Care Home: Nova House

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What the care home does well Residents live in a comfortable, clean and a homely environment with their personal possessions around them. There is a high standard of decoration and maintenance, throughout the home. The home demonstrates that it meets the needs of residents who have low to medium needs, and provides an environment where residents are able to make choices. Flexible routines are an integral part of daily practice at the home with residents able to exercise some control over their daily lives. The home has a core team of staff who have a good understanding of the needs of the people living at the home, and they were observed to treat residents with care and respect. One comment included `I would like to commend the home overall for the care`. The quality and standard of the food is good and this was complimented during the inspection process, `food presented nicely and varied menu which is displayed on the board daily. If food is not suitable or liked alternatives can be arranged` `food home cooked and good variety`. What has improved since the last inspection? The home has responded in some way to the requirements made at the last inspection but have not addressed them fully, and ongoing shortfalls have been recorded within this report. The admission procedure has been improved, and now includes a letter completed following the needs assessment to the prospective resident or their representative. This however needs slight amendment to ensure it clearly records if the home is able to meet the prospective residents assessed needs, and a copy needs to be retained by the home to evidence that these are sent. Each resident has an individual plan of care that has been improved to reflect a more person centred approach to care. Staff have been given training on the nutritional needs of residents and a nutritional screening tool has been established. Some procedures to underpin safe medicine handling have been established and any omissions of medicines are now recorded clearly within the medicine records. Staff have also recently received update training on the safe administration of medicines. Staff have also recently received training on Safeguarding vulnerable Adults. Practice seen during the inspection visit identified that appropriate infection control measures are in place, although appropriate procedures to underpin the practice in the home have not been established. Procedures followed when recruiting staff now ensures a full employment history, health check and references. However there are still some recruitment shortfalls identified in this report.Staff training has been reviewed, and systems established to provide a rolling programme of appropriate staff training to give them the required skills and competencies, to care for the residents in the home. Health and safety training has also been reviewed and updated. The required safety checks on the lifting equipment in the home has been completed, and all communal areas in the home have been risk assessed. What the care home could do better: As mentioned previously in this report, although there has been some work to address the requirements made at the last key inspection, a number of shortfalls remain. The current management structure has not been effective or proactive in establishing systems to ensure that shortfalls in the service are identified, responded to, and monitored by both the manager and the organisation operating the service. It has therefore been necessary to repeat 4 statutory requirements which reiterate shortfalls identified at the last key inspection. These requirements must be addressed immediately as the time scales for compliance have expired. The proprietor has been written to separately on this matter. In addition the manager has given assurances that a number issues discussed during the inspection will be responded to, as documented in this report. The care documentation still needs further improvements to ensure full guidelines are available to staff within the plan of care, the content of these must be updated and reviewed regularly, and the resident or their representative, should be consulted on with regard to its contents, if at all possible. Procedures for the safe handling of medicines still need to be established to ensure staff are given clear guidelines on the best and safest practice. Ongoing individual risk assessment needs to be established, to identify any risks early and to ensure they are responded to appropriately, in a timely fashion. Clear procedures on infection control need to be written for Nova House to guide staff on the best way to minimise any risks of infection in the home. The recruitment practice is still not adequate, all the required information is not retained, and employment practice does not ensure staff have the necessary checks completed before they start work unsupervised. This may put residents at risk. Suitable procedures need to be implemented and followed to ensure resident`s money and valuables deposited for safekeeping, are dealt with appropriately and safely. Systems for quality monitoring have not been implemented in the home, the AQAA had not been used as an accurate auditing tool and so some information provided within this document could not be relied on. The proprietor has not maintained effective supervision and monitoring systems for the home. Key inspection report Care homes for older people Name: Address: Nova House Belgrave Road Seaford East Sussex BN25 2EG     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: Melanie Freeman     Date: 1 4 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: Nova House Belgrave Road Seaford East Sussex BN25 2EG 01323896629 01323898332 dmham@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Seaford Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 20. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) . Date of last inspection Brief description of the care home Nova House is a care home registered for up to twenty older people. The home is a converted large detached house situated in a residential area of Seaford. It is located within a short journey of the seafront and town centre amenities. The home is furnished and decorated to a high standard. The accommodation Care Homes for Older People Page 4 of 30 Over 65 20 0 1 2 0 2 2 0 0 9 Brief description of the care home comprises of nineteen (19) single rooms with twelve (12) of these providing en-suite facilities. The home is presented across three floors with a passenger lift to the first floor. There is also a chair lift. There is a large lounge with a separate dining room, both with views out to the garden areas. The homes literature states that it aims to provide a Home from Home and provide an environment where residents can choose their own lifestyles. The fees for residential care are currently 1,976 to 2,220 pounds per month, depending on the services and facilities provided. Extras such as: newspapers, hairdressing, chiropody and toiletries are additional costs. 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: 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: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term service user to describe those living in care home settings. For the purpose of this report, those living at Nova House will be referred to as residents. This was a key inspection that included an unannounced visit to the home on Monday 14th December 2009. The allocated inspector spent approximately five hours in the home and was able to discuss matters with the manager who received the inspection feedback at the conclusion of the visit, and the proprietor who was contacted following the inspection visit. All the communal areas were seen along with a selection of the residents rooms. A range of documentation was reviewed including the homes service users guide, preadmission assessment procedures, the systems in place for handling complaints and Care Homes for Older People Page 6 of 30 protecting residents from harm, staff recruitment files, staff training records, quality assurance systems and some health and safety records. The care documentation pertaining to two residents were reviewed in depth, and time was spent with residents and visitors to the home. The required Annual Quality Assurance Assessment (AQAA) was well completed and returned when requested, and was used to inform this inspection report. At the time of compiling the report, in support of the visit, the Care Quality Commission received survey forms about the service from three residents, and three staff members. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? The home has responded in some way to the requirements made at the last inspection but have not addressed them fully, and ongoing shortfalls have been recorded within this report. The admission procedure has been improved, and now includes a letter completed following the needs assessment to the prospective resident or their representative. This however needs slight amendment to ensure it clearly records if the home is able to meet the prospective residents assessed needs, and a copy needs to be retained by the home to evidence that these are sent. Each resident has an individual plan of care that has been improved to reflect a more person centred approach to care. Staff have been given training on the nutritional needs of residents and a nutritional screening tool has been established. Some procedures to underpin safe medicine handling have been established and any omissions of medicines are now recorded clearly within the medicine records. Staff have also recently received update training on the safe administration of medicines. Staff have also recently received training on Safeguarding vulnerable Adults. Practice seen during the inspection visit identified that appropriate infection control measures are in place, although appropriate procedures to underpin the practice in the home have not been established. Procedures followed when recruiting staff now ensures a full employment history, health check and references. However there are still some recruitment shortfalls identified in this report. Care Homes for Older People Page 8 of 30 Staff training has been reviewed, and systems established to provide a rolling programme of appropriate staff training to give them the required skills and competencies, to care for the residents in the home. Health and safety training has also been reviewed and updated. The required safety checks on the lifting equipment in the home has been completed, and all communal areas in the home have been risk assessed. What they could do better: As mentioned previously in this report, although there has been some work to address the requirements made at the last key inspection, a number of shortfalls remain. The current management structure has not been effective or proactive in establishing systems to ensure that shortfalls in the service are identified, responded to, and monitored by both the manager and the organisation operating the service. It has therefore been necessary to repeat 4 statutory requirements which reiterate shortfalls identified at the last key inspection. These requirements must be addressed immediately as the time scales for compliance have expired. The proprietor has been written to separately on this matter. In addition the manager has given assurances that a number issues discussed during the inspection will be responded to, as documented in this report. The care documentation still needs further improvements to ensure full guidelines are available to staff within the plan of care, the content of these must be updated and reviewed regularly, and the resident or their representative, should be consulted on with regard to its contents, if at all possible. Procedures for the safe handling of medicines still need to be established to ensure staff are given clear guidelines on the best and safest practice. Ongoing individual risk assessment needs to be established, to identify any risks early and to ensure they are responded to appropriately, in a timely fashion. Clear procedures on infection control need to be written for Nova House to guide staff on the best way to minimise any risks of infection in the home. The recruitment practice is still not adequate, all the required information is not retained, and employment practice does not ensure staff have the necessary checks completed before they start work unsupervised. This may put residents at risk. Suitable procedures need to be implemented and followed to ensure residents money and valuables deposited for safekeeping, are dealt with appropriately and safely. Systems for quality monitoring have not been implemented in the home, the AQAA had not been used as an accurate auditing tool and so some information provided within this document could not be relied on. The proprietor has not maintained effective supervision and monitoring systems for the home. Care Homes for Older People Page 9 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 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 11 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. The home provides prospective residents and relatives, with a good level of information about the home, its facilities, services and the costs involved. The admission procedures ensures prospective residents are suitably assessed prior to their admission by a competent person, who ensures that the home admits only those residents whos needs can be met by the home. Intermediate care is not provided at Nova House. Evidence: The home has a combined statement of purpose and service users guide and this was available at the back door entrance area, and on request from the manager. These were found to contain useful information on the home and services it provides. However it now needs to be updated to reflect the change in the registering authority. A copy of the last inspection report was also available in the home and the registration Care Homes for Older People Page 12 of 30 Evidence: certificate was displayed in a prominent place. The last two admissions to the home were identified and the records relating to the admission procedures followed were reviewed. These confirmed that both were fully assessed prior to admission. This assessment is usually completed by the manager, or one of the two deputy managers. This assessment can either take place in the care home during a pre-admission visit, in the hospital, or the prospective residents own home. The assessment documentation used has been reviewed and updated to ensure all relevant information is considered as part of the admission process. Once the assessment is completed the manager confirmed that she writes to all prospective residents to advise if the home can meet their individual assessed needs. There was however no record of this letter within the care records. A copy of the letter used was available on the computer and the manager was advised to amend this to fully reflect the associated regulation clearly, and to keep a copy of letters sent for the home files. Care Homes for Older People Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was found to be meeting residents health and general care needs with assessed additional community support when needed. However residents specific care needs are not always reflected in a plan of care, along with the required review and consultation. On the whole the homes practice ensure residents medicines are administered safely. Care is delivered in such a way that promotes and protects the residents privacy, dignity and individuality. Evidence: The care documentation pertaining to two residents were reviewed in depth as part of the inspection process, and each of these residents were spoken with during the inspection visit to the home. The care documentation has been changed since the last key inspection and now reflects a more individual approach to care, with individual preferences and choices being recorded. Care Homes for Older People Page 14 of 30 Evidence: It was however noted that the plans of care still need further improvements to record all specific care needs, and to ensure the social and psychological care needs of residents are taken into account, and provided for. The care documentation did not record a regular review of the care provided and the plans of care were not dated or signed. There was also no evidence to suggest that the plans of care had been discussed and agreed with the residents themselves. This bought into question how current and appropriate the care guidelines provided were. Daily records are completed by care staff and provide a chronological account of the residents care and activity. Observation during the inspection visit indicated that residents are well cared for and have a good level of autonomy. All feedback from residents directly and within the surveys confirmed a satisfaction with the care provided and comments received included I would like to commend the home overall for the care we are well looked after here. Some routine risks assessments are completed and take into account residents personal environment. Since the last key inspection the manager has sourced advise from the Community Dietitian and now completes a nutritional screening on all residents and takes into account the need to fortify foods as necessary. It was however noted that risks associated with pressure sore development are not assessed, and moving and handling assessments are not completed. During the visit it was noted that one resident needed to be moved with the support of a moving belt, although this was not documented within the care documentation. Although there was no evidence to suggest that any residents had pressure damage to their skin, or that residents are being moved unsafely. The necessary risk assessments and guidelines need to be established to ensure any risks are identified and responded to appropriately. Records confirmed regular contact with GPs and other health care professionals, that support the home in providing a high level of care to residents. Medicines are stored in locked cupboards and are dispensed from the pharmacist in a Monitored Dosage System. The Medicine Administration Records (MAR) charts evidenced that on the whole medicines are administered safely and in accordance with prescriptions. However it was noted that one resident did not have their prescribed medicines for over 4 days. This was discussed with the manager who said that this would not happen again as communication with the pharmacist had been improved. It was also noted that one resident administers his own medicines, but the home had not completed a risk assessment for this, and no procedure was in place to ensure safety. Care Homes for Older People Page 15 of 30 Evidence: Following the last key inspection some procedures were established around the safe handling of medicines but they still do not cover all ares. For example there was no clear procedure for the receipt and return of any medicines,or how controlled drugs are to be handled. As required at the last inspection procedures to ensure the safe handling of medicines must be established. This will ensure staff have guidelines to follow and are aware of the best practice in respect of this home. Some medicines are prescribed on an as required basis and as identified at the last inspection individual guidelines need to be written to ensure staff administer these in a consistent way. Records confirmed that only those staff trained to do so administer medicines, and a list of their signatures are retained in the home for audit purposes. Although the manager acknowledges that this needed to be updated, and said that this would be done. Throughout the day residents were seen to be treated with respect and had their dignity maintained, with staff knocking on doors before entering and conversing with residents as equal adults. Staff were seen to be pleasant and kind and residents said that staff were kind and considerate. Residents rooms seen were personalised and individual. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a relaxed atmosphere where some activity is supplied and residents are supported in maintaining relationships with their families and friends. Residents choices are well respected and the food provided is both appetising and wholesome, and served in a way that promotes social interaction. Evidence: The home employs an activities person and she was seen to have a good rapport with residents being able to spend individual time with them, and being available to escort a resident to a hospital appointment. The AQAA recorded that the new activities coordinator has brought many new ideas and enthusiasm to the post . She has actively encouraging attendance in activities and the residents had benefited from her appointment. The home have committed to further development of this role in the future. As the Inspector was leaving the home a group of school children were arriving to sing carols with the residents. Interaction with staff is very important to the residents and this was seen to be positive and proactive, although one survey recorded that more staff for social interaction would be beneficial, and one visitor said that there should be more activity in the evenings. The use of individual social Care Homes for Older People Page 17 of 30 Evidence: assessments for residents would identify different expectations and lifestyle choices, that could then be responded to. Visiting is encouraged and the home is friendly and relaxed, staff were found to be welcoming and offered beverages to all visitors. Visitors seen during the visit were comfortable and confident with the staff, with communication being open and relaxed. The home is located very close to a church and residents said that they can attend church if they wish. The communal areas allow for a variety of uses and the space available is used to allow quite and private areas. The AQAA confirmed that this is to be improved further with the provision of a conservatory to the front of the home, by the end of February 2010. The dining room provides a pleasant environment for residents to eat and each table is laid with a linen table cloth, flowers and condiments. Meal times a good social events and all feedback about the food was positive. Comments included food presented nicely and varied menu which is displayed on the board daily. If food is not suitable or likes alternatives can be arranged food home cooked, and good variety. Meals are responsive to peoples likes and dislikes that are recorded in the home, and a good provision is maintained. The manager has confirmed that the kitchen has retained a clean food award from the Environmental Health Department for the fourth year. 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. The home has a complaints procedure to follow up on any concern raised. Staff awareness and information in the home should ensure that any Safeguarding Vulnerable Adult issue would be responded to appropriately when identified. Evidence: A complaints procedure is displayed in the home and a copy is contained in the service users guide, that is given to each resident on admission. This procedure needs to be updated to record what action would be taken if the complaint is about the manger, or is not resolved by the manager. It also needs to record the correct address for the Care Quality Commission and the contact details for Social Services, who they can also be contacted directly to make a complaint. The AQAA recorded that there had not been any complaint since the last key inspection, so it was not possible to assess how the home would deal with any complaint raised. Records in the home indicated that all staff had received training on Safeguarding Vulnerable Adults. This was provided by a senior carer who works at another home owned by the proprietors. The manager advised that this carer is suitably trained to provide staff with a range of training that includes safeguarding, and safe moving and handling. Although the home has a Adult Protection Procedure this has not been updated to reflect the most recent local Safeguarding policies and procedures, as recorded in the Care Homes for Older People Page 19 of 30 Evidence: last inspection report. It was again noted that the home did not have a copy of the most recent policies and procedures on safeguarding and the manager confirmed again, that these would be sourced as a priority. 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. Residents benefit from living in a homely, clean, well maintained and decorated environment. Residents bedrooms are decorated and furnished to a high standard and in accordance with their individual preferences and needs. Evidence: The home is a converted and extended domestic dwelling located in a residential area on the outskirts of Seaford. The environment is very attractive and the furnishing and fittings are welcoming and give a small hotel style. The communal space is found on the ground floor and consists of a large slitting room and dining room, which overlooks a well maintained front garden. The home has recently been extended into an adjacent bungalow that will provide four additional bedrooms to the home once registered. The building works involved in this has caused disruption to the garden area at the side, and rear of the home. The AQAA confirmed that the intension of the proprietors is to landscape the outside space, providing pleasant seating areas, and walkways. Building works have also started on the conservatory to the front aspect of the building, which will also increase communal space, and the number of sitting areas within the home. The AQAA confirmed that the conservatory would be completed by the end of February 2010. Care Homes for Older People Page 21 of 30 Evidence: During the inspection visit one resident identified that the new shower room had a very low toilet that residents found difficult to get up from, so were having to use commodes. This was raised with the manager and the proprietor who agreed to address this matter to ensure resident safety and comfort as soon as possible. It was also identified that the hot water supply was not sufficient for the whole home and this limited the number of baths and showers staff were able to offer residents. The proprietor was aware of this problem and had already had some quotes for boiler replacements. All areas in the home were found to be clean and residents rooms were attractive and personalised. Suitable hand washing facilities were available in the home and infection control practice seen was appropriate. However, as identified at the last key inspection although the home has the most recent guidelines for infection control in care homes, appropriate procedures for the home to guide staff on the best way to minimise any risks of infection, have not been implemented. The manager agreed to address this shortfall. 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. Staffing numbers and skill mix provides well-motivated staff team that meets residents health and personal care needs. Recruitment practice needs to be improved to ensure residents are protected at all times. Evidence: At the time of this assessment visit 19 residents were living in Nova House. Staffing arrangements provide three carers working in the morning with two working in the afternoon and evening up to 10pm. There are two waking carers at night. The manager also works in the home weekdays, and cleaning and catering staff are employed in addition. The staffing levels have been reviewed since the last inspection and now provide two care staff at night and an evening cook. Staff spoken with and surveys received indicated that there is a good team spirit, and that staff communicate well with each other. All feedback received about the staff working in the home was very positive, and comments included I have found the staff to be helpful Staff- friendly and helpful Care Homes for Older People Page 23 of 30 Evidence: staff are very good at looking after us. The recruitment files pertaining to three staff were reviewed as part of the inspection process and identified some shortfalls. Proof of identity is not retained and a recent photograph was not available on the files reviewed. Job descriptions and terms and conditions of employment were not available, and the manager advised as she did at the last key inspection that these were under review. It was also identified that one staff member was working in the home without a Protection of Vulnerable Adults (POVA) or Criminal Records Bureau (CRB) checks and without any supervision. During the inspection visit the POVA was sourced and the manager advised that she would ensure suitable supervision was established. This shortfall was also discussed with the proprietor following the inspection to ensure the recruitment and employment practice is robust and safe. Staff training has been re-organised since the last key inspection, and records now demonstrate that staff are receiving regular ongoing training, to ensure they have the appropriate skills to look after residents in a safe way. The AQAA recorded that staff training is an area that the home is investing in, with further training programmes planned. It also confirmed that over 50 of staff have completed a National Vocational Qualification (NVQ) at level 2 in care or above. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was found to be managed in an open and friendly manner. Systems to safe guard residents financial interests and to monitor the quality of care and services in the home need to be fully established. The health, safety and welfare of residents and staff are generally promoted and protected. Evidence: The manager has been in post since 1997 and is a registered nurse, she is well respected by staff and has an excellent rapport with residents, who she has regular contact with. During the inspection process it was confirmed that the manager is leaving her post in February 2010. The manager advised that the change to the management arrangements since the change of the homes ownership in February 2008 has been Care Homes for Older People Page 25 of 30 Evidence: problematic for her, as she was used to a far more hands on approach by previous owners. Discussion with the proprietor following the inspection visit confirmed that action had been taken to ensure suitable management arrangements are maintained at the home, following the managers departure. Although the AQAA recorded that a more robust quality assurance system had been established to obtain accurate feedback, this was not the case. A suitable quality monitoring system has not been established.The manager did advise that resident surveys were completed approximately a year ago, but once these were sent to the proprietor she had no further feedback. The AQAA was not completed by the manager, although the proprietor said that she had sight of it and had the opportunity to contribute to it. The AQAA was not used to audit the service accurately, and did not record action taken in response to the last key inspection and the shortfalls identified. The AQAA was therefore not a useful quality monitoring tool. The proprietor has completed some monthly visits as required, but these have not been used effectively to monitor the service, or the homes compliance with the Care Standards Act or its associated regulations. It was also confirmed that the manager did not receive regular supervision to monitor, and support her performance. The home holds small amounts of money for some residents in a secure way. The money held was checked and it was noted that two accounts were not correct. The manager confirmed that the small amounts of money that were missing would be replaced. There was no system to audit the accounts, and receipts are not always used. Clearly the system in place needs to be reviewed and made more robust to safeguard residents monies and staff. The AQAA recorded that all policies and procedures are in place and are up to date and that all the necessary safety checks have been completed. Some safety checks were reviewed during the visit and were found to be in place. An environmental risk assessment has been completed, but individual rooms have not been completed and the manager was asked to ensure that this matter was addressed. Care Homes for Older People Page 26 of 30 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 7 15 That individual plans of care 01/06/2009 providing specific guidance on person centered care to cover the health, personal, psychological and social care needs of each resident are devised. These should reflect peoples choices,preferences and need to be written in consultation with the resident or their representative. Taking into account relevant risk assessments. This will ensure that staff are given clear guidelines on how to meet peoples needs in an individual way, and in a way that takes into account peoples choices, and preferences. 2 9 13 The registered person needs to ensure suitable procedures are in place for staff to follow on all aspects of medicine handling, and that all staff have received thorough training on these and adhere to them. This will ensure staff have clear guidance to follow and ensure consistent and safe handling of medicines. 01/05/2009 3 29 19 That the registered person 06/04/2009 Page 27 of 30 Care Homes for Older People 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 operates a thorough recruitment procedure that ensures the fitness of people who work in the home. This should include the use of a thorough application form that records all previous employment, and the retention of all the required documentation. This will ensure that any staff employed are fit to be employed within the home. 4 33 24 That a suitable quality monitoring system is maintained to ensure residents and their representatives views are taken into account. Demonstrating ongoing review and improvement to the quality of care and services in the home. This will ensure the registered provider reviews the quality of the homes service, and can continue to evolve and improve the service in response to information gained. 01/05/2009 Care Homes for Older People Page 28 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 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). 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. 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