Care Home: Mount Pleasant, St Agnes

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What the care home does well People who use the service, who we spoke to, said they were happy living in the home. They said staff were caring and supportive. People were positive about the food provided and there are various choices available regarding the main meal and the evening tea. People living in the home are allowed to smoke there if they wish. People who have pets are also able to keep them. What has improved since the last inspection? The registered providers and senior staff have worked very hard to bring about a number of improvements since the last inspection. This includes improvement of care planning and record keeping regarding people living in the home, improvement in arrangements to look after the monies and valuables belonging to people who use the service, the provision of several policies which are required by the regulations-which are now to a satisfactory standard. There has been improvement in pre employment checks completed on new staff and improvement in the delivery of staff training. There is also a significant improvement in activities available to people living in the home. This includes trips out in a minibus which is an excellent initiative.The registered provider is also in the process of improving the decor of the home-many areas are currently being redecorated, and new carpets will be fitted to communal areas, and non slip flooring to bathrooms and toilets. There are all excellent developments. What the care home could do better: This inspection has resulted in several statutory requirements. Action must be taken regarding these matters, within the timescales set: (1) Ensure the home`s safeguarding policy includes a clear procedure of what the registered provider and staff will do if there is an allegation of abuse. (2) Fit additional heaters in to the main lounge, bathrooms and other rooms where it is necessary. (3) Ensure radiator covers are fitted to prevent the risk of scalding. This process has started but needs to be completed. (4) Ensure people always have access to a call bell. (5) Ensure the home`s Annual Quality Assurance Assessment, Improvement Plan and other documentation required by the Care Quality Commission is always returned within the timescales set. (6) Ensure a health and safety risk assessment process is developed regarding any risks to people using the service, staff and visitors to the home. This needs to include measures the home takes to minimise the risk of legionnaire`s disease. (13) Ensure any hazardous materials are stored appropriately in line with health and safety legislation. The commission has requested an improvement plan regarding what action the provider will take about the requirements set. We will monitor suitable improvement takes place regarding the required actions. Key inspection report Care homes for older people Name: Address: Mount Pleasant, St Agnes Rosemundy St Agnes Cornwall TR5 0UD     The quality rating for this care home is:   one star adequate 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: Ian Wright     Date: 2 1 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Mount Pleasant, St Agnes Rosemundy St Agnes Cornwall TR5 0UD 01872553165 01872553776 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Susan Ann Sear,Mr Godfrey William Sear Name of registered manager (if applicable) Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: To accommodate one named service user under the age of 65 years (62 years) Date of last inspection Brief description of the care home Mount Pleasant is located near the centre of St. Agnes. The registered providers are Mr G Sear and Mrs S Sear. Mount Pleasant provides accommodation and personal care for up to 22 older persons. The accommodation is on one level; there is full access around the home for people who use the service. There are 20 rooms of which 18 are for single occupation and two shared rooms. The majority of bedrooms have an ensuite toilet and washbasin facilities. Communal areas and rooms are decorated and furnished to a satisfactory standard. The kitchen area is clean and organised. The house is set in well laid out gardens, with pleasant views of the town and countryside. There is satisfactory parking for visitors. The home is close to local amenities with Care Homes for Older People Page 4 of 34 Over 65 22 0 1 6 1 2 2 0 0 9 Brief description of the care home access to transport links into the main city of Truro. The range of fees at the time of the inspection was £337-£505 per week. A copy of this and previous inspection reports is available from the Care Quality Commission via our customer services team or website. Alternatively the registered provider should be able to provide a copy. Care Homes for Older People Page 5 of 34 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place in six and a half hours in one day. All the key standards were inspected. The methodology used for this inspection was: (1)To case track four people using the service. This included, where possible, meeting and discussing with the people their experiences, and inspecting their records. (2) Discussion with staff about their experiences working in the home. (3) Discussion with other people using the service, and their representatives. (4) Observing care practices. (5) Discussing care practices with management. (6) Inspecting records and the care environment. (7) Carrying out a postal survey of the views of people using the service, staff working at the home and the views of relatives and carers of people living in the home. We received a total of 11 responses from people who use the service and 10 responses from relatives and carers of people who use the service. We did not receive any responses from staff who work in the home. Other evidence gathered since the previous inspection, such as notifications received Care Homes for Older People Page 6 of 34 from the home (e.g. regarding any incidents which occurred), was used to help form the judgements made in the report.) Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 34 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 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. Information provided to people who use the service (e.g. regarding services offered) is to a satisfactory standard. For example all people who use the service receive a statement of terms and conditions of residency or contract when they move to the home. This ensures people are aware of their rights and responsibilities. Pre assessment procedures are satisfactory. This helps to evidence that pre admission procedures are satisfactory, and should assist the registered provider to be clear that they can meet the persons needs before admission is arranged. Evidence: The registered provider has a satisfactory statement of purpose and service user guide (home brochure). A copy of the service user guide is given to the person / family when admission is arranged. We would advise a copy is also kept in the foyer of the home. The majority of people who answered our postal survey said they were provided with satisfactory information regarding the home before they moved in. Care Homes for Older People Page 11 of 34 Evidence: We inspected files for four people, some of whom had moved to the home since the last key inspection. In regard to people recently admitted, an assessment was completed by the registered provider before admission was arranged; this was documented and the assessment was contained in the persons file. We were able to inspect contracts for people admitted to the service. These were to a satisfactory standard, and a copy is provided to the person using the service and / or their representative. All of the people who answered our postal survey said they were provided with a contract / statement of terms and conditions regarding their care, when they moved to the home. Care Homes for Older People Page 12 of 34 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. Generally people appear happy with their support and care. Records and feedback from people living or involved in the service shows care is generally appropriate to meet the needs of people living in the home. People therefore should receive suitable support and care from staff at this home. Evidence: We spoke to several people who use the service who were complimentary about the care they received. People said they felt their privacy and dignity was respected by staff. People who we met all looked well cared for, and looked like they had their personal care needs met. The majority of people using the service, who answered our survey, said they always get the care and the support they need. Relatives, carers and advocates who answered our survey said staff either always (4), usually (4) or sometimes (1) meet the needs of their friend or relative. The majority of this group said staff always give appropriate support and care although some said this was usually (2) the case and one person said this was only sometimes the case. Care Homes for Older People Page 13 of 34 Evidence: All the people who we case tracked had a care plan and care plans we inspected were all to a satisfactory standard. The registered provider has introduced a new care planning system since we last completed an inspection in December 2009, and this is an improvement on the previous system. Care plans we inspected all contained comprehensive information regarding the needs of the people case tracked including a brief but informative pen picture of the person, which for example will help new staff to get to know the person. The staff team review care plans on a monthly basis, and the reviews we read were thorough. Daily notes are satisfactory, although should include more detail where this is appropriate. We reminded the registered provider of the importance of risk assessing the use of hot water bottles e.g. they should always have a cover etc. to reduce the risk of scalding. We also looked at records of health care support provided to the same group of people. There is clear evidence where someone has seen a general practitioner , district nurse, community psychiatric nurse (where appropriate), dentists, opticians and /or chiropodist. This information helps to ensure staff monitor people are getting appropriate medical support. We reminded the registered provider of the importance not storing incontinence pads in communal bathrooms. This is to ensure that people are only ever put in pads which belong to them and are the correct size. We inspected the registered providers medication policy which is satisfactory. We also inspected the homes medication system. Storage of general prescribed medication is satisfactory. Medication is stored in a purpose built medication trolley. We reminded the registered provider that this should be attached to the wall when not in use. Storage is well organised. There is a need to watch some items of medication are not over ordered, but all medication in stock was not passed the use by date. Medication records are satisfactorily maintained. There is a suitable system for the storage and recording of controlled drugs, although currently there are no controlled drugs prescribed to people living in the home. Staff, who administer medication, have received formal training regarding medication. Arrangements need to be made to ensure any outstanding items designated for return to the pharmacist are returned as soon as possible. Care Homes for Older People Page 14 of 34 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. Routines, food and recreational opportunities meet the needs of the people living in the home. Since the last inspection there has been a significant improvement in activities which are available. Evidence: People using the service, who the inspectors spoke to, said they could get up and go to bed when they wished. Routines in the home appear relaxed. There was a nice friendly atmosphere in the home on the day of the inspection. People living in the home are allowed to have their pets with them. For example at least one person has a dog. People living in the home are also allowed to smoke in their rooms, where it is safe for them to do so. Since the last inspection, the staff team have worked hard to develop a range of activities for people living in the home. This is an excellent development. Records show these include bingo, various games, external entertainers and arm chair exercises. There is also a hairdresser who visits weekly, and also a minister from the chapel who provides a service on a monthly basis. The staff have also organised regular bus trips to local places of interest. This is an excellent initiative. People who we spoke to, and who answered our survey, were all generally positive about the Care Homes for Older People Page 15 of 34 Evidence: activities that are now available. For example people using the service who answered our survey said activities were either always (9) or usually (1) or sometimes (1) to a good standard. Relatives answering our survey said people can either always (6), usually (2) or sometimes (2) live the life they choose. People are positive about the food provided. There is always two options of main meal at lunch time, and people living in the home were generally complementary about the standard of food. The inspectors shared a meal, with people using the service, at lunch time. This was generally to a good standard, the meal was unrushed and people received appropriate levels of support. There is also a choice of evening tea, and hot and cold drinks / snacks are available at regular intervals.The menu for the day is displayed in several areas of the home. Tea and coffee making facilities, and fresh fruit were available in the small lounge. There seems appropriate arrangements in place for people requiring special diets, such as diabetes. People using the service who answered our survey said meals were either always (9) or usually (2) to a good standard. Care Homes for Older People Page 16 of 34 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 registered provider has a satisfactory complaints policy and people did not raise any concerns or complaints to us. The adult safeguarding policy is adequate, although the current version needs to have a full procedure what staff will do if there is an allegation of abuse. We are generally satisfied that concerns previously expressed by external professionals have been addressed, although further work does need to occur to improve heating provision. As long as the registered providers can sustain the improvements they have made, and learn from the incidents which have occurred, people using this service should be able to be assured appropriate action will be taken if they have concerns or complaints about this service. Evidence: The registered provider has a complaints policy which is satisfactory. The Care Quality Commission or the registered provider have not received any complaints since the last inspection. The homes service user guide also contains a summary of the complaints procedure. People who we spoke to raised no concerns or complaints about the running of the service or the staff that worked with them. Our postal survey said the majority of people using the service knew who they could approach if they had a complaint (10 out of 11 people), and the same number of people knew who they could speak to informally if they had any concerns. A similar Care Homes for Older People Page 17 of 34 Evidence: number of relatives, carers and advocates said they knew how to make a complaint. In regard to this group six people said any concerns they have are always responded to appropriately whereas the remainder said this was either usually or sometimes the case.(two people did not respond to the question). One relative raised a concern to us, through the survey we received regarding cleanliness of their relatives bedroom and its decoration. The person had lived at the home for many years. The person themselves said they had no concerns, but the registered provider said they would arrange for the bedroom to be redecorated shortly. We received a concern from external professionals prior to the last inspection in December 2009. This matter was dealt with under the Cornwall Council adult safeguarding process, and this matter is due to be reviewed shortly by the professionals involved. The majority of the issues appear to be resolved. For example there is now a sufficient supply of hot water to all bedrooms, provision of food for people with diabetes is now satisfactory, and there is a good range of activities provided. The registered provider has not however replaced the heating system as we have recommended. We will monitor closely that people are always kept warm, and we think additional heating needs to be provided in the main lounge. The daughter of the registered provider does operate dog grooming business in the grounds of the home. The registered provider has said she does help out occasionally with this, but has stated to us that she is managing the home on a full time basis, and any assistance with the other business given, does not interfere with the running of the home. The adult safeguarding policy has been rewritten again since the last inspection. The new version omits a clear procedure regarding what the registered provider or other staff will take if there is an allegation raised about abuse. This needs to be added to the current policy which otherwise is satisfactory. Staff have the opportunity to attend adult safeguarding training. We assessed the training records of six members of staff and they had all received this training. Staff also have the opportunity to receive training regarding the Mental Capacity Act 2005 and also Deprivation of Liberty. Knowledge of these issues will also help ensure people are protected from abuse. All staff files we assessed had evidence that a Protection of Vulnerable Adults /Independent Safeguarding Authority First check (to ascertain people employed are not on a list of people unsuitable to work with vulnerable people) had been completed. Care Homes for Older People Page 18 of 34 Evidence: Staff also have a full Criminal Records Bureau check (to ascertain staff do not have any criminal convictions etc. which would deem them unsuitable to work with vulnerable people). Care Homes for Older People Page 19 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mount Pleasant is generally a comfortable and homely environment. However we are still concerned that previous issues regarding heating provision have not been resolved, and this matter needs now to be appropriately addressed. Matters regarding access to call points, and storage of cleaning materials also need to be addressed. Improvement in these areas will give us more assurance that the building is a suitable facility for the elderly and vulnerable. Evidence: The building was inspected. There is suitable shared space for example a large lounge and dining room. There is also a small quiet area with seating, and this area has fresh fruit, and tea/ coffee making facilities which people using the service can consume. Communal lounges are generally pleasant and homely. Toilet and bathroom facilities are suitable in size and facilities provided. The registered provider is in the process of redecorating communal areas of the building. This includes new carpeting in the corridors and lounge, and new floor covering in the bathrooms and toilets. Bedrooms are decorated and furnished according to individual tastes. People who use the service said they were able to bring their own furnishings and belongings with them when they moved in. We were told by the owner that people using the service can be provided with a key to their bedroom if they want one. People are asked if they want to be able to lock their bedrooms when they move in. The bedroom of one Care Homes for Older People Page 20 of 34 Evidence: person using the service has been requested, by their relative, to be redecorated, and the carpet replaced as it is stained. The registered provider said she would address this matter shortly. The home currently has storage heaters in each bedroom, and in the communal areas. There are no storage heaters in some of the bathrooms and toilets. At our last visit we recommended the system be replaced as it is clear it is not particularly effective in the winter months but this has not been done. There is also a problem that people cannot regulate the temperature of individual heaters in the communal rooms or their bedrooms. There are currently some portable electric heaters being used in peoples bedrooms. Their use needs to be risk assessed for example to minimise the risk of fire or scalding. At the last inspection we raised a concern that when the storage heaters are on-even though they may not provide sufficient heat- the surfaces of the heaters are too hot to touch, and there was a risk of scalding e.g if somebody fell against them (a significant risk in a care setting for older people). The registered providers are addressing this issue by fitting radiator covers to the heaters. However, now it is not possible to adjust the temperatures of the heaters at all, unless the covers are removed. The registered provider has discussed with people living in the home that they should ask if they need the temperature of the heaters to be adjusted, and this is recorded in peoples files. This is not entirely a satisfactory answer to the problems which have been raised to us. We continue to remain concerned that there is (a) people in the home are not warm enough in particularly cold weather (b) people cannot adjust their heaters and therefore regulate the temperature in their rooms. If there are further concerns we will have a further management review of this service, and this may result in a further safeguarding referral and /or enforcement action. We think it is essential-as a minimum- for additional heaters to be fitted in the home. For example at the very least in the lounge of the home, the bathrooms and where appropriate additional heaters in other communal rooms and peoples bedrooms. The registered provider is responsible for ensuring people are warm, and the must be vigilant in ensuring heating temperatures are adjusted as appropriate. At the last inspection we raised a concern about insufficient access to call bells in some bedrooms. At this inspection we again thought this was a concern; for example some people were not able to reach their call bells. We are therefore re notifying the previous requirement. Care Homes for Older People Page 21 of 34 Evidence: We noted there was no window restrictor fitted to at least one bedroom (room 18). It is essential the registered provider checks all windows are appropriately restricted (a) to minimise the risk of falls (b) to prevent the risk of intruders entering the home. The Health and Safety Executive publishes guidance regarding this matter, which needs to be consulted and acted upon. We also noted the lock on the toilet door (near room 6) was broken. The top of the tap on the wash handbasin, in the bathroom (near room 6) was broken. The registered provider said she would address these matters. We raised a concern that there were a number of door wedges around the building. The registered provider assured us that doors are not propped open, but the wedges are only used when people in wheel chairs are transported around the building and when the cleaner is vacuuming the building. We reminded the registered provider of the importance of ensuring that doors are not propped open (due to the fire risk), and that there are various systems on the market for automatic door closers, should fire doors need to be be kept open for significant periods of time. The building was generally clean and hygienic on the day of the inspection. A cleaner is employed at the home. The majority (10) of people living in the home thought the home is always clean, whereas one person said this was only sometimes the case. One person raised concerns that windows in one part of the home were not being cleaned. We raised this with the registered provider and it was agreed the matter would be resolved. Laundry facilities appear adequate. The registered provider stated the floor covering is due to be replaced shortly. We raised a concern that there is a clothes drier on a shelf in the laundry. This was not fixed to the shelf and was not in easy reach for staff. There was no risk assessment regarding the siting of the equipment.We are concerned that the equipment could fall and injure someone. The registered provider said it was not used anymore. We said the equipment did not look safe and should either be affixed to the surface or removed. We raised at the last inspection that some cleaning materials had been decanted into containers which were not properly labelled. This matter is not resolved and we are repeating the requirement issued at the last inspection that COSHH health and safety guidelines (Control of Substances Hazardous to Health Regulations 1988) must be adhered to. Care Homes for Older People Page 22 of 34 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. Staff are viewed positively by the people who use the service, and suitable processes are in place to ensure staff are appropriately recruited and trained. This should ensure people using this service receive satisfactory professional support from the staff who work with them. Evidence: On the day of the inspection there were three care staff on duty from 07:00 to 14: 00, and then two staff on duty until 21:00. A cleaner and cook are employed and were on duty on the day of the inspection. An administrator has been employed and works during the day. One waking night member of staff is on duty from 21:00 to 07:00. The registered providers live in the neighbouring bungalow. The record of staff hours (recorded in the house diary) appears to show there is satisfactory staffing levels provided for the people currently accommodated. We spoke to people using the service, and they were all positive about the support they received from staff members. Staff are viewed as kind and caring, and people said staff do what they can to meet their needs.Our postal survey results stated the vast majority of people using the service thought they always received the care and support they needed, and most people thought staff always listened to what they had to say (7 out of 11-with the remainder saying this was either usually or sometimes the case). The majority (9) thought there was always enough staff available, with a Care Homes for Older People Page 23 of 34 Evidence: minority saying this was usually (1) or sometimes (1) the case. Personnel records were inspected for six staff (i.e. staff on duty during the 24 hour period on the day of the inspection plus a person recruited since the last inspection). Records assessed were generally satisfactory. For example all staff had an application form with a record of the persons employment history. Two written references have been obtained for each person. However we noted that two staff who have started since the last inspection did not have an official reference from their last employer. We would strongly recommend this is always obtained so the registered provider can assess the candidate is fit to work with the vulnerable. There is evidence staff are medically fit (i.e. a self declaration of fitness.) Some staff did not have evidence to verify their identity, although this information would have been obtained when a Criminal Records Bureau check was applied for. All staff had evidence of receipt of a Criminal Records Bureau check (CRB) and a Protection of Vulnerable Adults First check (POVA First) / Independent Safeguarding Authority First check (ISA First) check. Advice was given regarding liaising with the police and Independent Safeguarding Authority regarding making a referral to the ISA list regarding a person the management of the home had concerns about. In regard to one member of staff who is awaiting a CRB check, it did not appear evident that the person was being supervised, as is required by the current guidance. The person had received a ISA check. However it is essential staff awaiting CRB checks are supervised, and preferably supernumerary, until their full CRB disclosure is returned to state they do not have any criminal convictions which may deem them an inappropriate person to work with vulnerable people. We looked at whether staff had a National Vocational Qualification in care, and felt assured there is satisfactory opportunity for staff to obtain this qualification. We checked records of training staff have received. By law staff require the following training: (1) Regular fire training in accordance with the requirements of the fire authority. (2) There must always be at least one first aider on duty (at appointed person level) (3) All staff must have manual handling training and regular updates of this (e.g. annually) (4) All staff must have basic training in infection control. (5) Staff who handle food receive food hygiene training. (6) All staff must have an induction and there needs to be a record of this. The induction record for one person, who commenced employment since the last inspection, was not on their file. We were assured the induction had been completed. Care Homes for Older People Page 24 of 34 Evidence: It is essential that this record is maintained on the persons file. In regard to other training courses, according to records assessed there is satisfactory opportunity for staff go on these courses. The majority of staff have just obtained up to date manual handling certificates. There are some gaps for newer staff in obtaining training regarding food handling, infection control and first aid training-although the registered provider said she would arrange this training. However overall the delivery of training is to a satisfactory standard, and organisation of this has improved considerably over the last year. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been improvements in the management of the home and we trust that time will provide us with further assurance these improvements are sustained, and further planned service improvements are completed. Some improvement is required to health and safety precautions. Improvement in these areas, and other areas elsewhere in the report, will give more assurance that the home is managed to a satisfactory standard. Evidence: The registered providers have owned and managed the home for nearly 20 years. Mrs Sear said she has attended a City and Guilds Advanced Management course, and an accountancy training course. Mr Sear is from an electrical engineering background. A Care Officer is employed five days a week to supervise care staff. An additional senior is employed to assist with management administration and day activities at the home. We have previously been told that Mr Sear is no longer involved in the day to day running of the business. If this is the case it is important that the registered providers Care Homes for Older People Page 26 of 34 Evidence: inform us formally of this change when they re register under the Health and Social Care Act 2008 (this has to be done by October 2008). If this is not the case our expectation is that Mr Sear is fully involved and takes equal responsibility regarding regulatory issues for carrying on the home. Similarly if Mrs Sear is not managing the home on a full time basis an application for a registered manager must be submitted. The inspector also discussed with Mrs Sear that she may wish to register as a company with her and her husband as directors. We have noted an overall improvement in the operation of the service and hope this will be sustained. We still have some concerns regarding some aspects of the environmental standards for example in regard to there being satisfactory heating. The report also highlights some concerns regarding health and safety precautions as highlighted below. We inspected the registered providers Quality Management Policy which is satisfactory. In the last six months a survey was completed by the registered provider of peoples views of the service.The responses of people using the service were all very positive. There have been a number of major improvements to the service since we last inspected for example in regard to the provision of activities, record keeping and care planning. We trust this improvement will continue and will be sustained. We are concerned that we had to request the Annual Quality Assurance Assessment (AQAA) to be returned to us on three occasions. This included us having to threaten to take enforcement action if the form was not returned. The AQAA is a self assessment, completed by the owners of the home, which outlines to us how the service is run and any plans there are for service development. It also provides us with a data set confirming policies in place, health and safety checks have been completed, and information about people living and working in the home. The document is vital as it provides us with assurance regarding the operation of the service, and also is vital for pre inspection planning. Following the last key inspection we also requested an Improvement Plan. Again we had to send several reminders for this document to be returned, and again it was not returned to us until after this inspection. The non receipt of these documents is particularly unacceptable as the commission increasingly works towards a model of self assessment and assurance from providers that they are meeting the regulations. However, when these documents were received both were satisfactory. We assessed arrangements regarding the management of the finances of people who use the service. Records kept are satisfactory and monies kept balanced with what is recorded. Money is stored securely. We were told no valuables are kept on behalf of Care Homes for Older People Page 27 of 34 Evidence: people who use the service. The registered provider has a health and safety policy. There is also a fire risk assessment. Testing of fire extinguishers and the fire system appears to have been completed appropriately by external contractors. In regard to fire precautions emergency call points are tested weekly. Suitable checks have been completed on fire doors. Fire drills have been completed appropriately. Emergency fire lighting is appropriately tested. Records of staff fire training is satisfactory. No records were presented to us regarding health and safety risk assessment. This used to be completed by an external consultant for the home. While the latter is not required, it is essential that health and safety risk assessments are completed and regularly reviewed. These should highlight any risks to people living in the home, visitors and staff working in the home; and what action is taken to minimise these risks. The registered provider has purchased an off the shelf system regarding the prevention of legionella. However this has not been implemented yet. The environmental health officer has visited regarding food hygiene standards (March 2009), and health and safety standards (November 2008). The results of the reports are satisfactory. Portable electrical appliances were last tested in December 2009. The electrical hardwire circuit was tested in January 2009 and was deemed as satisfactory by the contractor. Moving and handling equipment has been tested and is satisfactory. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 22 23 All people using the service 01/02/2010 must have ready access to a call bell when they are in their bedrooms This will ensure people can summon help when it is required. 2 25 12 Fit radiator covers to storage 01/03/2010 heaters / radiators. (Previous timescale of 01/07/2009 not met Second Notification) This will help to ensure the risk of scalding is minimised 3 26 12 Storage of cleaning materials 01/02/2010 must comply with COSHH guidelines (e.g. stored appropriately and in clearly labelled containers). This will help ensure the risk of accidents regarding to hazardous materials is minimised. 4 38 12 The registered provider must 01/03/2010 ensure a risk assessment is written regarding measures in place to minimise the risk of legionnaires disease This will help ensure the risk of legionnaires disease is minimised to the people living in the home. Care Homes for Older People Page 29 of 34 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 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 13 There must be a clear adult safeguarding procedure which staff and the registered persons follow if there are safeguarding concerns. This will help to ensure that people who use the service receive suitable support from the registered persons if there are any allegations of abuse. 01/08/2010 2 19 12 Fit window restrictors where this is necessary, in accordance with guidance published by the Health and Safety Executive. This will help ensure the risk of falls and intruders entering the building are minimised. 01/10/2010 3 22 23 All people using the service 01/10/2010 must have ready access to a call bell when they are in their bedrooms Page 31 of 34 Care Homes for Older People 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 (Previous timescale of 01/02/2010 not met Second Notification) This will ensure people can summon help when it is required. 4 25 12 Fit radiator covers to storage 01/10/2010 heaters / radiators. (Previous timescale of 01/03/2010 not met Third Notification) This will help to ensure the risk of scalding is minimised 5 25 23 Additional fixed radiators need to be installed, where necessary, in the building e.g. bathrooms, communal areas and bedrooms. This will give people who use the service assurance that they live in a warm and comfortable environment. 6 26 12 Storage of cleaning materials must comply with COSHH guidelines (e.g. stored appropriately and in clearly labelled containers). (Previous timescale of 01/02/2010 not met Second Notification) 01/07/2010 01/10/2010 Care Homes for Older People Page 32 of 34 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 This will help ensure the risk of accidents regarding to hazardous materials is minimised. 7 33 24 Ensure documentation required by the Care Quality Commission (e.g. AQAA, Improvement Plan etc.) are returned within designated timescales. This will ensure the registered persons are meeting regulatory requirements. 8 38 12 The registered provider 01/07/2010 must ensure there is a satisfactory system of health and safety risk assessment in place (including measures in place to minimise the risk of legionnaires disease). This will help ensure any risks to people living in the home, staff and visitors are assessed and where possible minimised. 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 01/07/2010 1 29 Always obtain an official reference from job candidates last employer as part of the recruitment process. Page 33 of 34 Care Homes for Older People 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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