Care Home: Mont Calm (Sandgate Road)

What the care home does well The service is managed and run in the best interest of the people who live there. The Manager is able to demonstrate that she has the skills and abilities to make sure that all of the residents have their individual care needs met, in a safe and caring environment. The Manager goes to meet people before they move into the home. She talks to the prospective resident, their families and any one else who is involved with the person. This is to find out the type of support and care they will need if they decide to come and stay at Mont Calm. She also gives them information about the home and the services that are provided. Prospective residents and their families are invited to come and visit the home. This means that the home can decide whether or not they can look after the person in the way that is best for them. And the prospective resident can make an informed decision about whether or not Mont Calm is the right place for them. People receive the care that they need in the way that suits them best. The home keeps them as safe as possible while encouraging people to be independent and make decisions about their life`s. People are supported to stay in good health. This includes keeping an eye on how everyone is and then calling doctors and nurses as soon as they are needed. There are activities and things for people to do if they want to. Mont Calm provides a friendly, homely and comfortable environment for people to live in. There is good atmosphere and residents, staff and management all said that they get on well together. The majority of people living there appeared relaxed and content in their environment. This is what some people told us, "Everyone is nice and friendly around here". "We are well looked after". "You can have a laugh". "I have made some new friend since I came here". A person who visits the home told us, "They do lots of different things here. A variety of activities are provided". "The staff are good with the residents. There is a good banter". "People are treated with respect". What has improved since the last inspection? The owner continues to invest in the home and improve the homes environment. They have re-decorated and put new carpets the communal areas. There are plans to continue with the decoration and up-keep of the property. The AQAA told us that the home have `caught- up` with a lot of the paper work and they plan to develop and improve this further in the next twelve months. They are sending out questionnaires to relatives twice a year and act on any comments that are made as soon as possible. The electrical systems in the home have now passed a safety check. What the care home could do better: We identified that some of the health needs of peoples are not incorporated in to their plans. Staff are aware of the conditions and are taking action to make sure peoples needs were being monitored and met but there was no consistent direction or guidance in place to tell staff what to do. Information about visits to doctors and or from nurses and specialist teams and what the staff had to do as a result of the appointment was difficult to find. The registered manager was aware of these shortfalls and told us in the AQAA that she is planning to redo all of the residents care plans in a more user friendly layout and add in even more information. Staff have not received all the training they need. There are shortfalls in mandatory and specialist training. This means that staff may not have the skills and knowledge to look after people in the way that suits them best. Staff have not received safe guarding training and therefore may not know what constitutes all forms of abuse. This means that people maybe at risk. Staff competencies are not being checked and they are not receiving the supervision to do make sure they are doing their jobs effectively and safely. The manager needs to make sure that she obtains a full employment history from staff and that any gaps in employment are explored at interview. This further protects people who use the service. There needs to be an up to date picture of staff on their file. The home needs to further develop its quality assurance systems to make sure that it is meeting its aims and objectives and is improving the service for the residents. The registered manager is not auditing all the systems used in the home to make sure they working effectively and in the best interest of the people who live in the home. The AQAA sent to us by the home needs to contain more detail about service. It needs to explain about how the service has improved and how it intends to improve in the future. Key inspection report Care homes for older people Name: Address: Mont Calm (Sandgate Road) 211 Sandgate Road Folkestone Kent CT20 2HU     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: Mary Cochrane     Date: 0 8 1 2 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 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) 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 33 Information about the care home Name of care home: Address: Mont Calm (Sandgate Road) 211 Sandgate Road Folkestone Kent CT20 2HU 01303251093 01303251093 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Stephen Anthony Castellani care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - DE Date of last inspection Brief description of the care home Mont Calm (Sandgate Road) is a large, period, detached, corner property with high ceilings and character features. It is situated on the main road between Folkestone and Sandgate. Folkestone town centre and The Leas area are only a short distance away. There is a bus stop and railway station nearby. The home is registered to provide care for 20 older people who have dementia. Currently the scale of fees is between £1,733 and £2,426 per month. Hairdressing, chiropody and toiletries are not included in the fees. Information about the service can be found in the homes Statement of Purpose and Service Users Guide. Care Homes for Older People Page 4 of 33 20 Over 65 0 Brief description of the care home A copy of the latest CQC report is available on request. 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: The quality rating for this home is 2 Star. This means that the people who use this service experience good quality outcomes. We did our last Key Inspection on 6th March 2008. In the intervening period we have also done an Annual Service Review. We completed this on 20th January 2009. This was an office based activity when we reviewed all of the information that we had gathered since the last Key Inspection. We arrived unannounced at the home at 10:00 and we were there for about six hours. This visit was a thorough look at how well things are going. We took into account information provided by the Registered Manager in the self assessment. This is called the Annual Quality Assurance Assessment. (AQAA). We received this on time and it contained some of the information we needed to assist us with the inspection. Care Homes for Older People Page 6 of 33 We looked at any other information that we have received about the Service in the past twelve months. During the visit, we spoke with four of the people who currently live in the home. We also observed and looked at what people were doing in the communal areas and had a general chat with them. We spoke with the Registered Manager, some of the care staff and a visiting professional who comes to the home regularly. We looked around parts of the accommodation. We also looked at a selection of records and documents. These included things like the individual written plans of care, medication records, the activities plan, the menu, complaints documents, the staff roster, staff files and training records, financial records and the quality assurance systems used by the service. We also took into account the things that have happened in the service; these are called notifications and are a legal requirement. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? The owner continues to invest in the home and improve the homes environment. They Care Homes for Older People Page 8 of 33 have re-decorated and put new carpets the communal areas. There are plans to continue with the decoration and up-keep of the property. The AQAA told us that the home have caught- up with a lot of the paper work and they plan to develop and improve this further in the next twelve months. They are sending out questionnaires to relatives twice a year and act on any comments that are made as soon as possible. The electrical systems in the home have now passed a safety check. 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. Care Homes for Older People Page 9 of 33 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 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 11 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. People can be sure they will receive all the necessary information to assist them in making an informed decision about the suitability of the home. People who are thinking of moving into Mont Calm are asked about what support they need and how they want this to be given. They will only be admitted if the home are confident of meeting these needs. People know what they are paying for. The home does not offer intermediate care. Evidence: The home has a Statement of Purpose and a Service Users Guide. The Statement of Purpose contains the information needed. It sets out the objectives and philosophy of the service. It does tell people about the present situation in the home and what to Care Homes for Older People Page 12 of 33 Evidence: expect if they decide to live there. We were told that the provider is in the process of updating the documents to tell people that the service is in the process of becoming part of a limited company. The Service Users Guide contains information to assist people in making a decision about whether the home is the right place for them to live. The guide is not written in a format that might make it more accessible and understandable for the people the home caters for. It does include information on how to make a complaint. When people decide to move into the home they receive a welcome letter from the manager. The home has a pre-admission assessment procedure. We looked at three assessments of the most recent people to move to the home. We saw that the registered manager visits prospective residents in their own home, in hospital, or in their existing placement to carry out a pre-admission assessment. This helps the service decide on whether they will be able to offer the person the support and care that they need. The registered manager told us they will not accept any resident unless they are confident that they do this. The assessment looks at the prospective residents physical and mental health, personal care and social needs. It also looks at cultural and religious needs. The preassessment tool is also supported by other assessments for nutrition, skin integrity and continence. Prospective residents and their families are involved in the process. Some of the assessments are done in conjunction with joint assessments done by care managers from the local social services team. There is also some information about peoples past lives and people that are important to them. The home does not offer intermediate care. Care Homes for Older People Page 13 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. People can be sure that their personal care needs are met but they cannot be sure all their health care needs are consistently monitored and met. The ethos of care ensures that residents are treated equally and with kindness and respect. People receive their regular medication safely and on time. Evidence: At the time of the visit the Registered Manager had identified the need to further develop and improve the care planning system. She was able to show an example of how the care plans are going to improve to make sure they are more invdiualised and contain more information about peoples preferences and how they like to have things done. The plan also gave more direction and guidance to staff on how to look after people in a way that suited them best. The AQAA told us, We promote the residents rights and their independence by Care Homes for Older People Page 14 of 33 Evidence: encouraging them to do as much for themselves as they can. If the resident is able to make choices then we encourage this, if we feel they are unable to do so we liaise with families, care managers and other professionals. To improve the care we give we are going to redo all of our residents care plans to a more user friendly layout and add in even more information. Each person at the home has a care plan. We looked at three of these in detail and at specific things in another two. The plans contain information on daily living needs like nutrition, personal care, skin integrity, mobility, health and social needs. If risks are identified then a risk assessment is developed. The home looks at ways in which people can be kept as safe as possible. There are risk assessments in the individual care plans. This means that they have looked at areas which might present a risk and have taken steps to reduce this. The care plans do give an account on the support and care people need with regards their personal care and who needs to do what and why. They did reflect what people can do for themselves. For example they explained that a person could wash and get dressed independently but needed some direction and prompting from the staff to achieve this. Another plan explained what to do for a person who had difficulty moving around. It gave direction and guidance on the support the person needs and how to reduce the risk of them falling. We did find that there was minimum information about how to support people with confusion and memory loss and how these needs are being supported and monitored for deterioration or improvement. We found that a plan identified a person as being resistive to personal care but there was no guidelines in place to tell staff how to deal with this situation if it should arise. There was also limited guidance on how best to communicate with people. This shortfall had already been identified by the registered manager and the new care plan system will incorporate how these needs are best supported. We spoke to staff they were able to tell us how they do support people. We observed staff communicating and interacting with people effectively. People were reassured if they were worried about something. Staff listened to what they were saying and took the necessary action to re-assure and guide them. We saw that staff used reassuring gestures with speaking with people. We also saw that they respected when people wanted to be on their own. Care Homes for Older People Page 15 of 33 Evidence: Health care needs of people are identified and they are incorporated into the plans but it is difficult to trail and find out how these needs are being supported and met. We did find that when people saw their doctor or district nurses the information was recorded in the daily records but if their care had changed the new information had not been transferred to the care plan. This meant that information about peoples could get lost and their conditions may not be fully monitored and reviewed. We found that peoples weight is closely monitored and if they are losing weight a doctors appointment is made. There was also more in depth information kept about what they were eating and drinking but their care plan and risk assessments had not been updated to reflect the changes. Staff keep a daily record of what people do during the day. These tended to be task orientated and not individualised. More information could be put in these so there is a better picture of how as individuals people spend their time and what significant events have happened. All staff who administer medication have received training. We saw no evidence to show that their competencies are checked at regular intervals. The prescription sheets were all signed and no gaps were identified. Medication policies and procedures are in place. The medication being used is stored safely and at the correct temperatures. A lot of the peoples medication is given by using blister packs which are made up at the pharmacy. This system reduces the risks of errors when giving out medication. Some people are given medication on a when required basis. We found there was no guidance or direction for staff on when to give this medication. This means that people cannot be sure they will receive their medication when they need it and they cannot be sure they will not be given extra medication. It also means that staff will not be consistent when giving out the medication. Hand written entries on the medication record sheets had not been signed by two people. People told us that the staff are very respectful and they are treated well. One person told us, Most of the staff are very good they always listen to what I say. Another said, They look after us well. We get everything that we need. Care Homes for Older People Page 16 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. The home does provide the residents with opportunities and facilities that enable them to maintain an appropriate and fulfilling lifestyle in- side the home. Family links are encouraged and maintained wherever possible. The home provides nutritious and varied meals for the residents. Evidence: We looked at what was happening in the home to make sure people are supported to do what they want and are encouraged to live fulfilling lives. We regarded activities not only as those that were laid on by staff, such as quizzes or arts and crafts, but being happily occupied, such as speaking with other residents or enjoying listening to music. We found that staff were friendly and attentive. We saw that most of the residents had some opportunity to have quality contact with staff and other residents. On the day of the visit the residents who wanted to were participating in a church service. They home also has other activities from out-side people like musical afternoons, massage and keep-fit. The AQAA told us that the home also has four major parties during the year which all Care Homes for Older People Page 17 of 33 Evidence: the residents, families and friends are invited to. They have also invited the current mayor and local newspapers to visit so that the community can see what they do. People told us that there is a friendly, relaxed and welcoming atmosphere at the home. They said they could join in organised activities if they wanted to but they are given the choice. Some people told us they preferred to stay in their own rooms and listen to the radio, read or watch T.V. We spoke to a professional person who has been visiting the home regularly for over a year. They told us, There is always a good atmosphere here and there is always something going on. There is a good banter between the staff and residents. The staff treat people with respect. There are lots of photographs on display showing different occasions which have been celebrated over the years. We did find that the staff do not record the things that people are doing to show how people spend their time and whether they enjoyed it or not. The registered manager told us she would address this. The people we spoke to felt they are able to have some choice in regards to their day to day lifes. Examples given were that they could get up and go to bed when they liked. They could choose what to eat and where to eat their meals. They said they could go to their rooms whenever they liked and join in activities if they wanted to. Generally they felt happy with the choices they are offered. People are encouraged to make their bedrooms personal. They can bring in things from their own homes so that they can have personal items around them. We saw lots of examples of this. People have their own photographs and ornaments so that their bedrooms feel more like home. The home plans to demonstrate how it offers more diverse choices to people so they are encouraging them to be as independent and in control of their lives. We did find that the home does not have regular residents meetings. The manager told us that she listens to people on an individual basis and acts on their wishes. Meetings would collectively give people the opportunity to express their views and make suggestions regarding their care at Mont Calm. This would help the service improve and demonstrate that suggestions are listened to and acted on. Care Homes for Older People Page 18 of 33 Evidence: Residents are encouraged to maintain contact with family and friends and are able to receive visitors in the privacy of their own room if they wish. The home employs one cook who works five days a week. A member of staff cooks for the other two days. She has the necessary training to do this. The service told us that they have a four weekly menu and an alternative choice of meal is always on offer. We observed a lunch time meal. We saw people served with hot and well presented food. The staff had an understanding of each persons nutrition. Those who needed bowls or spoons, rather than knife and fork, had their needs met. Staff were flexible in adjusting their support and observed people throughout the meal. Encouragement was given and peoples choices were respected when they did not want to eat any more. The home keeps a full record of what people eat if a they have concerns about their weight but there is no record kept of the dietary intake of the remaining residents. This means that there may be a delay in identify concerns about peoples dietary intake as it may only be discovered when people are weighed. The registered manager told us should would address this. Care Homes for Older People Page 19 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. The people who use the service who have complaints or concerns will be listened to and the concern/complaint acted on. They cannot be sure they will be protected from all forms of abuse as staff have not had the necessary training. Evidence: The home has a complaints procedure which is displayed in the hallway of the home. There is also a copy of the procedure contained in the Service User Guide. It contains all the information to tell people what they have to do if they want to complain and what will happen. The procedure is not easy to see and we did not see it displayed in other areas of the home. It also did not contain the new address of the Care Quality Commission. We spoke to service users who told us, If I was worried about anything I would tell the manager. She would sort things out. There has been one complaints made to the home since the last inspection. This was dealt with through safe guarding procedures. This means that a concern was looked at by the local social services safe guarding adults team. The concern was investigated by the registered manager who took all the necessary action and steps to protect the people living at the home. The alert has now been concluded and closed. Care Homes for Older People Page 20 of 33 Evidence: The home told us that it has policies and procedures relating to safeguarding adults. We found that staff have not received up to date training in safe guarding adults. This leaves people at risk as staff may not know what constitutes the different forms of abuse that can occur to elderly vulnerable people in a care situation. Staff were able to tell us about abuse and what they would do if they suspected or evidenced that someone was not being treated as they should be. Staff told us they knew about the whistle blowing policy. The service will be reviewing their whistle blowing policy to make sure that staff are confident that about being listened to and that the necessary and appropriate action will be taken by the management. The homes recruitment procedure includes undertaking formal checks to ensure that potential employees are suitable to work with vulnerable adults. The home has policies and procedures in place to assist in and support people to manage their finances. The policies and procedures protect people from financial abuse. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service continues to improve and maintain the environment to provide people with a comfortable, homely and safe place to live. The residents benefit from a clean environment. Evidence: We looked around different parts of the home. We looked at all the communal areas and we were invited into some of the residents bedrooms. The residential accommodation in the home is on the ground floor of the building. There is a large lounge where people spend a lot of their time and a separate dining area. There is also a smaller lounge. The communal areas downstairs have recently been re-carpeted and re- decorated. There is a new bathroom on the top floor and the fire escape has been over- hauled. Next year there are plans to redecorate the all the hallways and landings. The AQAA told us that as bedroom become available they are decorated and new furniture and carpets are put in ready for new residents. The AQAA also said as there are coded safety gates and doors to prevent any residents entering a dangerous area of the home. Environmental risk assessments are in place for each residents rooms and all communal areas. Care Homes for Older People Page 22 of 33 Evidence: Residents bedrooms are comfortably furnished and are personalised to meet their individual needs. Residents we spoke to said that they like their rooms and they can furnish their rooms however they choose. There is also a well maintained garden for people to enjoy in the better weather. Maintenance is planned but the service does not have a formal planned maintenance and renewal programme with timescales for the ongoing up- keep and improvements within the home. People told us that they are always warm. We did see that the home provides the necessary equipment and aids to meet the needs of the residents. The home is clean and hygienic with no unpleasant odours. Procedures are in place to control the spread of infection There are the facilities available in all the appropriate areas for hand washing and the home has the appropriate facilities for the disposal of waste. There is a laundry room and laundry is transported correctly and washed at the appropriate temperatures. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is enough staff on duty to enable people to receive an adequate level of care and support but they may not have the required skills and knowledge to care for the people who live at the home. The staff have a good understanding of the residents and positive relationships have been formed. Recruitment practises protect residents. Evidence: We looked at the number of staff on duty for each shift and spoke to residents and staff. From this we were able to see that there are enough staff on duty throughout the day and night to look after the people. During the day, there are other members of staff on duty. They work in the kitchen or do the housekeeping. There is also a maintenance person. Residents told us that there is staff available when you need them. They said the staff are very good and kind. We saw that staff interacted with service users. They supported people to be involved in what was going on. They asked people if they were alright and if they wanted Care Homes for Older People Page 24 of 33 Evidence: anything. Staff approaches were seen to be consistent. At the visit we saw peoples needs being anticipated and promptly met by staff. We noticed that two people who asked to be helped to use the bathroom were assisted straight away. The home has an NVQ programme for care staff and the service told us that they have not reached the target of having 50 of care staff with NVQ level 2. At the time of the visit only one staff member had achieved NVQ level 2 or above. The manager said that they are encouraging and supporting staff to enrol for NVQ 2 and 3. At the time of the visit the staff working at the home had not received all the necessary mandatory training to give them the skills and competencies to meet the needs of the people living at the home. There were shortfalls in health and safety, manual handling, fire and first aid. There is a training matrix and some staff had done some of the necessary training. However the training has not been planned and was not on-going to make sure that the staff have received the training when they need it. Some of the training is out of date and some people have not received any training in certain areas. Some staff had received specialist training. Eight had received dementia training. Six staff had received training in care of the dying. Five had Mental Capacity Act training. We did find that staff had not have up to date training in protect vulnerable adults. The manager told us she would address this as a priority. The registered manager told us she would rectify this and has already taken steps to plan training for the New Year. However this should have been done before the inspection. because of this shortfall a requirement will be made in the report. The commission also requires the manager to send us a planned programme of training to evidence this shortfall is being addressed. It is the responsibility of the provider to make sure staff have the necessary training to look after people in the safest and best way to meet their individual needs To make sure the residents are kept safe and are protected the home has thorough recruitment practises in place. We looked at three of the staff files these included two of the most recently employed staff. The manager completes a number of safety checks on new care workers. These include things such as confirming their identity, taking up references and doing a police check. Not all the staff have an up to date photo on file and some of the files did not contain a full employment history. The manager does not keep a record of the questions she asks people at interview and Care Homes for Older People Page 25 of 33 Evidence: their responses. She said that she would do this. It will make sure that all areas have been explored by the service especially when asking about gaps in employment history. 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 people live in home that is well managed and it is run in their best interests. The staff team may not receive the support and guidance they need. There are some shortfalls in the quality assurance system but the systems are being developed. People can be sure that their health and safety will be protected. Evidence: The registered manager of the home has the necessary qualifications, skills and experience to manage the home. Residents, staff and relatives reported that they thought the manager was good. They said that she listened to what they said and acted on it. The manager has had training regarding the Mental Capacity Act and plans to have Care Homes for Older People Page 27 of 33 Evidence: Deprivation Of Liberties training. She told us she knows what action to take if there are any concerns in these areas. We found that the manager is open and transparent. She is aware and was willing to discuss the weaknesses in the service and how she plans to address them. We feel confident that she will continue to improve the service for the people at the home. We received an AQAA when we asked for. However some of it was insufficient in detail to assist us with parts of the inspection process. It did not give full picture of how the service was performing and what improvements had been made since the last inspection and how they plan to continue to improve. The AQAA did tell us that all the relevant checks and inspection of equipment and gas and electric systems have been done. The registered manager told us that she is doing some regular audits on the systems used within the home to make sure peoples health and safety is being protected. She told us that care plans and medication is checked monthly but there is no evidence in place to show this is happening. Other systems are not included in the audits. Because this is not being done important things could be overlooked. The manager confirmed that the home does undertake quality assurance by means of asking residents and their families to complete questionnaires. At the moment the views of other people such as doctors, nurses or other specialists who visit the service are not asked for. The registered manager said she would include visiting professionals in the next time questionnaires are distributed. She plans to do this twice a year. The people who use the service are not being told about the outcomes of the quality assurance and how the home plans to develop and improve. The residents we spoke to expressed satisfaction living within the home and felt confident that their views and opinions were valued by both staff and management. A representative of the provider of the service does visit the home monthly and does complete what is known as a Regulation 26 visit These are statutory documented visits by the provider to monitor standards within the home. This means the provider is assessing the quality of care within the home and to make sure that it is meeting with the required National Minimum Standards. There is a system in the home whereby each member of staff should meet regularly with someone senior to discuss their work. This means that they can talk through any work problems they may have. We did find that this was not happening as often as it should. One member of staff had not met with a senior since May. These meetings Care Homes for Older People Page 28 of 33 Evidence: should happen at least six times a year. This means that staff may not be receiving the supervision and support to their jobs effectively and safely. Environmental and personal risk assessments are in place. We were informed by the registered manager that all fire assessments and checks are done at the required intervals. The manager told us water temperatures are taken and comply with regulations. Financial procedures are in place to safeguard residents monies. 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 30 12 All staff must receive the 30/12/2009 training they require to meet the assessed needs of the residents residing in the home. So that service user needs can be safely met and that their health and wellbeing be promoted, and that they are in safe hands, limiting risk from abuse. Regulation 12 of the Care Homes Regulations 2001 requires you conduct the home to promote and make proper provision for the health and welfare of service users. Failure to comply with this regulation is an offence. 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 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). 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. 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