Care Home: Millpond View Care Home

Similar services:

• Fairfields Country Rest Home
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma
• Hunters Care Centre
• Manor Lodge

What the care home does well The home provides a comfortable homely environment that is clean and safe for residents, staff and visitors. There is sufficient communal space and suitable washing and toilet facilities. People say they are happy living in the home and they say the staff are very kind and caring. They say their independence is respected and they can choose how to live their lives with their choices and preferences being respected. New people are only admitted to the home following a comprehensive assessment, of their health, personal and social care needs. Information is also sought from relevant external agencies. A written care plan is compiled from the initial assessment to instruct staff on the care to be provided. There is a suitable policy and system in place for the use of medicines in the home and a Registered Nurse administers all medication. Social activities, events and trips out are organised by a recreational therapist and people said they enjoy the activities provided. A programme of activities is displayed and there are records and photographs of previous events. The menu shows that a nutritious diet is on offer with choices available, homemade cakes, fresh fruit and vegetables are included. There are appropriate complaints and abuse policies in place to safeguard people and staff receive relevant training regarding what to do should there be an abuse allegation. The rotas show that a suitable number of staff are on duty at all times. There is a registered nurse on duty at all times and 71% of care staff have achieved an NVQ qualification to at least level 2, in care. Training is provided for staff to meet legal requirements and to ensure staff are knowledgeable in subjects relevant to the elderly people accommodated. The home has quality assurance systems in place to monitor and improve the services provided. People are encouraged to air their views through surveys and various meetings. The registered providers visit very regularly and talk to staff, residents and relatives during their visits. There is a safe system in place for the safeguarding of resident`s monies. The Registered Providers have implemented controls to ensure that monies left for residents personal use are secure. These monies do not form part of the business fund. The registered persons are committed to ensuring the health and safety of residents, staff and visitors. There is an active health and safety committee, appropriate fire precautions, a planned maintenance programme and services and equipment are checked regularly. What has improved since the last inspection? The registered providers are continually improving the environment, replacing furniture and upgrading rooms. Bathing facilities have been reviewed and a new bath has been provided for people who need assistance. The provision of a stair lift has been considered more fully and the management hope to be able to widen the staircase to enable this to happen. A new extraction system has been installed in the kitchen. Sluice facilities have been reviewed and it is hoped that a system using disposable products and a macerator will be introduced. A new tagging system for people`s clothing is being introduced to reduce the risk of items being mislaid during the laundry process. There is a planned programme in place for upgrading the nursing beds and most are now fully electrically adjustable. Stocks of air mattresses for pressure relief have been provided. The documentation in the welcome pack has been reviewed and improved. They have improved the provision of celebrations and parties for residents and their relatives. Work on the Gold Standard Framework accreditation is progressing and the completion for the Investors in People Award is imminent. The care staff are more involved in the care planning reviews and they record their involvement with residents in the daily records. Policies have been reviewed and provided in large print, they are now available to people using the service and their relatives. The organisation of the staff files has improved. The records of staff training have been improved with an electronic matrix now in use. Further external courses have been sought and more trainers come to the home to provide training. The number of care staff trained to at least level 2 in care has increased from 52% to 71%. The system for managing residents money has been reviewed and improved and the risk of insufficient funds in the residents account eliminated. What the care home could do better: Include social, religious and cultural needs into the care planning system and ensure that care plans are in sufficient detail to inform and direct staff on the care to be provided. Include a photograph of each resident in their file. Improve the arrangements for transcribing instructions onto medicine administration charts and ensure that medicines are only administered to the person they are prescribed for. Formalise training for care staff and include level 1 medicines training on the induction programme. People told us about concerns in respect of the food provision. The manager is aware of these concerns and is reviewing the situation. The homes safeguarding policy should be reviewed to ensure that it takes account of the Cornwall safeguarding arrangements. Review the recruitment system to ensure that all relevant employment checks are undertaken in compliance with legislation prior to staff commencing work in the home. Ensure that a written policy for the management of people`s money is put in place, that includes the systems used in the home not just the procedures for accounts and cash storage. Key inspection report Care homes for older people Name: Address: Millpond View Care Home 11 Millpond Avenue Hayle Cornwall TR27 4HX     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: Diana Penrose     Date: 1 1 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Millpond View Care Home 11 Millpond Avenue Hayle Cornwall TR27 4HX 01736754635 01736754635 millpondnursing@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Joyceleen Wendy Lissenburg,Omar Farook Thauoos Name of registered manager (if applicable) Mrs Tracy Jane Cameron Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: Service Users to include up to 5 adults with a physical disability aged 60 years and over on admission. Service Users to include up to 5 adults with a terminal illness aged 60 years and over on admission. Total number of service users not to exceed 32. Date of last inspection Brief description of the care home Millpond View is a care home providing nursing and personal care for up to 32 elderly people. The home is situated on the outskirts of Hayle and has views of the millpond Care Homes for Older People Page 4 of 31 Over 65 32 0 0 0 5 5 Brief description of the care home from the front of the property, which are enjoyed by the residents. The home comprises of a two storey Georgian house with an extension to the rear. The layout of the home has two distinct areas that are interconnected. The home has gardens to the front and rear that are well maintained with parking to the sides of the building. Access for residents is restricted in certain areas for safety reasons. Ramps and handrails are for dependent residents to access the home and sit outside weather permitting. Throughout the home aids and adaptations are provided to make life easier for residents. There are thirty bedrooms spread over two floors, two bedrooms are registered doubles and five rooms have en-suite facilities. Communal toilets and bathrooms are situated near to all rooms. There is a shaft lift that serves ground to first floor. A disabled vehicle suitable for wheelchairs is provided for appointments in the community and is free to residents. Information about the home is available in the form of a statement of purpose and service user guide; copies can be supplied to enquirers on request. Fees range from 455 - 610 pounds per week; this information was supplied to the Commission on the day of inspection. There are additional charges made for hairdressing, chiropody and newspapers. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: An Inspector visited Millpond View Nursing Home on 11 June 2009 and spent seven hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that the needs of people using the service are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that placements in the home result in good outcomes for people. All of the key standards were inspected. On the day of inspection twenty-eight people were living in the home. The methods used to undertake this inspection were to meet with people using the service, staff and the registered manager to gain their views on the services offered by the home. Records, policies and procedures were examined and the inspector toured the building. The registered manager has returned a completed Annual Quality Assurance Assessment (AQAA), surveys have been returned in respect of 6 residents, 3 staff and 2 professionals, these have been used to inform the inspection. This report summarises Care Homes for Older People Page 6 of 31 the findings of this key inspection. The people using this service expressed satisfaction with the care and services provided at the home and said they are treated with kindness and respect by the staff, manager and owners of the home. Some regulations have been breached and these have been discussed with the registered manager who has agreed to address the issues. Care Homes for Older People Page 7 of 31 What the care home does well: The home provides a comfortable homely environment that is clean and safe for residents, staff and visitors. There is sufficient communal space and suitable washing and toilet facilities. People say they are happy living in the home and they say the staff are very kind and caring. They say their independence is respected and they can choose how to live their lives with their choices and preferences being respected. New people are only admitted to the home following a comprehensive assessment, of their health, personal and social care needs. Information is also sought from relevant external agencies. A written care plan is compiled from the initial assessment to instruct staff on the care to be provided. There is a suitable policy and system in place for the use of medicines in the home and a Registered Nurse administers all medication. Social activities, events and trips out are organised by a recreational therapist and people said they enjoy the activities provided. A programme of activities is displayed and there are records and photographs of previous events. The menu shows that a nutritious diet is on offer with choices available, homemade cakes, fresh fruit and vegetables are included. There are appropriate complaints and abuse policies in place to safeguard people and staff receive relevant training regarding what to do should there be an abuse allegation. The rotas show that a suitable number of staff are on duty at all times. There is a registered nurse on duty at all times and 71 of care staff have achieved an NVQ qualification to at least level 2, in care. Training is provided for staff to meet legal requirements and to ensure staff are knowledgeable in subjects relevant to the elderly people accommodated. The home has quality assurance systems in place to monitor and improve the services provided. People are encouraged to air their views through surveys and various meetings. The registered providers visit very regularly and talk to staff, residents and relatives during their visits. There is a safe system in place for the safeguarding of residents monies. The Registered Providers have implemented controls to ensure that monies left for residents personal use are secure. These monies do not form part of the business fund. The registered persons are committed to ensuring the health and safety of residents, staff and visitors. There is an active health and safety committee, appropriate fire precautions, a planned maintenance programme and services and equipment are checked regularly. Care Homes for Older People Page 8 of 31 What has improved since the last inspection? What they could do better: Include social, religious and cultural needs into the care planning system and ensure that care plans are in sufficient detail to inform and direct staff on the care to be provided. Include a photograph of each resident in their file. Improve the arrangements for transcribing instructions onto medicine administration charts and ensure that medicines are only administered to the person they are prescribed for. Formalise training for care staff and include level 1 medicines training on the induction programme. People told us about concerns in respect of the food provision. The manager is aware Care Homes for Older People Page 9 of 31 of these concerns and is reviewing the situation. The homes safeguarding policy should be reviewed to ensure that it takes account of the Cornwall safeguarding arrangements. Review the recruitment system to ensure that all relevant employment checks are undertaken in compliance with legislation prior to staff commencing work in the home. Ensure that a written policy for the management of peoples money is put in place, that includes the systems used in the home not just the procedures for accounts and cash storage. 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 10 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are given information about the home enabling them to make an informed decision. People are only admitted to the home following a full healthcare assessment to ensure that staff are able to meet their personal, health and social care needs. Evidence: We were shown the statement of purpose and information packs that are available for enquirers and prospective residents. The manager told us that these are under review. The statement of purpose contains the information required by legislation. The manager explained that she or a primary nurse visits prospective residents to undertake a full needs assessment. Three peoples care files were examined, two were new people using the service, the assessment information was detailed but did not contain risk assessments. We were told that these are undertaken on admission to the home. Information was seen in two files that had been supplied by hospital staff. Care Homes for Older People Page 12 of 31 Evidence: People using the service told us that they were visited by someone from the home prior to admission. This home does not provide an intermediate care service. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service feel their healthcare needs are met however care plans lack detail to fully inform and direct staff on the care they have to provide. There is an appropriate medicines system in place however extra attention in some areas and training for care staff will ensure a safer system. Evidence: The Annual Quality Assurance Assessment (AQAA) states that primary nursing has been re-introduced and has focused on offering individual care and improved documentation. The care files for three people were inspected, they held written care plans, risk assessments, details of visits from healthcare professionals and other useful information regarding the persons care. The manager told us that the care plan is commenced from the initial assessment and a second needs assessment is completed on admission to gather more information. The care plans do not include social, religious and cultural needs. They do not fully inform and direct staff on the care to be provided, for example staff instructions include the words encourage and assist without specific detail on how to do this. One person had a urinary catheter in situ but this was not mentioned in the care plan. The manager said she would review Care Homes for Older People Page 14 of 31 Evidence: the care plans to provide more specific information for staff and ensure all needs are included. Care plan reviews were documented and take place monthly. Daily records were seen that are maintained by the nursing and care staff. The care staff also have a tick sheet that indicates the care tasks they have undertaken. None of the three files inspected held a photograph of the resident, the manager agreed to rectify this. The registered manager said there are good links with local healthcare professionals. She said that one nurse is a tissue viability link nurse and their continence adviser is a senior care assistant. She said that other staff have specific areas of expertise and these are utilised when necessary. We were told that the Gold Standard Framework is going well and that accreditation is planned for next year. Suitable equipment was seen for moving and handling purposes and for the prevention of pressure sores. The AQAA states that there is a planned programme in place for upgrading the nursing beds and most are now fully electrically adjustable. Stocks of air mattresses have also been increased. People told us they are well cared for and surveys told us that people always or usually have the care and support they need. One person said that sometimes the care varies and they get people who dont know them, but usually its good. People told us that doctors visit when required There is a suitable medicines policy and the registered manager has a copy of the most recent Nursing and Midwifery Council guidelines for the use of medicines. There are reference books for staff to use and the patient information leaflets are kept to inform staff and residents as necessary. We were shown the medicines policy and other relevant guidelines and reference books available to staff. The medicines system was inspected with the assistance of a nurse. The receipt, administration and disposal records were completed appropriately. Handwritten instructions on the medicine administration record charts were not signed or witnessed as was the case at the previous inspection. Some liquid medicines were being shared between several people and staff were aware that this should not happen. The manager told us she will make sure this does not happen in future. Level 1 medicines training for care staff has not yet been formalised and included in the induction process and the manager was aware of this. She told us that medicine assessments for nurses will be included as part of their supervision. We saw that peoples privacy was respected during this inspection and they were free to move around the home according to their wishes and ability. People said they are treated with respect and their privacy is maintained at all times. They said they Care Homes for Older People Page 15 of 31 Evidence: receive their post unopened and the telephone arrangements in the home are satisfactory. We saw that some of the toilet facilities have a curtain across the doorway for privacy when the door is not closed. The manager told us that she is going to review all of the toilet facilities in the home to ensure that privacy and dignity is always respected. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A variety of activities and social events are provided, visitors are welcomed and residents are encouraged to live a life of their preference. Evidence: There is a recreational therapist employed, 30 hours a week, to organise social activities and events for people using the service and their relatives. She was not on duty during this inspection but we were told that she is very enthusiastic in her role. Weekly activity sheets were seen and included art and crafts, quizzes, bingo, reminiscence, keep fit and games. We were told that the mobile library visits and that people go to church if they wish. Outings are arranged regularly and the home visits Paradise Park annually; staff from the park are going to provide a display of falconry at the home. There are photographs around the home of residents enjoying events that have taken place. Records are maintained for each person using the service, they contain their likes and dislikes, areas they have problems with and details of the time spent with them on activities. The recreational therapist compiles a monthly report for the manager who said she finds this useful. A newsletter was seen and is produced quarterly. We were told that the newsletter is circulated in the local community and forthcoming events at Care Homes for Older People Page 17 of 31 Evidence: the home are displayed on a notice board in the town and in a local newsletter produced in Hayle. People were aware of the activities on offer and said they could join in as they wished. Surveys told us that activities are always or usually arranged for residents to join in. The visitors record shows that people come to the home regularly. We were told there are no restrictions on visiting times and the telephone arrangements are good with direct lines available. One staff survey commented The home has a very family orientated feeling. People told us their individual preferences are respected as far as possible and they are supported to maintain their independence. Most people said they get up and go to bed when they like, one person said she would like to get up earlier and this was fed back to the manager. People were moving about the home as they wished, if able to do so. They said they choose what they do and can go out if they wish. People had their own belongings in their rooms including furniture. A four week set menu was seen and we were told that alternatives were available. The AQAA states that the menu is being restyled based on suggestions from people using the service. The manager told us that special diets are catered for, for example, vegetarian, dairy free and diabetic. We were told that homemade cakes, fresh fruit and vegetables are included on the menu. There is a small dining room and dining tables and chairs are provided in the lounges; during this inspection most people had their meals on small tables in front of their arm chairs or in their rooms. Staff support during the observed mealtimes was appropriate. We saw nutritional needs assessments in the care files and the manager said she is looking to utilise a different tool for these. Some people need their food pureed and some meals were seen to have all of the component parts mixed together. We were told that this is purely for people with dementia because research has shown they have a better appetite if food is served in this way. People told us that the food quality is variable. Some said the food is not hot enough and cups of tea are sometimes cold. One said that staff will re-heat the food if it is not warm enough. Comments include The foods not bad, The food is hit and miss and The food is diabolical. Surveys also told us that the food could be improved upon. The AQAA states that the catering and housekeeping departments are being restructured as they are currently run as one. The manager told us she was aware of problems with the food quality and temperature of the food and was addressing the Care Homes for Older People Page 18 of 31 Evidence: issues. She said she has surveyed the residents and has talked to them and their relatives about the food provision. She said they are recording the residents food likes and dislikes in a book in the kitchen. She told us that a member of staff has a degree in food science and was assisting to ensure that meals are not only tasty but highly nutritious. She said they hope to grow some of their own vegetables in the near future. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are suitable policies in place for complaints and adult protection and training for staff has been arranged to ensure that people using the service are safeguarded. Evidence: The homes complaints procedure was seen, it needs to be updated to include the reporting of complaints to the Department of Adult Social Care and to update the Care Quality Commissions contact details. There is a system for recording complaints, and the documentation for the one complaint since the last inspection, was seen, and dealt with well. There have been no complaints about this home to the Commission. There is an adult protection policy for staff to follow should the need arise. The manager said she was going to review this to make it more specific. The inclusion of telephone numbers for the relevant agencies would also be beneficial. The home does not have a copy of the local authority procedures but the manager was able to verbalise the correct process to be followed. The manager said that all staff will undergo training on the prevention of abuse in the next three months; it will be provided by an external agency. She said that three members of staff have attended training on the Mental Capacity Act and Deprivation of Liberties. She said that none of the current residents lack mental capacity as relevant assessments have been undertaken. Staff told us they have done abuse training using packs from a training company. Care Homes for Older People Page 20 of 31 Evidence: Surveys showed that staff and residents knew what to do if they had concerns. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, well maintained, decorated and furnished to a good standard with no unpleasant odours. The providers continue to improve the premises making it a safe and pleasant place to live in. Evidence: We were told that the registered providers continue to improve the environment for residents and staff. The home was clean on the day of inspection, warm and comfortably furnished. Peoples rooms were personalised with their own belongings and furniture in some cases. The grounds were tidy with colourful flowerbeds. The manager said they hope to improve the car park by marking out the parking spaces. People using the service said they feel safe and comfortable in the home. The managers office has been moved and is by the front entrance to the home. Her previous office has become a small dining facility and we were told it doubles up as a meeting / training room and is also used as a quiet room for interviews or talking with relatives and so on. The kitchen had a new extraction system fitted the week prior to this inspection and the staff were getting the kitchen back in order. The AQAA states that a chair lift will be installed when the stairs have been widened, in consultation with the fire authority. Care Homes for Older People Page 22 of 31 Evidence: We were told that the bathing facilities have been reviewed and a new assisted bathroom is being provided. The shower wet room has been completed and staff said this has been a success. One bathroom ceiling is due to be repaired. The manager stated that the toilet facilities are under review as mentioned in section two of this report. Laundry facilities are adequate with two washers and two tumble driers. A new tagging system for peoples clothing is being introduced to reduce the risk of items being mislaid. The AQAA states that sluicing facilities are provided in the laundry, they are under review and will be upgraded this year. The manager said she hopes to purchase a macerator system for use with disposable commode pots and so on; this would be excellent as we were told that commode pots are currently washed by staff in a bath that is no longer in use for residents. Information and written procedures to guide staff on the control of infection were seen and the manager told us that an infection control audit had been undertaken by a nurse who works as part of their bank team. Staff were observed wearing plastic aprons and gloves and there were soap dispensers and paper towels provided at each hand basin. Alcohol cleansing gel was also seen in use. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient skilled staff employed and they receive regular training to improve their knowledge and skills. Some recruitment procedures do not comply with legislation, the registered manager has agreed to review the systems in place to ensure compliance and protect people using the service. Evidence: The manager said there is one night staff vacancy. We were told that the staffing rota is organised 1-2 months in advance and staff rotate around different areas of the home and between day and night duties. The AQAA states that the Residential Forum tool is used alongside a bespoke dependency assessment tool to calculate the number of care staff required. The rota was seen and shows that a qualified nurse is on duty at all times and sometimes there are two in the mornings. There are generally 7-8 care staff in the mornings, 6 in the afternoons and evenings and 2 overnight that are awake. The day staff are divided into four teams and work in different parts of the home. There appears to be a sufficient number of staff on each shift. Staff spoken with felt the numbers were satisfactory to enable them to meet peoples needs. Surveys told us that there are usually sufficient staff available. One healthcare professional said There is always a member of staff ready for me to take me to the patients and to supply me with accurate information. Care Homes for Older People Page 24 of 31 Evidence: Staff seemed happy in their work and interacted well with people using the service. Residents said there are enough staff, they are kind and caring and look after them well. We were told that 71 of care staff have achieved an NVQ qualification to at least level 2, in care. Two others are working towards level 2, six towards level 3 and two towards level 4. The AQAA told us the recruitment system has been reviewed and improved. We examined six staff files during this inspection; four were for people employed in 2009. Each file contained an application form although health checks are not routine. Dates of and terms and conditions of employment were seen. We were told that usually two people interview new staff; Interview records were seen but one was not dated or signed. One file held two references the others only one, it was noted that the registered manager had supplied references for three of these employees. Photocopies of nurses pin number cards were seen in the files but no evidence that verification checks had been made with the Nursing and Midwifery Council (NMC); the manager was unaware of the process and said she would ensure these were done in future. POVA first checks were seen in four files and all files held an enhanced CRB check; all checks were dated after the persons employment start date. We were told that new employees have two induction shifts which maybe prior to any employment checks being received. The registered manager was informed that staff must not commence any work with residents until two satisfactory references and a POVA first check have been received. They must then be supervised at all times until a satisfactory CRB check has been received. The manager is aware that regulations have been breached and has agreed to rectify the system. The induction programme for new employees was seen and the manager said she is re-structuring this. Completed induction forms were seen in staff files along with certificates for other training attended. The manager showed us a training matrix that she said she set up when first in post. It showed the names of all staff and the dates they have attended training. She said that training needs are flagged up on a computer system which is updated daily and that training needs are discussed at supervision sessions. The AQAA told us that this year staff will be undertaking first aid training and some will be doing distance learning courses in dementia and palliative care. Staff told us there is a lot of training on offer and they are encouraged to attend. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is competent in running the home; systems are in place for health and safety and to monitor and improve the service for residents and staff. There is a suitable system for managing peoples money to ensure that their finances are safeguarded. Evidence: There has been a change in registered manager since the last inspection due to retirement. The new registered manager told us she has the following qualifications; Registered General Nurse (Part 1), Post Graduate Diploma in adult Education, Registered Nurse Teacher, Master in Health Care : Professional Education and is working towards the NVQ level 4 in Leadership and Management Award. She also has qualifications in manual handling and Health and Safety, Advice and Guidance, NVQ assessment and verification and is a qualified complimentary therapist. She said she keeps herself up to date with current practice by reading care magazines and using the internet. She said she receives regular updates from the Nursing Times. Recent training includes moving and handling instructor updates, Gold Standard Framework Care Homes for Older People Page 26 of 31 Evidence: and Liverpool Care Pathway, syringe driver and mouth care. She is involved in the Investors in People (IIP) process and has attended a CQC registration consultation conference. Staff and people using the service said the home is well run and the owners visit very regularly. They said the new manager has settled in well and changes she has implemented have improved the home. Some people said they do not see the manager very often but were aware that they could ask to see her if they wished. Staff told us they were supported by the manager and that meetings and formal supervision sessions take place regularly. We were shown the completed forms from a recent annual survey of residents and relatives, these were positive about the home and the services provided. An independent survey has also been carried out by a care homes consultant. The manager told us that a report was to be compiled with an action plan to address any issues arising. We were told that audits are undertaken in respect of infection control, medicines and accidents. The registered manager has completed an Annual Quality Assurance Assessment (AQAA) for the Commission in detail. The providers complete a monthly regulation 26 report that reports on the conduct of the home; These reports were seen in the home. We were told that the home is working towards the Investors in People Award which is due for completion in July 2009. The AQAA told us that a wide variety of meetings take place and we were shown the minutes during this inspection. It also told us that the management objectives are reviewed monthly and updated with the registered providers every 3 months. We were told that the homes policies are available in large print and available to residents and visitors. The administrator responsible for dealing with the monies of people using the service explained the process to us. She explained that a letter of introduction is sent to new residents and it explains the system. Money is held for several people in a non-interest bearing bank account; individual electronic records of transactions were seen. We were told that a printed copy of an individual s record is available to them or relatives (with the residents permission) on request. There is a float kept in the safe with a control sheet for transactions. The homes procedure sheet states that the float is used where a person runs low on money or runs into a deficit. Money is put into the residents account to ensure that their balance is never negative and it is invoiced for at a later date. Receipts are kept for purchases, hairdressing and chiropody and so on. We were shown the residents petty cash tin and record books. The tin is used for money received or given back to relatives / representatives and signatures are obtained. The system seems complicated and simplification was discussed with the Care Homes for Older People Page 27 of 31 Evidence: administrator and registered manager. The administrator holds the key to the safe but if she is sick or on leave it is available to the registered manager or her deputy. We were told that the registered providers examine the books regularly and reconciliation with the bank statement is done every three months. We saw that one person had a substantial amount of money held on her behalf. We were shown a letter from her relative stating satisfaction with the current arrangements provided by the home in respect of this money. We were shown a copy of the residents personal money control and procedures. The registered manager agreed to ensure that a full policy is in place for the safeguarding of residents money. This should include details of the amount of money to be held on behalf of residents, the safe key holders and what happens out of office hours if a person wants some money, for example. The AQAA states that a Health & Safety Committee monitor and encourage a culture of safety within the home and that the manager has a qualification in Health and Safety with IOSH. Accidents and near misses are analysed and risk assessments carried out. The records showed us that residents sustain few accidents 4 in May and 2 in June. We saw records that show that equipment and service checks are carried out regularly. A file for fire documentation and records was seen which was kept up to date. The records show that statutory training takes place and most was up to date. We were told that the moving and handling training would be up to date by the end of June 2009. We were told that the catering staff and about 95 of the care staff have food hygiene certificates. The AQAA told us that the HACCP document is up to date and fully adhered to. Risk assessments were seen for residents in respect of the environment. Fire and health and safety risk assessments have been undertaken and the manager said these are regularly reviewed. Several staff use computers in the home, some in confined space, we did not see any risk assessments in respect of the equipment used or the environment in which it is used. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 People using the service should have a written care plan that includes their social, cultural and religious needs and is detailed to inform and direct staff on the care to be provided. Transcribing onto the medicine charts should be witnessed and signed by the two members of staff to ensure the correct information has been recorded. 2 9 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!