Care Home: Median Road Resource Centre

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What the care home does well The home provides an effective service to meet the needs and wishes of people with varying needs and preferences. The Intermediate Care service provides an excellent short term rehabilitation service that residents really appreciate. One person receiving this service told us; "They enable us to do exercise, (there are) loads of activities and they listen to me". Residents receiving respite care, interim care and long term care also receive an effective service. The majority of the residents in the home at any time receive short term care. Evidence of the home`s planning for each individuals admission, during their stay and for their discharge shows a clear multi-disciplinary approach, which maximises the benefits that each person gets from their stay. What has improved since the last inspection? No requirements or good practice recommendations were made at the last inspection. What the care home could do better: One requirement is made at this inspection for the home to formally notify the Commission of any suspected incidents of abuse, this is to maximise protection to residents in this area. Four good practice recommendations are also made. These are that the home should continue working on making some people`s care plans more outcome focused, including to give staff more detailed guidance on how to meet people`s aspirations in the identified areas more effectively. That the home should consider providing more dedicated staff space should the day service that shares the building move elsewhere. This could assist staff to perform their tasks more effectively. That the home should should keep copies of staff recruitment documentation in the home to assist in evidencing that the home operates a robust recruitment procedure. That the home should keep an up to date staff training matrix to enable managers to quickly check that all staff have received all the necessary core training and to be able to pro-actively plan when refresher training is due. Key inspection report Care homes for older people Name: Address: Median Road Resource Centre 25 Median Road Hackney London E5 0PF     The quality rating for this care home is:   three star excellent 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 Illes     Date: 0 1 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Median Road Resource Centre 25 Median Road Hackney London E5 0PF 02083568710 02083568752 cecile.barrett@hackney.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: London Borough of Hackney care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Median Road Resource Centre is an in-house service run by L.B. of Hackney and offers support, personal care and accommodation for a maximum of 37 people. It currently offers four distinct services; long term residential care, intermediate care, respite care and interim care, which provides short term care for people who need a period of assessment, or other help, that cannot be provided in their own home. The home is in the process of reducing its long term residential care provision and the long term plan is to eventually phase out long term provision and increase the homes capacity in the other services it offers. The home is situated in Clapton within the L.B. of Hackney, in very close proximity to the local general hospital. Bus links are good and local shops and amenities are located nearby. Information about the home, including inspection reports, are available from the home on request. The nominal unit cost of a place in the home is between £450 and £800 per week, depending on need. However, Care Homes for Older People Page 4 of 30 28 0 9 Over 65 0 28 0 Brief description of the care home residents are individually assessed as to the charge they pay, depending on their circumstances and the type of service they receive at the home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection on this service was completed on 20th November 2006. The main fieldwork activity for this inspection took approximately 9.5 hours over two days, the 26th August 2009 and 1st September 2009. A deputy manager was available to assist on the first day of the inspection and the registered manager was available to assist on the second day. The inspection was undertaken by the lead inspector however, terms such as we,our and us are used where appropriate to indicate that inspection activity is undertaken on behalf of the Commission. The inspection activity included: meeting and speaking with a number of people living on each unit in the home; independent discussion with relatives, friends and visitors to the home; detailed discussion with a deputy manager; detailed discussion with the registered manager and independent discussion with care staff, therapy staff and support staff. Information was also obtained from: an Annual Quality Assurance Care Homes for Older People Page 6 of 30 Assessment (AQAA), submitted by the home to the Commission prior to the inspection, a tour of the premises, survey forms from residents, staff and health care professionals and documentation kept at the home. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a range of information about each of the services it provides to help people make an informed decision about moving into the home, they also benefit from being given a contract informing them of their rights and responsibilities. The needs of people are properly assessed by the home to assist staff to meet these needs when they are first admitted. Staff continue to reassess peoples needs in a range of key areas once the person is living in the home, this enables staff to respond effectively to changing needs. People referred for rehabilitation benefit from a competent multidisciplinary team to assist with this. Evidence: The homes annual quality assurance assessment, AQAA, states; All clients admitted to Median Road Resource Centre are informed about the services provided at Median that would meet their needs. This is done whilst the client is in hospital or in their own home. We have leaflets and brochures that are made available to the client to read in simple language. Care Homes for Older People Page 10 of 30 Evidence: We were given copies of the written information given to prospective clients about the four services currently offered at Median Road: intermediate care, interim care, respite care and long term residential care. These were clear, current and provided people with clear and useful information about the services that are offered. There are currently four people living at the home on a long term residential care basis and they have all lived at the home for a number of years. The registered manager told us that the home was planning to gradually phase out long term care when these four residents eventually move on from the home. The home would then concentrate on the other three services provided and do not intend to take any more referrals for long stay care. From discussion with residents and from feedback from survey forms there was a range of evidence that people felt that they had good quality information about the service before they were admitted to the home. Five residents files were inspected and included a resident from each of the four service offered by the home. All contained evidence that the home had up to date and detailed assessment information when they were admitted to the home. On occasion the home will admit a resident on an emergency basis. When this happens evidence was seen that an initial assessment and risk assessment are completed and further more comprehensive assessment information is obtained as soon as possible after that. For people admitted for intermediate care the person receives a multi-disciplinary preadmission assessment by a nurse, a lead therapist and a care support worker. Once admitted the person then receives a full occupational therapy and physiotherapy assessment within three working days. We were told that an assessment by physiotherapy and occupational therapy can be offered to respite and interim care residents as deemed necessary. The files of the people admitted on an interim and respite basis also showed clear assessment information, including from L.B of Hackney that use all the places, and an assessment by the homes staff. We also saw evidence on the file of one of the long stay residents that L.B. of Hackney holds annual placement reviews on long stay residents to ensure that the placement is still meeting the persons needs. The home provides all residents with a document called a licence to occupy which serves as a contract between the home and the resident and lists the rights and obligations of both parties in relation to the persons placement. Copies of these were Care Homes for Older People Page 11 of 30 Evidence: sampled and found to be satisfactory. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and wishes are recorded on their care plans to assist staff in meeting these. However, some people would benefit from their care plans being made more outcome focused. People are very well supported to have their health needs addressed, including by accessing a range of healthcare professionals, many of whom spend a significant amount of time in the home. Effective medication policies and procedures safeguard people living in the home. Staff are working hard to treat people with respect and dignity, which is appreciated. Evidence: The homes annual quality assurance assessment, AQAA, states; Care plans are kept up to date and current. We have completed a checking system for the night staff to use to assess the level of support required at night. This will identify if the risk to the clients or to others is low, medium or high, and the times the client will be checked. We inspected care plans for five residents, which included at least one person from each of services provided by the home. The care plans for people using the intermediate care service were particularly comprehensive with good multi-disciplinary Care Homes for Older People Page 13 of 30 Evidence: input. Evidence was seen that these care plans are reviewed and amended as appropriate through out the persons six week rehabilitation placement showing the progress the person is making against the agreed rehabilitation goals. Care plans seen for people using the other services: respite, interim care and long stay were up to date and showed that the person and/ or their relatives had been involved in the care planning process. There was evidence that the plans were reviewed on a regular basis and in any case when peoples needs have changed. However, although generally satisfactory these care plans were not particularly outcome based and some had more detailed guidance for staff than others. The registered manager informed us that the home were about to introduce a new care planning format that would be more person centred and include more details of how people prefer to be supported with their needs and aspirations. A good practice recommendation is made to reinforce this. All the plans seen had been informed by an up to date risk assessment, including a moving and handling assessment. Evidence was seen that residents are well supported to address their health care needs. Residents have the option of remaining registered with their existing GP or being registered with a GP practice local to the home. Evidence was seen that residents in the intermediate care unit could be temporarily registered with the local GP for the duration of their stay if that met their particular needs and wishes. The home has a dedicated multi-disciplinary therapy team that includes input from an occupational therapist, physiotherapist, speech and language therapist, social worker, psychotherapist and therapy assistant. Although primarily funded for the intermediate care service we were told that the therapy team would offer assessment input to people admitted on an interim and respite basis where necessary. Evidence was seen that residents were also supported to have access to community based healthcare professionals including chiropody, optician, dentist and general hospital treatment. The home encourages residents to self administer their own medication wherever possible. This is particularly important for residents that are not living in the home on a long term basis, to maintain their independence when they move on. We were told that if a resident is prescribed controlled medication the home has a local agreement with health care professionals that the district nurse will attend the home to administer this. The home has proper storage and a CD register to facilitate this. However, the registered manager told us that none of the residents were currently prescribed controlled medication. Medication and medication administration records (MAR) charts were inspected for a number of residents and these were accurate and up to date, indicating that residents were being properly protected by the homes procedures. Care Homes for Older People Page 14 of 30 Evidence: Staff were observed interacting with residents in an appropriately friendly and positive manner whatever the persons level of independence. One person told us They treat us with respect. Another more able resident who was receiving interim care told us that they had a key to their room and were supported by staff to travel independently in the community. It was clear to us on the day that residents receive appropriate staff support whatever their level of dependency and the reason for their stay. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from different activities being available within the home and within the community to meet their needs and preferences. Families and visitors are made welcome at the home, which they and people living there appreciate. People are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. People are also served good quality and appetising meals that they enjoy. Evidence: The homes annual quality assurance assessment, AQAA, states; Clients are encouraged to maintain their lifestyle as far as possible within the home and maintain leisure activities in the community. We saw evidence of a variety of activities including joint groups that everyone is invited to participate in. These included a music group, coffee morning and Happy Hour, the latter held on a Saturday and included drinks and snacks in an informal atmosphere. One resident told us (They) enable us to do exercise and there are loads of activities. We were told that a gardening group was being started as residents had expressed an interest in this. We also saw minutes of an African Caribbean group that meets every other week, run by staff, at which peoples views are sought on how to further meet the needs of people from an African Caribbean background. At these meetings a light snack is provided and one person Care Homes for Older People Page 16 of 30 Evidence: spoken to told us that they thought the home was making a good effort to meet peoples cultural needs. Other evidence was seen that the home is working hard to meet the cultural and religious needs of residents including holding religious services in the home and meeting the needs of minority groups, including people who are Jewish and people who are Muslim. One resident told us, The staff are very friendly and nice, I am able to fulfil my needs, for example, attending church. Staff care for me well. The nature of the service means that significant numbers of residents are admitted and discharged during the course of a year and evidence was seen that ongoing efforts are made to identify individuals needs and preferences, including with preferred activities. We were told that the home had recently taken a resident with a spinal injury and who enjoyed swimming to the local lido, which was very successful. The homes annual quality assurance assessment, AQAA, states; Families are encouraged to visit and participate in client care. Clients are asked who they want to visit them. A number of relatives were spoken to during the inspection and most were satisfied with the care their person received. One relative told us that they were very grateful for the care the staff showed their person. However, one relative spoken to was not happy during the inspection about an identified situation with their person. The relative told us that they were going to speak to the duty manager about the situation, which we understand happened and a suitable way forward agreed with the relative. Those residents that are able are supported to manage their own finances. Maintaining and maximising peoples independence skills is an important goal for all residents, especially for those who it is planned will move on to more independent accommodation. Some residents need the home to assist with their personal allowances and we saw evidence of effective systems to safeguard people in this area (see also the Management and Administration section of this report). Those people that are able are encouraged to travel independently in the community, and we saw that those people have the necessary key codes to leave the building independently. Residents are encouraged to bring their personal possessions with them to the home albeit most of the residents are not accommodated on a long term basis. Residents enjoy varied and healthy meals at the home. We spoke independently to one of the cooks who told us that the cooks meet each week with residents to find out what they needed and liked in relation to meals and then amend the menu to Care Homes for Older People Page 17 of 30 Evidence: accommodate this. We were told that the home could cater for a range of health needs, cultural and religious needs and preferences with regard to meals. The menu at the time included Kosher, Halal and West Indian options such as plantain, sweet potatoes, green bananas and Yam. Kosher meals are provided by a specialist external caterer when needed and we were told that the home prepares Halal meals from Halal ingredients when needed. The kitchen was clean and tidy and up to date health and safety records for the kitchen were seen. We received many positive comments about the food, including They serve good food, I really enjoy the meals here, and They are the best meals outside of your own home. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and relatives can be confident that any concerns they raise will be taken seriously and acted upon appropriately. The home has clear policies and procedures for protecting people from abuse that staff are aware of although the home also needs to inform all the relevant stakeholders of any disclosure or allegation to maximise this protection. Evidence: The homes annual quality assurance assessment, AQAA, states; We welcome complaints from service users representatives. We have a complaints policy and leaflets that are made available to clients. Leaflets are displayed. We saw the homes complaints log and saw evidence that ten complaints had been recorded by the home over the last twelve months. Those complaints sampled had been properly investigated and responded to within the time scale stated in the complaints policy, 15 days. We saw the complaints policy displayed in the home during the inspection and people spoken to felt confident that any issues they raised would be properly dealt with by the home. No complaints about the home have been received since the last inspection. The home had a satisfactory safeguarding adults policy and a copy of the L.B. of Hackneys safeguarding adults policy and procedures and a copy of both documents were seen. The home had made ten safeguarding adults referrals in the past year and Care Homes for Older People Page 19 of 30 Evidence: the records of these were sampled. Nearly all of these had resulted in the home identifying potential risks to the person concerned from third parties, i.e. people external to the home. The records inspected showed that these referrals had been properly dealt with by L.B. of Hackney although it was noted that these referrals had not been reported to the Commission by the home, as is required by Government regulation. A requirement is made regarding this. Records seen indicated that staff receive training in safeguarding adults and staff spoken to knew the actions they should take if an allegation or disclosure of abuse was made to them. There have been no allegations or disclosure of abuse made to the Commission since the last inspection. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable home that is well equipped, well decorated, well furnished, well maintained and that meets their needs. The home was clean and tidy throughout creating a pleasant environment for people accommodated, staff and visitors. Evidence: The homes annual quality assurance assessment, AQAA, states; All clients are given any special equipment that will make their stay safer and easier once their risk assessment is done, e.g. raised toilet seat, toilet frame, bath seat etc. At Median Road clients do not share rooms. Rooms are en suite with adjustable and comfortable beds. Bedrooms are well equipped with a lockable chest of drawers for clients to store medication, wardrobe for clothing, linen basket, curtains, adequate bed linen, dressing table with mirror sink and toilet, electrical sockets, outdoor TV ariel socket and lockable doors with a key for clients who want it. Accommodation is provided in five units on three floors, the first and second floors being accessible by both stairs and lift. Unit 1 provides 9 intermediate care places, (8 people accommodated in Unit 1 with an additional intermediate care bed located in Unit 5). Unit 2 has 4 respite places and 4 interim care places. Unit 3 currently has 3 long term residential places and 5 interim care places. Unit 4 has 7 interim care places and currently has 1 long stay place. Unit 5 has 4 interim places (and the 1 Care Homes for Older People Page 21 of 30 Evidence: intermediate care place). In addition the home has an appropriate central kitchen, laundry area, a conservatory, toilets/ washing facilities and other suitable communal areas. It was also noted that a gymnasium had been constructed since the last inspection, primarily for the use of people accommodated for intermediate care and we were told that this was a valued addition to the home. During a tour of the building it was noted that the home had a range of specialist equipment to assist with rehabilitation programmes, the bedrooms that were seen and the communal areas were clean, well decorated, well equipped and had been personalised to varying degrees by the person occupying them, depending on the length of stay the person is living at the home. People living at the home informed us that they were satisfied with their bedrooms and the accommodation generally. One resident told us on a survey form; The home provides a clean and safe environment and another resident told us; My room is really good, much better than I expected when they were first talking about me needing to come here. We also talked to a resident who was more able and could travel independently in the community, they told us that they had a key to their room and could come and go as they pleased. The building also houses a separate day care facility that is not regulated by the Commission. We were told that the two services work well together and share some resources, e.g. the residential home can use transport from the day service by negotiation. However, the registered manager stated that the day service may move to a separate site which would give more space for the residential home. The registered manager stated that the home would benefit from dedicated staff room space given the number of staff employed or using the building and because of the complex and sometimes stressful nature of the work. A good practice recommendation is made that consideration be given to creating more dedicated staff space should the day service move out of the building. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by a staff team who have a range of competencies and who are deployed in sufficient numbers to address their needs. People living at the home are protected by the robust homes recruitment procedures although further documentation kept in the home to support this would be helpful. Staff have access to a range of training opportunities to assist them keep their skills and knowledge up to date. Evidence: The homes annual quality assurance assessment, AQAA, states; Staffing is sufficient and suitable to cover the needs of the users. Good team work between the team, sharing skills and responsibilities. The home employs a registered manager, two deputy managers, five senior care support workers and a team of care support workers. In addition the home employs support staff including administrators, cooks, domestics, a laundry person and a handy person. Staff are deployed on the different units as follows: Unit 1, intermediate care unit, two care staff am and pm (and an occupational therapist, physiotherapist, and therapy assistant from 8 am to 5 pm); Unit 2, respite and interim care, two care staff am and pm; Unit 3, long term residential care and interim care, two care staff am and one or two care staff pm; Unit 4, long term residential care and interim care, one or two staff am and pm; Unit 5, interim care (and one intermediate Care Homes for Older People Page 23 of 30 Evidence: care place, one staff am and pm. In addition the home deploys three care staff at night to cover all the residents in the building. We sampled the staffing rotas in the units and these were up to date and accurately recorded staff on duty at the time. It was our judgement that the staffing ratio was satisfactory to meet the needs of the residents accommodated at the time of this inspection. The registered manager is in addition to the staff on the rota. The homes annual quality assurance assessment (AQAA) showed that 22 out of 24 permanent care workers had achieved or were working toward the national vocational qualification (NVQ) level 2 (or above) in care. Records sampled and discussions with the registered manager and a number of staff confirmed this. We were told that no new staff have been recruited to the home in the past two years. We discussed the recruitment procedure with the registered manager, sampled some staff files and received feedback from a number of care staff regarding their experience when recruited. The registered manager stated that she is fully involved in staff recruitment to the home and confirmed that all the required documentation received before a member of staff starts work at the home. However, there were not copies of all the documentation kept at the home, the originals being kept by the Human Resources department of the L.B. of Hackney, the registered provider. We were satisfied from the above that the home operates a robust recruitment procedure. However, a good practice recommendation is made that copies of recruitment documentation is securely kept at the home to further evidence this. Evidence was seen that the home provides staff with satisfactory training to enable them to keep their skills and knowledge up to date. We saw evidence from staff files, from training records and from discussion with staff that recent staff training has included: food hygiene; first aid, safe administration of medication and health and safety. We also saw evidence that staff receive regular training and updates in areas such as communication, healthy living, catheter care and diversity. Staff spoken to stated that they appreciated the training they receive. However, there was no easy way of checking that all staff have received all the necessary core training and refresher training without looking at each individual staff members file. A good practice recommendation is made that a staff training matrix is produced that managers at the home can use as a tool to check when each staff member undertook each area of core training, so that refresher training can be planned as appropriate. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from the service being managed by a competent, qualified and experienced registered manager and her management team. People are regularly consulted to promote and monitor the quality of the service they receive and clear action taken to act on this. Peoples financial interests are safeguarded while living in the home. Staff supervision is provided to support staff meet the needs of people accommodated and to assist in their own development. A range of effective health and safety procedures protect people living in the home. Evidence: The homes annual quality assurance assessment, AQAA, states; (The home has) a registered manager who has a track record of good performance. (The registered manager)is experienced, qualified and highly competent in doing the job. (The registered manager) is social work qualified and updates all relevant training. The registered manager presents as being competent and experienced in running the range of complex and sophisticated service at Median Road. She is knowledgeable Care Homes for Older People Page 25 of 30 Evidence: about the service and has a clear vision on how it should be managed, including how the service should evolve. An example of this is the registered manager informing us that she played a major part in obtaining the funding to have the gym built at the home, including helping manage the work during the construction process. Both staff and residents spoken to talked highly of her. One staff member told us; Management are open and available to discuss issues, grievances and to give support. One of the residents told us; The manager listens if you talk to her. The registered manager is supported by two deputy managers and five senior care support workers. We spoke to several members of the management team including one of the deputy managers who was available to assist during the first day of the inspection. The senior staff team also presented as being knowledgeable and competent in their roles. The home monitors the quality of the service it provides in a number of ways. As indicated throughout this report the majority of residents only live in the home for a limited period. Each resident is given a questionnaire before they leave the home; these were sampled and provided useful feedback, the great majority of it being positive. The results of these questionnaires are analysed and help inform the homes business plan, that was also seen. The business plan contained clear and measurable objectives, including objectives about staff development, promoting residents health and well being and to review the outcome of outcome focused care plans. Feedback from long term residents is sought, including through annual reviews and the home receives regular monitoring visits from the provider organisation; the reports of these were sampled and were satisfactory. The home has clear and up to date records relating to money held for residents that were seen. The money and related records for one long term resident was inspected and the money and were found to be accurate and up to date. Evidence was seen from staff files that staff receive regular supervision at least every two months. Both staff supervised and managers who provided the supervision told us that the process was helpful, both regarding the running of the home and for the individuals overall development. A range of satisfactory health and safety documentation was seen. This included for gas safety, electrical installation and testing of portable appliances. The homes fire prevention documentation was inspected and was also satisfactory with evidence of a current fire plan, fire risk assessment, fire drills and that fire fighting equipment is regularly serviced. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 13 The registered persons must 01/10/2009 inform the Commission of any event which adversely affects the well being or safety of any service user. This must include any safeguarding adults incident identified by the home. This requirement is made to maximise protection to residents in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The home should continue working on making some peoples care plans more outcome focused, including to give staff more detailed guidance on how to meet peoples aspirations in the identified areas more effectively. The registered persons should consider providing more dedicated staff space should the day service that shares the building move elsewhere. This could assist staff to perform their tasks more effectively. 2 20 Care Homes for Older People Page 28 of 30 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 3 29 The registered persons should keep copies of staff recruitment documentation in the home to assist in evidencing that the home operates a robust recruitment procedure. The registered persons should keep an up to date staff training matrix to enable managers to quickly check that all staff have received all the necessary core training and to be able to pro-actively plan when refresher training is due. 4 30 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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