Care Home: Oakleigh

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What the care home does well Prospective residents have enough information to help them in their decision where to live and they can be confident that their needs will be assessed, before they move in, to ensure that the home is a suitable place for them to live. People can be confident that they receive safe health and personal care and their dignity is valued. One of the resident`s surveys said `Oakleigh is an excellent residential home & cares for its residents.` Another of these surveys commented `They (the staff) go that extra mile which turns alright care into something special.` People are safe from the risk of harm and they can be confident that any concerns they may have will be listened to and action will be taken in response to their concerns. One of the residents said that they knew how to make a complaint by saying `Yep! And I do!` People can be confident that they are cared for by kind and knowledgeable staff as their interaction was good with the residents and the majority of the staff training is up to date. What has improved since the last inspection? The requirement about activities has been met. A resident`s survey added that `There are far more activities available for the residents and regular visits from entertainers.` There is working progress to improve activities for those people who have difficulties with remembering. The requirement about staffing numbers has been met. We received positive comments within the surveys and from the staff we spoke with. We also saw that the residents were having their needs met in an unhurried and timely manner. What the care home could do better: Although there is working progress on the standard of the care plans, these must have more detailed guidance: this is to ensure that the residents are not placed at any risk; this is also to ensure that the staff provide informed and consistent care in areas such as caring for people with sudden emergency situations, memory impairment and neurological conditions. The care plans must be reviewed at least each month, if not sooner, to ensure that the care provided is meeting the current needs of the residents. Risk assessments must be carried out, to include the risk of malnutrition and risk of choking and how any identified risks are to be managed. We expect the home to improve the standard of risk assessments and the standard of care planning. The outside of the home could be tidier and must be free from `clutter` as we saw a number of items deposited alongside one of the garden paths, which made the area unsightly and potentially hazardous. One of the bathrooms, that residents were currently using, also had a small number of items deposited within the area, such as a cover for a commode, making this part of the home unwelcoming for any person who visits this area. We have advised the Manager that she should expand her current knowledge by gaining information from sources such as local agencies and from the Internet with particular regard to risk assessments and care planning. We have made a requirement to ensure that all the required information is obtained before any person is allowed to work at the home. This is to ensure that none of the people are placed at risk of harm from unsuitable staff. We have made a requirement for a report to be made of a monthly visit, made by the registered provider, and a copy of this is to be kept at the home for inspection purposes. This report must provide evidence that the standards of care and standards of the service provided are reviewed, as part of the quality assurance of the home. We have made a requirement for staff to attend training in the control of hazardous substances. This is to ensure that no resident comes to harm because of their unnecessary contact with such hazardous substances. Key inspection report Care homes for older people Name: Address: Oakleigh 22 Great North Road Alconbury Weston, Huntingdon Cambridgeshire PE28 4JR     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: Elaine Boismier     Date: 0 9 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: Oakleigh 22 Great North Road Alconbury Weston, Huntingdon Cambridgeshire PE28 4JR 01480890248 01480896308 harriscelia@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Styllianakis Styllis care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Oakleigh provides accommodation, care, and support for up to 27 older people, including some who might have a degree of dementia. The home is in the small village of Alconbury Weston, which has a shop, public house and church, and is within easy reach of Huntingdon and Peterborough. The building was originally a private bungalow but it has been extended a number of times and now offers accommodation in 24 rooms on the ground floor, and one room on the first floor which is accessed by stairs or a stair lift. All 25 rooms have en-suite facilities; the two double rooms are currently used for single occupancy. The building surrounds a central courtyard; residents have a choice of communal accommodation, including three lounges and a dining room and there is access to the gardens that surround the house. Current fees range from £555 to £655 with additional costs to include those for hairdressing, newspapers and chiropody. Further information about the fees can be obtained from the home. A copy Care Homes for Older People Page 4 of 31 Over 65 2 27 0 0 Brief description of the care home of the inspection report can be obtained, on request, from the home or via our website at www.cqc.org.uk 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: We, The Care Quality Commission (CQC), carried out this unannounced key inspection (KI), by two Inspectors, between 10:10 and 14:50, taking 4 hours and forty minutes to complete. Before the inspection we received surveys from six of the residents and three from the staff. We also received surveys from two health care professionals. We looked at information that we have received about the home since our last key unannounced inspection that took place in June 2008 and since we completed an Annual Service Review (ASR) of the home, in May 2009. (An ASR is a review of the information we have received about the home since the previous KI). During this inspection we looked around the premises and looked at some of the documentation. We case tracked three of the residents. Case tracking means speaking with some of the residents and visiting their rooms and speaking with some of the staff Care Homes for Older People Page 6 of 31 who were looking after them. We compared what we saw and heard with the peoples individual records. We also spoke with and watched other people who were not part of our case tracking. We spoke also to some of the other staff, including the Manager, and we also were able to speak with a health care professional, who was visiting the home. For the purpose of this inspection report people who live at the home are referred to as people, person, resident or residents. 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: Although there is working progress on the standard of the care plans, these must have more detailed guidance: this is to ensure that the residents are not placed at any risk; this is also to ensure that the staff provide informed and consistent care in areas such as caring for people with sudden emergency situations, memory impairment and neurological conditions. The care plans must be reviewed at least each month, if not sooner, to ensure that the care provided is meeting the current needs of the residents. Risk assessments must be carried out, to include the risk of malnutrition and risk of choking and how any identified risks are to be managed. We expect the home to improve the standard of risk assessments and the standard of care planning. The outside of the home could be tidier and must be free from clutter as we saw a number of items deposited alongside one of the garden paths, which made the area unsightly and potentially hazardous. One of the bathrooms, that residents were currently using, also had a small number of items deposited within the area, such as a cover for a commode, making this part of the home unwelcoming for any person who visits this area. We have advised the Manager that she should expand her current knowledge by gaining information from sources such as local agencies and from the Internet with Care Homes for Older People Page 8 of 31 particular regard to risk assessments and care planning. We have made a requirement to ensure that all the required information is obtained before any person is allowed to work at the home. This is to ensure that none of the people are placed at risk of harm from unsuitable staff. We have made a requirement for a report to be made of a monthly visit, made by the registered provider, and a copy of this is to be kept at the home for inspection purposes. This report must provide evidence that the standards of care and standards of the service provided are reviewed, as part of the quality assurance of the home. We have made a requirement for staff to attend training in the control of hazardous substances. This is to ensure that no resident comes to harm because of their unnecessary contact with such hazardous substances. 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. Prospective residents have enough information to help them in their decision where to live and they can be confident that their needs will be assessed, before they move in, to ensure that the home is a suitable place for them to live. Evidence: Four of the six residents surveys said that they had enough information about the home before they moved in; one of these surveys said that this was not the case and the remaining survey was not completed within this section of the questionnaire. We looked at the current Service Users Guide and this had detailed information about the services provided and the information included the current range of fees and any additional costs. As part of our case tracking we looked at three of the residents pre-admission assessments and we spoke with the Manager: people have their needs assessed before they move in and information about their social history, such as place of birth, Care Homes for Older People Page 11 of 31 Evidence: work and relationships, was provided by the residents families. 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 can be confident that they receive safe health and personal care and their dignity is valued. People cannot be totally confident that they are fully protected due to the current standard of record keeping. Evidence: As part of our case tracking we looked at three of the residents care plans and we spoke with them, visited their rooms and we spoke with the staff, including the Manager. Evidence indicated that there is a working progress to improve the current standard of the care plans. We found that there was information about the peoples life histories which provided a sense of the uniqueness of the individual and we found that there was a new care plan for a persons changed of condition. We found, however, that there was insufficient detail to tell us how certain conditions may effect the person, such as memory impairment and conditions of the nervous system. We also noted, from examination of incident forms, kept in one of the three care files, that there was no care plan to guide staff in how to manage a person who had a recorded history of becoming suddenly unwell. We noted that, however, the Care Homes for Older People Page 13 of 31 Evidence: incident records provided evidence that the staff managed the situation, to ensure the persons health and safety were protected. We also noted that for one person they had a record of unintentional weight loss and they also had a care plan for choking although we could find no risk assessments for nutrition or for the risk of choking. We discussed our findings with the Manager and she agreed with what we had found. We saw that there were risk assessments for moving and handling and falls. Where possible the resident signed their care plans, indicating that they had consented to the care provided to them. Not all of the care plans were actively reviewed each month: for example the new care plans, for one of the three residents, was implemented on 1st October 2009 but these had not been reviewed since. The Manager stated that there is an ongoing review and we found these were of a tick box review, such as the persons ability to carry out their personal care. Those staff we spoke with were able to tell us the needs of the residents and, according to them and the Manager, any agency staff that the home uses are familiar with the home and the residents individual needs. When we spoke with the three residents the information provided in the care plans reflected, on the whole, with what we saw and heard, during these discussions. We spoke with the Manager about the importance of maintaining a good standard of record keeping: by ensuring that risk assessments are carried out and reviewed; that the needs of the person are more clearly identified as to how any conditions, such as memory impairment, may effect the day-to day-life of the resident with their activities of daily living. We expect the home to continue to work and develop the standard of care plans and risk assessments. Both of the health care professional surveys said they considered the home provided the residents with safe and dignified care and that they had no concerns about the standard of health and personal care provided. One of these surveys added, Oakleigh is an excellent residential home & cares for its residents. All of the six residents surveys said that the person always or usually received the care, including medical care, and support, that they needed. One of these surveys added, They (the staff) go that extra mile which turns alright care into something special. We spoke with a visiting health care professional and they considered the home provided very good care to the residents. We saw, from our case tracking and from observing other people who were not part of our case tracking, that the standard of their personal care was good: they were wearing co-ordinated clothes and their hair and finger nails were clean. Care Homes for Older People Page 14 of 31 Evidence: We saw a member of the staff helping a resident with their personal care in a manner that fostered the residents independence. We saw, as part of our case tracking, that one of the people wanted to maintain their level of independence, with their personal care, and this was also recorded within their associated care plan. We saw, from the three residents care plans and from talking with the visiting health care professional, that the residents have access to a range of health care professionals to include advice from out-of -hours general practitioner services, the residents own doctors, the district nursing services, a speech and language therapist, chiropody services and a Parkinsons disease specialist nurse. We saw that people are weighed most months and that action has been taken for someone who has had significant unintentional weight loss since May 2008. We visited the person and they were aware of their loss of weight; we found that they were not unduly underweight, from our visual observation. We also saw, from the persons care records and from information provided by the staff, that the person was prescribed dietary supplements. The homes catering staff were also aware of another persons unintentional weight loss and a dietary supplement, to sprinkle on the persons food, was available (the staff were waiting for instructions from the district nursing service about how this was to be administered). According to the Manager the home has not accessed a dietician for advice for any person with unintentional weight loss: we have strongly advised the Manager to make contact with this specialist health care professional. As part of our case tracking we looked at the three peoples medication records (MARS) and we found, on the whole, that these were satisfactory. Although there was no care plan to tell staff how to give a certain medication apart from other medications, we saw this was accurately recorded on the MARS. In addition the staff told us that this was how the medication was actually given to the resident. We saw that antibiotic medication was recorded as being given three times during the day time hours: we advised the Manager that antibiotic medication should be given with longer intervals to ensure that the blood levels of the medication are at the optimum level. We looked at staff training and competencies, for the safe management of medication. Medication training records were seen and the staff responsible for giving medication were spoken to. We saw that medication training was attended, for example, by the Manager and her deputy, in 2008 and a new member of staff had attended medication training in 2009: this also included having their competencies checked by the Manager Care Homes for Older People Page 15 of 31 Evidence: when this member of staff was administering medication. The visiting health care professional informed us that any person who has diabetes (mellitus) has their blood sugar levels monitored by the district nurses and these nurses are responsible in giving the injections of insulin to those residents that this medication is prescribed for. We looked at the storage of medication. The district nurses storage cupboard (for prescribed dressings etc) was seen and it was confirmed, by the visiting health care professional, that this is locked, when left unattended and the keys are kept by the home. We saw, within one of the three residents care plans, an incident where the person had easy access to their creams as these were left in their room. When we visited this persons room we found that there were no creams left in the persons room: all the creams, we noted, were locked away, in the medication room. Temperatures of where the medication is kept were recorded at least twice a day and these were satisfactory and ensured that the quality of the medication was preserved. People who we spoke with said that the staff were very good and we saw that the staff interacted with the residents in a respectable manner. One of the residents surveys added The staff are extremely caring and thoughtful towards the residents... Care Homes for Older People Page 16 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 can be confident that they have opportunities to live an improved social life. Evidence: A requirement was made, following our last KI, for suitable activities to be provided. We said The activities organised by the home must be expanded to include activities appropriate for users abilities and conditions and include some activities appropriate for people with dementia. The timescale for this was to be achieved by 30th August 2008. Within the residents surveys and within the staff surveys we received varied comments about the range of activities provided; four of the six residents surveys said that the home always or usually provided suitable activities that the person could take part in; one of the surveys said that sometimes there were such activities with the remaining survey stating that this was never the case. One of these surveys added, that the home could be better to Provide more entertainment. Provide outings whereas another of these surveys said that, within the last year, There are far more activities available for the residents and regular visits from entertainers. In one of the staff surveys we read , that the home could do better to provide More activities for residents and to provide Trips out for small groups. We spoke with the staff, including the Manager and we looked at the record of Care Homes for Older People Page 17 of 31 Evidence: activities. Information provided from these sources indicated that there has been some improvement in the range and frequency of activities, to include crafts and arts, quizzes and church services held at the home. The Manager said that there is working progress in developing activities for people who have difficulties with their memory, such as reminiscing therapies. According to the Manager some of the residents take part in folding napkins for the dining tables and some of the people have made cards for Christmas. One of the members of staff considered that some of the residents should have been encouraged in helping with decorating the Christmas trees; we discussed this view with the Manager for it to be considered as a template to look at ways in how day-to-day meaningful activities could be offered to the residents. Both of the surveys from the health care professionals said that home enabled the residents to live the life that they chose to. As part of our case tracking we visited those peoples rooms and we saw there were personal pictures, ornaments and photographs. We saw the visitors record book and this told us that people can receive their guests without restrictions. From our discussion with those people who we case tracked, we were told that they contact with their families. All of the six residents surveys said they always or usually liked their meals. One of these surveys added that the home does well as the Meals are good. We looked at a sample of the menus and we saw that people were offered a choice at breakfast time to include eggs and had a choice at tea time to include fruit and yogurts. For the main meal there was a record of a range of food such as gammon, traditional English roasts and a variety of vegetables such as carrots and broccoli. Following the main meal and following tea, to include sandwiches, people had a choice of dessert such as stewed fruit, crumbles, cakes, yogurts and fruit. The staff, including the catering staff, were aware of any person who needed a special diet, to include soft or pureed food and people who had diabetes (mellitus). 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 are safe from the risk of harm and they can be confident that any concerns they may have will be listened to and action will be taken in response to their concerns. Evidence: All of the surveys, with the exception of one residents survey, said that the person knew how to make a formal complaint if they so wished. All of the residents surveys said that the person knew who to speak to if they were unhappy about something and considered that the staff listened and acted on what they said to the staff. One person added that Yes definitely (the staff did this). As part of our case tracking one of the people said that they knew who to speak to if they were unhappy about something, saying Yep! And I do! The person told us what action the home had taken, in response to a concern they had had, and they were satisfied with how the home responded to their concern. We looked at the record of complaints and the home has received no complaints since 2006. We have received no complaints about the home since our last inspection of the home. In August 2009 the home was subjected to a safeguarding investigation during which it was considered the home co-operated with this investigation. Care Homes for Older People Page 19 of 31 Evidence: We spoke with three staff who told us that they had attended training in safeguarding awareness. They were competent in their knowledge of safeguarding, telling us what would constitute abuse and what they would do if they suspected or witnessed any such abuse. Information, such as telephone numbers, about key contacts, such as the police and the lead agency, the community services -previously known as social services- was not freely available in the reception area of the home or on the noticeboard in the staff room. The Manager said that she would provide this information, to be more easily accessible for any person visiting or working at the home. 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 live in a clean and comfortable home that could be a more pleasant place to live in. Evidence: The home is on two levels although currently the downstairs was solely occupied. Access to the first floor is via a stair lift and we saw that a service check was in date for this. Access in and out of the home was safe as there are portable ramps available. We noted most areas were comfortable and safe for people who live there. Other areas where these did not meet the same standard included a bathroom: for example there was a cover for a commode, propped against an external wall and, by the far side of the bath, there were toilet frames. The bath itself, although clean was stained: the Manager stated arrangements are in place for the bath to be upgraded during 2010. We looked around the garden area and found all areas to be accessible. The majority of the garden areas were tidy and we saw that there was a bird feeder outside a residents window for them to watch the wildlife. We pointed out an area, accessible by the residents, where articles such as a toilet seat and cover, a used paint tray, a damaged portable heater, two walking frames, rods for unblocking drains and an artificial Christmas tree, were deposited on a gravel area by the garden path located outside the laundry room. The Manager agreed that this was unsightly and potentially Care Homes for Older People Page 21 of 31 Evidence: hazardous. She stated that she would remind the staff that this was unacceptable practice. We saw, when visiting one of the bathrooms, that a record is kept of when a person has a bath and the temperature of their bath water was also recorded: these temperatures were delivered at a safe level of no more than 43 degrees centigrade. All of the residents surveys said that the home was always or usually clean and fresh. Additional comments included that the home does well with the cleanliness of the residents bedding and also the Standards are very good. Hygiene & cleanliness (are) excellent. Another survey added, that the homes environment could be better...to become a no-smoking environment. There are often full ashtrays in the garden left from (the) staff breaks. We saw that there were two ashtrays; one contained seventeen cigarette ends and the other had nine cigarette ends. The Manager said that these ashtrays were emptied after each shift. The staff told us what they would do if there was any person who had acquired an infection, such as clostridium difficle and methicillin-resistant staphylococcus aureus, commonly known as MRSA, and we were satisfied with the staffs knowledge. We have received no notifications that any person has acquired such infections since our last inspection. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they are cared for by kind and knowledgeable staff although they cannot be completely confident that the current recruitment procedures will fully protect them from the risk of harm from unsuitable staff. Evidence: Following our last KI we made a requirement that said The staff number per shift must be increased to ensure that users needs are met at all times, including peak times and weekends. The timescale for this requirement to be met was by the 30th August 2008. All of the three staff surveys and five of the six residents surveys said that there was always or usually enough staff on duty. The remaining residents survey said that this was sometimes the case, adding that the home could do better to ensure that there was Prompter response to bell pull (sometimes someone comes immediately, turns off the bell and says theyll come back later). We timed the response of the staff to a call bell and this was less than ten seconds duration. We also watched how the staff were working and we found that the residents were being supported by the staff in an unhurried manner. The staff who we spoke with considered that there was usually enough staff on duty and that any agency supplied to the home were knowledgeable of the residents individual needs. The staff also told us that there is a good team of staff which works well and that communication is good within the staff group. A Care Homes for Older People Page 23 of 31 Evidence: visiting health professional told us, unsolicited, that the communication at staff level is good. This tells us that the residents needs are currently met in a timely manner and currently in a consistent way. This requirement has been met. According to the Manager the home has 50 of care staff with the National Vocational Qualification in care, level 2 or equivalent, with two other staff working towards this desirable qualification. In August 2009 the home was subjected to a safeguarding investigation in which it was found that the home had, at least on this occasion, not followed correct recruitment procedures, to ensure that the residents were being cared for by suitable staff. We looked at two of the staff recruitment files and we found that some, but not all, of the required information was contained in both of these files: for the first file we saw all the required information was available, such as a clear criminal bureau check and clear vetting and barring lists, with the exception of a photograph; for the second file we found two written references and the Manager found a third written reference. The person started working at the home on the 17th October 2009: one of the written references was dated 2008; another was undated and the third written reference was date 23rd October 2009 i.e. 12 days after the person started to work at the home. We discussed this issue with the Manager who agreed with our findings. As a result of the evidence, found from the safeguarding meeting and from this inspection, we have made a requirement about recruitment of staff. Comments, about the staff were received in some of the residents surveys, such as The staff are extremely caring and thoughtful towards the residents and show a good knowledge of the sort of care required for each resident. All of the three staff surveys said that the person was satisfied with their induction and ongoing training and felt that it enabled the person to do their job and meet the needs of the residents. Both of the health care professional surveys considered that the staff had the right skills and experience to meet the residents needs. We examined the staff training records and we spoke with the staff: evidence indicated that the staff have access to a wide range of training opportunities to include health and safety matters and medication training. 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 live in a generally safe place that is managed to a satisfactory standard. Evidence: The Registered Manager has been working at the home for almost ten years and has been the Registered Manager since 2002. She is supported by a deputy manager, care staff and ancillary staff to include catering staff, maintenance staff and domestic staff. The Managers training records, for 2008 and 2009, indicates that she has attended training in the management of medication (2008) the Mental Capacity Act 2005 (2009) and health and safety mandatory training, such as fire safety and moving and handling, all attended during 2009. We offered advice where she could gain information to expand her existing knowledge in areas such as risk assessments and care planning. Both of the requirements have been met, indicating that there has been an improved standard of service within activities and with staffing numbers. Care Homes for Older People Page 25 of 31 Evidence: According to the Manager the home is visited three to four times each week by the registered owner although currently no monthly reports are made by the person to provide evidence of their quality review processes. We have made a requirement about this so that we can assess how the registered owner is making sure that the residents care and the service provided to them is reviewed as part of the homes quality assurance. The Manager explained that no surveys have been sent out for 2009, to ask people about their views of the home, although she explained that arrangements are in place for these to be issued in 2010. Internal audits include medication audits, carried out by the deputy manager and there is a working progress to improve the standard of recorded keeping, as recorded in Standard 7 of this inspection report. The Service Users Guide told us that the home does not keep any of the peoples personal monies for safe-keeping and the Manager confirmed that this was still the case. The staff we spoke with said that they had attended training in safe moving and handling, fire safety, first aid and we saw a fire drill had been carried out in September 2009 for all of the new staff to attend. We saw staff training records, including certificates of attendance, for first aid, safe moving and handling and fire safety; all of these were in date. Tests for fire alarms were recorded each week and emergency lights were tested each month. On the day we were at the home the fire alarm was tested and we noted, with the Manager, that a bathroom door was not fully closing: she said that she would take action to improve this area of fire safety. Service inspections had been carried out on the hoists and fire detection and fire fighting equipment and records of these indicated that these safety inspections were in date. During the tour of the premises we found, in an unlocked cupboard, in the unlocked laundry room, three bottles of hazardous cleaning agents: action was immediately taken, by the home, to remove these to safer place. The staff we spoke with said that they had not attended training in the Control of Substances Hazardous to Health (COSHH). We have made a requirement about this. We saw a report, dated the 26th November 2009, made by the Environment Health Officer, who had inspected the management of the food within the home: they Care Homes for Older People Page 26 of 31 Evidence: reported that the home had Good standards. 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 29 19 Full and satisfactory information must be obtained about any person before they are allowed to work at the home. This is to ensure that the residents are safe and only cared for by suitable staff. 10/01/2010 2 33 26 A report must be made of a monthly visit made to the home by the registered provider and a copy of this to be kept at the home. This is to provide evidence that the standard of care and standard of service provided to residents is reviewed as part of the homes quality assurance and that such services are of an acceptable standard. 31/01/2010 3 38 18 Staff must be trained in the control of substances hazardous to health (COSHH). 31/03/2010 Care Homes for Older People Page 29 of 31 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 This is to ensure that staff are trained and competent to protect any resident from the risk of harm from contact with such substances. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 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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