Care Home: Oakcroft Nursing Home

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What the care home does well The manager is experienced and provides good direction for staff in how to do their jobs. Both she and the owner are available to speak with residents when they need their help. All of the residents spoken to said the manager and owner are always available for meetings and discussions and that they take action to put things right. When residents diagnosed with dementia are referred to the home there is now a formal agreement with social services reflecting that the home is able to safely look after these residents. People live in a comfortable well maintained and mainly safe home which is clean and hygienic and some residents said that this is a strength of the home. Residents said that staff are friendly and welcoming to visitors. Residents predominately said that they enjoy a good choice of food and are offered choices. They are supported by an adequate amount of staff with a good level of NVQ training. What has improved since the last inspection? The home now puts more information about the activities that people like to do in their care assessments before they move in to the home. This helps them to quickly provide the right activities for people after they move in. There is also more detailed information in residents care plans about the activities that residents now want to take part in and about how to support people with dementia care needs. The care plans now show the improvements in activities that have happened for most residents although more work is needed. Risk assessments have improved and are now being reviewed every month. All staff now have training in safeguarding adults and the reporting of safeguarding issues to social services and to the Care quality Commission is now being done efficiently. There is now a deputy manager who helps with staff supervision and with care planning. The homes living room and dining room space has been made bigger so that residents can now be more comfortable and move about more easily. The redecoration of bedrooms and communal areas has continued and is almost complete. New care staff are CRB checked before starting work at the home and staff supervision is now ell managed. The manager has now registered with the Care Quality Commission. The owner now visits the home monthly for a monitoring visit and records his findings about any improvements needed. What the care home could do better: The home should remind all residents about the fact that they have got contracts showing the care provided and the costs so that they are fully aware of these. There should be more information in care plans showing what individual residents can do for themselves in order to maintain their independence. The information about hoists in care plans for residents who use them must be clearer and separate so that it can be easily reviewed. The management should remind staff to try to be aware of the need to respond quickly to provide additional support for people who seem to need more urgent attention. This is not to say that staff are not responding reasonably well but on the day of inspection there were a couple of occasions when the response could have been more immediate. The home should check out residents views about whether they would like more activities and outings and respond to the findings. Thought could be given to providing more opportunities to read with residents or provide talking books for more residents. The home should ask all residents about their views on whether the current mealtimes and bedtimes suit their needs and advise residents about how any improvements can be made. Key inspection report Care homes for older people Name: Address: Oakcroft Nursing Home Oakcroft 41-43 Culverley Road Catford London SE6 2LD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sean Healy     Date: 0 2 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 31 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 31 Information about the care home Name of care home: Address: Oakcroft Nursing Home Oakcroft 41-43 Culverley Road Catford London SE6 2LD 02084615442 02086980636 oakcroftnursing@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr John Moore care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 28 The registered person may provide the following category of service only: Care home with nursing (CRH - N) 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 - Code OP Physical disability - Code PD Date of last inspection Brief description of the care home Oakcroft Nursing Home provides care for up to 28 older people and caters for respite stays as well as long-term care. The manager is experienced in the field of providing nursing care has taken up the post of manager. There has also been a substantial change in the care and nursing staff and the staff and management are well regarded by residents and families. The home is a detached house with three storeys close to Catford train station and local shops and services. The area is also well served by buses to central and south Care Homes for Older People Page 4 of 31 0 9 0 1 2 0 0 9 0 28 Over 65 28 0 Brief description of the care home London. There is accessible off road car parking space for up to 6 cars at the front of the building. On the day of inspection there were 7 vacancies according to the homes current registration. Double rooms were now being used as singles to provide more privacy for residents and this accounts for most of these vacancies. Information about the service provided is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide, which are given to all service users. The recent Care Quality Commission report is kept in the lobby area of the home open for viewing. A reference is also included in the homes newsletter. At 2nd December 2009 the weekly fees are between 606 pounds and 625 pounds per week for private and publicly funded residents. These fees cover all of the homes charges including food. Residents have to pay extra for other personal expenses such as hairdressing, transport, and personal shopping. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality Rating for this service is 2 Star. This means that the people who use this service experience Good quality outcomes. The inspection was unannounced and was completed on the 2nd December 2009. The homes manager facilitated it. One care staff and the newly appointed deputy manager spoke with the inspector and their comments are included in this report. Five staff employment files were examined to check whether they had been properly recruited trained and supervised. Five other staff gave their views in response to inspection surveys distributed. The inspection was supported by an Expert by Experience and eleven individual residents gave their views on the home to the inspector and the expert by experience. Five other residents and four relatives responded to the inspection surveys. Five Care Homes for Older People Page 6 of 31 residents files were examined to see whether they had been fully assessed and that care plans and reviews happening. Comments and information are included in the report. Comments from the Lewisham adult protection team were also considered. There were seven residents vacancies but this is mainly due to the fact that the home has reduced the number of shared rooms to none to provide more privacy for residents. The inspection involved a tour of the premises and examination of a range of management documentation. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The home should remind all residents about the fact that they have got contracts showing the care provided and the costs so that they are fully aware of these. Care Homes for Older People Page 8 of 31 There should be more information in care plans showing what individual residents can do for themselves in order to maintain their independence. The information about hoists in care plans for residents who use them must be clearer and separate so that it can be easily reviewed. The management should remind staff to try to be aware of the need to respond quickly to provide additional support for people who seem to need more urgent attention. This is not to say that staff are not responding reasonably well but on the day of inspection there were a couple of occasions when the response could have been more immediate. The home should check out residents views about whether they would like more activities and outings and respond to the findings. Thought could be given to providing more opportunities to read with residents or provide talking books for more residents. The home should ask all residents about their views on whether the current mealtimes and bedtimes suit their needs and advise residents about how any improvements can be made. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 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 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. This judgement has been made using available evidence including a visit to this service. All residents have adequate written assessments of their care needs in place and improvements have been made in areas regarding social and leisure needs and information about the care of dementia. Residents have written contracts in place which have been updated. Intermediate care is not provided. Evidence: A requirement was made at the last inspection for the home to include the rooms to be occupied and the fees payable in all residents contracts. This has now been done and this requirement has been met. The five files axamined showed that these ares are now included. The majority of residents and relatives who reponded to the inspection surveys said they had up to date contracts. However three said they were Care Homes for Older People Page 11 of 31 Evidence: not aware of their contracts and it is recommended that the home remind all residents about their contracts so they are aware of their rights and obligations. (Refer to Recommendation OP2) There is an up to date Statement of Purpose and Statement of Terms and Conditions for living at the home and the residents I met said that they had received a copy of these. All residents have full and detailed assessments of need on file. I examined five residents files and all were seen to have a detailed assessment of their health and social care needs. The residents at the home have been placed in the home mainly by the London borough of Lewisham who is the main contracting agent. Core care assessments have been provided by these local authorities and they show the primary care needs of the residents to be associated with ageing needs such as personal care and physical disability with secondary care needs such as dementia and mental health support also being met. All five residents files I examined showed that they had a contract in place which included the fees paid for their care and showed the service they can expect from the home and their rights and responsibilities and the room allocated to them. The home does not provide intermediate care for residents and therefore Standard six does not apply to this home. Care Homes for Older People Page 12 of 31 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 using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Health and personal care needs are well set out in care plans and care plans and risk assessments are now consistently reviewed each month. Health care needs are being met and medication is well managed Evidence: There were two requirements made at the last inspection concerned with care planning and review of risk assessments. These were both met and improvements have been made to residents care plans so that they are now of a good quality and reflect the assessed care needs of residents. Dementia care needs of relevant residents are now described better in their care plans and exercise and mentally stimulating activities have improved although further improvements are recommended. (See Recommendation Standard 12 of this report) Residents interviewed confirmed this and said more activities such as exercise activities are now happening a number of times a week which are led by the homes Care Homes for Older People Page 13 of 31 Evidence: activities coordinator. Care plans have written guidance for staff to follow to protect residents from risk and to also enable them to do things for themselves. Care plans and risk assessments are now being reviewed each month and residents are being asked about important areas so that they can have an effect on the care given. I examined care plans for 5 residents and found that all had a care plan based on their assessment of health and social care needs. All were comprehensive and were reviewed on a monthly basis. Many included high levels of personal care support needs where areas of risk are assessed especially regarding moving and handling. The care plans also showed residents food preferences preferred activities and health care needs and emotional support needs. Almost all of residents have support needs in bathing dressing and some need support with the care of dementia. Continence care and physical support are also provided for other residents. I found these areas to be included clearly in care plans and staff spoken to understand their responsibilities. The homes management and staff understand how to provide the care residents need and that they understand and have the necessary care plans in place for their safe support. All of the care plans I examined were for residents who had high moving and handling support needs who also use hoists. However there needs to be more detailed reference to the use of hoists in risk assessments for each resident who uses them to improve those already in place. This is not to suggest that the current practices are not adequate but given the potential for injury if not used properly or if one becomes faulty this is an area where risk need to be more clearly identified and reviewed monthly. (Refer to Requirement OP 7). There is a range of health care professionals involved in the provision of specialized support for the home. All residents are registered with a GP dentist chiropodist and optician with some receiving support from the district nurse and psychiatry. There is also involvement from the Care Home Support Team regarding nursing and dementia care needs. A continuing support nurse visits a number of times weekly and previously commented that she is happy with the improvements in care and with the staff and management response to intervention plans and for requests for information needed. Records showed weekly visits from GPs. Nursing care is provided at the home and all nursing staff are in charge of medication management and nursing care issues while leading the shift. There is always at least one nurse available and the homes manager is a qualified and experienced nurse. There have been few hospital admissions and Care Homes for Older People Page 14 of 31 Evidence: tissue viability issues are well managed. The homes medication policy is up to date and includes the sections required. Residents medication needs have also been reviewed. Medication is supplied to the home by Lloyd chemists and the majority of residents who use medication use a blister pack system which is easier to administer. All staff receive management of medication training by the home and residents abilities to self-medicate are assessed as part of the assessment process. I examined five residents files including medication administration recording and found that these were satisfactory. All residents need support in personal care and examination of five randomly chosen residents files showed that there is a personal care plan on file for each resident. Residents commented positively about how they are supported in personal care by staff. Any concerns raised are investigated by the manager and action is taken to address any problems. Care plans for residents who have high personal care supports needs now are good and provide for safe and dignified support in personal care. However it is recommended that more individual personal information be included about each residents preferences and abilities in doing some aspects of personal care for themselves such as using the shampoo or holding the shower or switching it on and off. This would improve residents independence and sense of wellbeing. (Refer to Recommendation OP10) During the inspection it was observed that while care staff were respectful to residents they were not always able to respond quickly to residents who clearly needed some additional personal support. One person needed to go to her bedroom for personal reasons and another needed some additional support with eating but staff were busy tending to other residents and tried verbally prompting rather than the more hands on support that was needed. Comments received from three other residents who responded to the inspection surveys suggest that this an area for management to be more aware of and to remind staff about. Overall comments from residents and families about staff and management were very positive. (Refer to Recommendation OP10) Care Homes for Older People Page 15 of 31 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 using the 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 are satisfied with their lifestyle but more activities and exercise opportunities are needed. They are supported to maintain contact with family and friends. Residents are involved with making decisions about their life and are given a choice of good and wholesome food. Evidence: All residents have assessments and care plans that clearly state their interests and preferred activities. These include education training and leisure activities. Care plans reflect these activities and these include residents views on desired new activities. The home carries out its own assessment of residents interests and past experiences with residents and families as part of the admission process and records this on a life plan. I examined five residents files and each had a life plan showing interests such as watching TV listening to music having Sunday lunches in pubs walks in the park sewing and crochet and playing cards or dominoes. These assessments of activities have transferred onto all individual residents care plans and staff are now engaging residents in more activities such as games and exercise in the home. There is more Care Homes for Older People Page 16 of 31 Evidence: verbal communication between care staff and nursing staff and the expert by experience noted that the atmosphere in the home has improved and residents are now interacting more with other residents and with staff. Relatives and three residents who responded to the inspection surveys said that they are asked about activities and that the staff and manager are now listening and making positive changes. At the last inspection they said that things have changed for the better and there are monthly meetings with the management and the residents and relatives and now things are much better. This inspection has showed continuing improvements with positive comments about the activities coordinator who is said to work hard to provide more activities and provide more entertaining pastimes for residents. There is now much more involvement of health care professionals in the home and this is resulting in better quality of care for residents. There had been improvement in the activities for residents in group activities. Comments from residents and relatives reflected this. However a number of residents who spoke to the expert by experience and who responded to surveys said there is not enough activities to do and they would like more opportunities to be supported to access talking books and to use be supported to use games provided to them by their families. A number suggested that the home should help them to get out more on trips to the seaside or to other outdoor pursuits. The home has been successful in organising dial a ride to provide transport for some residents and also use the taxi card system to provide transport. It is recommended however that the home survey residents views specifically about their desire for more outings and activities and seek to provide improvements where possible. (Refer to Recommendation OP12) One resident who spoke with the expert by experience mentioned that the suppertime mealtime regularly clashed with her favourite TV programme and another resident said this to me also. They felt that the teatime was fixed and would like it to be more flexible. Others had commented that bedtimes were flexible enough but I examined five residents files regarding agreements about bedtimes and found that the home now includes specific agreements with residents about this so that the times are suitable to them. It is recommended that the home raise both of these issues with residents at the residents and family meetings to explain these arrangements to all residents so that they are fully are aware of the opportunity for flexibility in mealtimes and bedtimes. (Refer to Recommendation OP12) All residents religious preferences are included in their care assessments and there is involvement from church representatives in the home. This was reflected in the five residents files examined and in comments from residents and families. All residents have their own room where they can receive visitors in private. Residents are encouraged to bring personal possessions into the home including furniture and Care Homes for Older People Page 17 of 31 Evidence: pictures. Residents rooms are personalized with their own pictures and family photos displayed. The home does not have any restriction on visiting times and two relatives who were visiting said that they are welcomed and offered the opportunity to have a meal with their relative. The comments from all who spoke to he inspector and the expert by experience reflected that the food is very good and that they see the Management on each visit and attend monthly meetings at the home where they are able to express any concerns. Residents and their families are responsible for the management of their benefits and bank accounts. The responsible individual and manager said that family who hold money for some residents are very good at providing the necessary items needed by the resident and in providing funds for spending when requested. The home operates a four-week rolling menu and the meals offered appeared to be varied and nutritious. They also included meals for vegetarians and people from other cultural backgrounds. Residents are assisted to complete a form every day to indicate their choices of meals. Residents who spoke to the expert by experience and to me said they were generally very happy with the meals provided. Menus are kept and two main meal menus are offered daily but the chef said residents could have what they want if it is available. The cook is well aware of any cultural needs of the residents and keeps a record of allergies and special diets for residents who need it. Meals provided are of a high standard and residents are happy with the food provided. Care Homes for Older People Page 18 of 31 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 using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory systems are in place to manage complaints and the protection of vulnerable adults. Evidence: There is a complaints policy for the home which was updated in 2007. Most relatives and residents who were asked said they know how to complain. If they needed to and felt management would take appropriate action. Relatives also said that they meet at least monthly with the homes management and see the manager and sometimes the owner when they visit. However a number of residents and families (three out of 12 who gave comments during the inspection process) said they did not know how to make a complaint. It is recommended that the home remind all resident of the process for complaining through the arranged meetings or by whatever means is most effective. (Refer to Recommendation OP16) Six complaints had been made since the last inspection and had been properly recorded and investigated. The complaints record showed that complaints were clearly summarised with details of investigations recorded in a complaints file. Four staff training records showed that staff are properly trained in management of complaints. The homes vulnerable adults policy had been updated in 2007 and covered all necessary areas. There have been four adult protection issue reported to social Care Homes for Older People Page 19 of 31 Evidence: services since the last inspection. These were appropriately investigated by the home in liaison with social services and appropriate action was taken to resolve any areas of concern. Two requirements were made at the last inspection regarding safeguarding adults processes at the home. One required that all nursing and care staff receive training in adult protection and the second required that instances of safeguarding concerns be reported promptly to the Care Quality Commission. (Previously CSCI). Both of these requirements were found to be met and examination of five staff files showed that they had this training. Discussion with social services regarding reporting of safeguarding issues showed that CQC and social services are now being notified appropriately by the home and that the home liaises well with social services in the investigation of safeguarding issues. There was an outstanding safeguarding issue which may merit referring a previous member of staff to the POVA register and the manager said that this has yet to be agreed with social services and that they will do this if it is appropriate. Overall the reporting and recording and investigation of safeguarding issues by the home has improved and is now well managed. Forging positive relationships with social services safeguarding team and working in cooperation with them is very important to protect residents and staff and the homes management has shown they have a commitment to building on the improvements already made. Care Homes for Older People Page 20 of 31 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 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable clean well maintained and safe home. Their need for increased communal space is now met. Evidence: There have been significant improvements made to the fabric and facilities in the home which have direct benefits for residents. All residents who participated in the inspection process and their relatives said they are pleased with the improvements made especially with the prospect of using the newly built conservatory attached on to the living room and dining area. These improvements have shown serious commitment on behalf of the provider and manager to improving the residents comfort and space in the home. Improvements include a newly built conservatory which is now ready for use by the residents. This provides alternative space for relaxation and socialising and residents are very pleased with this prospect. A ramp has previously been created to the side exit to increase wheelchair accessibility. The lounge has been rearranged for residents comfort and privacy and the majority of the 20 residents rooms have been redecorated giving individual residents choice of colour for their own rooms. Care Homes for Older People Page 21 of 31 Evidence: All bedrooms are now single occupancy bedrooms and work has also been done on the respite room. New curtains and carpet have been provided throughout the home and there is a decorating and maintenance programme in place outlining further work to be done. At last inspection eight new beds and six new wheelchairs had been purchased and now new armchairs and footstools have replaced the old ones. There are plans to provide grip bars for residents in their rooms where needed. Occupational Therapists have been involved in carrying out necessary assessments. The home is now of a good standard and all health and safety and fire safety equipment and systems are in place and in good working order. There are three bathrooms one on each floor and two of these have toilets. There are four other separate toilets and all are in good condition. There are four mobile hoists and one standing hoist in use all of which are maintained under contract. The home now has high standards of cleanliness and Dept of Health guidelines for control of infection are applied. There are adequate numbers of cleaners employed and there are no unwanted odours in the home. Overall the home continues to be well maintained clean very comfortable to live in. During the inspection it was noticed that two of the residents bedrooms had the heating turned off and the residents asked for it to be turned on again. Management were informed and said they could not understand the reason for this but that it was not the policy of the home to do this. Care Homes for Older People Page 22 of 31 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 using the 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 numbers and skill mix of the staff meets residents needs and they are in safe hands at all times. Residents are now protected by the homes recruitment and induction practices. Staff are trained and competent to do their jobs. Evidence: There were two requirements made at the last inspection regarding staff recruitment and training improvements needed. Both of these requirements are now met. Inspection of five staff recruitment and training records showed that all of these staff had been fully CRB checked and that all has stand alone safeguarding training as required. The staff team is made up of a registered manager who is an experienced manager and qualified nurse and a newly appointed deputy manager. There are 18 care staff and 8 qualified nursing staff. The deputy manager has developed a good rapport with residents and has some responsibilities for organising care planning systems in the home. The rota showed that the home deploys an adequate number of nursing and care staff on duty at all times of the day and night. There are at least three carers and one Care Homes for Older People Page 23 of 31 Evidence: registered nurse on shift during the daytime from 8am until 9pm supported by the manager or deputy manager during office hours. Night support is provided by one carer and one registered nurse. There is an out of office on call support provided mainly by the homes manager and deputy manager. Cooking cleaning and maintenance are catered for by separate other staff. The files of three care staff two nurses and the deputy manager all of whom had been recruited in the last year were checked and showed that recruitment information is well organised with a good system for recording all recruitment information including CRB checks. There is a good induction system for new staff with records of induction in place for all of these staff. The manager and staff members were signing off this induction. At the last inspection there were eight care staff found to have been working under false working documentation since the last inspection and all of these were dismissed. The home has done well to recruit to these posts and to induct and train all the new staff. The number of care staff with NVQ level 2 training exceeds 80 which is a high level of qualified staff. Examination of five staff files three of which were nursing staff showed that staff induction is now consistently happening in accordance with Skills for Care standards. Generally the files showed a good range of appropriate training is also in place for care staff and nursing staff. Training recorded included continence management fire safety medication communication dementia and food hygiene. Staff are now also receiving training in the safeguarding and protection of residents. It is recommended that the home provide more training for staff in the management of dementia and to ensure that all new staff have this training. (Refer to Recommendation OP30) Care Homes for Older People Page 24 of 31 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 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. This judgement has been made using available evidence including a visit to this service. The manager is experienced and competent to run the home. Some good quality assurance systems are in place which ensure that the home is run in the best interests of the residents. Residents financial interests are being effectively safeguarded. The home has adequate health and safety policies and systems in place and these are well managed. Evidence: There was a requirement made at the last inspection for the provider to ensure that monthly management monitoring visits to the home are supported by a written report showing findings and recommendations. This has now been done and this requirement is met. There was also a requirement to ensure that all staff receive formal supervision at least 6 times a year. This requirement has also been met. There was a Care Homes for Older People Page 25 of 31 Evidence: recommendation also made for the home to employ an assistant manager to help with staff supervision and care planning. This recommendation ahs also been met and is welcomed by the manager and staff. As at the last inspection the manager is very competent and experienced and is a qualified nurse with long standing management experience. She is a qualified Level 4 NVQ assessor and a moving and handling trainer and has been working hard on updating the physical environment. Many improvements have been made to the fabric of the home. Staff comments were very positive regarding the support they get from the manager and all staff that took part in this inspection process said they feel the manager and new assistant manager are very approachable and supportive. Residents who spoke with the Expert by Experience and with me said that they felt the manager and owner were available and easy to speak with and that the homes management was good. They said that manager and owner are working hard to listen to residents and to improve life at the home. The atmosphere in the home and the morale of staff is good. There is an out of office hours on call system that staff at the home say they can use to get management support at any time at evenings and weekends. As at the last inspection the owner has put in place a formal and methodical quality assurance audit system and has begun the process of carrying out a full audit of all of the homes quality assurance systems. This is done by carrying out sections of the audit monthly and producing a report after a 12-month cycle. Consultation with residents and families has been good and this was supported by comments received from residents and families. Surveys of residents views are now happening four times a year and meetings with residents take place at least quarterly. Typed minutes are distributed to residents and families showing the issues discussed and the results of the surveys. Residents and relatives are invited and attend relatives/residents meetings every couple of months and have completed surveys. They receive feedback on survey findings at these meetings. At the last inspection the registered provider attends the home a number of times a week and does complete written reports on the checks that he does. The home has an Annual Development Plan in operation. Residents money is well managed and protected and the home is not responsible for any residents bank accounts or benefits. Residents and their families are responsible for the management of their benefits and bank accounts. There are clear written agreements in place for these residents showing how their money is managed where families have responsibility. As at the last inspection Health and safety is generally given due care and attention by the homes management. There is a health and safety policy and appropriate systems Care Homes for Older People Page 26 of 31 Evidence: being used for training staff checking fire equipment storing dangerous liquids and substances carrying out risk assessments and doing regular health and safety checks within the home. The fire officer for the LFEPA, has previously been involved in inspecting the home and the home meets all fire safety requirements. All of the staff files examined showed that appraisal is now happening. Supervision is now happening at least six times a year and staff say that they feel supported by this process. Care Homes for Older People Page 27 of 31 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 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 The registered provider and manager must ensure that specific reference to the use of hoists is made in risk assessments for residents who use hoists for personal care support. These should then be reviewed monthly. This is to further protect residents from potential harm 31/03/2010 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 and manager should remind all residents about their contracts so they are aware of their rights and obligations The registered manager and provider should include more individual personal information about each residents preferences and abilities in doing some aspects of personal care for themselves in order to improve residents independence and sense of wellbeing. 2 10 Care Homes for Older People Page 29 of 31 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 3 10 The registered provider and manager should raise awareness amongst staff of the need to respond quickly to residents when they appear to need additional personal support as discussed in this report The registered provider and manager should further seek residents views on improving the in house activties provided and regarding their desire for more organised outings as discussed in this report. The registered provider and manager should inform all residents about the homes arrangements for flexibility regarding bedtimes and mealtimes in order to seek to meet their individual needs in these areas as discussed in this report. The registered manager and provider should remind all residents annd relatives of the homes process for reporting complaints as discussed in this report The registered provider and manager should continue to focus on the provision of training in the management of dementia for new staff who have not had this training. 4 12 5 12 6 16 7 30 Care Homes for Older People Page 30 of 31 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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