Care Home: Oaklands

Similar services:

• Claremont House
• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home
• Henrietta House

What the care home does well The Home has a pleasant, friendly atmosphere and decor. It is clean, tidy and staff obviously work hard towards providing a warm, kind and caring service. There is a pre-admission process which helps to ensure that people receive sufficient information before making their decision to move to the Home and that the Home can meet their needs and preferences. Residents feel they are treated respectfully and all those spoken with said they were happy living in the Home. " I am content living here" said one person. Residents` views are sought and they have choice in their day-to-day activities. Changes have been made in the Home as a result of listening to residents` views. People living in the Home said they enjoyed their meals and that personal choices are taken into account in drawing up menus. There is an enthusiastic staff team who say they are well supported and supervised by the Manager and her Deputy. One relative`s comment card stated that the Home: "provides warm, clean accommodation, helps residents maintain a high standard in appearance, i.e. hair always clean and clothes well co-ordinated. Helpful staff. Very pleasant location. Food appears to be of a high standard." What has improved since the last inspection? The Home has made a number of improvements since the last inspection: Good progress has been made in care plans, but there are still improvements to be made. Residents` nutritional needs are assessed and these needs are communicated to the kitchen staff who keep good records. The Home is fully staffed and the most recent members of staff are fully inducted. Staff training and development has improved, although there are still improvements to be made. Furthermore, staff supervision takes place on a regular basis and there is a key worker system in place. All care staff have received training in Safeguarding Adults, but this should be extended to all staff, regardless of their role. There is an activities programme in place. An Aromatherapist, as well as the `Pat Dog` scheme visit the Home, which are enjoyed by some residents; but this programme of activities could be further developed to further improve the quality of life for residents. There is better heating in the bathrooms, several areas of the Home have been refurbished and the health and safety issues addressed since the last inspection.The Manager has now been registered with the Commission and is providing leadership to the staff team, but she is keen to further her training and that of the staff. Complaints are now recorded and logged, showing details of any resultant changes. What the care home could do better: There are some improvements which the Home must do by law: These are: Improved care plans still need to be consistently completed, be more person centred, `user friendly` for staff and to be compiled together with the resident and/or their representative. The Home should continue to forge links with the local community. Further training opportunities should be offered to all staff, including the Manager, to fill gaps in individual staff training and training in areas specific to the needs of the people living in the Home; also training in Safeguarding Adults regardless of their role. Although residents felt their privacy and dignity were generally respected, nonetheless there were some issues in this regard which need attention. All staff references and CRB certificates should be original documents, or verified as such. There were current health and safety issues which needed to be addressed. There are a number of improvements recommended which the Home can choose to put in place or not. These are: The appointment of a designated and trained activities organiser on addition to the Manager to coordinate individual and group activities in order to develop and maintain skills, as well as life story work would further improve the quality of life of the people living in the Home. Consideration should be given to surveying the views of healthcare professionals, who visit the Home, and staff by written questionnaires to further ensure that the Home is run in the best interests of the residents. Consideration should be given to improving the access to the front door by wheelchairs. Consideration should be given to seeking advice on alternative continence products for beds for the comfort of residents. Consideration should be given to replacing frayed towels used by residents. Key inspection report Care homes for older people Name: Address: Oaklands Norwich Road Scole Diss Norfolk IP21 4EE 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: Jenny Rose Date: 2 4 0 2 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 star – poor 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. things that people have said are important to them: 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 They reflect the 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. Care Homes for Older People Page 2 of 28 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. Care Homes for Older People Page 3 of 28 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 4 of 28 Information about the care home Name of care home: Address: Oaklands Norwich Road Scole Diss Norfolk IP21 4EE 01379740646 01379740479 sophie@kingsleycarehomes.com www.kingsleycarehomes.com Regal Healthcare Properties Ltd Miss Sophie Cotter care home 28 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): dementia old age, not falling within any other category Number of places (if applicable): Under 65 1 0 28 Over 65 Additional conditions: Old age, not falling within any other category - Code OP Dementia - Code DE (maximum number of places: 1) Maximum number of service users who can be accommodated is: 28 Date of last inspection: 2 8 0 1 2 0 0 8 Care Homes for Older People Page 5 of 28 Brief description of the care home: Oaklands formerly known as Scole Lodge is a large detached building situated just outside the village of Scole near Diss In Norfolk. It is set in eighteen acres of grounds with mature gardens and meadowland. Bedrooms are on the ground and first floors and consist of two double and twenty-four single bedrooms. Nineteen of the single rooms and both the double rooms have ensuite facilities. The home has a variety of communal rooms for the residents use. A shaft lift and a wheelchair lift are provided to aid residents to the first floor, which is on three levels. The home informed CSCI of its charges in January 07 and charges residents from £347 to £500 per week for care provision. Residents pay extra for hairdressing, chiropody, optician, dentist, newspapers and toiletries. Care Homes for Older People Page 6 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: two star good service Our judgement for each outcome: Care Homes for Older People Page 7 of 28 How we did our inspection: This Inspection was completed following evidence gathered from information that had been sent to the Commission after the last key inspection on 28th January 2008. The Home Manager had completed an Annual Quality Assurance Assessment (AQAA) on 23rd January 2009 giving details of what the Service offers, what they have done to improve the Service and what barriers have caused the Service to not develop and improve. The site visit to the Home took place over 8 hours and during this time care plans were seen, medication records were looked at, personnel files and training records studied and health and safety records examined. A partial tour of the building was undertaken and two bedrooms were seen at the invitation of the residents. Three members of staff were spoken with in private, as well as two staff members in the course of the Inspectors tour of the building. In addition there were discussions with the Manager and the Regional Manager for the Provider who was present for part of the day. Discussions also took place with a visiting healthcare professional, the hairdresser and a visiting relative. Three residents were spoken with in private, as well as several others in a group: all these discussions are reflected in this Report. There were 26 residents living in the Home on the day of the Inspection and one person was in hospital. Notifications received at the Commission were also looked at. Six residents at the Home had sent comment cards to the Commission along with two relatives cards giving us a picture of the way the Home offers its service. Two of the residents comment cards were completed independently, a further two with the help of relatives and two others were completed with the help of a member of staff and these comments are also reflected throughout this Report. Care Homes for Older People Page 8 of 28 What the care home does well: What has improved since the last inspection? The Home has made a number of improvements since the last inspection: Good progress has been made in care plans, but there are still improvements to be made. Residents nutritional needs are assessed and these needs are communicated to the kitchen staff who keep good records. The Home is fully staffed and the most recent members of staff are fully inducted. Staff training and development has improved, although there are still improvements to be made. Furthermore, staff supervision takes place on a regular basis and there is a key worker system in place. All care staff have received training in Safeguarding Adults, but this should be extended to all staff, regardless of their role. There is an activities programme in place. An Aromatherapist, as well as the Pat Dog scheme visit the Home, which are enjoyed by some residents; but this programme of activities could be further developed to further improve the quality of life for residents. There is better heating in the bathrooms, several areas of the Home have been refurbished and the health and safety issues addressed since the last inspection. The Manager has now been registered with the Commission and is providing leadership to the staff team, but she is keen to further her training and that of the staff. Care Homes for Older People Page 9 of 28 Complaints are now recorded and logged, showing details of any resultant changes. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. 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 28 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 28 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 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. People who are considering moving to this Home have relevant information available and can visit beforehand to help them make a decision. Their needs are assessed to ensure the Home can meet those needs. Evidence: The Home has a Service Users Guide and Statement of Purpose which are given to prospective residents and their families. Both had been updated as recommended at the last Inspection to reflect the changes in provision in the Home. They included the new names of the larger organisation and the change of name of the Home. However, there had been insufficient time for the very recent registration of the Manager with the Commission to be inserted, neither was her forthcoming work towards the Leadership and Management for Care Services Award (LMC) mentioned. The Statement of Purpose states that emergency admissions are only undertaken after careful consideration and this was confirmed by the Manager. The Annual Quality Assurance (AQAA) states that encouragement is given to relatives and potential residents to visit the Home, as well as social workers. One assessment seen demonstrated that the Manager had visited the resident at home before admission. Two assessments examined, together with Social Services assessments, formed the basis of the care plans to ensure that the health, personal and social care needs of residents could be met. Five of six comment cards received from residents Care Homes for Older People Page 12 of 28 stated that enough information had been received before admission, although the sixth one stated that he/she could not remember. Two comment cards stated that their relatives had dealt with this information. The Home does not offer Intermediate Care. Care Homes for Older People Page 13 of 28 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 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 care plans are much improved and residents felt their care needs were met. The most recent care plans were person-centred and involved the individual and their representative/advocate. However, there were not always appropriate signatures to support this. Peoples privacy and dignity are respected but there are some improvements which could be made. Evidence: Three care plans were looked at in detail and three others also seen. It is evident that the Home have worked hard since the last inspection to improve all the care plans. The care plans seen contained details of individual preferences particularly in the activities of daily living. There were risk assessments for potential falls. Malnutrition Universal Screening Tool (MUST) Assessments were carried out on admission and updated on a regular basis. These Assessments seen were all reviewed and up to date. One of the more recent care plans showed an Assessment based on individual strengths and indicated ways staff could support that person, bearing out the information in the AQAA that care plans were now more reflective of individual needs. In addition, it was observed on the day of the Inspection that people were able to choose when they got up in the morning and whether or not they wished to have a bath. The Home is supported by the local GP surgeries. There was evidence of visits from other healthcare professionals. One professional who has been visiting the Home on a regular basis for the last five years said the staff were friendly and caring that he always found the residents well groomed. The District Nurses have been involved in training for staff in Diabetes. Individual dietary requirements were seen to be recorded daily in the kitchen, which had been a Requirement from the previous Inspection. Following a discussion with one resident, consideration should be given to seeking Care Homes for Older People Page 14 of 28 advice from the Continence Advisor concerning the comfort of continence products used on some beds. Five comment cards from residents and one from a relative stated that they always received the care and support they needed, whilst one resident and one relative stated that they usually did. One person who had lived in the Home for seven years said, I am contented here, I wouldnt be anywhere else. All the care plans and daily records were seen to be up-to-date and regularly reviewed, but the filing system was not sufficiently robust. Pages were loose and falling out, making it difficult for staff to use efficiently. In addition, there was no evidence that the care plans had been compiled with residents, or their representatives, as there were no contributory signatures. One relative spoken with stated that she had been closely involved with her relatives care plan and continued to be so on a twice weekly basis. Several care plans contained life story books, but only one had been completed. In addition, some care plans did not contain photographs, although photographs of all residents were in place on the medication records. From one care plan there was evidence that a solicitor was acting as an advocate for a resident with no representative, but there was no evidence that there were arrangements for advocacy for residents with differing communication styles to ascertain their wishes regarding their care. Residents, however, do have the benefit of keyworkers. (See elsewhere in this Report Standard 17) Part of a medication round was observed. The medication records, audit trail and storage arrangements appeared to be in order. Staff administering medication are trained. There was one person administering her/his medication and a signed risk assessment was seen for this. Staff also monitored this self medication on the MAR sheets and sought the advice of the GP if necessary. A senior member of staff said there was a good relationship with the local Pharmacy on whom they could call for advice. Small signs displaying Treatment is in progress, please knock were seen to be in use on residents doors and throughout the day of the Inspection it was observed that staff were interacting with residents in a respectful way and with appropriate humour. There was also evidence from one particular care plan and from the individuals keyworker that his/her dignity was respected in the support given. Residents spoken with throughout the day also confirmed that this was the case. Evidence of peoples letters being handed to them unopened was observed. However, the use of frayed and threadbare towels (see elsewhere in this Report in Standard 19) did not promote the dignity of residents; neither did the drying of residents hair in the dining room (see elsewhere in this Report Standard 19) promote privacy. One comment card from a relative expressed a wish for there to be somewhere private where she could visit her relative rather than having to go to her bedroom which would entail further time and effort for her relative. Care Homes for Older People Page 15 of 28 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made in involving residents in enjoyable activities and their choices in daily living are respected and meals enjoyed. However, the development of a more person specific activities programme would support residents to maintain and develop their skills, as well as improving links with the wider community according to their wishes. Evidence: There were more activities available for residents since the last inspection and the Manager has undergone Activities Management training. There was a scrap book in the hall recording activities which had taken place in-house during the year. Staff spoken with confirmed that they organised activities such as Bingo, games and music in the afternoons. For those residents who liked animals the Home had acquired a cat, following the suggestion from a residents meeting, and also the Pat Dog scheme visited. One resident spoken with particularly enjoyed the regular visits to the Home of an Aromatherapist. However, although there were notices in residents rooms regarding activities, the record of such activities in the care plans were not consistently completed. Only one Life Story Book was seen to be completed by a resident, who had lived in the Home for some years. Whilst it is accepted that the gathering of such information is dependent on the willingness of residents and/or their relatives to be involved in the process and the length of the stay of the resident, better recording of activities and particularly of residents’ individual interests would provide a basis for a more meaningful, person centred activities programme. Such a programme could maintain and develop skills according to residents’ wishes, particularly for those residents with differing communication styles, two of whom were communicated with on the day of the Inspection. In addition, from information in the AQAA, confirmed by the Manager and Care Homes for Older People Page 16 of 28 comment cards, there were also several residents with a visual impairment for whom more specific activities may be more appropriate. Of the six comment cards received from residents three stated that there were always activities in which they could join, one card completed with support from a relative stated that it was not possible to comment and two others stated there usually were and one of these added that the person was blind. One comment card stated that Visitors are always welcomed at any time and that there was always a friendly atmosphere. Four visitors were seen on the day of the Inspection; one visited daily to assist her relative at mealtimes. Visitors have access to tea and coffee making facilities. However, although ministers of religion visit on a regular basis, the Home has no involvement with community groups or organisations, although the Manager said that the Home hoped to hold a community event with Morris Dancers in the grounds in the summer. Residents spoken with said that they had choice in their daily living activity and there was evidence from a residents meeting that the menu had been changed to include chip butties at the request of residents. Since the last Inspection two cooks are now employed, one of whom has an NVQ 2 qualification and is wishing to undertake further training. She makes a point of discovering residents preferences on a one-to-one basis. There were good records kept of residents choices from at least three choices of main meal and their dietary requirements. Five out of six comment cards stated that they always enjoyed their meals; one said he/she usually did. One relative spoken with said that the meals suited her relative. Residents spoken with all confirmed that they enjoyed their meal on the day of Inspection, either in the dining room overlooking the garden, or in their rooms if they wished. It was seen that meals were well presented and pancakes were on the menu as it was Shrove Tuesday. There was evidence of fresh vegetables being used and salad being available on the menu. Care Homes for Older People Page 17 of 28 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home has an open door policy where people feel confident to share any concerns and are protected as far as possible by the care practice, policies and procedures carried out by staff members. However, advocacy services should continue to be sought for those people with no representatives and all members of staff should receive Safeguarding training, regardless of their role, in order to ensure that residents are further safeguarded. Evidence: There is a clear complaints policy and procedure since the last inspection which is contained also in the Service Users Guide. The Manager confirmed the information in the AQAA that there was an open door policy and all eight of the comment cards confirmed that people knew how to make a complaint if necessary and this was the same for the residents and relatives spoken with on the day of the Inspection. The complaints book was seen. The Regional Manager confirmed that complaints were logged and reviewed on a regular basis and the resultant changes recorded. With reference to Standard 7 of this Report, for those residents with no representatives and/or differing communication styles the Home could consider facilitating access to available advocacy services in addition to financial and/or legal advocacy. The second full training matrix sent by the Manager and seen by the Inspector following the Inspection gave evidence that all care staff have received training in Safeguarding Adults and there were dates recorded for future reviews. Discussion with three members of staff in private provided evidence that care staff have a good knowledge of the issues surrounding the protection of vulnerable adults. However, this training should be extended to all members of staff, regardless of their role, to further ensure the safety of the people living in the Home. Care Homes for Older People Page 18 of 28 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home has addressed the health and safety issues from the previous inspection to improve the environment in which people live, but further improvements remain to be made. Evidence: The Home now have maintenance records, with a communication book for staff notify running repairs, together recently with the daily services of a Maintenance Person. Improvements have been made in the garden; also there has been new furniture, redecoration and refurbishment, particularly in the entrance hall area, which is in keeping with the architecture of the building where it is pleasant for residents to sit. Several issues regarding safety were identified at the last inspection; these have all been resolved. A partial tour of the building demonstrated that fan heaters have been installed in the shower room and other bathrooms. Window restrictors are in place on upstairs windows. One sluice was found to be clean and tidy, although the light pull had broken. The staff kitchenette can be locked, as could the laundry door, as cleaning materials were stored outside secure cupboards in the laundry. However, the glass in the laundry door was cracked. In view of the dryer door in the laundry opening directly on to the glass, further damage could ensue. The laundry was well equipped and a member of staff spoken with explained that all clothing was marked and there was a new system of dissolvable bags for soiled linen which were used to transport linen directly into the washing machine. She confirmed that she had received training in COSHH, Infection Control and Health and Safety. Towels were seen in the laundry which was for use by residents and they were frayed. (See elsewhere in this Report Standard 10) and consideration should be given to replacing these. All areas of the Home seen were hygienic, clean and pleasant. There was a suggestion from one relatives comment card that an alternative ramp to the front entrance would better enable wheelchair access. Care Homes for Older People Page 19 of 28 A keypad has been fitted on a door opening on to an unsafe staircase which is understood to be disabled automatically should the fire alarm sound. There was some minor confusion concerning this fact during the Inspection which has been resolved by the Operations Director. A bathroom on the ground floor has been refurbished including an assisted bath and a back basin for hair washing. The hairdresser was using this basin on the day of the Inspection, but she was finding that it was not fit for purpose. In her opinion the basin was placed too high, people had to lean forward, leaving a gap through which water was seen running on to the floor, making the area potentially slippery for residents and staff. The water was then running through on to the carpet in the corridor. Furthermore, there was not a suitable movable and adjustable chair for ease of movement, for both resident and hairdresser, to the basin. Hairdressing equipment was seen to be placed on tables at the back of the dining room and remained there during lunch. The dining room having to be used for the drying of residents hair, apart from affording no privacy (see elsewhere in this Report Standard 10) is seen as being not appropriate. One relatives comment card remarked that the cleanliness of residents and Home are both excellent and another stated, the Home provides warm, clean accommodation. Care Homes for Older People Page 20 of 28 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made in staffing levels, statutory training and records which together with the recruitment procedures help to ensure that residents are cared for by suitable staff. However further development of training opportunities would help to ensure that staff gained further skills to deliver person-centred care specific to the needs of the people living in the Home. Evidence: All the issues raised at the previous inspection regarding staffing have improved. There was evidence from staff rotas, speaking with residents, staff and relatives and from comment cards that staff are now employed in sufficient numbers to meet the needs of the residents in the Home. Two cooks are now employed, one in the morning and one in the afternoon, which frees care staff from food preparation. Four staff are on duty at lunch time assisting residents with their meals. Three care staff are on duty in the afternoons during which time they promote activities with residents (see elsewhere in this Report Standard 12). All staff spoken with were enthusiastic, gave a good account of their keyworking roles and the particular support they could give to individual residents. They also stated that they felt they had a good staff team and were well supervised and supported by the Manager and the Deputy. They confirmed that there were regular staff meetings and meaningful handovers between shifts. The Home has worked at improving its NVQ2 targets since the last inspection. The AQAA states that 5 members of staff have this qualification and the Manager said that 5 are working towards it and one member of staff wishes to work towards NVQ3. Three staff files were inspected. Generally these files were well organised and complete with the relevant records for recruitment, i.e. two references, CRB certificates, forms of identification, such as passports and driving licences, also application forms and contracts. However, in one file there was a photocopy of a CRB certificate and not the original. In another, there was only a copy of an undated reference and a reference from the previous Proprietor, neither of these issues were the responsibility of the present Proprietors. This was discussed with the Regional Manager who said a note Care Homes for Older People Page 21 of 28 would be put on these files. There was a Recommendation from the previous Inspection that overseas staff files containing copy references should be validated, but we are informed by the Operations Director “that senior managers travel to EU countries and interview staff personally before they undertake POVA first and CRB checks in the UK”. Training opportunities and records have improved since the last inspection, although there is still progress to be made. The most recent members of staff have completed induction training, but there were some gaps in training in First Aid, Infection Control and Food Hygiene, although kitchen staff had received the latter. There is now a training matrix in place and this showed evidence that eight staff had received training in Dementia in 2007, but there were gaps in training for some staff in Dealing with Challenging Behaviour, Palliative Care, Diversity in the Workplace and the Malnutrition Universal Screening Tool (MUST). In the course of discussion, information from the AQAA and the training matrix the Manager had identified gaps in her training to support the staff team to perform their jobs fully and that this was seen to as a barrier to improvement. At the time of the Inspection there appeared to be no members of staff with training in Person Centred Care Planning nor training in specific issues relating to residents needs, such as the Mental Capacity Act, Visual Impairment or the Affects of Strokes. All seven comment cards were positive about the care given by the staff team and one member of staff remarked: If the residents are happy, then I am happy. Care Homes for Older People Page 22 of 28 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 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 and staff are now benefiting from an improved management approach to the Home through regular supervision, appraisal of staff and better record keeping. However, further specific training opportunities for the Manager and the staff team; canvassing of the staff teams and healthcare professionals views; and attention to health and safety issues would further ensure that the Home is run in the best interests of residents. Evidence: The Manager was Registered with the Commission on 27th January 2009, up until which time she had been Acting Manager since the last inspection. She has worked in the Home eight years. In her role as Manager she is supported by a Deputy Manager and six Senior Carers. A Regional Manager from the Provider company was in attendance for part of the Inspection. The Manager had demonstrated to the Registration Team of the Commission that she used her management role and skills to direct and monitor staff, managing poor practice by working alongside staff members, using clear communication and discussion in regular supervision and staff meetings and dealing with issues as they occurred. This was confirmed by the three staff spoken with in private and in a relatives comment card: The Manageress is charming and always approachable if necessary. The Manager appears to be progressing well and is evidently working hard. There had been considerable improvement in record keeping, regular staff supervision, appraisals Care Homes for Older People Page 23 of 28 and basic staff training since the last inspection. The Manager is now qualified to deliver in-house staff training in Moving and Handling. However, the Manager has recognised that there are gaps in her training and that of the staff team, which is dealt with elsewhere in this Report (Standard 30), but she is confident that these issues will be addressed. The Home has a quality assurance system and a Report from October 2008 was seen, together with actions to be taken as a result of residents and relatives comments. However, this Report did not appear to canvass the views of healthcare professionals who visited the Home, nor the staff team. The Manager stated that the Home does not handle money on behalf of the residents. There is a Maintenance person who was now visiting the Home every day and maintenance records were seen to be up to date. A sample of records of fire alarm and fire fighting equipment testing, as well as Gas and Electrical servicing records were seen to be up to date. All, except new members of staff had received training in CosHH , but there were some gaps in training in Health and Safety (see elsewhere in this Report Standard 30). Accidents are reported and recorded. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes No Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 13 The Home must ensure that all staff, regardless of their role, are trained in adult protection and that this is regularly updated. 29/05/09 2 22 16 To further ensure that residents are safeguarded The Home should seek a 15/05/2009 professional assessment (Occupational Therapist) of the basin and chair used for hairdressing To ensure that this equipment meets the needs of the people living in the Home The Home must ensure that 29/05/09 the staff team have training opportunities to equip them with the skills to meet the specific changing needs of the people living in the Home. To ensure staff are trained to deliver person specific centred care 3 30 18 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 26 of 28 Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Consideration should be given to continuing to improve the person centred care plans, which must be drawn up with the involvement of the resident, recorded in a style accessible to the resident; agreed and signed by the resident and/or representative/advocate where possible and appropriate. Consideration should be given to seek advice on alternative continence products for beds for the comfort of residents. Consideration should be given to finding ways of residents having their hair dried in private and not in the dining room where they can be seen by visitors and other people living in the Home. Consideration should be given to replacing frayed and threadbare towels to promote the dignity of residents. Consideration should be given to finding some privacy for residents and their visitors without them having to go to their bedrooms. Consideration should be given to the appointment of a designated, trained activities organiser, in addition to the Manager, to promote a person centred programme of individual and group activities to maintain and develop individual skills and forge links with the community to further improve the quality of life of the people living in the Home. Consideration should be given to continuing to work to improve community links for people living in the Home. Where residents lack capacity the Home consideration should be given to facilitate access to available advocacy services in addition to financial/legal advocacy. Consideration should be given to improving the ramp for wheelchairs to the front door Consideration should be given to surveying the views of healthcare professionals who visit the Home by written questionnaires to further ensure that the Home is run in the best interests of the people who live there 2 3 8 10 4 5 10 10 6 12 7 8 13 17 9 10 20 33 Care Homes for Older People Page 27 of 28 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!