Care Home: Mount Pleasant, Weymouth

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What the care home does well Comments from people`s surveys included; `It looks after the residents very well. They do very good activities each morning. Residents are always clean and tidy` `Everything` `Nice meals, bus trip, care staff very good` `Very pleasant staff always ready to help`. There are good quality and easy to follow care plans in place. People have good access to local District Nurses, General Practitioners and specialist health care when required. People enjoy the food provided by the home and specialist diets are catered for. Some people living at the home are involved in residents meetings and contribute to how the home is run. People and their families know how to complain or raise their concerns about the home. Visitors are made welcome and people are encouraged to maintain contact with family and friends. Relatives spoke positively about the home and the staff. Relatives are encouraged and supported to remain involved in the care and support of people living at the home. Staff employed by the home undergo an induction programme and there is an active NVQ (National Vocational Qualifications) programme. What has improved since the last inspection? Toiletries and razors are now safely stored to reduce the risk of ingestion by people. People now have sufficient supplies of toiletries and toothbrushes so that their personal and oral hygeine can be met. People now have a moving and handling plan in place so that staff know how to move them safely. People now have pressure area and nutritional risk assessments and plans in place. The mealtimes at the home are now staggered so that in the main there are enough staff to assist people to eat and drink. The communal areas of the home have been redecorated. The outstanding laundry works and repairs have now been completed. Staff have completed mandatory training and refreshers. Electrical equipment has now been PAT tested. What the care home could do better: Staff must acknowledge people as individuals and with respect at all times. This is to make sure that people are acknowledged and are given the respect they deserve. The administration and recording systems and storage for prescribed creams should be kept under review. This is so that people receive their creams as prescribed and they are securely stored. People must be provided with suitable stimulation and have the opportunity to be occupied. This is to ensure that people have a good quality of life and well being. Key inspection report Care homes for older people Name: Address: Mount Pleasant, Weymouth 21 Mount Pleasant Avenue Weymouth Dorset DT3 5JF     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: Jo Johnson     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 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 30 Information about the care home Name of care home: Address: Mount Pleasant, Weymouth 21 Mount Pleasant Avenue Weymouth Dorset DT3 5JF 01305760903 01305766475 mountpleasant@care-south.co.uk www.care-south.co.uk Care South care home 36 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 36 in the category OP (Old Age), including up to 28 in the category DE(E). No service users who are accommodated under the category of DE(E) will be accommodated on the unit known as Marigold (first floor level). Date of last inspection Brief description of the care home Mount Pleasant accommodates and provides personal care for up to 36 older people including a maximum of twenty eight people who may be mentally frail and who have dementia. In August 2005 a new registration certificate was issued allowing an increase of numbers of people who have dementia who may be accommodated at the home. Since then two of the units, Monty and Primrose, have been developed to provide care for people who are mentally frail, leaving Marigold unit for people who are physically frail. Jubilee unit accommodates some people with mild dementia and others who have moderate or more significant physical care needs.The home is managed by Care South, a not for profit organisation, formerly the Dorset Trust, with a number of homes in Dorset. Accommodation is provided on the ground and first floors, which are Care Homes for Older People Page 4 of 30 Over 65 28 36 0 0 1 4 0 7 2 0 0 9 Brief description of the care home divided into four units, each with a combined day/dining room complete with beverage kitchen. There are additional day areas on the ground and first floors. All bedrooms are for single occupancy. The home has a range of baths suitable for assisted use. Gardens are level and attractively laid out. All areas are accessible by the lift and there are no steps or ramps in corridors or bedrooms; all areas used by people who live in the home are accessible by uninterrupted level floor surfaces. A copy of the most recent inspection report is displayed in the front hall. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by us is upon outcomes for people who live at the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. This report uses information and evidence gathered during the key inspection process, which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The manager supplied the commission with an AQAA (Annual Quality Assurance Assessment). Information from this has been used to make judgements about the service, and have been included in this report. Surveys were distributed by the manager to people who live at the home, health/social care professionals and staff. Seven surveys from people and their relatives, six health/social care professionals and seven staff surveys were returned. The findings of these surveys have been included in Care Homes for Older People Page 6 of 30 the report. This inspection visit was unannounced (we did not let the home know that we were coming) and took place on 8th December between 9.30 am and 4.15 pm. The acting manager was present throughout the inspection. The inspection was conducted by two inspectors and involved observations of and talking with people who live or were staying at the home, the staff on duty and the manager. Five people were identified for close examination by reading their care plan, risk assessments, daily records and other relevant information. This is part of a process known as case tracking, where evidence is matched to outcomes for people. A tour of the environment was undertaken, and home records were sampled, including staff training and recruitment, health and safety, and staff rotas. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 30 Staff must acknowledge people as individuals and with respect at all times. This is to make sure that people are acknowledged and are given the respect they deserve. The administration and recording systems and storage for prescribed creams should be kept under review. This is so that people receive their creams as prescribed and they are securely stored. People must be provided with suitable stimulation and have the opportunity to be occupied. This is to ensure that people have a good quality of life and well being. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into or staying at the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. Evidence: The statement of purpose and service user guide have been recently updated following the appointment of the new manager. The staff told us that people and or their families come and visit the home before making a decision about moving in. A relative told us that they had visited the home and that someone from the home had visited their relative to assess their needs. The manager or deputy manager undertakes a pre admission assessment before determining whether they can meet someones needs. A fuller assessment, risk assessments and a social history assessment are completed with people as soon as they move in. From this a care plan is developed. Care Homes for Older People Page 11 of 30 Evidence: The assessment for the last person to move into the home was seen. Information was sought from care management assessments, and where appropriate other health professionals. People spoken with and four of the seven surveys told us that they had enough information about the home and have a contract. The surveys from health and social care professionals told us that the homes assessment arrangements always (1) or usually (5) ensures that accurate information is gathered and that the right service is planned for people. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs and is in the main detailed in care plans. Evidence: We looked at five peoples care records. The care plans seen were of a good quality and detailed how staff were to meet peoples needs. They included assessments for any areas of risk and the action staff need to take to minimise these and the how often to monitor for any changes. Risk assessments were completed for falls, tissue viability, mobility, and nutrition. People were weighed on admission to the home and this was recorded in their plans. There was additional information available on medical conditions. Care plans had been reviewed on a monthly basis and as and when peoples needs have changed. For example: One person had a short term care plan in place for their pressure area care following Care Homes for Older People Page 13 of 30 Evidence: intervention by the District Nurse. One person had a clear plan and risk assessments completed so that staff had clear information on how to support the person and manage behaviours. Since the last key inspection, the standard of care planning and record keeping about people has improved. However, one persons care plan had the end of some sentences missing. The acting manager agreed to amend this care plan. Peoples care plans included a brief life history and pen picture so that staff have some basic information about people and who is important to them. One persons care plan included photographs of people throughout their life that were important to them. Staff told us this was very useful in understanding the individual and their life history. The daily care records for people seen were mainly task focused and did not all reflect how people are spending their time at the home. Staff should record how people have been spending their time. This is so records give a more accurate reflection of peoples day to day lives and not just the care and support provided to them. The surveys from people told us that they always (5) or usually (2) receive the support and care they need. Discussion with the staff, surveys and observation of care plans and daily records tell us that people living in the home have access to health professionals such as GP, dietician, dentist and specialist consultants and chiropodist. The surveys from health and social care professionals told us that the home always (2) or usually (4) seeks advice and act on it to meet peoples health care needs and improve their well being. We observed that people who are transferred by hoist were left sitting in their slings throughout the inspection. Following the inspection the Manager has provided further information confirming that advice had been sought from the Occupational Therapist regarding this practice, and that care records have now been updated to reflect this plan of care. We spent time in two different living units observing, talking with people, staff and relatives. We observed some varying practices from the staff on duty. Some staff spent time talking with people, engaging with them and explaining what was happening when they were supporting them. Other staff did not interact of acknowledge people when they came into the lounge where people were sat. Care Homes for Older People Page 14 of 30 Evidence: During discussion with us staff referred to some people as wheelchairs and one person used the terminology good girl whilst assisting someone to eat their meal. We observed one person who was sat on a dining room chair at the table. This person was not supported to move from the table to a comfy chair or be taken to the toilet from 10.15 am to 3.20 pm. Staff respected peoples privacy and dignity, by knocking on their doors and offering personal care discreetly and in private. Staff maintained peoples dignity when they were hoisted and carefully rearranged their clothes. There are a number of people who have bed rails in place for their safety. There are risk assessments in place for these rails. The Registered Provider has advised us that there are appropriate systems in place to monitor and ensure safe use of bed rails throughout the home. The medication and the records for the five people being case tracked were seen. The home uses a monitored dosage system for medication. The records and monitored dosage packs in use had only been started the previous day. They had all been completed correctly. We looked at the prescribed creams and eye drops for people as there had been shortfalls at the last key inspection. Out of the five people who we case tracked we found that one persons eye drops had not been dated when they were opened. Peoples prescribed creams are kept in their bedrooms but not in a locked storage facility. We looked the the records for three people who have prescribed creams that are stored in their bedrooms. According to the cream charts one persons Betnovate cream had run out on 07/12/09. The manager contacted us following the inspection to inform us that the cream had not run out but had been placed in the District Nurses box. We were not able to locate two other peoples creams in their box in their bedrooms, there cream charts had been signed by staff that the prescribed creams had been applied. The manager contacted us following the inspection to inform us that one persons cream had been found in their bedside cabinet and there were spare tubes of the other individuals cream in the spare medication cupboard. We acknowledge that the creams were in the home. The Manager should continue to monitor these arrangements to ensure that creams are stored safely and that people who have dementia care needs receive their creams as prescribed. Care Homes for Older People Page 15 of 30 Evidence: The controlled drugs record book and stock were seen and were correct. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people who live at the home are able to participate in social activities and are given choices to maintain their quality of life. People with later stages of dementia who live at the home have very little opportunity to participate in daily living or stimulating activities. Evidence: There is an activities co-ordinator employed to work at the home in the mornings. On the morning of the inspection five people went to Brewers Quay for coffee. There is a programme of activities displayed and activities on offer included; church service, creative artwork, bingo, skittles, trips out and accordion band. We observed an agency member of staff painting peoples nails and sitting with one person going through a magazine. However, overall there was little time when staff interacted or engaged with people when they were not providing personal care or support. There a a number of people who are at the later stages of dementia and are very physically frail. There was not any sensory environments or tactile and sensory Care Homes for Older People Page 17 of 30 Evidence: activities freely available for these individuals and or the staff did not have the time to sit with people to offer them any stimulation. There were dolls and some things for people to pick up and do who are independently mobile. Staff observed did not give people a choice of music being played and on one unit and in the foyer Christmas CDs were repeated all day. The surveys from people told us that the home always (4) or usually (3) arranges activities that they can take part in if they want. We observed lunchtime on two different living units. The lunchtimes are now staggered so that there are enough staff available to assist and support people with eating their meals. On one living unit two relatives come in every lunchtime to assist their relatives to eat and drink. People choose their meals each morning and either choose verbally or from a photographs of the meals. The manager told us that there are plans for people to be able to choose from plated meals at time of each meal. We observed that some staff sat with people and explained to them what they were eating. However, some staff communicated very little with people whilst they were eating and drinking. People spoken with and observed appeared to enjoy their meal. Following the last key inspection, there is now a different choice of soft diet at tea time . Some staff just put on peoples disposable bibs or tabards without explaining what they were doing or checking whether they wanted to wear a tabard. Current good practice recommends that serviettes or napkins be used to protect peoples clothes rather than bibs or tabards which can appear institutional. The surveys from people told us that they always (3) or usually (4) like the meals at the home. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints procedures make sure that peoples, relatives and representatives concerns and complaints are listened to and acted upon. A staff team who have a good knowledge of how to respond to any suspicion of abuse and to keep people safe from harm support the people living at the home. Evidence: The home has a formal complaints policy which is accessible to people and their families. People are encouraged to raise their concerns with the manager. Relatives spoken with and surveys told us that people know who to speak to if they are unhappy and they know how to complain. Health and social care professional surveys told us that the home responds appropriately to concerns. Staff spoken with and surveys told us that they know what to do if a individual or relative or friend has concerns about the home. We looked at the complaint records kept at the home. There has been three complaints since the last key inspection. There were good clear records for two of the complaints including the investigation, the outcome and the actions taken to reduce any recurrence. However, for one complaint there was not any written acknowledgment or outcome to the complainant. The manager told us that this was Care Homes for Older People Page 19 of 30 Evidence: because the relatives had not raised to as a formal complaint but as a verbal concern. Any concerns that are recorded and dealt with under the complaints procedure should be managed in line the organisations policy and procedure. Staff have attended training in the Protection of Vulnerable Adults (POVA) so that they are aware of the different ways vulnerable people are at risk of abuse, and would know how to respond. Staff spoken with and surveys told us that they were confident on how to whistle blow and how to report any allegations of abuse. There have been five safeguarding investigations undertaken by the local authority since the last key inspection. The home has cooperated fully with the investigations and taken action where necessary. These incidents do not involve allegations made against staff. The acting manager is now keeping separate safeguarding data and analysis as part of the quality assurances processes. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the home is maintained and furnished so that people live in a relaxed, homely and comfortable environment. Evidence: We looked at some of the bedrooms of the people involved in case tracking. They were clean and well furnished. The rooms were personalised with their own belongings. However, the decor in one bedroom was in a poor state repair. The walls were damaged and the wall paper was peeling off. The windows in some bedrooms had black stains in the corners possibly due to damp as some of the windows are metal. In the AQAA the manager told us that since the last inspection the following improvements have been made to the home; redecorated a number of communal areas, completed the partially finished building works in the laundry, ensured that all laundry equipment is in a good state of repair, repaired and replaced dishwashers on units, provided additional lined clinical waste bins in toilets and bathrooms, replaced frayed towels and flannels and provided individual nail clippers and manicure sets for all residents. We have replaced 12 commodes and provided some profiling beds and additional manual handling equipment to meet individual needs. We have personalised the bathrooms and shower room in the home to create a homely more domestic and Care Homes for Older People Page 21 of 30 Evidence: comfortable environment for residents. We have replaced the carpet on the ground floor and provided attractive notice and information boards for residents and visitors. We saw that a number of clocks in peoples bedrooms had stopped. It is important that people with dementia have access to working clocks so they are orientated to the time of day or night. There are radiators and pipes that are hot to touch and are uncovered. The acting manager has been asked by the organisation to audit these radiators so that covers can be provided. Equipment is available to assist people and staff in the delivery of personal care, which includes assisted baths, profiling beds, accessible showers and moving and handling equipment including hoists. The laundry room was clean, tidy and well organised. All of the washing machines were in working order. Systems are in place to reduce the risk of infection. Disposable gloves, aprons are available and used by staff when handling soiled linen and when supporting people with personal care. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are protected by robust recruitment practices and supported by a trained staff team. There are insufficient staff on duty at times to fully meet the social, emotional, and well being needs of the people living there. Evidence: On the day of the inspection there were 32 people living at the home. There were sufficient staff to meet the physical and personal care needs of people living at the home. The acting manager told us that she is closely monitoring the dependency of people on each living unit and is aware of the very high mental and physical frailty of people living on Primrose living unit. As identified in the daily living and social activities section of the report, there are not always sufficient staff to meet the social, emotional and well being needs of people, who are at the later stages of dementia and who are very physically frail and cannot access activities independently. The surveys from people told us that there are always (3), usually (3) and sometimes(1) staff available when they need them. The surveys from staff told us that there are always (2), usually (5) and sometimes Care Homes for Older People Page 23 of 30 Evidence: (1) enough staff to meet the individual needs of all the people at the home. Three staff files were looked at including the most recently recruited staff members. All of them included CRB(Criminal Records Bureau) and PoVA (Protection of Vulnerable Adults) checks. Two references had been received before staff started working at the home. The AQAA, discussion with staff, surveys and the staff training records demonstrate that staff complete an induction programme. The training matrix shows that staff attend a range of training programs to be able to meet the needs of the people living at the home. A majority of staff have attended dementia awareness training. The home does not currently have any volunteers. Since the last inspection the organisation has produced a draft volunteer policy that includes robust recruitment procedures. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most people benefit from living in an improving home. People and others are able to express their views and these are listened to and acted upon. Evidence: There have been a number of changes in the management of the home since the last inspection. The acting manager has only been in post just over a month. There is currently additional management team support being provided to focus on improvements at the home. The acting manager told us that there is now either a manager or deputy manager on duty at the weekends as well as during the week. The requirements from the last key inspection have now been met. Care Homes for Older People Page 25 of 30 Evidence: The impact of staffing levels and the dementia care skills of the staff need to be closely monitored by the acting manager to make sure that people are receiving the right care and support to maintain and enhance their well being. There is a quality assurance system in place that includes clinical audits, monthly monitoring of accidents, incidents and falls analysis. Surveys and regulation 26 visits are also undertaken. The AQAA completed by the acting manager tells us that the findings of this information informs the plans for the home. Regular meetings are held with people who live in the home and their relatives and friends. We checked the personal monies held at the home for people we case tracked and the monies and records balanced. Information provided in the AQAA shows that relevant Health and Safety checks and maintenance are being carried out at the home. A number of Health and Safety records were checked, including the fire safety log. These records showed that health and safety matters are well managed. There are organisational systems in place for the routine servicing of equipment and fire, heating and electrical systems. Equipment seen during the inspection was in good order. Staff training in mandatory areas, including fire safety, health and safety, moving and handling, emergency aid, and basic food hygiene, is ongoing. Staff receive supervision from their line manager. However, the process would benefit from having a structure that focuses on their role, training and development needs. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 10 12 Staff must acknowledge people as individuals and with respect at all times. This is to make sure that people are acknowledged and are given the respect they deserve. 04/02/2010 2 12 12 People must be provided 04/03/2010 with suitable stimulation and have the opportunity to be occupied. This is to ensure that people have a good quality of life and well being. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Staff should record how people have been spending their time. This is so records give a more accurate reflection of peoples day to day lives and not just the care and support provided to them. Page 28 of 30 Care Homes for Older People 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 2 9 The Manager should continue to monitor these arrangements to ensure that creams are stored safely and that people who have dementia care needs receive their creams as prescribed. All prescribed creams and ointments should have an opening and expiry date clearly marked. People should be provided with suitable stimulation and have the opportunity to be occupied in the afternoons and evenings. People should be consulted about their choice of music or television throughout the day. Current good practice recommends that serviettes or napkins be used to protect peoples clothes rather than bibs or tabards which can appear institutional. Staff should sit and talk with people when assisting them to eat and drink. This is so mealtimes are a relaxing and dignified experience and people know what they are being given to eat and drink. Any concerns that are recorded and dealt with under the complaints procedure should be managed in line the organisations policy and procedure. The radiators and heating pipes should be covered to reduce to risks to individuals. The ongoing programme of refurbishment and maintenance should include the redecoration of bedrooms and maintenance of window frames. There should be sufficient staff to meet the social, emotional and psychological needs of the people living at the home. Supervision sessions should have some structure so that they focus on the staff members role, training and development needs. 3 4 9 12 5 6 12 15 7 15 8 16 9 10 19 19 11 27 12 36 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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