Care Home: Memory House Care Centre

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What the care home does well For the six months prior to this inspection, the home had been through a period of review and change. This was because the delivery of care to residents needed to improve. It was too early to report on what good practice had been sustained and what systems were robust as process were still being reviewed, introduced and implemented. However, the significant changes that have been introduced and evidenced as working well have been noted in the next section of this report. What has improved since the last inspection? There had been significant positive changes in the day-to-day management of the home and in the delivery of care to residents. The manager had introduced a more transparent and open style of leadership. This meant that staff appreciated the `hands on` style of management, relatives told us that they appreciated the commitment and openness of the manager and residents told us that the home was a happier environment to live in. To support this we noted that regular resident, relatives and staff meetings had taken place. Stakeholders told us that they felt listened to and felt their opinions were valued. During the day we observed good natured conversions between relatives, residents, staff and management. Relatives told us that the new home`s management had `made such a difference to the home`. When asked why they thought this had occurred, we were advised that the manager was `open, transparent and committed to making things better for the residents`. Staff told us that `we are much happier now`...`everything is so much better for the residents`...`we`re not frightened to ask about things`...`so much nicer`. Residents had also noted improvements. We were told `it`s much brighter here now`...`more friendly`...`staff seem to be around more`...`(the manager) keeps them (staff) on their toes you know and nothing gets past her`...`ah, yes more happening here now`...`my room has been decorated, it`s lovely`. The various recording systems used by the home were in the process of being reviewed. Many had already been reviewed and the necessary changes made to improve systems. For example there were regular environmental and medicines administration management audit tools in place. The activities programme had been extended to be as inclusive as possible. The staff training programme had bee reviewed and extended. An `employee of the month` scheme had been introduced by senior staff. This had boosted morale. The environmental changes had made the home lighter and brighter. The function of some of the rooms had been changed. This had created a new quieter lounge for residents and the manager`s office was now in a position near to where the day to day activity of the home takes place. What the care home could do better: It was stated in the AQAA that `all complaints have been filed in the complaints or SOVA log`. Our findings were that the home could not support this comment as there was no robust clear audit trail of complaints in place. The AQAA also stated `all care plans are evaluated monthly`. Our findings would support that more development work needs to be undertaken as not all records were current and the record system/format used for care planning was not `user friendly`. The Quality Adviser informed us that that the recording system would be changing but was unable to provide a date. Although the Quality Adviser and manager stated that the format used was not helpful, we explained the importance of having up to date information in records. This was to ensure that staff referring to the documents were clear about current care needs and how to meet them. There were no robust generic and safe working practice risk assessments in place. These are important to keep people in the home safe. Residents must have independent safe access to the home`s garden area. Currently, none of the residents could use the garden area unless accompanied by a member of staff. The maintenance of the rear garden area was not suitable for residents and the area was unsafe because of direct access to adjacent main roads. The home was registered to care for people with dementia and this shortfalls must be addressed by the provider. The provider must ensure that their monthly visits and subsequent reports are more robust. The shortfalls identified at this inspection by us should have been referred to within their latest report dated 3rd June 2010. The purpose of their monthly visits and subsequent reports is that they may be satisfied that the home is being managed on a day-to day basis in accordance with regulatory requirements. Key inspection report Care homes for older people Name: Address: Memory House Care Centre 6-9 Marine Parade Leigh On Sea Essex SS9 2NA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ann Davey     Date: 2 4 0 6 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 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) © 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 30 Information about the care home Name of care home: Address: Memory House Care Centre 6-9 Marine Parade Leigh On Sea Essex SS9 2NA 01702478245 01702711168 memory.house@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Personal care to be provided for older people aged over 65 years. Personal care to be provided to no more than forty-five service users who have dementia and are over the age of 65 years. The number of persons for whom personal care is to be provided shall not exceed forty-five. Date of last inspection Brief description of the care home Memory House provides accommodation for up to forty-five older people. Some residents may have care needs associated with dementia. Accommodation is provided in a large older style building that over looks the Thames estuary. The home is within a short walk of Leigh Broadway and Old Leigh Town. Memory House has thirty-three Care Homes for Older People Page 4 of 30 Over 65 45 45 0 0 2 4 0 6 2 0 0 9 Brief description of the care home single bedrooms and six shared bedrooms. There are three dining areas and two lounge areas. The manager advised us that fees for accommodation range from £439.88 to £750.00 per week. The actual fee depends on the source of funding (local authority or private), the type of bedroom required or available and the assessed care needs. There are additional fees for hairdressing, chiropody and personal items. The homes Statement of Purpose and Service Users Guide are displayed in the main entrance. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection took place on 24th June 2009. This inspection took place on 24th June 2010 between 9am - 4.30pm. Since the last inspection, there had been a change in the day-to-day management of the home. The new manager had been in post since December 2009. There had also been changes in the senior management team that visit the home periodically. The homes current Annual Quality Assurance Assessment (AQAA) which is required by law had been received by us and was dated 31st May 2010. The document provided the home with the opportunity of recording what it does well, what it could do better, what had improved in the previous twelve months and its plans for the future. The document had been completed by the manager. In the past year there have been significant challenges for the home in providing a safe Care Homes for Older People Page 6 of 30 and competent delivery of care. With the appointment of a new manager and improved senior management support and structure, the delivery of care had improved. The AQAA, which was completed in May 2010 was a fair refection of what improvements had been made and stated the homes plans for further improvement. Additional comments about the AQAA are made later within the report. During the day we spoke with the Quality Adviser (by telephone), the homes manager, a community nurse, a GP, nine members of staff, six visitors and many of the residents. We looked briefly around the home, viewed aspects of various records and observed care practices. We discussed all our findings with the manager and outlined our findings with the Quality Adviser via the telephone. We asked the manager to take notes so that they had their own record of what was discussed and agreed. Time was given for discussion, clarification and explanation when required. We acknowledged that our unannounced visit coincided with pre-arranged commitments for the manager. This was managed well by the manager. The cooperation of all those involved in the inspection process was appreciated. 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: It was stated in the AQAA that all complaints have been filed in the complaints or SOVA log. Our findings were that the home could not support this comment as there was no robust clear audit trail of complaints in place. The AQAA also stated all care plans are evaluated monthly. Our findings would support that more development work Care Homes for Older People Page 8 of 30 needs to be undertaken as not all records were current and the record system/format used for care planning was not user friendly. The Quality Adviser informed us that that the recording system would be changing but was unable to provide a date. Although the Quality Adviser and manager stated that the format used was not helpful, we explained the importance of having up to date information in records. This was to ensure that staff referring to the documents were clear about current care needs and how to meet them. There were no robust generic and safe working practice risk assessments in place. These are important to keep people in the home safe. Residents must have independent safe access to the homes garden area. Currently, none of the residents could use the garden area unless accompanied by a member of staff. The maintenance of the rear garden area was not suitable for residents and the area was unsafe because of direct access to adjacent main roads. The home was registered to care for people with dementia and this shortfalls must be addressed by the provider. The provider must ensure that their monthly visits and subsequent reports are more robust. The shortfalls identified at this inspection by us should have been referred to within their latest report dated 3rd June 2010. The purpose of their monthly visits and subsequent reports is that they may be satisfied that the home is being managed on a day-to day basis in accordance with regulatory requirements. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can expect that their needs would be assessed or identified to ensure that their admission would be appropriate. Evidence: There was a current Statement of Purpose and a Service Users Guide on display in the entrance hallway. We noted that copies of these documents had also been placed in the bedrooms we viewed. The home had a coloured brochure which provided further information about the service. Copies of these documents can be sent by the home to any interested party. We viewed various elements of the pre-admission process documentation belonging to three recently admitted residents. The documents had been completed well and the care needs clearly identified. We noted that the respective resident and their relatives had been involved in the process. Interim care plans had been put in place on admission to the home. Care Homes for Older People Page 11 of 30 Evidence: We spoke with a relative of a resident who had been recently admitted. They confirmed that they had visited the home prior to the admission taking place. We asked them about their experience of the pre-admission and admission process. They described the home as clean...no smell...lively...friendly. They felt that the preadmission and admission process had been managed well. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can expect to have their health and social care needs recorded within a developing system that would promote a safe and competent delivery of care. Evidence: The manager advised us that since their appointment, the content of all care plans and risk assessments had been reviewed. We looked at various elements and aspects of five residents records. This included care plans, risk assessments periodical reviews and health care documentation. The files we looked at were well indexed and the various documents within them were filed in an orderly manner. The manager confirmed that the format used by staff to record care needs, risk assessment, reviews, health care records, daily records was not user friendly and were perhaps more suited to a clinical/nursing environment. Care needs, health care needs, risk assessments and reviews were in place but the formats used had led to duplication and some identified care plans had not been Care Homes for Older People Page 13 of 30 Evidence: updated. The updated information was in the evaluation section, but the care plan had not been updated. The manager confirmed that there had been some confusion about the purpose of the evaluation document. Following discussion, the manager confirmed that whilst adequate information was available to provide good care, the process of recording the information required developing. The Providers last visit took place on 3rd June 2010. Their subsequent report stated review of service users plans...all up to date, no problems noted. This was not entirely consistent with our findings. We spoke with the Quality Adviser who had undertaken that visit about this. They advised us that the formats currently in use were subject to review. They also confirmed that they would provide a full day training session for all staff on 14th July to ensure that whilst the new formats were being reviewed, the information on the existing formats would be recorded in a way that was more user friendly. Staff would be assessed as to their competency in this area of their work. This confirmation of the training to take place, influenced our overall assessment rating of this group of key standards. Relatives and residents we spoke with all confirmed that they had been consulted about their respective care issues. Relatives commented that they had seen care being delivered in a sensitive and dignified way. We observed that staff engaged with residents in a friendly and supportive manner. We noted during the day that whilst staff were updating various records, they were sitting with residents and interacting with them. Staff told us that they had full access to care plan documentation. A key worker system had been introduced and was well established. One resident told us that this was a good idea and it works well. Another resident said I like my key worker, shes mine you see and I can tell her anything. The residents were spoken with expressed satisfaction with the care they had received. Nobody raised any concern or expressed a negative view. Staff we spoke with were knowledgeable about individual residents care needs. We spoke with a community nurse who advised us that the care in the home had improved in the past six months and neither they, or any of their colleagues had concerns about the home. During the morning a GP asked to see us to express their satisfaction about the general management of the home and to compliment a named member of senior staff. We looked at the medicine storage facility and viewed aspects of the medicine administration recording system. We were assisted by a senior member of staff. The Care Homes for Older People Page 14 of 30 Evidence: member of staff advised us that they had up to date medicine administration training and had access to relevant guidance. We were advised that a monitoring visit had taken place the previous day by the contracted supply pharmacist. The home was asked to ensure that the temperature within room which stores medication is maintained within practical guidelines. We sampled the MAR (medicine administration records) and noted that there were no anomalies in the recording process. We noted that there was a small fridge to store medicines that require refrigeration. This was locked and the temperature of the fridge had been monitored and recorded on a daily basis. 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. Residents benefit from a varied, balanced diet and are able to participate in a wide range of social activities Evidence: The menu for the day was clearly displayed and demonstrated a choice and variety for each meal. Records were available to show the daily choice of individual residents preferences. We noted that fluid intake charts were current. The day of the inspection was very hot and the chef was preparing alternative dishes for those residents who preferred something lighter because of the heat. We noted that there was a good supply of drinks available and staff were encouraging residents to drink regularly. Residents and relatives were positive about the provision of food. We noted that tables had been attractively laid for lunch and tea. We saw an appetising cooked tea being prepared and served. The home employs 2 part time activity co-ordinators. There was evidence to support that was a good activity, social, recreational and occupational programme in place. There was information in the entrance hallway about the various activities and events. During the afternoon of the inspection, there was a live music session. This was being enjoyed by a number of residents. We spoke to one resident who had chosen to Care Homes for Older People Page 16 of 30 Evidence: spent the afternoon in a quieter part of the home. They told us theres always something going on if you want it, but I like a bit of quiet sometimes...nice things go on though. Within the residents surveys, three residents said that they would like to have direct access to the garden area. The manager confirmed that due to safety and access issues, residents had been unable to use the garden area independently. The manager assured us that plans were in place to rectify this and agreed that residents had the right to use these facilities if they wished. This matter influenced the overall judgment outcome of these group of key standards. Relatives told us that they were always made to feel welcome and appreciated the open door policy of the manager. We were told theres always somebody around to ask about anything...we have refreshments here and if I asked, Im sure I could have a meal too if I wanted it. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their concerns will be dealt with appropriately and their care provided in a safe way, but may find that the associated record systems are not robust. Evidence: The manager advised us that since the last inspection there had been six safeguarding alert referrals made to the local authority. The manager advised us that five of these referrals were not upheld and one was upheld. This was in connection with poor care practice. The manager further advised us that for the past six months there had been no further referrals. There had been a change in the homes management in December 2009 and the manager expressed the view that management systems were now more robust, communication between all parties was more effective and care practice had improved. Their view was that these elements had eliminated any further referrals. Staff we spoke with had a good understanding of safeguarding vulnerable adults and what to do if they suspected poor practice. We requested to view the homes complaints record log and experienced some confusion about the way in which complaint details, the investigation process and the outcomes had been managed. The details of any complaint, the investigation process and the outcome were in the main held in different places. For example, there was a complaint index log which identified complaints and safeguarding referrals, a record sheet for each complaint which had reference to a few of the complaints and an email Care Homes for Older People Page 18 of 30 Evidence: printout from the Quality Adviser about other complaints and safeguarding matters. The email printout had details of all the complaints the home had dealt with and had been stored in a different record. Some of these complaints were in association with the safeguarding alerts. The manager confirmed that although the required information was available and kept in different places, the audit trail was poor and not clear. The manager advised us that the Quality Adviser had responsibility for this aspect of care. Our findings were not entirely consistent with the Quality Advisors report on 3rd June 2010 which stated review of complaint logs, all up to date and managed well. Since the last inspection there had been a number of concerns raised by various parties in connection with the care provided by the home. There must be a clear audit trail in relation to safeguarding issues, concerns and complaints. Our findings have been referred to further within the management and administration section of this report. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe and comfortable environment but do not have independent access to the garden area. Evidence: We looked around the home with the manager and viewed some of the facilities. At the beginning of the year, there had been a major water leak which caused considerable damage to a large area of the home. Residents had been moved to another sister home whilst repairs were made. The bedrooms we viewed were homely and comfortable. Many contained items of personal belongings. Each room had a copy of the Service Users Guide, the name and photo of their key worker and a comments book for either the respective resident or the relative/visitor to complete if they wished. We noted that bedroom doors had the name of the occupant displayed. The decoration and furnishings in these rooms we viewed were of a good standard. Bathrooms and toilets facilities were clean and functional. The communal areas were clean, bright, airy and furnished to a good standard. The entrance hallway contained useful and helpful information about the home. The kitchen was clean and orderly. We noted that staff in the laundry area did not have direct access to disposable gloves and aprons. The member of staff told us that they Care Homes for Older People Page 20 of 30 Evidence: collect them from another area when needed. We asked that gloves and aprons be made available in the laundry area and this was addressed. The managers office had been relocated to the ground floor which meant that they are now situated in an area close to where most of the residents and staff spend their time. The managers previous office had been refurbished and was now a quiet lounge/visitors/activity room. The manager told us that it had become a popular venue for some residents. The manager acknowledged that the garden area needs considerable work to be completed to ensure that it is safe and appropriate for residents to use independently. We noted that the front and rear garden gates had been left wide open. Any resident who found their way to the garden areas would have direct access to busy main roads. The manager confirmed that they knew of the risks but there was no risk assessment available. The garden area was large and had potential for being a good resource for residents. The manager assured us that they would ensure that the matter would be raised again with the provider. This aspect of the premises influenced the overall judgment of this group of key standards. It was the view of the Commission that residents should have independent and full access to grounds that are tidy, safe and attractive. This was reflected within residents surveys sent to us and in our conversations with residents on the day. Within the providers recent monthly report undertaken by the Quality Adviser, there was no reference to residents not having access to the garden area. We suggested to the manager that as the inspection had taken place mid summer, it was considered not acceptable by us that there was no provision for residents to enjoy the outside garden area independently. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are looked after by appropriately recruited, trained and supervised staff. Evidence: The current manager was recruited in December 2009. There was evidence at this inspection to support that the appointment had been a positive impact on the staffing establishment within the home. The outcome of this was that the day to day delivery of care to residents was better managed and consistent. The current staff rota was displayed and reflected the staff on duty at that time. The home was registered to accommodate forty five residents. At the time of the inspection twenty nine residents were accommodated. The manager advised us that there was a minimum of five/six care staff on duty in the morning, five care staff on duty during the afternoon and evening period and three awake staff on duty at night. The home had an established team of support staff consisting of housekeeping, cooking and administration staff. The manager advised us that once the number of residents had increased to thirty, their would be a minimum of six care staff on duty every morning. The manager told us that once the numbers increase further, there would be a full review of the number of staff on duty at every shift. This would ensure that the current good delivery of care continued. Also, it would mean the ratio of staff to the number of residents Care Homes for Older People Page 22 of 30 Evidence: accommodated was not compromised in any way. The manager told us that they understood that the regulatory requirement was that sufficient numbers of appropriate staff must be on duty at all times to meet the assessed needs of residents. It was positive to note that the home does not use agency staff. The manager told us that they have authority to authorise additional staff at any time should the need arise. For example, training, holidays or sickness. The manager was in the process of implementing a bank of relief staff. We looked at the recruitment records belonging to two of the recently recruited members of staff. The elements we looked at were in good order. We noted that both records had contained induction documentation. The manager had a detailed staff training spreadsheet in place and there were completed staff training certificates in the staff records we viewed. Staff told us that they had been given the opportunity to attend training sessions. There were records in place to support that staff had received regular supervision sessions and attended staff meetings. This was confirmed by staff we spoke with. Staff were very positive about working in the home. The manager advised us that the home had two Dignity Champions. These members of staff had received specific training to ensure that the dignity, safety and welfare of residents was promoted to its highest level. The senior staff had recommended that the home adopted an employee of the month competition. We spoke with the nominated employee of the month who told us that they felt very honoured. Their photograph had been displayed in the hallway. From speaking with staff we noted that morale was positive. Staff members were enthusiastic about their work. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall monitoring and review system carried out by the provider was not robust. The developing day-to-day in-house management processes and systems ensure a more positive delivery of care to residents. Evidence: The last key inspection took place twelve months ago. During these past twelve months, there had been multi-agency professional interest about the day-to-day management and the level of support provided to the home by external senior managers. There was concern about the delivery of effective and competent care to residents. The impact of this interest led to the provider fully reviewing the day-to day-management of the home and the role and function of senior management support staff. The current day-to-day manager had been in post since December 2009. They acknowledged that when recruited, they were made aware of the improvements in the delivery of care that needed to be made. At this inspection there was evidence to Care Homes for Older People Page 24 of 30 Evidence: support that a number of improvements and developments had taken place since their appointment. The manager advised us that they were in the process of making their application to the Commission to become the registered manager. We noted that the home had health and safety notices, infection control guidance displayed and machinery operating instructions were displayed in utility areas. The manager was unable to locate the homes current environmental and safe working practice risk assessments. The manager told us that they had not seen these documents since being in post. We acknowledged that much of the information was available but there were no risk assessments in place to ensure that staff and residents know of risks and the measures in place to minimise harm or injury. For example there were no risk assessment in place regarding the gates used on all internal stairways, the garden area was not safe for residents to use and we noted a number of caution signs placed in main corridors through the home following cleaning. Staff knew of the risks but there were no assessments in place advising on how to minimise harm or injury. The manager informs us of incidents and matters that they are required to notify us about. We noted that there was a residents incident and accident folder available. The community nurse told us that there had been a significant reduction in the number of injuries to residents which had required their services. We noted that the manager had implement a number of daily management audit tools. For example, environment audits and medication audits. These audits had been used to identify shortfalls and monitor good practice. The home looks after residents personal allowances if requested. There was a detailed and orderly transactional audit trail in place. We viewed some of the service and maintenance agreements and contracts. These were current and in order. There were records in place to support that the temperature of the hot water in residents bedrooms were being monitored and that the various aspects of the fire alarm system were in good working order. The manager advised us that all stakeholders had recently been sent survey forms and the results were in the process of being collated. There were records to support that regular resident/relatives meeting had taken place. There was one due to take place on the evening of our visit. The manager advised us that the Essex Fire and Rescue Service had arranged to visit the home on 5th July 2010. This was for a routine inspection and the manager said that the opportunity would be used to discuss the gates across the stairs, fire risk Care Homes for Older People Page 25 of 30 Evidence: assessment and safe access to the garden area. The manager told us that there had been a previous issue with Fire and Rescue about restricted emergency exits. We advised the manager that issues noted by us at this inspection must be raised with the Fire Service and addressed or resolved to the Fire Services satisfaction. The local authority had made several recent visits to the home and the manager was awaiting the subsequent report of their findings. In February 2010, the Environmental Health Department carried out a routine visit. The manager advised us that the shortfalls identified at that visit had been addressed. We noted that the Quality Adviser had undertaken visits on a regular basis to the home on the providers behalf and had provided reports. We viewed the last report following a visit which took place on 3rd June 2010. As recorded earlier in this report under the complaints and personal care section, the statement within their report was not consistent with our findings. Within their report it was stated that records had been reviewed including care plans and noted as all up to date. Our inspection took place three weeks after their visit. Their findings were not consistent with our findings. There was no reference in their report about the current recording format not being suitable or helpful as reported to us by the manager. There was no reference on their report about residents not having independent access to the garden areas. There was no reference to there not being any recognised generic and safe working risk assessment documentation in place. The manager provided us with a photocopy of the report dated 3rd June 2010. We acknowledged that regular visits had taken place and subsequent reports had been produced. However, the purpose of this regulatory activity was to inform the provider of the day-to-day business of the home. As part of the inspection process, we made an assessment of management and practice that had taken place within the home over the past twelve months. We have acknowledged the improvements and developments that had taken place for the benefit and wellbeing of residents. However, the monthly report we viewed was considered by us to be brief in content and detail, not accurate in all areas and would not have provided a robust overview of the homes conduct for the registered provider. The provider must ensure that robust monitoring and review processes are in place to ensure that the improved delivery of care to residents is maintained. The provider must be provided with an accurate and fair report in order that they may be satisfied that the home is being managed in accordance with regulatory requirements. Our findings influenced the overall rating of the home. 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 19 23 Arrangements must be 31/10/2010 made for all residents to have direct and safe access to the homes external garden area. This area must be suitable for residents and maintained in good order. This is to ensure that all residents have safe and independent access to the homes garden area. 2 33 26 Monthly visits must be undertaken by the provider or their nominated representative and a subsequent report written based on their findings. These visits and subsequent reports must be an accurate and fair refection of conduct within the home. This is to ensure that the registered provider can be satisfied that the home is being conducted on a day to day 24/07/2010 Care Homes for Older People Page 28 of 30 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 basis in accordance with regulatory requirements. 3 38 9 There must be robust current environmental and safe working practice risk assessments in place. These must be in place to ensure that the safety, welfare and wellbeing of residents and staff is maintained at all times. 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 24/07/2010 1 7 A full review should take place to ensure that care plans and risk assessments contain the most current information. This is to ensure that staff know what the care needs are and how to meet them There should be a clear audit trail in place for all complaints and safeguarding matters received by the home. This should include details of the complaint, the investigation process, the outcome and contain copies of all associated correspondence. 2 16 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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