Care Home: Meadows House

What the care home does well The home provides a homely environment. Residents appear to be well supported, and well cared for, with many favourable comments being received from both residents and relatives. There was evidence of good staff interaction with residents, with privacy and dignity being respected, and attention being given to developing individuals` participation in the range of activities provided. What has improved since the last inspection? Changes have been made to provide more effective management of the home, including the appointment of a new manager in June 2009. The new manager has begun implementing improvements in staff training and development. This work is ongoing and will be monitored by the CQC. What the care home could do better: The home must complete steps to improve security and safeguard vulnerable residents. In particular, CCTV screens must be installed on each of the units, so as to effectively monitor the entry and departure of visitors at the main front entrance during the hours when the reception desk is unstaffed. The home must ensure that all staff receive regular one-to-one supervision. Supervision should be appropriately recorded. Key inspection report Care homes for older people Name: Address: Meadows House Tudway Road Kidbrooke London SE3 9YG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Peter stanley     Date: 1 0 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 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 31 Information about the care home Name of care home: Address: Meadows House Tudway Road Kidbrooke London SE3 9YG 02083313080 02083313099 meadows.admin@sanctuary-housing.co.uk www.sanctuary-care.co.uk Sanctuary Care Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 59 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: 18 Service users in the category continuing care, nursing 5 Service users may be between the ages of 55 to 65 Minimum staffing levels are those set out in correspondence dated 18/03/02, Explanatory notes (staff at LBG Resource Centres) No more than five Service Users may be admitted for respite / emergency placements Date of last inspection Brief description of the care home Meadows House is a purpose built care home for older people. It is located on the Ferrier Estate, Kidbrooke, in the London Borough of Greenwich. It is operated by Sanctuary Care and is one of a group of three neighbourhood resource centres in the London Borough of Greenwich. The home is divided into four units Crownwood 12 residential dementia care beds on the second floor; Queenscroft 15 residential dementia care beds on the first floor; Jackwood 18 continuing care nursing beds on the Care Homes for Older People Page 4 of 31 Over 65 59 0 2 1 0 7 2 0 0 9 Brief description of the care home ground floor; and Harwood 15 residential dementia care beds split between the ground and first floors. All units accommodate people needing dementia care. The home has an integrated Day Centre in a dedicated area of the building on the ground floor, and these facilities are also available to long term service users. Accommodation is provided in single bedrooms, and all of these have en-suite shower and toilet facilities. Each unit has its own lounge and dining space, and there are additional communal rooms for reminiscence, a sensory room, activities room for crafts, and a hairdressing salon. Kitchenettes are available on each unit, and visitors are able to access these. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home and spoke with both the manager and regional operations manager. We also spoke with four members of staff, three visiting relatives, and with a number of residents on each of the four units. We completed a site inspection, and examined documentation relating to health and safety and the day-to-day management of the home. We looked at a sample of both staff and service user records, looking in particular at staff recruitment records, care assessments, risk assessments and care plans. We also looked at the homes AQAA (Annual Quality Assurance Assessment), which is completed by the home, and which provides both descriptive and numerical information about the home. Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 31 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 8 of 31 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. People who receive services are provided with the information they require to make an informed judgement about the home. People who receive services are fully assessed as to their needs and how these can be met. Evidence: The home maintains an up to date Statement of Purpose and Service User Guide. A copy of these information documents are kept just inside the main entrance together with a copy of the most recent inspection report. A copy of the Service User Guide is given to each resident and kept in their room. Meadows House provides a pathway of care for people with dementia care, and most of the residents who are admitted will have experienced the home through attending the Day Centre or through short carers respite stays. Care Homes for Older People Page 9 of 31 Evidence: The home has been working towards the development of a more robust admission and assessment process. All potential admissions are now discussed and reviewed by the homes manager to ensure that the individuals needs can be met, and that these can be met within the context of the group of residents on the unit in question. Meetings are held, with relevant professionals from the various agencies attending, to review recent admissions and discharges, and to provide advice and support regarding any issues that may arise with a placement. A number of pre-admission assessments, covering admissions within the last 12 months to Jackwood Unit and the 3 residential units, were sampled. Inspection of the files found that the documentation provided was generally comprehensive and that individuals had been fully assessed and risk assessed. Files included essential preassessment information regarding residents care and support needs. Prospective residents and their relatives are invited to visit the home to view the facilities, and ask questions. They are then offered the opportunity to spend a day at the home, to have lunch, talk to residents and staff, and to generally get the feel of what its like to be living in the home. Should the application for admission proceed, there is a full pre-admission assessment. This involves a manager or senior carer, and the prospective keyworker from the designated unit, visiting the potential resident to fully assess their needs and suitability for living in the home. For placements on the continuing care unit (Jackwood), there is close liaison between the homes manager and nurse manager with the PCT wards that provide placements, to ensure that any prospective admission is fully assessed and monitored. Following admission, each resident is reviewed after an initial period of residence, with feedback being provided by the resident, family members and a report from the care manager identifying any further actions required to meet the persons care needs. We met with two visiting relatives, and a number of residents including two who had been admitted to the home in recent months. The views expressed were favourable regarding the home and the care and support being provided. Staff were generally perceived to be caring and supportive, this being supported by observation of staff interaction with residents across all four units. Residents generally presented as being happy and settled living in the home. The home was observed to have a relaxed and friendly atmosphere, with residents Care Homes for Older People Page 10 of 31 Evidence: being viewed as individuals with individual needs and preferences. A person-centred approach to providing care is gradually being developed through a programme of staff training and the development of more person-centred care plans. Care Homes for Older People Page 11 of 31 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. Residents have their, health, personal care and social needs set out in a detailed care plan, with review taking place on a regular basis. Care plans do, however, need to be developed so as to become more person-centred. The health care needs of residents are being met, with ongoing monitoring of residents physical and mental health. Improvements have been made to ensure that residents are being fully protected from any possibility of medication error. Accredited medication training is being extended to all care staff. Residents are being treated with respect, and are have their right to privacy upheld. Evidence: Residents care plans are drawn up following admission, and are based on the information provided by the care manager and the pre-admission assessment. A Care Homes for Older People Page 12 of 31 Evidence: sample of two care plans from Jackwood Unit, and four care plans from the residential units, were inspected, including those for four recently admitted residents. These clearly indicated how residents identified needs were to be met in respect of the assessed care needs and risks. Care plans were evidenced as having being reviewed on a regular basis, with changes being noted where required. Risk assessments were evidenced, these being reviewed annually or more frequently, as required. These cover moving and handling, and a range of risk factors relating to the individuals mental and physical safety and wellbeing. The home is moving towards a more person-centred approach to providing care, with training being provided for all staff, To be consistent with this development, the present care plan format needs to be revised so as to reflect a person-centred structure and approach. A recommendation applies. Following a concern highlighted in the previous inspection report, all staff are now having their awareness of diabetes care management raised through a programme of training. The care plans inspected included one resident with diabetes for whom it was evidenced that regular monitoring and recording of blood sugar levels has been taking place. Following a requirement from the previous inspection, the home is evidencing the actions required to respond to this condition, as detailed in residents care plans and care records. The home has taken steps to address the concerns regarding falls and the prevention of these from occurring. From the evidence of a sample of residents files, for whom there is a high risk of falls, risk assessments are being updated so as to detail the actions required to minimise the risk of falls. The number of falls are closely monitored, the number of notifiable incidents having decreased, indicating a measurable improvement. The home was evidenced to be maintaining good relationships with the local GP practice and with other health care professionals. A visiting GP visits weekly and monitors the residents, with any concerns being discussed. The home has developed a close relationship with the community mental health team, and there are regular consultations with the older persons psychiatrist (who visits fortnightly) and other mental health professionals. Inspection of files indicated that residents are having contact with a wide range of health care professionals. These include regular weekly GP visits, and visits from Care Homes for Older People Page 13 of 31 Evidence: district nurses and community psychiatric nurses. Visits are also arranged with podiatrists, chiropodists and a visiting dental clinic. During the course of the inspection the inspector met with a visiting occupational therapist, who expressed her professional view that the home was providing a generally good quality of care for residents. Inspection of a sample of residents files evidenced the recording of health information, with any concerns being noted. Weight charts are being regularly maintained, with more regular weekly weighing where there are any concerns regarding weight loss. The advice of a nutritionist or dietician is sought where concerns exist. The home has developed good practice in providing care for people with dementia and mental health related issues. Records indicate that the psychological needs of residents are being closely monitored, with any concerns being recorded, and indicating prompt responses by staff, with evidence of referral for professional psychiatric input in emergency situations. Anecdotal evidence received from visiting relatives indicated that the needs of the residents, that they visit, are generally being well monitored, and that staff are caring and professional in their approach. From discussions with a number of care staff across all four units, there was substantial evidence of good practice in this area. The home has a medication policy and procedures in place which provide guidance for staff. Following some concerns about medication from the last inspection the home has been tightening up its procedures. The manager advised that she completes weekly checks on medication records, and completes a monthly audit. The home has recruited more senior staff to improve the staffing structure in the home and to ensure a more consistent approach with medication procedures and practice. The manager has arranged formal medication training sessions for all staff who administer medication, and undertakes regular medication competency tests so as to review their knowledge and understanding of procedures. Records of these were evidenced on staff files. The home has a formal arrangement with a major high street Pharmacy, which provides consultancy and accredited medication training for staff, and which has introduced a colour coded system for the recording and administration of medication. Storage arrangements were inspected and found to be secure, safe and satisfactory. No controlled drugs are used or stored at the home. Records are kept of the receipt, administration and return of medicines. Staff were observed to be administering and recording medication appropriately. Checks were Care Homes for Older People Page 14 of 31 Evidence: completed on a sample of medication records, with appropriate recording of medication administration being noted. Following a previous concern from the last inspection report, any variation in medication dosage is being signed off on the medication records by the GP. This was evidenced from the sampling of residents medication records. Residents are able to see relatives or friends in the privacy of their own rooms, or in the relative privacy of a quieter communal area within the home. Discussion with two visiting relatives and a number of residents indicated that there is broad satisfaction with the present visiting arrangements, and that the privacy of residents is being respected. Residents were observed to be treated with respect and dignity by staff, and there was substantial evidence of purposeful and caring interactions with residents, some of whom have been assessed as presenting challenging behaviour. All four units were visited during the inspection, and good interactions were observed across the board. Views expressed by those residents spoken to indicated that they had generally good relationships with staff, and felt well supported. Care Homes for Older People Page 15 of 31 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. Residents are provided with a varied range of opportunities for recreational and social activity. Residents are consulted regarding their individual interests and preferences Residents are enabled to exercise choice and control in their daily routines and activities, and are encouraged to participate fully in decisions that affect the home, their welfare and their daily lives. Residents are encouraged, and assisted, to maintain contact with their friends and relatives, and to access and develop links with the wider community. Residents can receive visitors at any time throughout the day, with privacy for visits being respected. Evidence: Residents files include information about the interests, hobbies and preferences of residents before they are admitted to the home, and a summary of their life histories, The home aims to provide as varied and stimulating an environment as possible, with residents being consulted both individually and within residents meetings as to their preferred choices and interests. Care Homes for Older People Page 16 of 31 Evidence: The home has made efforts to identify the individual interests and preferences of each resident, and to develop opportunities for pursuing both individual and group activities. The daily activity of every resident is recorded in an activities log. The home has an activities coordinator who has developed an ongoing activities programme within the home, facilitating a varied range of activities with residents. Activities include arts and crafts, and games involving some physical movement and spatial awareness. A small group activity was observed on one unit. A range of games and activities are available. These include listening to music, reading and reminiscence. Newspapers and magazines are made available for residents to read or look at. The home also has a day centre which offers a range of activities for older persons with dementia living in the community, and which is open to residents from the residential units to attend if they wish. The home should develop a clearly displayed programme of activities on each of the units, and in a form which residents can understand. This would assist residents to make choices as to their preferred activities, and to be kept informed as to any planned events or outings. A recommendation applies. The home has a sensory room which is well-equipped, and quiet rooms, one of which is set aside as a spiritual space where residents can sit quietly and enjoy relaxation therapy. Occasional coffee mornings are held, to which relatives and friends are invited, and visiting clergy hold church services for residents. The home has access to a minibus and organises occasional trips and outings to places of interest. Outside entertainers are also invited to the home. These events, to which residents, staff and relatives are invited, are subsidised from a range of fund-raising activities within the home. The home has a group known as The Friends of Meadows House which provides support and help with fund-raising activities. Relatives and other visitors are made welcome at this home and are encouraged to spend as much time as they wish with the residents they are visiting, and to provide whatever support they wish, including sitting with them at mealtimes. Relatives are able to attend relatives meetings on the units, and attend residents meetings if they so wish. Relatives are encouraged to share any concerns, ideas or views that they may have. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are protected from abuse by the homes safeguarding policies and procedures. While previous lapses in the homes security arrangements have been addressed, further actions to safeguard vulnerable users must be completed. The home has a comprehensive complaints procedure. This is publicised in the homes literature, and enables anyone who wishes to raise concerns, can do so, and have these appropriately addressed. Evidence: The home has a Safeguarding policy and procedures in place, which is being kept updated. All staff undertake Safeguarding of Vulnerable Adults training, with refresher courses having been rolled out in recent months. Whilst there have been a number of safeguarding concerns within the last 12 months, the home has been addressing the issues that have been highlighted in inspection and safeguarding reports, and has taken steps to raise staff awareness of safeguarding issues. The home provides a specialist service for older people with dementia. This is provided within 3 residential units (Harwood, Crownwood and Queenscroft), and within 1 continuing care unit (Jackwood) for older persons with more advanced dementia and challenging behaviour. There is a 72 hour assessment of any hospital discharge to the home so as to ensure that the persons needs can be fully met. There have been previous occasions when vulnerable individuals with dementia have Care Homes for Older People Page 18 of 31 Evidence: left the building without supervision. Any proposed new admissions to the home are closely monitored so as to ensure that any resident assessed as being at a high risk of wandering from the building is not placed at The Meadows. Where there are concerns for an existing resident, the homes practice is to refer the person concerned to social services for a reassessment of their needs. Since the last inspection, the home has been notifying the Commission, with Regulation 37 notifications, of any incidents of wandering involving significant risk to a resident. These evidence that security is being closely monitored and that appropriate actions are being taken to secure the safety and well-being of residents. Where incidents have occurred, the home has informed social services, and reviews, involving relevant professionals, undertaken. In line with a previous requirement, and recommendations from a Safeguarding Strategy Meeting on 30 June 2009, security measures have been put in place to address the risk of a vulnerable adult wandering out unescorted. Keypads are in place at the main front entrance and on Jackwood and Queenswood units. CCTV cameras have been installed by the main front entrance, and at the front and rear of the building. At the present time, monitoring of visitors coming in and out is done from the main reception area office. Whilst the reception area is staffed during the day, the home does not provide cover for the hours from 5pm through to 9am the following day. An assurance was given that for any visitors entering or leaving between these times, a staff member from the unit concerned would escort visitors to the reception area so as to ensure that no resident would be at risk of wandering out. This does, however, depend on the vigilance of staff on the individual units. Given the need to ensure security, particularly between these times, the home must prioritise the installation of CCTV screens on each of the units so as to effectively monitor the reception area, when visitors come and go, and to prevent any possibility of a resident being able to wander unescorted out of the home. A requirement applies. Other security measures that are being taken include the installation of electronic sensors on those doors accessing the units. The home has also taken steps to to raise staff awareness and actively review risk assessments for any users who are at particular risk of wandering. All new residents admitted to the home are closely monitored to ensure that any pattern of wandering, or attempting to leave the building unescorted, is promptly identified and the placement reviewed if not manageable. Care Homes for Older People Page 19 of 31 Evidence: The home has a complaints policy and procedures which complies with the statutory requirements. A register of complaints is maintained, detailing the nature of the complaint and the outcome. All complaints are being responded to within the required timescales. Previous contact with relatives indicates that they are broadly satisfied that complaints are responded to in an appropriate way, and that, generally, there is confidence in the ability of the service to address the issues raised. Care Homes for Older People Page 20 of 31 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. Residents benefit from living in a clean, safe and well-maintained environment, and have good and sufficient personal and communal facilities. The home provides open spaces, enabling residents to move about safely in an unrestricted way. Concerns regarding the security of the home are being addressed. Evidence: The home comprises of a contiuing care unit (Jackwood) providing 18 places on the ground floor, for adults with advanced dementia and/or challenging behaviour, and three residential units- Harwood, providing 15 places on the ground and first floors, Crownwood, providing 12 places on the 1st floor, and Queenscroft, providing 15 places on the 2nd floor. The art work carried out by residents in the home has contributed to giving each unit a different character, and is perceived by visitors as having helped to create a positive environment for people with dementia to live in. The home has open spaces so that residents can move about safely and feel unrestricted. Large windows provide ample daylight. The home is clean throughout, with good standards of hygiene being apparent. All the bedrooms are ensuite single rooms with an inbuilt shower to maximise Care Homes for Older People Page 21 of 31 Evidence: independence. Some rooms were viewed. These presented as being furnished and equipped to meet required standards, and personalised with residents photos and personal possessions. Each unit has a communal lounge and dining area, a small open-plan kitchen area, and a separate quiet room. The communal areas presented as being clean, well furnished and equipped with a large flat screen television and music centre in each of the main lounges. On Jackwood Unit, the lounge patio doors open up on to an enclosed courtyard and garden area where residents can, if they wish, sit out in warm weather. A number of garden benches have been provided for this purpose. The home has a large, well resourced day centre which residents from the residential units can attend and join in activities, and where social events are held. There is a large and well-equipped onsite kitchen which provides home-cooked meals and snacks at set times throughout the day. The home is well-maintained by a contractor, with responsibility for health and safety. Two maintenance workers employed by the home, and are responsible for undertaking routine repairs and checks. There is an ongoing programme of redecoration and refurbishment in the home, and areas identified in the last report as requiring attention have been followed up. The home is generally well-equipped with aids and adaptations, and has three separate lifts for the use of residents and visitors. These are regularly serviced and maintained under an existing contract. Care Homes for Older People Page 22 of 31 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. Staff are being provided in sufficient numbers and skill mix to meet the needs of this resident group.Training needs are being addressed, with the development of an ongoing programme of training for all staff. Whilst staff feel generally well supported, supervision is not currently being provided on a sufficiently regular basis. Residents are protected by the homes robust recruitment procedures. Evidence: The home operates a robust recruitment process, based on equal opportunities. Inspection of a sample of files, for staff recruited within the last 12 months, indicated that CRB ehanced disclosure and POVA checks, identity and employment checks are being appropriately completed. Files were found to be generally in good order and well maintained. It is recommended that staff files include a front page checklist detailing all the checks required, and the date when each check was completed. Staff receive an induction and ongoing training which covers the required mandatory training. Based on the most recent available figures, for May 2010 approximately 87 per cent of the care staff had completed at least NVQ Level 2 and were up to date with their mandatory training. Care Homes for Older People Page 23 of 31 Evidence: A training matrix has been developed which evidences the training that has been planned and completed for each staff member. Recent and ongoing training has included statutory safeguarding of vulnerable adults, dementia awareness, managing challenging behaviour, diabetes awareness, medication. and person centred care planning. A high proportion of staff are stated in the AQAA as having completed at least one session of training in dementia care. The home is required to provide regular supervision for all care staff. Inspection of a sample of 8 staff files indicated that this is not currently taking place. Supervision is presently only taking place on a very infrequent basis, 7 of the 8 files indicating only one supervision session having taken place within the last 6 months. 2 of these evidenced only one supervision session within the last 12 months.This was addressed with the manager who agreed that this was unsatisfactory and needs to be addressed as a priority. A requirement applies. Another concern was that supervision was not being properly recorded and signed off in most cases. Recording of supervision must also be completed on the one to one supervision form and must not be presented as handwritten notes. The date of the previous and next supervision sessions should be entered, and the supervision record should be signed by both the supervisor and supervisee. A recommendation applies. The manager confirmed that supervision and appraisal training is to be provided for the senior care workers on each unit with view to raising standards and awareness of good practice in this area, and achieving consistency in recording. The need for the manager to develop a checklist so as to more effectively monitor the frequency of supervision for every staff member was also discussed. A recommendation applies. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally, the home is being managed competently and in the best interests of residents. The manager is waiting to complete her registration with the CQC. Structure and systems are in place to ensure that there are good lines of communication between staff and management, and to promote good practice through training and staff development. The rights and best interests of residents are being protected by the homes record keeping, policies and procedures. Health and safety is generally good, promoting and protecting the welfare of residents and staff. Evidence: The home has had a new manager since June 2009. After a delay of several months, Care Homes for Older People Page 25 of 31 Evidence: she has applied to the CQC to become the homes Registered Manager. The manager has had 10 years experience of managing homes for people with dementia. and has the relevant experience, skills and qualifications for this post. She has gained an NVQ Level 4 in social care, and an RMA, and is also a qualified trainer in several areas including dementia care. After a long period without a manager, the new manager has made progress in addressing the shortcomings highlighted in the last report. She has been able to work effectively with the unit managers and staff group to address shortcomings and give renewed direction to the home. Many positive comments were received from residents, relatives and staff regarding the manager and her management style, perceived as supportive, inclusive and reassuring. The manager was able to demonstrate her commitment to promoting good quality outcomes for residents, and to involving them and their relatives more fully in the day to day life and running of the home, whether through an extension of the consultation processes (staff, residents and relatives meetings) or through encouraging more opportunities for personal and social activities, and therapeutic and sensory input, for residents. Improving staffing in the home has been a priority. Senior carers have been recruited to each of the four units so as to improve the consistency and continuity of care provided, and contribute to an overall improvement in the management structure. The home has experienced some difficulties with recruitment, and is seeking to appoint further senior carers and a deputy manager. Some staffing difficulties have been experienced due to a number of staff having retired or taken maternity leave. Any staffing shortfalls are, however, being covered by the use of internal bank staff and staff from other Sanctuary homes. There has been an ongoing recruitment drive for new permanent care staff. Following a number of safeguarding concerns, the manager has worked closely with the regional operations manager, for Sanctuary Care, to address issues of security in the home. While progress has been made on this front, further work remains to be done. The home has a good record on health and safety, with health and safety policies being in place to promote the health and safety of residents and staff. An annual health and safety audit is completed. It was confirmed that both fire safety and health and safety risk assessments have been recently updated. We received confirmation Care Homes for Older People Page 26 of 31 Evidence: from the AQAA and home records that the premises are being well maintained and that health and safety checks are being completed. It was noted, however, that hot water temperature checks are presently being completed only on a monthly rather than on a weekly basis. So as to ensure that residents are safe in this regard, regular weekly hot water temperature checks must be carried out. A requirement applies. The home has taken steps to ensure that it regularly completes Regulation 37 reports, and follow up reports, and that these are sent to all the relevant agencies. A log is kept of all such notifications. Following previous safeguarding concerns, the home has made efforts to improve its recording of information on residents care plans and logs, this being evidenced from a sample of files. Generally, the standard of record keeping was found to be good, with all the required documentation being in place and completed to a satisfactory standard. The home maintains a wide range of policies and procedures which are being periodically reviewed and updated. Care Homes for Older People Page 27 of 31 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 28 of 31 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 18 13 The home must install a CCTV screen on each unit to provide effective monitoring of the main doors and reception area, for when visitors arrive and depart, and the reception desk is unmanned. To ensure the safety of service users. 30/09/2010 2 30 18 All staff must receive one to one supervision at least six times a year (Standard 36). To ensure that staff are fully supported, and residents welfare is protected 31/07/2010 3 38 13 Regular weekly hot water 31/07/2010 temperature checks must be carried out and recorded. To ensure that residents are safe. Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 12 The present care plan format should be revised so as to reflect a person-centred approach. The home should display a clearly displayed programme of activities on each of the units, and in a form which residents understand. This would assist residents to make informed choices as to their preferred activities, and be kept informed as to any planned events or outings. A front page checklist should be included on staff files. This should detail all the employment and identity checks required, and the date when each check was completed. Recording of supervision should be completed on the one to one supervision form and should be not be presented as handwritten notes. The date of the previous and next supervision sessions should be entered, and the supervision record should be signed by both the supervisor and supervisee. 3 29 4 30 Care Homes for Older People Page 30 of 31 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. © 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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