Care Home: Oak Tree House

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What the care home does well The service provides suitable information on what is to be expected when living at Oak Tree House, to enable people to make choices about living there. It carries out satisfactory assessments of people`s needs and produces suitable care and health care plans to enable staff to meet those assessed needs. The service protects people with the use of robust procedures and practices for handling medication, and it treats people with respect and upholds their privacy and dignity. People say "We are very well looked after, it is your own fault if not. I came here two years ago, just called in and liked it straight away. I am given all of my medication and am capable of being in control of it once I`ve got it." The service offers some opportunities to engage in social and occupational pastimes and activities, encourages and welcomes visitors, enables people to be selfdetermining where possible and provides wholesome fresh cooked foods. People say, "I am interested in cooking and used to grow my own tomatoes. There`s no chance to cook now, but I wouldn`t mind doing some baking. The helpers take me out shopping. The food is very healthy and lovely, we get plenty of milk products and fresh fruit, so we should be healthy." The service offers the opportunity for people to speak up where things may not be right, it deals with their complaints effectively, and it has efficient systems in place to handle any issues of a safeguarding nature, ensuring people are protected from the risk of harm or abuse. People say, "I would talk to the manager if I had a complaint, but I am very happy here." And, "You`d have to go a long way to beat this home, we`ve nothing to complain about." The premises are suitable for providing care and accommodation to older people, and rooms are mainly singles that are personalised, warm, clean and comfortable. The service has sufficient staffing available to meet the needs of people, and staff are appropriately recruited and suitably qualified and trained. People say, "The staff spend time talking to us, we go in the garden when we want and though it`s not our own home it is comfortable." The service is run by a qualified and experienced manager and in the best interests of the people living there. It safeguards their financial interests and it promotes and protects their health, safety and welfare. What has improved since the last inspection? The service has recently enabled staff to update their medication administration training and have their competence assessed, though this was required on the last key inspection two years ago. It has improved the controlled drug storage facility. The service has tried to offer people with memory impairment more meaningful activities to occupy them. It has improved the hygiene facilities by fitting a wash hand basin in the bathroom next to the toilet without one, and posted a notice to instruct people to wash their hands there after using the toilet. What the care home could do better: The service could make sure all documents compiled on people are dated and signed at the time, as well as on review, so people are confident the information held on them is current and relevant and shows they have been included in the process and are in agreement with it. It could consider obtaining a designated lockable medication fridge to store those medicines requiring colder storage, instead of using the home`s fridge, so people are confident the drugs to be stored at lower temperatures are being safely stored. And make sure staff administering medication are regularly competence checked to do so safely and a record of this should be maintained, so people are confident they are having their drugs handled and administered safely. The service could make sure those people with less cognitive ability and selfdetermination are offered more opportunities to enjoy meaningful activities and pastimes, so they are able to lead a more fulfilling lifestyle. It could make sure all staff are given annual updates of the safeguarding procedures and record these, once their safeguarding training is completed with Hull & East Riding of Yorkshire Council Safeguarding Adult`s Board, so people are confident they are being protected from the risk of harm. The service could make sure staff infection control training is up to date and current, and that evidence of such training is maintained, so people are confident they are protected from the risk of harm from infection. It could make sure staff keep their training plans and records up to date, so training can be monitored and evidenced and people are confident staff are well trained to meet their needs. The service could make sure that in the absence of having a trained first aider on each shift there is a first aid risk assessment document in place, that considers the needs of people and considers how likely first aid and what kind of first aid could be needed, so people are confident their needs following an accident will be met. It could make sure the quality assurance system is developed to involve all stakeholders, to collate information as evidence the service is quality checked, and to review any processes, so people are confident their views underpin good practice within the home and monitoring systems are effectively checking the level of quality of the service. Finally the service could make sure the electrical safety check is carried out on the home, and a copy of the certificate is sent to the Care Quality Commission as evidence, so people know the home is electrically as safe as it can be. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oak Tree House Oak Tree Estate Station Road Preston East Yorkshire HU12 8UX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janet Lamb     Date: 2 4 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 29 Information about the care home Name of care home: Address: Oak Tree House Station Road Oak Tree Estate Preston East Yorkshire HU12 8UX 01482899169 01482891419 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) : PWC Care Limited care home 23 Number of places (if applicable): Under 65 Over 65 23 23 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 Oak Tree House is a privately owned residential care home, registered for 23 people over the age of 65 years of either gender. It may provide services to people with a memory impairment. The home is situated in the village of Preston close to the City of Hull and has easy access to local facilites. It is a short distance from the main road where public transport into and out of Hull and Withernsea is available. There are bedrooms on the ground and first floor with a stair lift for those people that are less mobile. There are five shared rooms and fourteen single rooms of which seven have en-suite facilities. The home has two lounges and a separate dining room all on the ground floor. Care Homes for Older People Page 4 of 29 Brief description of the care home To the rear of the premises is a small car park and a garden area that is accessible to people in the home. Information about the home and the service provided is available in the statement of purpose and service user guide. The current fees, supplied by the provider/manager on the day of the site visit range from £295.00 to £375.00 per week. Items not covered by the fee are chiropody, manicure and hairdressing. Care Homes for Older People Page 5 of 29 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 key inspection of Oak Tree House took place over a period of time and involved the requesting of an annual quality assurance assessment (AQAA) from the home in February 2009, asking for details of the service provided and of the people receiving that service. The AQAA was returned to us in March 2009. Unfortunately surveys were not sent to people or staff in the home following this. So information already known about the home and from notifications sent to us, was used to determine what it must be like living there. Then on 23rd and 24th April Janet Lamb carried out a site visit to check with people living there what it was really like. Three people in the home, the manager and three staff were interviewed, and several people were observed, to seek views of the service of care provided. Some of the Care Homes for Older People Page 6 of 29 premises were inspected, some of the records and documents held were viewed and some files belonging to people and staff were looked at, with the permission of the people they refer to. This key inspection report shows the overall findings and gives an overall rating of the quality of the service. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. 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 29 The service could make sure all documents compiled on people are dated and signed at the time, as well as on review, so people are confident the information held on them is current and relevant and shows they have been included in the process and are in agreement with it. It could consider obtaining a designated lockable medication fridge to store those medicines requiring colder storage, instead of using the homes fridge, so people are confident the drugs to be stored at lower temperatures are being safely stored. And make sure staff administering medication are regularly competence checked to do so safely and a record of this should be maintained, so people are confident they are having their drugs handled and administered safely. The service could make sure those people with less cognitive ability and selfdetermination are offered more opportunities to enjoy meaningful activities and pastimes, so they are able to lead a more fulfilling lifestyle. It could make sure all staff are given annual updates of the safeguarding procedures and record these, once their safeguarding training is completed with Hull & East Riding of Yorkshire Council Safeguarding Adults Board, so people are confident they are being protected from the risk of harm. The service could make sure staff infection control training is up to date and current, and that evidence of such training is maintained, so people are confident they are protected from the risk of harm from infection. It could make sure staff keep their training plans and records up to date, so training can be monitored and evidenced and people are confident staff are well trained to meet their needs. The service could make sure that in the absence of having a trained first aider on each shift there is a first aid risk assessment document in place, that considers the needs of people and considers how likely first aid and what kind of first aid could be needed, so people are confident their needs following an accident will be met. It could make sure the quality assurance system is developed to involve all stakeholders, to collate information as evidence the service is quality checked, and to review any processes, so people are confident their views underpin good practice within the home and monitoring systems are effectively checking the level of quality of the service. Finally the service could make sure the electrical safety check is carried out on the home, and a copy of the certificate is sent to the Care Quality Commission as evidence, so people know the home is electrically as safe as it can be. 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 set out on page 4. Care Homes for Older People Page 9 of 29 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 29 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 29 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 are provided with good information about the service on offer, receive a full assessment of their needs before moving in and are offered a satisfactory contract of care or terms and conditions of residence, so they are confident their needs will be met. Evidence: Discussion with people in the home, the manager and staff and viewing of case files with permission from the people they concern shows care needs are still being assessed before people move in, and information is available to them on what to expect. The home has an updated statement of purpose and service user guide, offered to prospective people and to those already staying there. Copies are held in bedrooms. Care Homes for Older People Page 12 of 29 Evidence: The home has copies of contracts with placing authorities, such as the ERYC residential service notification and service specification document. Where people pay privately there is a terms and conditions of residence form between them and the provider. There is a newly formated pre-assessment of needs carried out that covers all of the information listed in standard 3.2, though the form seen has not yet been used to assess anyone. Files seen still contain old assessments that are very scant in detail. The home also obtains copies of the placing local authority community care assessment document, where possible. This information and that obtained from discussion with the person and their family is used to determine a full range of an individuals diverse needs. People spoken to say they cannot remember their admission as they were poorly, but were happy for family to represent them at the time. All gave permission to view their files and documents. They cannot remember assessments or contracts, but are aware of case files being in place with details of their care needs. Some documents seen do not have dates on though people or their family representative have signed them. Care Homes for Older People Page 13 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from good care and health care plans that inform staff what action to take to meet peoples needs. They are well protected from harm from the wrong medication by the robust systems for handling and monitoring medicines, and they are treated respectfully with adherence to good levels of privacy and dignity. Evidence: Discussion with people, the manager and staff and viewing of case files and documents with permission of the people they concern and observation of interactions between people and between people and staff shows there are useful care and health care plans in place, that medication is satisfactorily handled and people are treated with respect. Care and health care plans seen contain information and action plans on such as personal care, mobility, nutrition, health, leisure, emotional state, communication, safety etc. and generally follow the requirements of standards 7 and 3.2. Risk assessments are completed in conjunction with care plans and also cover the relevant areas of individuals needs. Evidence of care plan reviews, involving the placing Care Homes for Older People Page 14 of 29 Evidence: authority and the person concerned, is available in files, in the form of monthly updates and twice annual review meeting minutes. All health care needs are shown within the general care plans under specific headings, and special health care treatment received from professionals etc. is recorded on specific health records. Diary notes, charts and health records etc. are evidence of the care and support provided. Medication administration systems follow a policy and procedure and there are good handling practices in operation. Medicines are stored appropriately, if not ideally, in a locked facility and also in the homes main fridge in a designated box. The requirement at the last key inspection to ensure controlled drugs are stored properly is now being met with the availability of a double lock facility in the office. Where possible future consideration should be given to supplying a designated lockable medication fridge for the storage of medicines requiring colder temperatures. The medication is received from the local pharmacy in the form of monitored dosage system manrex cards. There is very little actually prescribed, and no controlled drugs at the moment. Medication administration record sheets are available and show monitoring and administration is consistent and accurately recorded. Staff giving out medication are trained to do so, and because training and competence checking has not been done since April and June 2006 and April 2007 for some of the staff, a recent medication course with First Response and through Train to Gain has been embarked on. This meets the requirement of the last key inspection to ensure staff are competence assessed. The training consists of three units and some staff have completed this since Feb 2009 and some are still doing it. Evidence is to be retained on staff files and in the form of copy certificates for future inspections. People receive assistance with personal care usually in private and in the way they prefer. People are cared for in private, are addressed the way they choose and make decisions about their daily lives wherever possible. There are no adverse comments about receiving care in private or in a dignified manner. Staff interviewed express the view they would want their own parents or grandparents to receive care and support in a specifically dignified and caring way and therefore they use this as their guide to caring for others. Care Homes for Older People Page 15 of 29 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. People lead fairly satisfying lives, have some good opportunities for pastimes and occupation, have good contact with family and friends, and enjoy good food provision. Evidence: Discussion with people , the manager and staff and observation of interaction between people and people and staff, and viewing of records in case files shows there are some opportunities to undertake pastimes, but not a great many, that those more able make more choices and decisions, while everyone enjoys good fresh cooked foods. Visitors are very welcome to the home and there is an open house feel to the place. There are some opportunities to undertake pastimes such as listening to music, watching television, reading newspapers, taking a walk in the garden or in the village, visiting the local shops, playing cards or dominoes, doing quizzes, singing and dancing along with staff or visiting entertainers, having the hairdresser cut and set your hair, or just chatting about the old days. There is little organised formal activity and no one mentions organised trips or outings. Some people have opportunities to go out with family members to the pub or for tea. People say they are relatively satisfied with what goes on and usually enjoy a good chat with lively banter. One off duty staff Care Homes for Older People Page 16 of 29 Evidence: brought her dog in for people to pat, while a carer on maternity leave came to visit everyone with her young son. Clearly children and animals bring a smile to peoples faces. For those with less cognitive ability more should be offered that gives them satisfaction and fulfillment. This requirement from the last key inspection has not fully been met, but efforts and some improvements have been made. Autonomy is fairly well exercised by those able to get up and move around etc. Those with less mobility are very reliant on staff assistance and only move when assisted. Meals are at set times and there is some routine to the day, but some people that are self-caring are able to rise, go to bed etc. when they choose. People were observed asking for drinks. People exercise choices at meal times though only if they do not like the option available. People are encouraged to vote and to handle their own finances where possible, though none do and those spoken to say they are quite happy for family to deal with such things for them. They say they have sufficient money on them and do not need more. Meal times are set through the day and usually a hot, fresh cooked meal is provided at lunch time. Everyone spoken to is satisfied with food provision, one person would just like more tomatoes offered and should like to do some baking from time to time. The cook discusses menus with people , seeks likes and dislikes and compiles menus according to healthy eating options and any medical diets. There is no planned alternative but anyone not liking or wanting a particular meal is given something they do like. People requiring assistance are helped sensitively. There are no adverse comments about food provision and the meals on offer on the days of the site visits looked and smelled appetising. Beef stew with mashed potatoes and dumplings, peach and butterscotch pudding with cream on the first day and fish and chips on the second day. Care Homes for Older People Page 17 of 29 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. People and their relatives have good opportunities to make complaints known and have them resolved, and they are well protected from the risk of abuse because of good procedures in place and staff understanding and training. Evidence: Discussion with people, the manager and staff and viewing of some records and documents shows systems in place to handle complaints and safeguarding issues are effective for handling complaints and protecting people from harm. There is a clear complaint policy in place that is in information documents provided by the home, and is also posted up in the home. People say they usually have no complaints, but would talk to the manager or a senior if they needed to. They say the care is good and the home is a lovely place to be. There is a record of complaints held, but it shows nothing in the last twelve months. Staff spoken to say they would try to resolve any issue for people and if unable they would refer matters to the manager. There is a safeguarding adults policy and the Hull & East Riding of Yorkshire Council Safeguarding Adults Board protocol is available for consultation. Staff spoken to demonstrate good understanding of the procedures to follow and some have received safeguarding training. The manager and four seniors have completed the one day managers training course, and eight more staff are to complete the half day course in Care Homes for Older People Page 18 of 29 Evidence: July and September 2009. Once the majority of staff has completed the training then they should receive an annual update on procedures and issues from the manager or a competent person and this should be recorded. There is a record of referrals made to the council safeguarding team and one such referral record is held in a confidential section of a persons case file. The issue was resolved in collaboration with the council and a referral to the Protection Of Vulnerable Adults list was made. The home handles issues appropriately. Care Homes for Older People Page 19 of 29 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. People have a well maintained environment to live in, where bathroom facilities are satisfactory and the home is clean, pleasant and hygienic. Evidence: Discussion with people, the manager and staff and viewing of some parts of the home with permission where necessary, and checking of records, show the home to be appropriately used for providing care and accommodation to older people and that it is clean and comfortable. There is a planned programme of maintenance and a maintenance staff member keeps checks on repairs and so on. As far as can be determined the home complies to the local fire service and environmental health department requirements and recommendations, though the fire officer has not visited for some time. There is an inappropriately graded concrete ramp to the rear of the home, giving wheelchair access, but it must only be used by people in wheelchairs that are adequately accompanied by one or two people where necessary. The house is suitable for its stated purpose of providing care and accommodation to older people and it has hand rails etc. inside as are necessary. The home is close to the local bus route into and out of Hull and Withernsea, and within walking distance of local shops and South Hunsley School. Care Homes for Older People Page 20 of 29 Evidence: The premises are kept clean and comfortable and free from offensive odours. The laundry meets the requirements of the Water Supply (Water Fittings) Regulations 1999 and is readily cleanable. Staff have an infection control policy to follow and they have received infection control training, though evidence shows this to be 2006 and 2008 for two of them. A recommendation is made to trawl the staff records and bring staff up to date in respect of their infection control training, and to maintain evidence of it. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a sufficient number of care staff on duty each shift to meet their needs, and that are satisfactorily recruited and appropriately qualified and trained. Evidence: Discussion with people, the manager and staff and viewing of some documents and files with permission shows the home is meeting standards on staffing. There is a weekly roster maintained that shows three staff on duty throughout the day and two waking staff at night. There is also a manager, an administrator, a cook and a cleaner in the home throughout the day time during the week. Staffing levels may be at their minimum of three at the weekends. People spoken to say their needs are adequately met by the numbers of staff on duty, and staff in interview back up that they usually have enough staff to cover the shifts and that they would cover any sickness or leave. There is an annual training plan in place that shows what staff are to do each year, but it is not kept up to date. The manager informs us there are now more than 90 of the care staff either with or still completing NVQ level 2 in Care. Some are doing level 3 and others are to progress to this soon. This information was not verified other than in Care Homes for Older People Page 22 of 29 Evidence: interview with the staff who say they have good opportunities to complete qualifications and to undertake training courses to improve their skills. There is a written recruitment and selection policy and procedure in place and generally evidence is held to show these are adhered to. Two files seen show people have their identity confirmed by supplying such as passport, birth and marriage certificates, national insurance numbers, driving license, utility bills etc. Files show that job applications are completed, references are taken up, initial and full security checks with the Criminal Records Bureau are made, and a declaration of health is completed. Staff undertake induction taking up to six weeks to complete and they are given job descriptions, contracts of employment, staff handbooks and a copy of the General Social Care Council code of conduct. Staff have individual training plans in files but they do not seem to show all of the mandatory training courses needed each year. Recording of actual courses done is not well maintained. Within the two files viewed there is some evidence of courses done from 2005 to 2008, with the bulk having been done in 2006 and 2007. These included medication administration, infection control, health and safety, moving and handling, pressure care, and nutrition and health. Each staff member should maintain an accurate annual record of the training they have completed, so that mandatory training can be accurately evidenced. It is understood all staff have either completed or are completing a medication administration training course, begun in February 2009, the manager and senior staff completed Deprivation of Liberty training in March and April 2009, and that eight staff are to complete safeguarding adults training in July and September 2009. All of these need to be recorded on training files. Care Homes for Older People Page 23 of 29 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. People have a qualified manager in post that runs the home well and in their best interests, providing good protection from financial abuse and good protection and promotion of their health, safety and welfare. Evidence: Discussion with people, the manager and staff and viewing of some records, maintenance certificates and safety checks shows a qualified registered manager is running the home in the best interests of people living there, and is safeguarding peoples financial interests and protecting and promoting their health, safety and welfare, and those of the staff. The provider/manager is a qualified Registered General Nurse and maintains her personal identification number with the Nursing and Midwifery Council. She operates a simple quality assurance system to monitor the quality of the service provided and ensures people have their financial interests protected. Care Homes for Older People Page 24 of 29 Evidence: The quality assurance system needs developing to ensure all aspects of the service is included and to ensure all stakeholders are consulted in the process. It also needs to collate information on an annual basis and evidence how the service has been quality checked, how it can improve and whether or not any review of the system is required. The safe keeping of money in the home follows satisfactory accounting principles for handling money and recording it, and allows people access to their money while keeping it safe. People are provided with monthly printouts and receipts for expenditure are maintained. There are systems in place to monitor the areas of health and safety that affect everyone in the home. There is a handyman whose job is to carry out minor maintenance and repairs and also to ensure professionals carry out major maintenance and repairs according to legislative requirements. Sample checks were made on keeping of records and certificates for fire safety, gas and electric, hoists and stair lifts, waste disposal, legionella bacteria, and portable appliances. These are appropriately maintained and certificated in a timely manner, but evidence shows an electrical safety certificate was last supplied in January 2006. This is now overdue and requires action, to have the electrical systems within the home checked and certificated as being safe. Once this has been done a copy of the certificate should be sent to the Care Quality Commission, as evidence. Care Homes for Older People Page 25 of 29 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 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The registered provider should make sure all documents compiled on people are dated and signed at the time, as well as on review, so people are confident the information held on them is current and relevant and shows they have been included in the process and are in agreement with it. The registered provider should consider obtaining a designated lockable medication fridge to store those medicines requiring colder storage, instead of using the homes fridge, so people are confident the drugs to be stored at lower temperatures are being safely stored. The registered provider should make sure staff administering medication are regularly competence checked to do so safely and a record of this should be maintained, so people are confident they are having their drugs handled and administered safely. The registered provider should make sure those people with less cognitive ability and self-determination are offered more meaningful activities and pastimes, so they are able to lead a more fulfilling lifestyle. The registered provider should make sure all staff are given annual updates of the safeguarding procedures and record these, once their safeguarding training is completed with Page 27 of 29 2 9 3 9 4 12 5 18 Care Homes for Older People H&ERYC SA Board, so people are confident they are being protected from the risk of harm. 6 26 The provider should make sure staff infection control training is up to date and current, and that evidence of such training is maintained, so people are confident they are protected from the risk of harm from infection. The registered provider should make sure the QA system is developed to involve all stakeholders, to collate information as evidence the service is quality checked, and to review any processes, so people are confident their views underpin good practice within the home and monitoring systems are effectively checking the level of quality of the service. The registered provider should make sure the electrical safety check is carried out on the home, and a copy of the certificate be sent to the CQC as evidence, so people know the home is electrically as safe as it can be. 7 33 8 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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