Care Home: Marmora Residential Home

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What the care home does well Information given to prospective residents was good and helped them make choices about their admission. The process of admission included a thorough assessment process that ensured that the home was clear about the individuals needs and that the service had capacity to meet these. This ensures that admissions are well planned and that the resident can be confident that the home will meet their needs. The care planning documentation introduced after the last inspection at the last inspection in 2009 had been embedded into the way in which the home understood residents daily routine, and provided staff with a good understanding of how they should support the individual during their day. The staff complete care plans that set out instructions for staff in meeting people`s needs. There is a greater emphasis on the resident as a whole in both the care plans and the staffs recording of the resident`s daily lives. The development of this tool is ongoing and the manager and staff demonstrated a good understanding of how the quality of information could be improved to benefit residents and staff in delivering care although some suggestions were made to enhance this further. The service offers individualised support to residents and encourages independence and the development of personal life skills in comfortable, homely surroundings. The residents spoken with were proud of the home and the way of life it provided them with, and appreciated the choices in how they spent their day and the opportunities for activity and stimulation. The premises are generally clean and homely. They provide a comfortable environment for the people living there. People are able to personalise their rooms. The service maintains and reviews all policies and procedures in a clear, tidy format that are easily accessed and readily available. Other required documents are also well stored and maintained. What has improved since the last inspection? The requirements and suggested recommendations made at the key unannounced inspection in 2009 had been addressed at this inspection. People moving into the service now have all their needs, strengths and aspirations documented. This ensures that the service is fully aware of these and how they will support them before they agree to the admission. The management team have developed care plans and risk assessments. Each person now has a comprehensive plan of care which is person centred and indicates the assistance required to aid the person`s predominant needs such as physical, social and healthcare needs. These correlate with the daily evaluations to ensure all service users individual care needs are met and that staff are aware of these needs. A clearly documented staff rota is available showing the designation of staff, their names and the person in charge. The programme of activities is continually being developed to ensure that each individual living in the home receives the stimulation they need to have an interesting and fulfilled lifestyle. The home now has a formal recording system in place for complaints that clearly evidence their processes and records not just the complaint but the actions taken and the outcome with dates. Staff rotas and staff numbers are representative of the home staffing requirements and dependency levels, showing contracted hours worked, names and designations, person in charge and NVQ qualifications. This will ensure there are sufficient staff on duty to meet individual care needs with no time constraints. What the care home could do better: No requirements were made at this inspection and only three recommendations were made. Any transcribed medications must be clearly documented with evidence of two signatures to ensure the risk of medication errors being made are reduced. The specific recording of social care activities and one to one interactions in care plan documentation would ensure peoples choices were sought and that their individual social care needs were being met. The quality of information provided to the Commission in the Annual Quality Assurance Assessment should support the understanding of how the service is complying with their responsibilities under the Care Standards Act 2000 and what steps they are taking in order to improve the outcomes for people living at the service. Key inspection report Care homes for older people Name: Address: Marmora Residential Home 4/6 Penfold Road Clacton On Sea Essex CO15 1JN     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: Helen Laker     Date: 2 8 0 4 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 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 28 Information about the care home Name of care home: Address: Marmora Residential Home 4/6 Penfold Road Clacton On Sea Essex CO15 1JN 01255422719 01255423830 kcarson@fsmail.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Salsar Ltd Name of registered manager (if applicable) Mrs Glenda Wadsworth Type of registration: Number of places registered: care home 27 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 who can be accommodated is: 27 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Marmora is an older style detached property situated very close to the sea front in Clacton and within walking distance of all local amenities and the town centre. There is parking available to the front of the property and well-maintained attractive gardens to the rear. The home provides care and accommodation for up to 27 people mostly in single Care Homes for Older People Page 4 of 28 Over 65 27 0 0 8 0 7 2 0 0 9 Brief description of the care home rooms, with the exception of 2 double rooms. Accommodation is provided on three floors, with access to the upper floors by means of a passenger lift and stairs. Communal areas include two pleasant lounges and dining rooms. The home charges between 390.39 pounds and 450.00 pounds per week with additional charges for hairdressing or chiropody services and for personal items such as newspapers, sweets and outings. This information was provided to us in July 2009. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 quality rating for this home is two star. This means that people who use this service experience good quality outcomes. This key unannounced inspection looking at the core standards for care of older people and took place on a weekday between 10:00 and 16:00. The proprietor, registered manager and staff were available on the day of inspection and assisted with the inspection process by supplying records and information. This report has been compiled using information available prior to the visit such as surveys sent out, evidence found on the day of inspection and the annual quality assurance assessment (AQAA), which is required by law and is a self assessment completed by the service. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some progress be noted as this contributes to the inspection process and indicates the homes understanding of current requirements, legislation changes and own audited compliance. This document will be referred to as the AQAA throughout the report. This Care Homes for Older People Page 6 of 28 inspection looked at the quality of information given to people about the care home and whether people experience open and fair conditions of care. The findings of that inspection have been incorporated into this report along with any updated information in respect of the issues considered. During the day the care plans and files for four of the residents were seen as well as three staff files, the policy folders, the medication administration records (MAR sheets), some maintenance records and the fire log. The manager also supplied a copy of the duty rota, the menus, and other pertinent documentation which was required. A tour of Marmora was undertaken and six residents and three members of staff were spoken with. The home was clean and tidy offering homely accommodation to the resident. The residents seen were relaxed and clearly felt at home in the environment using all areas of the building. All the records and files were well maintained and easily accessible. Interactions between staff and residents were friendly and appropriate. Feedback on findings was given during the visit with the opportunity for discussion or clarification. The inspector would like to thank the proprietor, manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? The requirements and suggested recommendations made at the key unannounced inspection in 2009 had been addressed at this inspection. People moving into the service now have all their needs, strengths and aspirations documented. This ensures that the service is fully aware of these and how they will support them before they agree to the admission. The management team have developed care plans and risk assessments. Each person now has a comprehensive plan of care which is person centred and indicates the assistance required to aid the persons predominant needs such as physical, social and healthcare needs. These correlate with the daily evaluations to ensure all service users individual care needs are met and that staff are aware of these needs. A clearly documented staff rota is available showing the designation of staff, their names and the person in charge. The programme of activities is continually being developed to ensure that each individual living in the home receives the stimulation they need to have an interesting and fulfilled lifestyle. The home now has a formal recording system in place for complaints that clearly evidence their processes and records not just the complaint but the actions taken and the outcome with dates. Staff rotas and staff numbers are representative of the home staffing requirements and dependency levels, showing contracted hours worked, names and designations, person in charge and NVQ qualifications. This will ensure there are sufficient staff on duty to Care Homes for Older People Page 8 of 28 meet individual care needs with no time constraints. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. People moving into the home can expect their needs to be appropriately assessed and identified and they can be confident that their needs will be documented so staff are aware they can meet their needs. Evidence: Information received in the Annual Quality Assurance Assessment (AQAA) submitted by the home states that a thorough pre-assessment procedure is carried out prior to admission and all information is recorded on their pre-admission form. People who are admitted through the social services referral process also have a COMM 5 assessment carried out by the local authority before admission. The examination of four care records showed that people living in the home had their individual needs assessed and these assessments formed the basis of individual care plans. The care records examined showed that the date of admission in most cases Care Homes for Older People Page 11 of 28 Evidence: was the day before the pre admission assessment was formulated. This was discussed with the staff on the day of inspection as this does not show that service users are being assessed prior to entering the home. The AQAA states Further to our previous CQC inspection it was identified that there was a short fall in our assessment/care planning procedures. We have now introduced a person centred computerised assessment and care planning system which meets the needs of the identified short falls. This system allows for more in depth person centred information to be collated resulting in a high standard of individual care. In turn respecting each individuals privacy and dignity whether permanent or respite. We listen to constructive criticism and follow through on advice given positively acting upon it. On the day of the inspection there were twenty three people living at Marmora. The primary care needs of these people related to their old age. The admission process was discussed and considered with the proprietor and manager who were both present at the inspection, and sampled paperwork was overall seen to support a comprehensive assessment and admission process. Three resident surveys returned all stated that they did have enough information about the home to enable them to make an informed choice and the most recent resident admitted to the home confirmed that they had had discussions before coming to the home. Discussions with the staff and service users supported the evidence found in care records and indicated that these assessments gained views and insights from the individual, and their families and professionals were involved in the individuals care. The homes AQAA also identifies that The feedback gained from surveys and prospective residents show that the information given is accurate and gives them informed choice. We have a family buddy system, which is where a new service users family can converse with a family whos relative may already be living at Marmora. This has evidenced to us that it provides reassurance and support. There is an improvement since the homes last inspection in July 2009 and more detailed pre admission assessments are undertaken by the home now in addition to receipt of a COMM 5. This ensures the home is able to meet and understand the needs of the people they care for. No intermediate care is offered at Marmora. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents can be confident that staff will understand how to best support them in their daily lives. They can be assured that their health care needs will be met and they are supported to access health professionals as needed. Evidence: The support and documentation of four residents was considered at this inspection in order to understand how the service understands the way in which it should meet their needs. The admission procedures in the home provides sufficient introductory information and from this information the home would be able to determine whether they could meet the identified needs and commence an individualised plan of care. The home has introduced a new computerised care planning system called Care Docs since the last inspection. The care plans of four people living at the home were sampled and inspected and they were used to case track care in the home. An assessment of needs is usually identified covering, health, personal and social care needs. Within the care plans sampled, plans had been created which covered topics Care Homes for Older People Page 13 of 28 Evidence: such as personal hygiene, food and drink, mobility, night care, elimination, social, communication, interests and medical awareness. Each service user is also appropriately risk assessed and documentation included in their plan of care. Pen pictures are also in place and the AQAA states The documentation that is in place allows care staff to have an insight into the wishes of service users and so treat them with greater respect and dignity. The inspector was able to discuss the way in which the documents were used with the Registered Manager and identified the improvement in care plans since the last inspection which now provide a comprehensive instruction to staff in meeting the individuals needs. The Registered Manager agreed that the revised documents which had been developed and discussions with staff about the way in which they used the care planning tools in existence, had highlighted that they were not fulfilling their function previously in developing a consistent approach to care provision in the service. The health care of residents was monitored through the documents contained in care plans, these included health professional visits, and their outcomes, monitoring sheets for weight, diet etc. Residents generally visit their GP at the surgery wherever possible accompanied by a member of staff. The home uses a blisterpack system of medication that is dispensed by a local pharmacy and delivered to the home weekly. The storage and administration of medication was examined. Medicines are stored in a securely locked trolley. Any medication that needs to be stored in a controlled temperature is kept in a refrigerator that is solely for medication. On the day of the inspection a senior member of staff was observed administering medication at breakfast time. Good practices were followed and the member of staff was able to demonstrate knowledge of the medication being administered. Medicine Administration Record (MAR) sheets were examined and were generally found to be in order. Discussions with staff indicated they understood practice and were able to demonstrate a sound knowledge of medication process. Photographs were seen in the medication folder of each person and records were found to be in general good order. Medication Administration Records (MAR) sheets were neat but there were some hand written / transcribed medication entries without two signatures. A signature audit may be of value to keep this issue in check. Staff need to make better use of the omissions code. MAR sheets did however contain photographs of individuals to reduce the risk of errors in administering. The majority of residents spoken with and surveyed were very satisfied with the standards of care and said that they received the care and support they needed. It was evident from discussions with residents that staff did try to provide person centred care. They confirmed that staff respected their privacy and dignity whilst providing care. One resident described the care staff as Very caring, loyal and never have to complain about care needs not being met Two relatives spoken with both agreed that management and staff met the care needs of their relative well and they received the medical support they required and had no Care Homes for Older People Page 14 of 28 Evidence: complaints. During the inspection we were able to observe staff going about their duties and as they approached and spoke with the people living at Marmora, it was observed that they were both respectful and sensitive to the residents needs and there was lots of friendly chatting and joking going on between staff and residents. Staff approach to privacy is good and relatives confirmed this on the day. Interaction between staff and residents was seen and heard to be friendly, caring and respectful. It was also evident that the people living at Marmora were also able to express their individuality in their accommodation, and there was evidence of personal possessions, small pieces of furniture and photographs in their rooms. The home supports people appropriately in the final stages of life. The care plan files examined during the inspection all contained reference to the residents preferences in respect of terminal illness and following their death. This information will enable staff to ensure that they are adhering to the individuals wishes even at a difficult and emotional time when such enquiries would be unsuitable if not noted previously. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents living at Corner House are able to make choices about their lifestyles and the social, cultural and recreational activities meet their expectations. Evidence: At the time of the last inspection improvements had been made to activities available in the home and this continues to be the case. The AQAA states We continue to hold regular meetings with Service Users and staff and they still do not identify any major faults or lack of quality provision. We continue to provide one to one stimulation. Service Users are still being encouraged to get involved with daily tasks such as folding laundry, laying tables. As the Manager I speak to all Service Users regularly to ensure their needs are continually being met. People spoken with on the day of inspection confirmed that they are encouraged to get involved in household tasks such as folding the laundry and laying tables. People spoken with confirmed they do things around the home; one person said they do help with folding the laundry and napkins. Although there were no organised activities taking place on the day of this inspection, people were socializing and the atmosphere throughout the home was relaxed. Discussion with the registered manager and proprietor highlighted that the home Care Homes for Older People Page 16 of 28 Evidence: provides person centred activities based on their own personal choice. Examples of this were external theatre groups coming into the home, Shenton and Elvis impersonator, and Lea soprano singer. Additionally we are informed that shopping trips take place, walks on the seafront and new arts and crafts have been purchased. One service user has a small workshop in the conservatory where they make matchstick models. Staff spoken with stated We dont force them to become involved but sometimes we would like more staff so we can provide more one to one activities. The AQAA also details that the home would like to do better by Continue to encourage our service users to speak up and tell us what they want to do. Also to advise us of what changes they would like in order to enhance their daily lives. We continue to be more accepting of our service users choice to not want to join in on arranged activities and we continue to evidence fully their right to choice. Despite this overall activities offered do seem to meet most peoples needs, but some people may benefit from more one to one stimulation or different activities. The home is looking into other options as an ongoing venture. Social interactions and one to ones are not recorded clearly in plans of care and the proprietor stated on the day of inspection that there were plans to address this via the new care planning systems. Visitors spoken with all said they are made welcome in the home. There is a small conservatory that can be used to meet visitors in private if people wish. The AQAA states that families are regularly invited to attend functions. People spoken with confirmed this saying they can choose what they want to do. The home continues to offer a varied diet that is well cooked and enjoyed by the people who live there. Menus examined are worked out on a three-weekly rotational basis. All the food is home cooked and the emphasis is on traditional meals such as roast beef or sausages with onion gravy. The evening meal is a choice of sandwiches, soup or a light meal such as burgers. The cook leaves prepared cakes and snacks out for supper. A weekly order of fresh fruit and vegetables is delivered. Food stocks and storage were examined during a tour of the premises and there is evidence that plenty of fresh vegetables and meat are used. People spoken with confirmed that the food is good. One person said that if a particular meal is not to their taste, there is always an alternative like a cheese sandwich. Dining rooms are pleasant and well appointed. Surveys completed by people living in the home are complimentary about the food. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. People who use the service have access to a clear and understandable complaints procedure that ensures that they are listened to. The home operates good practices and procedures to ensure the protection of the people who live there. Evidence: The AQAA states that there is a comprehensive complaints policy in force and they ensure everyone at the home is aware of the procedure. The complaints policy for the home was noted to have been updated in March 2010. People living in the home and relatives spoken with are all confident that they would know what to do and who to speak to if they have a complaint. One person spoken with stated I have not made a complaint but would speak to the manager and another stated If I have a concern about anything they put it right it is a very good home. The AQAA also tells us We ensure everyone at the home is aware of our complaints procedure. All staff are given a copy of Protection from Abuse and carry out SOVA training. We also ensure staffs knowledge is continually updated and we keep abreast of changes in legislation and any impact they have on our service. The home have introduced an in house training programme which they believe gives staff the opportunity to continually update their knowledge. They have listened to external agencies comments and now ensure that minor complaints are investigated and evidenced. Records seen recorded the concern and also now evidence actions taken or Care Homes for Older People Page 18 of 28 Evidence: the outcome of the same. People living in the home are protected by the homes processes around safeguarding people. The AQAA states that all staff are given a copy of Protection from Abuse and receive training around Safeguarding of Vulnerable Adults (SOVA). Records examined confirm that staff have received SOVA training with the latest course attended noted to have taken place on the 18th December 2009, and Criminal Record Bureau (CRB) checks are carried out on all staff. The home has a whistle blowing policy in place so that staff can be confident they will be protected if they were to report any suspected poor practices or abuse. Staff spoken with were able to explain processes involved around safeguarding vulnerable adults and the actions required to ensure people remained safe. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. People living in Marmora benefit from a safe and well-maintained environment that is clean and pleasant. People may be confident that their bedrooms are comfortable and they are surrounded by their own possessions and their independence is promoted. Evidence: Information received in the AQAA states that We carry out routine maintenance throughout the home. All external grounds are kept in good order. We are continually striving to provide a homely environment. We listen to our service users requests for change. Colour schemes are their choice in their own rooms. The home has undergone significant refurbishment. A tour of the premises confirms that improvements have been made since the last inspection and the work is continuing to the outside of the home. Specifically we were told by the proprietor that new dining room furniture has bee purchased, new curtains are in the lounge, the conservatory has been refurbished and five new toilets have been installed. there are plans to have a new walk in bath and easy access toilet developed and continual decoration of the rooms as they become empty continues. Furnishings throughout the home are domestic in nature and overall there is a homely feel throughout. People spoken with said they like the homely atmosphere. A tour of the premises shows that there are appropriate adaptations and equipment in place Care Homes for Older People Page 20 of 28 Evidence: including hoists and assisted baths. Individual bedrooms are well furnished and contain ample evidence of personal possessions. One person spoken with liked their room so much that they did not take up the offer of a larger room with better facilities when one became available. A tour of the premises shows there is a good standard of cleanliness throughout the home. There are no odours and the carpets are clean and replaced when required. The laundry is suitable for the size of the home and contains appropriate equipment. The flooring is impermeable to help ensure good infection control and there are hand washing facilities. There are liquid soap containers in toilets for washing hands and hand dryers are being installed throughout the home to replace the existing paper towel system. The cook is using the Safer Food Better Business pack provided by environmental health to record kitchen activities such as cleaning and maintenance. Kitchen records such as fridge temperatures were examined and are completed appropriately. Previous EHO inspections of the home highlighted no problems. Overall the impression is of a homely environment where people are comfortable. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive the care they need by a staff team who have skills and knowledge to support them. The homes recruitment procedure provides the safeguards to ensure that appropriate staff are employed and service users are protected. Evidence: The numbers of staff on duty are generally sufficient to meet the needs of people living in the home. Staff rotas examined show there are either three or four staff on duty. It was observed that staff are kept busy and work hard, although people do not appear to have to wait excessively when they need support. The AQAA states We make our staff feel valued resulting in a very low turnover of leavers. We work with our staff to try and provide a healthy work life balance. Staff spoken with on the day of inspection confirmed that the morning shift staff ratio was acceptable and there were enough staff to meet service users needs. Overall surveys completed by people living in the home are positive about the staff. One service user stated The carers are good and they meet all my needs even though they are busy On the day of the inspection, staffing levels did not appear to impact on care being compromised although some tasks may have taken longer. The home has a training planner/matrix in place and the proprietor informed us she Care Homes for Older People Page 22 of 28 Evidence: has employed a development and quality manager to aid training schedules. Information provided in the AQAA shows that 80 percent of care staff employed by the home have completed or have almost completed a National Vocational Qualification (NVQ) at level 2 or above. The home has an appropriate recruitment process in place. A sample of three staff files examined contain all the required documents including photographs, proof of identity, two written references and Criminal Records Bureau (CRB) checks. Staff files are well organised with a checklist at the front. There have been improvements in staff training since last inspection. The homes training matrix was examined and shows that all staff have had training in manual handling, food hygiene and fire awareness, the mental capacity act, deprivation of liberty and nutrition. There is also a rolling programme that includes Health & Safety and infection control. Records examined confirm senior staff have had training in drug administration. There is also evidence that some staff have received training around diabetes and Alzheimers awareness and funeral bereavement training. Staff spoken with made positive comments about training. The homes AQAA states that they have maintained their current staff team for over a year and feedback suggests they feel valued. Specifically it states There have been very few changes. We now provide in house training which fits in with individual staffs personal lives. This has resulted in high attendance levels. More staff have come forward for NVQ training than in any other year. We will continue to listen to our staff and offer up to date training, regular supervision and appraisal to help them to grow into care sector professionals. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents are cared for by a committed management team, who listen to their views and respond to improve the service. Residents can be confident that the home is run in their best interests and it ensures their safety and welfare. Evidence: The home has a registered manager who was on duty on the day of inspection. Previous inspections have evidenced that they are able to demonstrate an awareness of good management practices and also show an enthusiasm and commitment to continuing to raise standards in the home. The manager has completed an NVQ level 4 Registered Managers Award and discussions on the day of the inspection with the proprietor confirmed that the manager is well supported by the proprietor who was also present at this inspection. Staff and residents spoken with feel the manager is very approachable and runs the home well. Care Homes for Older People Page 24 of 28 Evidence: The homes quality assurance process has been further developed since the last inspection. Records examined show that the home consults people living there and their relatives and they are using the feedback to make improvements to the home. The AQAA states that there are regular meetings with people living in the home and any major faults or lack of quality provision have not been highlighted. The completion of the AQAA was noted to be somewhat repetitive and non specific in areas. Although it showed review dates and an understanding of the home, a much more detailed completion is required and would have clarified the homes development and potential progress. The proprietor and manager are reminded that there is an expectation that the AQAA be an up to date audit tool for the home required by law, and should identify how the home plans to develop and ensure positive outcomes for residents. As noted at the last inspections, the home does not manage the finances of anyone living there and only personal allowances are handled. Records examined confirm that all monies are kept individually and securely and there is appropriate documentation and receipts for amounts spent. The home has processes in place to ensure people living there are protected by safe working practices. Health and Safety records examined confirm that appropriate checks are carried out such as Portable Appliance Testing (PAT), servicing of gas appliances, lifts, hoists and fire fighting equipment. The proprietor is able to demonstrate a good awareness of the homes responsibilities in keeping people safe. The AQAA states that the manager carries out a weekly audit to ensure the home is safe and all equipment is regularly serviced and maintained. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 9 Any transcribed medications must be clearly documented with evidence of two signatures to ensure the risk of medication errors being made are reduced. The specific recording of social care activities and one to one interactions in care plan documentation would ensure peoples choices were sought and that their individual social care needs were being met The quality of information provided to the Commission in the Annual Quality Assurance Assessment should support the understanding of how the service is complying with their responsibilities under the Care Standards Act 2000 and what steps they are taking in order to improve the outcomes for people living at the service. 2 12 3 37 Care Homes for Older People Page 27 of 28 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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