Care Home: Mansion House Nursing Home

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What the care home does well People`s needs are properly assessed before they move into the home. One person who recently moved into the home told us they had settled in well and are happy living at the home. Two relatives were very satisfied with the admission process and said the home had been `brilliant because they had sorted things out when it was an emergency`. People who live at the home told us their daily routines are flexible. One person said, "I like going to bed at 11 o`clock. Staff know this and always make sure I go at the right time." Another person said, "Staff ask me when I`m ready to go to my bedroom because they know I watch my television on a night." One person said, "The staff all muck in and look after us". Two visitors told us the care is excellent. One person said, "I would move in when I`m older." The staff we spoke to knew the people who live at the home well, and talked about their routines, families and friends, likes and dislikes. Staff thought the home was good because it is small so people get to know `each other`. One staff said, "It`s really homely." Another staff said, "It`s very friendly." The records have good information about healthcare appointments and show people are receiving regular input from healthcare professionals. They also cover routines, and eating, drinking and sleeping patterns. This is good practice because people`s health and welfare can be properly monitored. What has improved since the last inspection? At the last inspection we asked the provider to make some improvements to the environment. They have made the recommended improvements and carried out further improvements, which includes redecoration, and new flooring, furniture and carpets in one unit. Redecoration and new furniture in the lounge, dining room and corridors of the other unit. Bathrooms are being refurbished and the area manager responsible for the environment said the bathrooms should be completed in the next three/four months. Some bedrooms have also been decorated. People who live at the home, staff and management said the environment has improved in the last year. What the care home could do better: The home`s statement of purpose could contain more up to date information. This will make sure people receive the right information to help them choose where to live. Care plans could be further developed to make sure people`s needs are clearly identified. This will help make sure people`s needs are recognised and met. Privacy and dignity could be further promoted in the home. This will help make sure people`s rights, privacy and dignity are maintained. People who live at the home could be offered more daily activities. This will give people a more stimulating and fulfilling lifestyle.The quality and satisfaction of meals could be more closely monitored. This will make sure people receive good quality meals. The registered person could make sure recruitment practices are robust. This will help make sure people who live at the home are protected. Staffing levels could be more closely monitored. This will help make sure there are sufficient staff to meet people`s needs. Several people raised concerns about recent changes to the staffing compliment. One person who was staying at the home said `carers are too busy`,`staff are running around` and `there are not enough staff`. The training matrix could be kept up to date so staff training needs are identified. This will help make sure staff training needs are met. The home could continue working towards achieving a higher percentage of care staff that hold an NVQ level 2 in health and social care. The manager could have more time to carry out her role and responsibilities. This will make sure the home is well managed. Staff could receive more regular supervision. This will help staff development and make sure they understand the home`s aims and objectives. Key inspection report Care homes for older people Name: Address: Mansion House Nursing Home 164 Main Road Drax Selby North Yorkshire YO8 8NJ     The quality rating for this care home is:   two star good 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: Carol Haj-Najafi     Date: 2 4 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Mansion House Nursing Home 164 Main Road Drax Selby North Yorkshire YO8 8NJ 01757618659 01757618659 mail@rochehealthcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Roche Healthcare Limited care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: 1. The registered person may provide personal care with nursing and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories:- OP 13, DE 16, PD 1. 2. The maximum number of service users to be accommodated is 29 Date of last inspection Brief description of the care home Mansion House is a care home registered to care for up to 29 service users over 65 years of age who require nursing care. The service is provided in a detached house built on two floors; the upper floor is serviced by a vertical lift. There are 23 single rooms and 3 two bedded rooms the majority of which are en-suite. The home is set in well-kept and accessible grounds located in the village of Drax. The home is close to local shops. At the inspection in July 2009, the manager told us the fees range from Care Homes for Older People Page 4 of 30 Over 65 16 13 1 16 13 1 Brief description of the care home £375.77 to £675.00. Information about Mansion House, including the last inspection report and up to date fees is available at the home. The homes Statement of Purpose and Service User Guide is available on request. Care Homes for Older People Page 5 of 30 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection was carried out in July 2007. 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 significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before this visit we reviewed the information we had about the home and the manager completed an annual quality assurance assessment (AQAA). The AQAA provides us with information about the home and tells us what has happened in the last twelve months. We used this information to help us decide what we should do during our inspection visit. Surveys were sent out to people who live at the home and other people who have an Care Homes for Older People Page 6 of 30 interest in the service. We received surveys from three people who live at the home and one staff. Comments from the surveys have been included in the report. An inspector was at the home for one day from 10:00am to 6:45pm. We spoke to five people who live at the home, two visitors, five staff, two area managers and the registered manager. We looked around the home, and looked at care plans, risk assessments, daily records and staff records. We spent a total of 8.75 hours at the home. Feedback was given to the registered manager and an area manager at the end of the visit. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The homes statement of purpose could contain more up to date information. This will make sure people receive the right information to help them choose where to live. Care plans could be further developed to make sure peoples needs are clearly identified. This will help make sure peoples needs are recognised and met. Privacy and dignity could be further promoted in the home. This will help make sure peoples rights, privacy and dignity are maintained. People who live at the home could be offered more daily activities. This will give people a more stimulating and fulfilling lifestyle. Care Homes for Older People Page 8 of 30 The quality and satisfaction of meals could be more closely monitored. This will make sure people receive good quality meals. The registered person could make sure recruitment practices are robust. This will help make sure people who live at the home are protected. Staffing levels could be more closely monitored. This will help make sure there are sufficient staff to meet peoples needs. Several people raised concerns about recent changes to the staffing compliment. One person who was staying at the home said carers are too busy,staff are running around and there are not enough staff. The training matrix could be kept up to date so staff training needs are identified. This will help make sure staff training needs are met. The home could continue working towards achieving a higher percentage of care staff that hold an NVQ level 2 in health and social care. The manager could have more time to carry out her role and responsibilities. This will make sure the home is well managed. Staff could receive more regular supervision. This will help staff development and make sure they understand the homes aims and objectives. 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 30 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 30 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. Peoples needs are properly assessed before they move into the home, which makes sure their needs are known and could be met. Evidence: We talked to one person who had recently moved into the home, and two relatives who helped a person move into the home. The person who recently moved into the home told us they had settled in well and are happy living at the home. The relatives were very satisfied with the admission process and said the home had been brilliant because they had sorted things out when it was an emergency. Surveys from people who live at the home told us some people received enough information about the home before they moved in but some felt they had not received enough information about the home. One survey said the information in the homes brochures was not up to date. The area manager checked the homes statement of purpose and accepted that some information was out of date. The management team Care Homes for Older People Page 11 of 30 Evidence: said they are introducing a new service user guide which will provide clearer information about the service. In the AQAA the manager explained the process they follow before people move into the home. This includes arranging visits to the home and completing assessments to make sure the needs of the service user can be met and to allow the home to prepare for the admission. We talked to the registered manager who is generally responsible for co-ordinating admissions to the home. She said they only admit people after their needs have been assessed by the home or a social or healthcare professional. We looked at two peoples assessment records. They had detailed assessments that were completed before the person moved into the home. The assessments contained good information about the type of support they required. The information from the assessments had been transferred into the persons care plan. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main, people who live at the home are treated with dignity and respect, and their individual needs are recognised and met. Development of care planning processes will make sure peoples needs are not overlooked, and further promotion of privacy and dignity will make sure everyone fully recognises the importance of valuing good care principles. Evidence: We talked to people who live at the home and looked at survey responses. We received mixed feedback. Some people said they are happy with the care; others thought the home could improve some aspects of the care. Several people said the staff are nice. One person said, The staff all muck in and look after us. Another person said, The home has improved in most areas over the year. Concerns were raised about some care practices and staffing levels. One person said, When people are brought back to bedrooms their needs could be catered for, buzzer in hand, TV on if desired. Several people said staff do not have enough time to spend Care Homes for Older People Page 13 of 30 Evidence: with people who live at the home. One person said, The atmosphere is upsetting for residents and carers are asked to do duties such as laundry and cooking. One person who was staying at the home was very upset and said carers are too busy,staff are running around and there are not enough staff. They also said they had been left on the toilet for a long time. The area manager was present during this discussion and agreed to meet with the person again to monitor the situation. A few days after the inspection we received an e mail from the area manager confirming the person was feeling much better, staff are attending to them promptly and they are happy with the care they are receiving. We have covered staffing issues in more detail under the staffing section of the report. We spoke to two visitors. They told us the care is excellent. One person said, I would move in when Im older. We talked to five staff. They all knew the people who live at the home well, and talked about their routines, families and friends, likes and dislikes. Staff thought the home was good because it is small so people get to know each other. One staff said, Its really homely. Another staff said, Its very friendly. In the AQAA the registered manager said peoples privacy and dignity are promoted and they plan to further promote and implement good practice from the dignity challenge campaign in the next twelve months. Staff talked about promoting privacy and dignity and gave us examples of how they do this. One person said they have sometimes observed staff assisting people to get undressed in the bedroom but have not closed the door. Part of the day was spent talking to people and observing the care being given to people. This included how staff interact with people at the home. Staff treated people with respect and they were kind and courteous. The general appearance of people who live at the home was good, they were dressed appropriately and attention had been given to their personal care. For example, peoples hair had been brushed and their glasses, shoes and clothing were clean. Staff record important information about peoples health and welfare. The records have good information about healthcare appointments and show people are receiving regular input from healthcare professionals. They also cover routines, and eating, drinking and sleeping patterns. This is good practice because peoples health and Care Homes for Older People Page 14 of 30 Evidence: welfare can be properly monitored. People who live at the home said they are happy with the support they get with healthcare. Management and staff told us the home works very well with healthcare professionals. We looked at three peoples care plans and assessments. These were well organised. Some information in the care plans was good and gave sufficient information about potential risks and how individual needs should be met. One care plan stated that the person likes to have milk when staff administer their medication. The person told us the care plan is always followed. Other information in care plans was vague and didnt really explain how the persons needs should be met. One care plan said, ensure privacy and dignity is maintained and another care plan said, if hot reduce clothing. This guidance is about care practice and should always be followed for everyone living at the home. Some information was missing from care plans. Three staff told us one person did not like getting in the bath and got upset. The persons care plan said offer bath at least once a week and gave no other information. Staff described one persons communication. They said the person can understand what people are saying but get muddled with their words when they are talking. The persons care plan gave no specific information about communication. A range of risk assessments have been completed, and these identify the level of risk. Each assessment has been regularly reviewed. The care plans and assessments are generally completed by qualified staff but care staff are being encouraged to get more involved. The manager said they are continuing to develop involvement which will help improve the care planning process. We looked at medication systems, checked storage of medicines and counted some medicine stock. These were all correct and showed us systems are in place to make sure the right medication has been administered. Care Homes for Older People Page 15 of 30 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. Routines are flexible which meets peoples individual preferences. People enjoy organised outings but would benefit from more stimulation on a day to day basis. This would help make sure people have a more varied lifestyle. Evidence: People who live at the home told us they have flexible routines at the home. One person said, I like going to bed at 11 oclock. Staff know this and always make sure I go at the right time. Another person said, Staff ask me when Im ready to go to my bedroom because they know I watch my television on a night. We spoke to two relatives. They told us they can visit anytime and receive important information about their relative who lives at the home. In the AQAA the registered manager said, From the date of admission a map of life is completed, with the assistance of relatives and friends. Details are incorporated into care plans and used for reference. We looked at four peoples files. Two had a map of life that provided information about personal histories. Two files had blank maps of life. One of the people had been at the home for four weeks, the other person had been at the home just over three weeks. Care Homes for Older People Page 16 of 30 Evidence: People who live at the home and staff generally thought the level of activities should improve. Some people who live at the home said they would like more to do on a daily basis. The home organises outings and people said they enjoy the trips out. The homes activity organiser has left and the management team said they are hoping to recruit one shortly. Staff said generally they do not have sufficient time to spend quality time with people. We looked at activity records but these did not show that people are involved in regular activities. For example the last recorded activity for one person was more than three weeks before the inspection. The management team acknowledged that the the activity programme could be improved but also felt that staff dont always recognise that when they engage with people who live at the home this is a form of activity They gave examples of chatting, reading papers and watering plants with people. Menus are displayed in the home. We looked at these but they did not match what meals were being provided. The area manager said that they were changing the menus but the new menus had been put on the notice board before they had been introduced. The new menus offer choice and are nutritiously balanced. We got a mixed response when we asked about meals. Some people said they were good; others said they did not think the quality of food was good. On the day of the inspection people had pie for lunch. Some struggled to eat the pastry because it was very hard. One person who was not satisfied with the meals said meat was sometimes tough and they had difficulty eating just a couple of days ago. One staff confirmed people had made comments about the meat. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are safeguarded. They will be listened to and appropriate action will be taken when necessary. Evidence: In the AQAA the manager said, The home has a robust complaints and comments policy and procedure which is made available to service users, relatives and advocates. Complaints are taken seriously and acted upon within the determined timescales. Recommendations made from complaints are actioned to promote service improvement. The complaints procedure was displayed in the entrance when we looked around the home. People who live at the home told us they talk to their relatives or staff if they are unhappy. Two surveys from people who live at the home told us there is someone they can talk to if they are not happy and they know how to make a formal complaint. One survey said they didnt know how to make a complaint. Staff told us they know what to do if someone has concerns about the home. In the AQAA the manager told us, Protection of Vulnerable Adults training is provided on induction with annual updates thereafter. Staff we spoke to were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They said they would report any concerns to the management team and they were confident they would deal with them promptly and appropriately. Care Homes for Older People Page 18 of 30 Evidence: Since the previous key inspection visit there has been one safeguarding referral. This was dealt with appropriately Care Homes for Older People Page 19 of 30 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. People live in a clean, safe and comfortable environment. Evidence: We looked around different areas of the home, all of which were clean and tidy. People told us the home is usually fresh and clean. At the last inspection we asked the provider to make some improvements to the environment. They have made the recommended improvements and carried out further improvements, which includes redecoration, and new flooring, furniture and carpets in one unit. Redecoration and new furniture in the lounge, dining room and corridors in the other unit. Bathrooms are being refurbished and the area manager responsible for the environment said the bathrooms should be completed in the next three/four months. Some bedrooms have also been decorated. When we looked around we noted that a bath chair was cracked which could pose a risk to anyone using the chair. During the day the area manager arranged for the chair to be replaced and said this would happen the following day. People who live at the home, staff and management said the environment has improved in the last year. Care Homes for Older People Page 20 of 30 Evidence: We received a comment that a staff smoking area should be allocated that is away from the main entrance and dining room. The manager confirmed this had been addressed and the allocated smoking area is more discreet. We did not see any discarded cigarette ends or notice staff smoking during our visit. The home is set in pleasant grounds and these are kept in a good condition. People use the garden and sunbathe outside the lounge patio doors. Access to the grounds is provided by means of ramps, to allow wheelchair access. An environmental health officer visited the home in January 2009 and found that there were no significant problems at their visit. Health and safety checks and maintenance is undertaken to ensure that peoples health and safety is protected. Clinical waste is properly managed and staff wear protective clothing when attending to the personal care needs of people who live at the home. Hand wash facilities are available throughout the building and at the entrance of the home hand sanitising gel is available. This ensured that infection control is maintained. Care Homes for Older People Page 21 of 30 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. People who live at the home are supported by a suitably trained staff team but training records should be up dated to make sure there are no gaps. Staff do not always have sufficient time to spend quality time with people who live at the home. Recruitment process are not robust which does not safeguard people who live at the home. Evidence: People who live at the home said staff usually listen to what they say. People said staff are nice but raised concerns about staffing levels. People who live at the home and staff raised concerns about recent staffing changes. The organisation has reduced the staffing compliment but explained that it was a planned process, and the home has a number of empty beds so less staff are required. The area manager explained that the staffing changes have recently been introduced and as an organisation they would closely monitor this and keep staffing levels under review. The home no longer employs an administrator or laundry worker, and has reduced the Care Homes for Older People Page 22 of 30 Evidence: number of catering hours. At the time of the inspection the activity organisers post was vacant but they were trying to fill this vacancy. As stated in the Health and Personal care section of this report one person was upset and said there are not enough staff. Concerns were raised about staffing levels in two of the surveys from people who live at the home. Some staff also said they thought the staffing levels were not adequate and were concerned that care staff are now carrying out other tasks such as laundry and cooking which reduces the amount of care hours. One staff said, It all falls on the carers shoulders. The management team said the home operates with four care staff from 8am until 7pm, and three care staff from 7pm to 8pm. We looked at staffing levels and generally four care staff were working between 8am and 7pm although occasionally only three staff were working for parts of a shift. The manager said this was because they had few staff to call on to cover the extra shifts. We received some positive feedback from staff about what the service does well. Staff told us the team generally works well together. One person said, I couldnt wish to work with better people; service users and staff. Staff told us they receive good training. They said they receive training that is relevant to their role, and helps them understand and meet the needs of people living at the home, and keeps them up to date with new ways of working. A training manager co-ordinates training packages and makes everyone aware of the training on offer. We looked at training records. Individual staff files showed us that staff had received regular training. The home has a training matrix but this was not up to date so it was not possible to tell if staff had received all the relevant training. The area manager started working on the training records during our inspection and said these would be updated shortly. In the AQAA the registered manager told us, Training is provided to give staff the underpinning knowledge to perform their job role safely and within the homes policies and procedures as well as national guidelines. The registered manager said five staff out of fourteen staff hold an NVQ level 2 certificate or above and three staff are registered to complete the award. Eleven staff Care Homes for Older People Page 23 of 30 Evidence: have completed an NVQ level 2 in Dementia Care. In the AQAA the registered manager said, Recruitment procedures are robust to ensure the services users are supported and protected by new staff employed by the Home. Previous employment history is thoroughly checked and CRB and POVA obtained for all new starters. We looked at the recruitment process for two people who have recently started working at the home and found that pre employment checks were incomplete. Both files had application forms that were singed by the applicant. Neither files had a full employment history. One person had written worked at residential home but did not give details of the home. At interview, employment history was discussed and notes were written by the interviewer but this did not cover all employment. References were obtained but these were not from the most recent employee. The area manager showed us a draft copy of their new recruitment checklist that is being introduced which will help make sure recruitment processes are robust. The manager said she tries to interview with two people on the panel but had not achieved this during the last recruitment process and had interviewed on her own. Equal opportunities good practice guidance recommends that two people should be involved in the recruitment process. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed. Recent changes have resulted in the manager having less time to carry out her management tasks, which could affect the overall management of the home. Evidence: In the AQAA the manager said, The Home is managed by an experienced and competent manager who has the ability to lead the teams. The manager is registered with CQC and is a qualified nurse. The manager told us she will complete a Leadership and Management award Level 4 in the next twelve months. The manager told us the home gets good support from senior management. On the day of the inspection two area managers were at the home. These were pre arranged visits. As stated in the previous section of the report, the organisation has introduced some changes to the staffing compliment. In addition to the changes listed previously the Care Homes for Older People Page 25 of 30 Evidence: registered manager has less hours to carry out specific management tasks because she is now working 12 hours on shift which has resulted in the manager working extra hours. Senior management are aware of this. Management should also be monitored closely to make sure the manager can carry out her role and responsibilities. People told us they are generally happy with the management of the home although concerns were raised about the recent changes. One staff said, Its well managed; they make sure its a good home. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA gave us some very good information about the service. It gave us good examples of what they do well, how they have improved and what they want to do better. They also told us about changes they have made as a result of listening to people who use the service. The manager said generally they do not hold monies on behalf of people who live at the home. Sometimes families leave a small amount of cash. Purchases are recorded and receipts are obtained. When we asked staff about supervision and support, staff said they received support from the management team although they did not receive formal supervision at least six times a year. The manager said she is developing systems for making sure staff receive more regular supervision, and has started by doing an annual appraisal with staff. We looked at staff records and the majority of staff had attended a recent appraisal, and some had also received a supervision session. In the AQAA the manager told us they have all relevant policies and procedures in place, and equipment has been tested as recommended by the manufacturer. No concerns around safe working practices were seen on the day of the inspection. Care Homes for Older People Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 18 The registered person must make sure recruitment practices are robust. This will help make sure people who live at the home are protected. 30/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The homes statement of purpose should contain up to date information. This will make sure people receive the right information to help them choose where to live. Care plans should be developed to make sure peoples needs are clearly identified. This will help make sure peoples needs are recognised and met. Privacy and dignity should continue to be promoted in the home. This will help make sure peoples rights, privacy and dignity are maintained. People who live at the home should be offered more daily activities. This will give people a more stimulating and fulfilling lifestyle. Quality and satisfaction of meals should be more closely Page 28 of 30 2 7 3 10 4 12 5 15 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations monitored. This will make sure people receive good quality meals. 6 27 Staffing levels should be more closely monitored. This will help make sure there are sufficient staff to meet peoples needs. The home should continue working towards achieving a higher percentage of care staff that hold an NVQ level 2 in health and social care. The training matrix should be kept up to date so staff training needs are identified. This will help make sure staff training needs are met. The manager should have sufficient time to carry out her role and responsibilities. This will make sure the home is well managed. Staff should receive more regular supervision. This will help staff development and make sure they understand the homes aims and objectives. 7 28 8 30 9 31 10 36 Care Homes for Older People Page 29 of 30 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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