpose and service users and their relatives can understand what is written about them. The practice in place for maintaining service users` records such as fluid balance and turning charts must be completed fully by all staff to ensure there are clear with no gaps. The home must review its medication practice to ensure that service users receive their medication in a manner that is not intrusive and their dignity is not breached. Staff`s practice in the recording and administration of medication must be consistent to ensure that it complies with current best practice guidelines and promotes safety. The supervision framework must be consistently applied to ensure that all staff are supported to understand their roles to enable them to care appropriately for service users. Key inspection report Care homes for older people Name: Address: Mandeville Grange 201-203 Wendover Road Aylesbury Buckinghamshire HP21 9PB     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: Joan Browne     Date: 2 9 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 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 27 Information about the care home Name of care home: Address: Mandeville Grange 201-203 Wendover Road Aylesbury Buckinghamshire HP21 9PB 01296435320 01296397509 mcsmand@googlemail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mandeville Care Services Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 31. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Mandeville Grange Nursing Home is situated on the outskirts of Aylesbury Town, which provides a variety of shops and other local amenities. The home provides nursing care for up to thirty-one service users, who are accommodated on two floors of the building. All floors are accessible by stairs, a passenger lift or stair-lift. Registered nurses and carers staff the home. Care Homes for Older People Page 4 of 27 Over 65 31 0 2 3 1 0 2 0 0 9 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 unannounced key inspection was carried out on the 29 March 2010 and covered all of the key National Minimum Standards for older people. The inspection lasted for approximately nine hours. commencing at 09:30 am and concluding at 18:30 pm. The last key inspection on this service was completed on 23 October 2009. Prior to the inspection a detailed self assessment questionnaire known as the annual quality assurance assessment (AQAA) was sent to the manager for completion and surveys were sent to service users, staff and visiting professionals. The AQAA was returned by the due date and contained detailed information demonstrating how the home had listened to service users and their relatives and recognising the areas that it still needs to improve in and how it was planning to do this. Five service users, six staff members and a health care professional completed surveys and their replies have helped to form judgments about the service. The manager, deputy manager, staff members, service users and three relatives were also involved in the inspection Care Homes for Older People Page 5 of 27 process and their responses and views of the home have been incorporated into the report. Further information was gained by observing staffs practice, examination of care plan documentation, staffs records, and a tour of the premises. Feedback was given to the responsible individual and the manager on the inspection findings. There were no requirements made on this visit. This is because the home manager has been proactive and forwarded to the Commission the following day after the inspection an action plan detailing how the shortfalls identified would be addressed and monitored to ensure the safety and well-being of service users living in the home. We (the Commission) would like to thank service users, relatives and staff who made the visit so productive and pleasant on the day. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: Information recorded in the care plan documentation must be explicit, factual and free from jargons.This is to ensure that it is fit for purpose and service users and their relatives can understand what is written about them. The practice in place for maintaining service users records such as fluid balance and turning charts must be completed fully by all staff to ensure there are clear with no gaps. The home must review its medication practice to ensure that service users receive their Care Homes for Older People Page 7 of 27 medication in a manner that is not intrusive and their dignity is not breached. Staffs practice in the recording and administration of medication must be consistent to ensure that it complies with current best practice guidelines and promotes safety. The supervision framework must be consistently applied to ensure that all staff are supported to understand their roles to enable them to care appropriately for service users. 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 8 of 27 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 9 of 27 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. Service users needs and wishes are assessed before they move to the home. This is to ensure that the home can confidently meet their diverse needs and preferences. Evidence: The care files of four service users were examined. A pre-admission assessment was undertaken to identify their care needs and this formed the basis of their initial care plan which was developed when they moved to the home. A summary of the care management assessment was seen in the care plan documentation for those individuals referred through care management arrangements. Three relatives and one service user were asked about their experience when they moved to the home. The relatives confirmed that they had visited the home before their family member moved in and were made to feel welcome, shown around and had been given written information about the home. Four service users who returned a survey to us said that they had received enough information about the home to enable Care Homes for Older People Page 10 of 27 Evidence: them to decide if the home was right for them. However, one respondent could not remember. At the last key inspection the home was required to review its admission procedure. It is pleasing to report that the homes admission policy has been reviewed and the preadmission assessment documentation amended to ensure that prospective service users have a thorough pre-admission assessment and the home can be confident that it can fully meet individuals diverse needs. The AQAA informed that the home offers a settling in period of one month during which time both parties are able to assess the placement. During this period the service user will not be required to give the statutory one month notice should they wish to decide not to continue with the placement. The home does not provide intermediate care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has introduced a system which enables service users identified needs to be reviewed regularly and to provide staff with up to date information. Further improvement is needed to ensure that staffs practice in maintaining records relating to service users health and welfare is consistently followed to promote their safety and well-being. Evidence: The care of four service users was followed through. All had care plans in place which gave guidance to staff on the support individuals required and were updated monthly or as and when required. We noted that some family members were involved in the review of some care plans. The manager informed us that the home had introduced a system to ensure that the care plans were reviewed at least six monthly with service users and their relatives. To date fourteen care plans had been reviewed with relatives involvement. Three visitors spoken to during the visit confirmed that they had been involved in the review of their relatives care plan. The AQAA informed that the home operates a named nurse system with clear lines of responsibility and accountability and the named nurse was responsible for developing the care plan with Care Homes for Older People Page 12 of 27 Evidence: the service users and their relatives. We found that the content and style in some of the care plan documentation and daily progress sheets examined did not always comply with best practice guidelines. For example, tippex correction liquid was used to correct entries recorded in error. Some entries were scribbled over, written in jargon and were not always explicit. The manager was advised to review the practice of recording. This is to ensure that records comply with best practice guidelines to protect the welfare and safety of service users and to promote a high standard of record keeping. We were told that service users are registered with a local general practice and have access to the primary health care team such as, the physiotherapist, continence adviser, dietitian and the chiropodist. Each service user had been provided with a risk assessment relating to tissue viability, mobility, falls, nutriton, moving and handling and bed rails. Identified risks were supported with plans detailing how actual and potential risks would be managed. There were no service users on the day of the visit with tissue damage. The home now ensures that fluid balance charts and turning charts are maintained for service users that are cared for in bed. It was noted that staffs practice in maintaining the charts was not always consistent. For example, gaps were noted on the fluid balance charts and turning charts. The manager has been proactive to address the shortfall. Within twenty-four hours he submitted to the Commission an action plan detailing how he intends to remedy the shortfall to ensure improvement in the quality of the care provision. We spoke to a number of service users during the visit. They expressed satisfaction with their care. We also spoke to a health care professional who was visiting. The following comments were noted: staff communicate effectively and ensure that the treatments prescribed for service users are appropriately administered and request for medical intervention appropriately. A second health care professional who completed a survey said that the homes assessment arrangements always ensure that accurate information is gathered and that the right service is planned for. Service users social and health care needs are always properly monitored reviewed and met. We were told that there were no service users in the home that had been assessed as capable to self-medicate. We observed that medication was offered to some service users at the same time they were eating lunch. This practice appeared intrusive and distracting and should be reviewed to ensure that peoples dignity is maintained. Examination of the medication administration record (MAR) sheets identified no gaps. However, inconsistencies in staffs practice were noted. For example, handwritten entries on the MAR sheets were not countersigned by a second person to minimise the risk of error when transcribing. A particular medication was prescribed for an individual four times daily but was being administered three times daily because the Care Homes for Older People Page 13 of 27 Evidence: individual did not appear to require the fourth dose. The appropriate code was not being used to reflect this. In such an instance it is a good practice for staff to have the frequency of the medication reviewed by the general practitioner. It was noted that staff were using an inappropriate code when medication prescribed to be given when necessary (PRN) was not administered. The controlled drugs were checked and the balance in stock corresponded with the record. There was an audit trail of all medicines entering the home and those disposed of. Records reflected that two staff members signed for medication disposed of. The staff spoken to said that medication was never given covertly. If a service user did not wish to take their medication this would be recorded. If the medication was essential and the individual lacked capacity the doctor and family would be told and a way forward agreed. Service users were supported by staff to maintain their personal hygiene and to wear clothing of their choice. We observed staff speaking to individuals politely and gently. They were not seen to hurry them and gave them time to express themselves. No one was restrained and staff spoken to confirmed that medical examination and treatment were provided in the service users own room. Where service users had chosen to share a room, screening was provided to ensure that their privacy was not compromised when personal care was being given. The following comments were noted from a relative spoken to during the inspection: staff respect my mothers privacy and dignity. Since the last key inspection the home had reviewed its admission protocol for end of life care. The AQAA informed that within the service users documentation formal decisions regarding end of life care, such as advance directives, wishes and feelings, were recorded. There was no one in receipt of end of life care on the day of the visit. The manager told us that the home was in the process of adopting the Liverpool care pathway plan for end of life and palliative care. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an activity programme in place which means that individualised and meaningful activities are provided to service users. Contact with family members is encouraged. Meals and snacks are provided at regular intervals. Evidence: The home employs an activity person to co-ordinate the activity programme. A four week activity programme was displayed on the notice board to enable service users and their relatives to be aware of what was on offer. We were told by the activity person that the programme was flexible and service users request for change was always granted. Activities provided included board games, crosswords, reminiscence, ball games and quizzes. A music to movement session is facilitated weekly by an outside facilitator and a therapist visits the home weekly and provides hot stones treatment and nail care. A pet as therapy (PAT) dog visits every other week. Inhouse entertainment such as pantomines and singalongs are provided. A church service is held once a a month to enable individuals who wish to promote their spiritual needs to do so. We were told that each service users birthday is celebrated with a home-made cake and relatives and friends can participate if they wish to. The AQAA informed that more one to one sessions are provided to service users who were unable to join in with group activities. The activity person confirmed that she provides one to one Care Homes for Older People Page 15 of 27 Evidence: activities to service users who are not able to participate in group activities. Service users who returned a survey to us said that the home arranges activities that they can take part in either always (4) or sometimes (1) Relatives spoken to during the inspection said that the homes staff always make them feel welcome and provided them with refreshments. Service users are made aware of their rights to bring bring personal possession such as, small pieces of furniture, television and family pictures if they wish to personalise their bedrooms. The home provides three meals daily with snacks and drinks throughout the day and night. We observed jugs of fruit juices with glasses were placed in the lounges whilst service users were present and staff were seen offering drinks to service users. Special diets such as diabetic or vegetarian are catered for. Service users who returned a survey to us said that they liked the meals provided either always (2) or usually (3). Those spoken to during the visit said that the food was very good and they enjoyed most meals. Staff were observed assisting those service users who needed assistance in a sensitive and unhurried manner. We were told that if service users did not like what was on offer an alternative would be provided. Care Homes for Older People Page 16 of 27 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. The home has a complaints and safeguarding policy in place. This should ensure that service users would be confident that their complaints would be investigated and the appropriate action taken to protect them from any potential risk of harm or abuse. Evidence: The homes complaints procedure was displayed in the home. Service users who returned a survey to us said that they were aware of the homes complaints procedure. All staff who returned a survey to us said that they knew what to do if anyone had any concerns about the home. Three relatives spoken with during the visit said that they had never had the need to make a complaint but were confident if they had to, it would be responded to appropriately. The home had received one complaint since the last key inspection and the action taken in response to it was fully recorded. The Commission was made aware of the complaint for information by the complainant. The home has a safeguarding of vulnerable adult policy which incorporates Buckinghamshire County Council safeguarding protocol.The AQAA informed that the home provides a rolling programme of safe guarding of vulnerable adult training for all staff. A staff member spoken with at the inspection visit described appropriately the action they would take if they suspected that a service user was the victim of abuse. The home has had two safeguarding referrals which the Commission was aware of. The referrals had been investigated and one investigation remains outstanding. The home has been co-operating fully with the outstanding investigation and lessons have Care Homes for Older People Page 17 of 27 Evidence: been learnt to improve the service delivery. For example, the manager has reviewed the homes admissions procedures. Protocols relating to emergency calls during the night and do not attempt resuscitation (DNAR) have been developed. Care Homes for Older People Page 18 of 27 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. The standard of the environment within the home is satisfactory. This means that service users are provided with a homely clean, comfortable, pleasant and hygienic place to live to promote their diverse needs and independence. Evidence: The building is an Edwardian house with an extension providing a variety of rooms for service users. The sitting room and dining area are situated on the ground floor and the standard of decor and furnishings were satisfactory. The grounds were tidy, attractive and accessible to service users. There is a patio area with seating and an awning, which provides space for service users to sit out weather permitting. There is an ongoing maintenance and refurbishment plan to ensure that the standard of decoration and furnishing is appropriately maintained. The AQAA informed that the homes manager undertakes a monthly maintenance audit and areas identified as requiring attention is referred to the maintenance person. Service users are encouraged to personalise their bedrooms and some rooms seen were personalised with family photographs and mementos. Bathrooms and toilets were fitted with the appropriate aids and adaptation to promote independence. It was noted that the shower facility in the home had improved with the installation of a shower/ wet room on the first floor. Care Homes for Older People Page 19 of 27 Evidence: Generally the home was presented as clean, pleasant, and free from offensive odours on the day of the visit. The AQAA informed that staff were trained in infection control and the training matrix demonstrated that staff had undertaken training in infection control. Service users have their own hoist slings and bed sliding sheets if they need them. The laundry is separate from the kitchen area and the washing machines have suitable disinfection programmes to wash soiled laundry. The manager said that arrangements were being made to install an overhead airer in the laundry room. We were told that there was a quick return of service users personal laundry and the walls in the laundry room were recently re-painted. Staff were observed wearing protective clothing and gloves when carrying out personal care. Antiseptic hand gel solutions were situated in areas of the home for staff and relatives to use to minimise the risk of cross infection. Service users who returned a survey to us said that the home was fresh and clean either always (4) or usually (1). Relatives spoken to were complimentary about the standard of hygiene in the home. The following comments were noted from a relative: I visit at different times and I always find my mothers room clean and tidy. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skill mix of staff on duty ensures that service users are appropriately supported to promote their well-being. Recruitment and vetting procedures are effectively applied to minimise the risk to service users of inappropriate staff being employed. Evidence: The home employs a multi-cultural staff team. The rota reflected that the staffing numbers and skill mix of staff were appropriate to meet service users assessed needs for any twenty-four hour period. Domestic staff were employed in sufficient numbers to ensure that the home is maintained in a clean and hygienic state. Response to surveys were complimentary about the staff. Comments included the following:staff care for the residents extremely well. The nursing and care staff are friendly and pleasant. The home cares for my mother very well shes happy and well cared for. A relative spoken to said that the staff were like extended family members and were always smiling. Staff who completed a survey and those spoken with during the inspection visit said that they enjoyed working at the home and appreciated the support they receive. Written comments included the following:the home has a lovely happy family atmosphere which is commented on by visitors, prospective residents and other health professionals. Care Homes for Older People Page 21 of 27 Evidence: The manager confirmed that 77 of the care staff have a nationally recognised qualification in care - national vocational qualification (NVQ) at level 2 or above. The AQAA informed that all staff are inducted on commencement of employment and are required to attend mandatory training and regular updates. The induction sheets for two staff members were not fully completed. The home must make sure that induction sheets are fully completed and they are signed for by staff to confirm that they understand the topics discussed. The AQAA informed that new staff were subject to thorough recruitment checks. All staff who returned a survey to us said that pre-employment checks were carried out. We looked at the recruitment file for a staff member recently recruited. The file contained the required documentary evidence of employment history, references and criminal record bureau (CRB) disclosure. The AQAA stated that all staff working in the home complete mandatory training applicable to their role which include safeguarding of vulnerable adults, manual handling, infection control, fire safety, infection control, food hygiene, first aid, COSHH and safe handling of medication. Training is on a rolling programme and is ongoing. We observed that dates of planned training such as, moving and handling fire awareness and diversity and cultural awareness were displayed on the notice board in the office for staff to be aware what training they were nominated to attend. Care Homes for Older People Page 22 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home aims to provide a good service but inconsistencies in staffs practice to maintain records appropriately could put service users at risk. The supervision framework needs to be consistently followed to ensure that all staff are supported to understand their roles to enable them to care appropriately for service users. Evidence: The manager was appointed in October 2009. He is a registered general nurse and holds the ENB certificate in accident and emergency. He has a certificate in management and has managed staff in a hospital setting. He has started the registration process with the Commission. Staff spoken with said that the manager was approachable and operated an open door policy. The AQAA informed that regular staff meetings take place where staff can air their views. Staff spoken with confirmed that regular staff meetings take place and a list of planned staff meetings was displayed in the office. The AQAA stated that each service user is sent an annual satisfaction questionnaire so Care Homes for Older People Page 23 of 27 Evidence: that the home can monitor what they are doing well. At the time of this visit the outcome on the user satisfaction questionnaire was not available to be looked at. However, since the last key inspection the manager has introduced a monitoring system to ensure that care plans are reviewed regularly or as and when individuals needs change. The home has also reviewed its admission and end of life procedures. Protocols relating to emergency medical treatment during the night, re-admission of a service user after a period of more than twenty-four hours in hospital have been introduced. The homes do not attempt resuscitation (DNAR) protocol has also been reviewed in line with the royal college of nursing and british medical association guidelines. Measures have been put in place to promote service users safety and welfare but further work is needed to ensure that staff practice is consistent when maintaining records such as, medication sheets, fluid balance and turning charts to ensure that there are no gaps and entries are clear. The homes financial policy and procedures ensures that service users money is protected. The AQAA informed if the service user does not want to or is unable to manage their finances the home can assist by appointing an enduring power of attorney with the involvement of the social worker and advocate. The AQAA informed that supervison and staff appraisasl are carried out regularly. From disucssions with staff and examination of records it became apparent that the frequency of supervision was not consistent. Since the inspection the manager has sent us an action plan detailing how this shortfall would be addressed. An allocated list of staff supervision has been introduced to ensure accountability and at least 10 of the supervision summary sheets will be checked monthly. All sections of the AQAA were completed and the information gave us a satisfactory picture of the developments in the home and ways in which the home intends to develop and improve in the next twelve months. The AQAA informed that all routine health and safety and maintenance checks were carried out on equipment in the building. Records relating to risk assessments of the premises were looked at and presented as being appropriately maintained. We were told that the recent environmental health officers vist showed that food hygiene standards were good. Care Homes for Older People Page 24 of 27 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 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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