Care Home: Milbanke HFE

What the care home does well The residents in this home are well cared for. Residents are given enough information about the home before admission so they can decide whether they want to live in the home. Staff meet residents to assess their care and support needs before deciding if the home can meet their needs effectively. Care records are informative and reviewed regularly with information easy to find. Medication administration is given, stored and disposed of correctly and residents are given medication at the correct times ensuring that it gives maximum benefits to residents. There are a variety of interesting and stimulating social and leisure activities for resident to do in the home and local community. We observed staff interacting with residents. staff were sensitively supporting people who needed help with personal care. One resident said of the staff, "They are the best." Routines in the home are flexible and residents spoken to said that they can choose when they get up and go to bed and whether they want to join in activities. Meals are varied and plentiful. Special diets are provided as needed or requested. Residents are supported to see the visiting ministers on their regular visits. Relatives are welcomed at any time. Residents feel they are listened to and any concerns acted upon. Any concerns are robustly investigated and dealt with appropriately and sensitively. We toured the home and found the environment was well maintained, comfortable, clean and tidy. Residents were complimentary about the staff and managers of the home. Residents said there were enough staff to support them well. Most care staff have completed National vocational qualifications (NVQ). NVQ`s are national awards in care that enable staff to gain up to date skills and knowledge about current care practice. This helps staff have up to date skills and knowledge in care practice. The management team are enthusiastic about caring for older people and pass this onto the staff team. What has improved since the last inspection? Care records have been improved to provide more detailed information about residents and care plans and risk assessments are signed and reviewed monthly, so that information is clear and up to date. Professional visits and activities residents have been involved in are recorded on individual forms and kept with the persons care records to ensure confidentiality. There are regular resident meeting and staff meetings so that everyone has an opportunity to air their views and gain up to date information. What the care home could do better: Some areas of recruitment need attention to reduce the risk of employing anyone unsuitable to work with vulnerable people. Staff should receive induction training that meets national standards on starting working in the home, so they have the basic skills and knowledge needed to care for people. First aid, food hygiene and fire safety training should be provided to all staff so that they have the skills and knowledge to carry out their duties effectively Key inspection report Care homes for older people Name: Address: Milbanke HFE Station Road Kirkham Lancashire PR4 2HA     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: Pauline Caulfield     Date: 1 9 0 3 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 33 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 33 Information about the care home Name of care home: Address: Milbanke HFE Station Road Kirkham Lancashire PR4 2HA 01772684836 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Lancashire County Care Services Name of registered manager (if applicable) Mr Aidan Finley Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Dementia - Code DE. Mental disorder, excluding learning disability or dementia - Code MD. Physical disability - Code PD. The maximum number of service users who can be accommodated is: 44. Date of last inspection 2 1 0 4 2 0 0 9 44 44 0 44 Over 65 0 0 44 0 Care Homes for Older People Page 4 of 33 Brief description of the care home Milbanke Care Home provides high quality accommodation for a range of people with different needs and requirements. The home is currently separated into three different self contained units two of which provide accommodation for older people and the other is for people assessed as requiring specialist dementia care. In addition, the building houses a designated, separately run day care centre and office accommodation. Milbanke Care Home is located in a convenient location close to the main shopping centre of the town and local amenities. The accommodation is purpose built, arranged over two floors and offers individual bedroom accommodation to all residents some of which are provided with an en-suite facility. Each individual unit also has a large lounge/dining room that is bright, airy and comfortable and a smaller quiet lounge. Bathroom/shower and toilet facilities are conveniently located and provided with aids to promote independence. A passenger lift is provided for ease of access throughout the home. The fees for the home are between £386.50 and £486.50 per week There are additional costs for hairdressing, outings and newspapers and magazines. Care Homes for Older People Page 5 of 33 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: This was an unannounced visit undertaken as part of the inspection process which commenced at 10am for eight hours. Before the visit the home completed an annual quality assurance assessment (AQAA). This is a document that provides CQC with written information and an assessment about the quality of the services the home provides. The registered person is asked to provide us with this information each year. The inspection involved case tracking four people living in the home as a means of assessing the care provided in the home. Case tracking means the inspector looks closely at a small group of people living in the home. We talk to them about the home if they are willing to and are able to talk to us. If they cannot talk to us we watch how staff care for, talk to and involve them in activities. We look at any information about their care and support and look around the home, particularly at rooms the case tracked residents use. We also spend time talking to other people in the home. We also talked to some staff and looked at administrative records in the home. Care Homes for Older People Page 6 of 33 Comment cards were received from ten people living in the home, one relative and six members of staff. We have put this report together from watching the care provided, from comments received from people living in the home, relatives and staff and written information we saw before or during the inspection. The last key inspection on this service was completed on 21st April 2009. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? Care records have been improved to provide more detailed information about residents and care plans and risk assessments are signed and reviewed monthly, so that information is clear and up to date. Professional visits and activities residents have been involved in are recorded on individual forms and kept with the persons care records to ensure confidentiality. Care Homes for Older People Page 8 of 33 There are regular resident meeting and staff meetings so that everyone has an opportunity to air their views and gain up to date information. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 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 33 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. Detailed assessments are carried out before admission so that staff know what care the residents needs and residents know their needs can be met. Evidence: We case tracked four people living in the home, some of the residents had been admitted since the last key inspection and were using the new assessment and care planning information which provided detailed information on residents. Prospective residents are provided with the written information they need to make an informed choice about whether to live at the home. Since the last inspection, the homes Statement of Purpose and Service User Guide have been updated and amended to make sure that the information provided is accurate and up to date. The information is now provided in large print text and can be provided in other languages, the alternative language copy seen was in Polish. The service user guide is also available as an audio CD, so that prospective residents can, if needed, choose to listen to the information instead of reading it. Care Homes for Older People Page 11 of 33 Evidence: The home also provides a welcome pack of toiletries and goodies for every new admission to help them feel they are wanted in their new home. There have been several new residents, admitted to Milbanke care home since the last key inspection in June 2009. There are policies and procedures in place so that individuals needs and requirements are known prior to admission. The manager undertakes an assessment of the prospective residents care and support needs to identify if the home can provided their care and meet their needs. There is also a Health or Social Services assessment in place before admission, unless the person is self funding. People are only admitted to the home if their health, personal and social care needs can be met. These assessments provide information so staff are aware of the needs of the new resident and staff base the initial care plans of the new resident on these assessments. Most people living in the home who spoke to us or who returned comment cards said they and their families had been given information about the home and discussed their care needs before they moved into. The intermediate care unit at Milbanke care home is not operational at present, therefore the standard relating to an intermediate care service was not assessed on this occasion. Care Homes for Older People Page 12 of 33 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. Information about residents care needs is accurate and up to date and medication management is good. Evidence: We case tracked four residents looking at their care records to check if the information was relevant, up to date and accurate. Care plans are written for each resident. These have been updated since the last inspection. They included care plans in the following areas: Personal care and physical wellbeing, Personal safety and risk, sight hearing and communication, Continence, social interest, hobbies, religious and cultural information, medication and any other relevant areas. It was clear that these were working documents as although the first part of each area of need was type written, staff had added any changes or additional information by hand. This is ggod. All staff are encouraged to write any information in the care plans. These were reviewed monthly and where appropriate the information collated to form the next months care plan. There were also risk assessments in place showing the action taken to reduce any Care Homes for Older People Page 13 of 33 Evidence: identified risks for each resident case tracked including, mobility, falls, nutritional, night risk, continence, dementia dependency. These were also regularly reviewed so any risks were reduced and managed appropriately. Weights were monitored and recorded regularly and food eaten by each resident was recorded. There were detailed daily reports completed by staff which recorded information on health and wellbeing, activities undertaken, visits from friends and relatives and any other issues noted. This enabled staff to provide a person centred service. Medication was checked as part of the inspection. Medication stock was well organised. Medication was given as prescribed and good storage and administration was in place. Medication was signed when administered and there were no missing signatures. Medication is checked in and out of the home and there are regular medication audits carried out. Where possible residents administer their own medication. We looked at how people were supported to look after their own medication and we saw good procedures for this. People were encouraged and helped to do this and we saw examples of people managing their medicines safely. Medication management has continued to be managed well. We looked at how staff were trained to handle medicines. Staff who handled medication had attended medicines training. These staff had been formally assessed for competency when handling medicines. Regular training and competency checks on staff help make sure they have the necessary skills to handle medicines safely. People living in the home said staff were helpful and caring. One resident said They are the best, the staff here. Another resident commented, They look after me well. Individuals spoken to were pleased with the care they received. We observed staff interactions throughout the inspection. Staff were respectful and polite to people living in the home chatting to them frequently and checking they were comfortable. Staff respected the privacy and dignity of residents and they were sensitive and mindful of residents feelings. A relative said, They look after my mum well. Another relative said, The staff are caring and make people comfortable. Residents that completed comment cards said that they usually got the care they needed at the time that they needed it. They stated that people living at the home always received the medical attention that they needed when they needed it. There is a good relationship with health and social care professionals in order to Care Homes for Older People Page 14 of 33 Evidence: maintain residents health and social well-being. A health professional said relationships were good and she had no problems with the home. Since the last key inspection, the home had stated to use an individual Health profession visits sheet for recording any information on each resident ensuring confidentiality of information. A member of staff said, The home provides a caring service in a safe and respectful environment. During the inspection there were two separate incidents of staff managing a medical emergency effectively. One resident already ill and having seen the GP earlier in the day, deteriorated and staff reacted quickly, another resident suddenly became ill and breathless and was supported well until the emergency services arrived. Staff supported the residents, called the emergency services quickly and calmly and collected the relevant documents ready for the paramedics/hospital on arrival. Care Homes for Older People Page 15 of 33 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. Meals are nutritious, routines are flexible and there are a some regular social and leisure activities. Evidence: Routines in the home are flexible and residents spoken to said that they decide when they get up and go to bed and whether they want to join in activities. The manager said that several residents rise quite late and stay up late at night and residents are encouraged to choose when they want to rise and retire. One resident said, I get up and go to bed when I want. Activities have increased in the home over the last year and staff are encouraged to engage residents in a variety of activities. A member of the management team has attended an extended activity development training programme covering a range of interests. The person undertaking this training has cascading the training to other members of the staff team so that more appropriate activities can be provided by members of staff. A member of staff said there were now a wide range of activities offered to residents, including special events to mark occasions such as Burns night, Valentines day and Easter. We observed activities for a while in one unit, residents were engaged in discovering the everyday item placed in small cotton bags. The member of staff was moving from Care Homes for Older People Page 16 of 33 Evidence: one resident to another discussing the item and engaging their interest. Armchair exercises and ball games were also carried out during the day. Several residents said that there are regular activities available including some entertainers coming into the home. The hairdresser visits regularly and one resident said she enjoyed getting her hair done. Staff said most residents enjoy the social side of having their hair done. Staff provide manicures and hand massages to residents regularly. Staff are attentive to residents wishes. One resident had just had nail polish applied to her finger nails and was pleased with this but did not enjoy the feel of the hand cream on her hands and staff assisted her to wipe this off. Leisure activities are an important part of life in the home as leisure and social activities enable residents to interact with each other and to spend time together and pass time in a pleasant manner. In better weather staff said they enjoy taking residents into the garden for picnics and some games. One resident said she only really joined in when entertainers came to the home. Another resident said she enjoyed the Bingo and two residents said they liked exercises. Staff record the activities each resident engages in on their individual activity records, showing whether they have enjoyed the activity. Staff encourage residents to get involved with and assist them in carrying out everyday living tasks such as setting the table and folding napkins. There are plans for residents to get more involved in gardening as the weather improves. One resident enjoys delivering mail around the home and is encouraged to do so with support as needed. Residents enjoy this purposeful activity. People living at the home are provided with well balanced and nutritious meals with a choice of menu. Residents spoken to and those who returned comment cards said the meals were usually good. One resident said. I enjoy the food here. All my meals are made for me. However another resident said the choice of food could be better. We discreetly observed residents in one unit having their evening meal. Staff were calm and supportive throughout the meal, which was relaxed throughout, with people encouraged to chat to each other and to staff during the meal. Staff were providing a choice of crockery and cutlery according to resident needs and preferences. The manager said he has talked to residents and to the chef about moving the main meal of the day from lunchtime to the evening. Residents have agreed to give this a try as it would allow residents that enjoy a lie in the morning and then to enjoy the Care Homes for Older People Page 17 of 33 Evidence: main meal of the day in the evening instead of having a late breakfast and then not wanting a main meal soon after. All current residents are nominally Christian or have no religious persuasion. The home would endeavour to meet the needs of people from any other religion or background. Ministers of local churches and places of worship regularly visit the home and residents are able to attend services in the home if they wish. Staff are encouraged to look at residents individual and diverse needs to ensure everyones needs are met. Friends and relatives of residents can visit at any time so that relationships are maintained and developed and they can sit in the communal areas of the home or the residents bedroom if they wish. Relatives of a resident said how comfortable the resident was in the home. Individuals are also supported to manage their own financial affairs for as long as they are able and wish to do so. For some people however, a family member takes on this responsibility. Care Homes for Older People Page 18 of 33 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. Concerns are handled appropriately and people living in the home feel that they are listened to. Evidence: According to the AQAA, discussion with the manager and from surveys it is clear that residents know how to make a complaint and the home has responded appropriately to any concerns or complaints received. All concerns or complaints are recorded and followed up. Two complaints have been received in the last twelve months, investigated and any necessary action taken. One resident said, I have no complaints regarding the home at all. There are policies and procedures in place for the protection of residents. This includes the adult protection policy and a whistle blowing policy to help protect people living at the home from abuse or discrimination. Staff have received safeguarding adults training on induction and on National Vocational training (NVQ) and also receive refresher training. They have a good understanding of the action to be taken if they are alerted to a safeguarding issue. Staff said they could talk to senior staff if they had any concerns about care and know they would deal with it. The manager said he has an open door policy and staff can discuss any concerns throughout their working day, during one to one supervision and Care Homes for Older People Page 19 of 33 Evidence: at staff meetings. Staff are aware of the importance of protecting residents. Over the last year some issues resulting from a safeguarding alert have been investigated and appropriate action taken. This matter is now concluded. Staff are aware of their responsibilities in safeguarding residents. Care Homes for Older People Page 20 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment in the home is comfortable, clean and pleasant to live in. Evidence: Milbanke care home is purpose built, situated on a main road and located in a residential area of the town. The home is close to the centre of the town and all local amenities Accommodation is provided on the ground and first floor of the building and there is a passenger lift to and from the first floor. There are lawns to the front and side of the home and a secure rear garden area. There is also a car park. Two of the units provide accommodation for older people and the third unit is an extra care unit specifically designed for people with a diagnosis of dementia. Radiators are guarded and there are thermostatic devices on all hot water outlets in the accommodation to prevent the risk of accidental burning or scalding. The home is well maintained, clean and tidy and pleasant smelling. The building is divided into four separate units although one of the self contained units is currently not operational. Each unit comprises of a large communal lounge and dining area, a smaller separate quiet lounge, bedrooms and bathroom and toilet facilities. All bedroom accommodation is for single occupancy and some bedrooms are provided with an en-suite facility. Care Homes for Older People Page 21 of 33 Evidence: We toured the home and found the environment comfortable, clean and tidy. Communal areas of the home are bright, welcoming and airy. Residents spoken to said how much they liked sitting and relaxing in the comfortable lounges. The main lounge and dining room in each unit in use, are provided with space saver kitchen units providing facilities for making drinks and snacks. Residents are encouraged to personalise their bedrooms so that they have familiar things around them. Residents enjoyed being able to have their own things around them in their bedroom, reminding them of home. Aids and adaptations are in place to help residents get about more easily and to be as safe and as independent as they can be. A lockable facility is provided for the safe storage of personal items and all bedroom doors are fitted with a lock to ensure privacy. Laundry facilities are in a designated area of the home and situated away from resident accommodation and food preparation areas. The laundry is well equipped there is a laundry assistant employed. Information seen on the inspection showed all care staff team have either received infection control training or were receiving it the week following the inspection. This ensures that people working at the home are aware of good infection control measures in order to protect residents. Care Homes for Older People Page 22 of 33 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. Most areas of recruitment and selection are robust and thorough and many staff have most of the training needed to support residents effectively. Evidence: Staff rotas showed sufficient staff on duty doing the inspection. Residents and staff felt that there were sufficient numbers of staff on duty to provide good care and support to residents. There were some concerns that as residents age more personal care is needed and care staff may not have time to spend with each resident. The manager has some flexibility in the budget so would be able to provide short term staffing if needed because of additional care needs. There are now a minimum of seven care staff plus an officer in the home during the day, including three staff at all times during the day in the extra care dementia unit. Staff and relatives felt that this improved the service and when we observed care in this unit, staff were busy but able to chat to and engage residents in the unit. In addition to management and care staff, domestic staff, a laundry assistant and catering staff are also employed. Although a high number of casual bank staff and agency staff are used, the people use work in the home regularly so are familiar with the residents needs and routines in the home. Care Homes for Older People Page 23 of 33 Evidence: Last year the night time staffing arrangements were reduced to two waking watch members of staff and a member of the management team sleeping in. However the homes manager does have a flexible budget to bring in additional night staff should a resident be ill or for any other reason that an additional member of staff may be required. There were no concerns expressed over the night time cover by residents, relatives or staff during this inspection. Some of the staff have worked in the home for several years. This ensures that staff are familiar with residents and their care needs and residents know the people caring for them. One resident said, Staff are very kind and helpful. I am so pleased I am here. Another resident commented, Staff look after you well. We looked at the recruitment process for some members of staff and found that in most areas of recruitment this was robust and thorough, but more detailed previous work history is needed. The records of two members of staff were checked. Both applicants had an application form with work history although each only had a short work history although they had worked for a number of years in a variety of jobs. One of the applicants only had the year of any change of employment rather than the month and year, making it difficult to see if there were any gaps in employment. A complete working history from first to present job exploring any gaps is required so that the manager has full details of applicants previous jobs, duties and the length of time they remained in these jobs. This helps to keep people living at the home safe and to make sure that only staff with the right personal qualities are employed to care for and support vulnerable people. The staff files checked had two or three written references in place providing information about previous employment and the applicants character. Applicants did not have the reason for leaving previous employment and should do as this provides more information about the applicants work history and enables the employer to gather more information about the skills and experience the prospective member of staff has. There was health information in place and PoVA checks CRB checks. These are checks that look at whether staff have been convicted of a crime or have been reported as unsuitable to work with vulnerable people. All staff had received a limited induction, however the manager said that although the nationally recognised, Skills for Care induction training for care staff is in place for new staff at the home, the two most recently appointed members of staff have not been provided with this training. One member of staff commenced in post earlier in the year so is only a little late with this training but the other member of staff has been in post Care Homes for Older People Page 24 of 33 Evidence: six months and still has not had this training. It is important that staff, undertake this training within the first few weeks of employment. This makes sure that care staff new into post, have the basic skills and knowledge to ensure that they can support residents effectively. Twenty nine of the thirty management and care staff have now completed National vocational qualifications (NVQ) to at least level 2. This is well above the requirement that fifty percent of staff complete this training. NVQs are national awards in care that enable staff to gain up to date skills and knowledge about current care practice. This means that residents can be confident that they are supported by a skilled staff team. At the last key inspection the home did not keep a staff training matrix and it was difficult to establish just what training staff had been provided with. At this key inspection there was a detailed matrix of staff training clearly showing the training staff had received and the training they still needed. It also provided a trigger for when refresher training was due. The manager advised that all staff had received infection control training or or were receiving this training the week following the inspection. All staff have also completed safeguarding adults and moving and handling training. Medication training for those staff that have responsibility for the administration and recording of medication has been provided. Most staff were also receiving or had received in depth dementia awareness training and health and safety training. Fifteen of the thirty management and care staff have received first aid training but the others have not and this training needs to be provided for all. Some staff have received risk assessment training, food hygiene training, and fire safety training. This training is strongly recommended for all care staff to ensure that staff have up to date information regarding best practice. There are plans for staff to complete mental capacity act training and challenging behaviour training in the near future. It is positive that staff are receiving more training to support their care practice. Staff spoken to or who completed comment cards said they received regular training including moving and handling, medication and other mandatory training. We spoke to several staff individually and in a small group during the inspection as well as receiving their views through through the comment cards. Staff spoken to or who returned the comment cards were satisfied with and enjoyed working in the home and felt well supported. They also felt that the home had improved in the last year. Staff spoken to said they were offered more training now which they thought was beneficial to themselves in developing new skills and to the residents as they implemented the skills and knowledge they gained. One member of staff said, We have good staff Care Homes for Older People Page 25 of 33 Evidence: training. Another member of staff said, We have had lots of training lately. The training really helps us to look after residents better. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager runs the home competently and people living in or involved in the home are listened to. Evidence: Mr Aiden Finley is the registered manager. He has completed the Registered Managers award (RMA). He also has completed training in other areas including: Professional trainers award, NVQ 3 Promoting independence and British Sign Language. He is also a Dementia Facilitator, He updates his skills and knowledge so that he is familiar with any developments in care practice. Staff feel well supported by colleagues and by senior staff in the home. Staff said morale has improved over the last few months and staff feel settled and enjoy coming to work and supporting residents. Systems are in place for quality assurance. The home has met the standards for investors in people which is a national quality assurance award. The award is valid Care Homes for Older People Page 27 of 33 Evidence: until August 2010 when the home will have the opportunity to be reassessed. The home has also met the Customer service excellence award valid for three years from November 2009. Resident meetings are now regularly taking place and residents are satisfied that their views are listened to and acted upon. There are also regular staff meetings. Issues discussed in the meetings affect and improve care practice in the home. The meetings give senior staff the opportunity to discuss and issues and pass on information to staff or residents and check if the needs of residents are being met. Customer complaints, concerns and complements leaflets are available in the home and there is an open door policy for relatives. Residents feel well supported by staff and feel that they listen and try to help if they have any concerns or worries. Most staff feel communication is good but one member of staff said, More communication is needed between staff and managers. Monthly visits are carried out by an area manager from the organisation to audit records and to speak with resident and staff. This helps the area manager to make a judgement as to whether the home is well managed and whether the care and support provided by staff at the home is meeting the needs of the people that live there. There have also been regular resident surveys over the last year, formally asking their views. about the environment at the home, attitude of the staff, meals and activities. Some of the comments from residents from recent surveys about food and quality of care included: I am quite satisfied with everything. You know you are cared for here. This is my first home. I am not living in a suitcase any more. I always get help when needed. The manager said that fire safety training and risk assessment training is due to be delivered to staff soon. It is important that all staff are provided with comprehensive fire safety training and first aid training for the protection of residents, protection of themselves and to ensure a safe environment. Some staff have completed risk assessment training although others have not and should do to develop their skills in this area. All staff dealing with food should complete food hygiene training. The manager said that he planned to extend training to include nutritional care, report writing and record keeping. Generally there were good arrangements in place for maintaining the health and Care Homes for Older People Page 28 of 33 Evidence: safety of those living at the home. There were regular health and safety checks to ensure residents staff and visitors are kept safe. Any accidents or incidents were recorded and audited to see if any lessons could be learned and risks reduced. Maintenance records were available to show that health and safety checks are carried out regularly including fire alarm tests and visual checks of equipment and servicing of equipment. It is also noted that the water temperature of hot water outlets in resident accommodation and fridge and freezer temperatures are routinely tested and recorded. This helps to prevent the risk of accidental scalding or food being stored incorrectly. People living at the home are encouraged to remain financially independent or are assisted in this task by a relative or other advocate. However where the home do retain monies for some people, a robust system is in place to protect the interests of residents. Records are kept for all transactions and receipts obtained. Care Homes for Older People Page 29 of 33 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 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 A full working history with month as well as year of changes of employment needs to be obtained for all prospective staff members so that the employer is aware of prospective staff skills and any gaps in employment. 23/04/2010 2 38 13 Care staff that have not done so must receive first aid training. so staff have the skills and training to provide a safe working environment for the protection of residents 21/05/2010 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 30 Staff should receive an induction meeting sector skills standards so they have the skills and knowledge to meet Care Homes for Older People Page 31 of 33 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 the care and support needs of residents. 2 38 Food hygiene training and fire safety training should be provided to care staff so that they protect residents as well as possible. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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