Care Home: Ogilvy Court

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What the care home does well There has been a relatively smooth transition when the previous manager left the home after she had been promoted and when the new manager was appointed. The process was managed well to create as little disruption as possible. The quality of the service has not significantly changed but there are areas that must be addressed to ensure that the quality of the service continues to be good. People who want to use the service that the home provides receive up to date information and are supported by the home to make an informed decision about moving into the home. Once they moved into the home they are offered a contract that details their obligations and rights as residents. In addition to a preadmission assessment of prospective residents` needs that the home carries out to determine if the residents` needs will be met in the home, there are processes in place to fully assess the needs of residents at the point of admission to the home. The admission process looks not only at the physical needs of residents, but also looks at the social, spiritual and recreational needs of residents. The home has a computerised system for the management of the home`s records, including the care records. This has the advantages that all records are kept in a systematic way, are legible and easily understood, and are easily accessible to those who have authorisation to see them. There are some very good care records in the home that have been completed by staff with the involvement of residents or their representatives. The wishes and instructions of residents or of their representatives about end of life care are identified during admission or shortly after admission and care plans are drawn up to address these areas. Appropriate risk assessments are carried out and recorded to make sure that the freedom of residents are not being curtailed unnecessarily and to manage risks while promoting the safety and rights of residents. The home has systems in place to monitor the quality of the service and is proactive enough to take actions to address areas where improvement is required. It was able to demonstrate that it takes the health and safety of residents, visitors and staff seriously by ensuring that all health and safety checks and the maintenance of equipment in the home, are carried out in a timely manner. What has improved since the last inspection? The care plans of some residents who had behavioural needs were clear about the type of behaviours that they exhibited and the action to take to manage these. These were particularly clear for residents who were having one to one care and support. One of the six care plans seen was however, still not very clear about this area of care for the resident. The condition of residents who are acutely ill are monitored by nursing and care staff and care plans are in place to address these needs. This ensures that any deterioration is noted promptly and appropriate action can then be taken. The clothes of residents are appropriately ironed and stored in residents` bedrooms to provide a high standard of ironing and laundry. As a result residents presented well, with clothes that looked well ironed and in good condition. What the care home could do better: The care plans of many residents were good and comprehensive. A few were not that good and might not addressed the needs of residents in a comprehensive manner. Staff must ensure that all care plans fully addressed the needs of residents and that the care plans and risk assessments are reviewed and amended as required. We observed that some of the interactions and engagements of a few members of staff with residents were not positive. The home must either by the provision of training in dementia care or otherwise ensure that staff fully understand the type of engagement and interaction that is positive for residents and demonstrate that by their action. When we visited on the first day of the inspection a resident did not have a care plan addressing the management of a pressure ulcer. As a result we were not entirely sure how staff were managing the pressure ulcer. This was addressed by the next day, but staff must be proactive and take action as required to address the needs of residents in the care records. The amount of all medicines that is carried forward after a medicines cycle must be carried over to provide an audit trail. All medicines must also be administered as prescribed to make sure that the amount that remains, balances with the amount of the medicines that has been received and the number of times that the medicines have been administered. The home must ensure that there is a supply of all the ingredients that are required to prepare the meals that are on the menu to make sure that residents are offered real choices for their meals. The system must be robustly managed to evidence how the choices of residents are being met. The recruitment of staff could have been more robust in terms of ensuring that all members of staff have all the necessary checks including, suitable references before they are offered employment at the home. Staff must as far as possible have all the updates in mandatory training to make sure that they continue to be skilled and competent to do their jobs. In depth training must be provided to nursing and care staff in dementia care for them to fully understand what is good dementia care. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ogilvy Court 13-23 The Drive Wembley Park Wembley Middlesex HA9 9EF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ram Sooriah     Date: 1 9 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Ogilvy Court 13-23 The Drive Wembley Park Wembley Middlesex HA9 9EF 02089085311 02089085807 manager.ogilvycourt@careuk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Care UK care home 57 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 57 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE Mental Disorder, excluding learning disability or dementia - Code MD Learning disability - Code LD Date of last inspection 57 57 57 Over 65 0 0 0 Care Homes for Older People Page 4 of 34 Brief description of the care home Ogilvy Court is a care home, which belongs to Care UK. It is situated in The Drive, which is a small road off the main and busy Forty Lane. It is easily accessible by buses, which pass on the main road and is about 5-10 minutes walk from local shops and local amenities. More extensive shopping facilities are found in Wembley, which is a short bus ride away. The home has a large car park in the front, which can easily accommodate about fifteen cars. Ogilvy Court is a care home that specialises in the provision of nursing care for elderly residents with mental health needs or with dementia care needs and for residents with a learning disability. It is purpose built and provides accommodation in mostly single rooms with en-suite facilities. It has one double bedroom also with en-suite facilities. There are three units in the home. Ivy and Dahlia are on the ground floor and Bluebell is on the first floor. Ivy accommodates thirteen residents with a learning disability, Dahlia accommodates fifteen male elderly residents with mental health/dementia care needs and Bluebell accommodates twentynine female elderly residents with mental health/dementia care needs. The management structure in the home consists of the manager and three unit managers. The manager is closely supported by an operations manager. The home provides all the other necessary ancillary services such as laundry, cleaning and catering. The home charges 616-650 pounds weekly for residents with mental health/dementia care needs and 800-1000 for residents with learning disability care needs, depending on the needs of the residents. The majority of the residents are publicly funded and they do not pay a top-up. Private residents should make enquiries to the home for information about fees. At the time of the inspection, there were fifty-two residents in the home. Care Homes for Older People Page 5 of 34 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: This report contains the findings of a key unannounced inspection that took place on Thursday 18th June from 10:30-19:20 and Friday 19th June from 12:30-16:00. The last key inspection took place on 7th August 2007 when the service was rated a 2 star service. Since then we have been monitoring the service from notifications about things that have happened in the home and about which the home is legally obliged to inform us. As part of the monitoring of the service we also received feedback from healthcare and social professionals about the service. On the 22nd September 2008 we carried out an annual review of the service based on the information that we had. A copy of this report is available from the service or from the Commmission on request. Since the last key inspection, the registered manager at the time, Michelle Sampang has been promoted and Rosalyn Maxwell has been appointed as manager. The latter is now in the process of being registered. Care Homes for Older People Page 6 of 34 During the course of this inspection we toured part of the premises, spoke to at least three visitors, eight residents and ten members of staff. We also looked at a sample of records that the home keeps and at some personnel and training records. The manager completed an Annual Quality Assurance Assessment (AQAA) as it is legally obliged to. The AQAA has generally been well completed and has been used to plan the inspection and where possible to inform the report. We would like to thank the residents and visitors who kindly spoke to us to tell us about the service and we are grateful to the operations manager and the manager and all her staff for their support and cooperation during the inspection. What the care home does well: What has improved since the last inspection? The care plans of some residents who had behavioural needs were clear about the type of behaviours that they exhibited and the action to take to manage these. These were particularly clear for residents who were having one to one care and support. One of the six care plans seen was however, still not very clear about this area of care for the resident. The condition of residents who are acutely ill are monitored by nursing and care staff and care plans are in place to address these needs. This ensures that any deterioration is noted promptly and appropriate action can then be taken. Care Homes for Older People Page 8 of 34 The clothes of residents are appropriately ironed and stored in residents bedrooms to provide a high standard of ironing and laundry. As a result residents presented well, with clothes that looked well ironed and in good condition. 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 set out 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 34 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 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has all the necessary information to offer to people for them to make an informed decision about using the service. The needs of all prospective residents are assessed before they are offered a place in the home, to make sure that the home will be able to meet their needs. Evidence: The service users guide and the statement of purpose were available in the foyer of the home and we noted that these documents have been dated and reviewed. The manager stated that all residents are offered a copy of the SUG that they can refer to to find information about the service that the home provides. We found preadmission assessments of the needs of residents when we looked at the care records of two newly admitted residents. These were completed by the manager when she visited the residents prior to their admission to the home. The format of the preadmission assessments contained prompts to cover most of the needs of residents Care Homes for Older People Page 11 of 34 Evidence: and were appropriately completed. The care plans of local authorities or discharge letters from hospital were also available in residents care records to provide additional information about the needs of residents. Residents that are admitted to the home are mostly referred to the home by local authorities. This is confirmed by the information in the AQAA that shows that the overwhelming majority are funded by a local authority. We noted that in some cases, choices of people about moving into the home seemed restricted because of the contract of the local authority with the home or because the needs of residents cannot be met within another service, as the home does offer a specialised service for some clients. However some people did confirmed that they had the opportunity to choose the care home. Relatives of two residents that we spoke to, said that they were given a number of care homes to choose from, and that they visited a few of them, before choosing Ogilvy Court. The AQAA states that all residents are given a contract or statement of terms and conditions to inform them of their obligations and rights while living in the home. We checked the records of two newly admitted residents and noted that a contract was in place for one resident and that a contract has been sent to the representative of the other resident to be signed and returned to the home. Care Homes for Older People Page 12 of 34 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. Some care plans were very good but a few did not address the needs of residents in a comprehensive manner. Residents generally receive the care and support that they require to meet their healthcare needs. The level of engagement with residents at times fell short of the expected standard. A few areas were noted with the management of medicines that need improving to fully ensure the safety of residents. End of life care of residents is appropriately addressed in the care records and staff have the necessary knowledge and skills to meet the end of life care of the residents that the home accommodates. Evidence: We looked at the care records of six residents to find out whether residents receive the care and support that they require and whether the care plans accurately reflect the care that the residents receive. The home keeps most of its care records in a computerised format. There was also a hard file for each resident where hand written records such as consent forms, care plans and risk assessments were kept. These Care Homes for Older People Page 13 of 34 Evidence: generally were care records that did not have a format on the computer and records where residents or their representatives have signed to show that they have agreed to care plans and risk assessments. The assessments of the needs of residents were both in hard format and on the computer. These generally describe the individual needs of residents in sufficient detail to identify the needs of the residents and areas where they needed care and support. We however noted that one of the six care records did not not contain a needs assessment that was fully completed. The standards of care plans varied from unit to unit. We were able to see comprehensive care plans and some that were not so comprehensive. For example on the Bluebell unit we noted that a residents care plan about their behaviour, clearly identified the behaviour and the action to take when the resident exhibited the said behaviour. On another unit the care plan about the behaviour of a resident was not so clear. We found that risk assessments were in place when there were limitations on the freedom and rights of residents such as when bed rails were used. It was also positive to note that staff have considered issues about the capacity of residents to make decisions and have recorded the areas where residents were able to make choices. Residents who received one to one care and support because of their needs had clear care plans and risk assessments detailing their behaviour and the reasons for them to have one to one care. This is good practice. Care plans were reviewed monthly but a few plans were not. A few were also not updated with changes in residents needs. One resident needed thickened fluid but this was not addressed in the care records. The same resident had lost weight and this was also not addressed in a care record although there was some evidence that staff were taking action to manage the weight loss. One resident had a recurrent pressure ulcer and there were no care plan in place when we first looked at the care records although one was later written. The care plans and risk assessments are discussed and agreed with residents or with their representatives. The visitors who spoke to us during the inspection told us that members of staff discuss the care of the residents with them. We looked at the care plans in the hard folder to find out if residents or their representatives have agreed to the care plans. We noted that at least one of the care plans had not been agreed with the relatives of a resident or their relatives as there were no signatures to evidence Care Homes for Older People Page 14 of 34 Evidence: this. We observed interaction of members of staff with residents by spending some time in the communal areas. Some interactions were good but a few were not so good. In some cases staff sat with residents and talked to them in an equal and respectful manner and asked them about their choices. In a few cases that we observed we noted that staff did not always tell residents when they were doing something to the residents. We observed staff standing and talking to residents and on some occasions also standing and feeding residents, residents being told to do things rather than being supported and encouraged to do things and one resident was touched by a member of staff while they were sleeping that prompted them to wake up with a jump. We found that the radio and television were on at the same time in the same communal area and that modern music was being played. A few members of staff did not call residents by their preferred names and called them by their first name and with the title Mister. Feedback from trained nurses and visitors confirmed that there were some very good care staff and some that were not so good in terms of their attitudes and the quality of the care and support that they give to residents. Residents presented as appropriately dressed and with a good standard of personal care. The clothes of residents were appropriately ironed and residents were groomed or shaved as required. The manager stated that she has provided more hours for staff to iron residents clothes as previously this was an area that needed improving. While observing residents we observed a resident spilling some tea on them because they were offered a beaker of tea filled right to the brim. In addition, the resident needed to be fed and the thickener that had been added to the tea had not mixed appropriately. On the first day of the inspection we noted that one resident on Ivy unit had a pressure ulcer. We did not find a care plan in place and there were no photographs or wound mapping. The repositioning regime was not identified for that resident although there was evidence that staff knew that the resident should not sit all day in the wheelchair. We observed that the resident was helped to bed during the course of the day then sat again in their chair for meals, to reduce the amount of time that they sat in their wheelchair. We also noted that there was pressure equipment in place to provide pressure relief. The pressure ulcer was a recurrent ulcer and the repositioning regime would have considered the steps to take to prevent the pressure ulcer from recurring. This issue was addressed on the second day of the inspection. Care Homes for Older People Page 15 of 34 Evidence: Medicines were inspected on Dahlia and Bluebell units. The standard of medicines management was on the whole good with systems in place for auditing and quality monitoring. All staff who administer medicines have yearly competency assessment with records available to evidence this. The home uses the Boots system to manage medicines and receive medicines mostly from Boots, but staff reported some delay in getting new medicines that are prescribed in between the 28 days cycles. For example it took 2 days to deliver the antibiotics that had been prescribed for a resident. Staff said that they have already addressed this issue as they now use the local chemist to get medicines that are prescribed in between the medicines cycle. During the last inspection we noted that residents who had difficulty swallowing had medicines that were being given to residents in their meals. We were informed that residents no longer have their tablets with their pureed meals. We however noted that a resident who had a swallowing problem and was on pureed diet, was still being given tablets. We were not sure how safe it was for the resident to take tablets when they could not take solids. We suggested that this should be clarified when residents have their swallowing assessment. The clinical rooms were tidy and clean and the temperature was kept constant by air conditioning. Medicines administration records(MAR) charts were kept in good order and were on the whole clear but, the instructions for the administration of topical medicines including creams and ointments were not always that clear about the location to apply these medicines. One medicine did not seemed to have been administered as prescribed as we noted that there was still some left in the bottle when there should not have been any left if we calculate the amount that has been given from the number of times that it has been given and compare that with the amount that has been supplied and the date when the bottle was opened. We noted that the amount of a few medicines, particularly those that were to be administered when required, were not carried forward when a new MAR chart was started. As a result it was difficult to fully audit the amount of the medicines that should be in place at a given time. The date of opening of medicines was recorded on the container to monitor the date of expiry and we also noted that residents who were acutely ill and were on antibiotics had a care plan in place. The care records of a resident who had not been well showed that their condition was Care Homes for Older People Page 16 of 34 Evidence: being monitored by regular vital signs observation. The home is commended for progress in this area. The home has an end of life questionnaire that is given to residents representatives to fill in when residents are admitted to the home. These identify the wishes and instructions of residents about end of life care and the funeral arrangements that might have been made. On the basis of the findings of the questionnaires, care plans are then drawn to address the individual need of each resident. This is an area that the home does well. The Commission is notified of all deaths that happen in the home and from the notifications, we note that the home manages the end of life care of residents in an appropriate manner. Care Homes for Older People Page 17 of 34 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. The home ensures that residents receive appropriate recreational and social activities to enhance their lifestyles. The meals that are provided are nutritious and varied but at times do not always match the choices and tastes of residents. Evidence: The social and recreational needs of residents are recorded in a life history and a social care assessment. The life history sheet is given to the relatives of residents to complete and when returned are placed in residents care records. This was well completed and contained good information about the needs of residents but as the form is not loaded on the computer care file (by scanning or otherwise) of residents, which seems to be the main working file, the life history of residents seemed a little detached from the rest of the care of residents. The home has four activities coordinators. Some work full time and work some parttime, but there is at least once activities coordinator that is attached to each unit. The activities coordinator prepares an activity programme for the unit that they are responsible for. In addition to activities being planned for each unit there are also activities when all the residents that live in the home can join in. Care Homes for Older People Page 18 of 34 Evidence: some units were better at the provision of activities than others. In the Ivy unit residents were engaged in doing something or taking part in doing something such as drawing, puzzles or board games. On Dahlia most residents were asleep or withdrawn as there did not seem to be anything stimulating enough to interest the residents. This could well be the nature of the residents that are accommodated on the Dahlia unit, but some stimulating activities and appropriate engagement with residents might have drawn the attention of some residents. The home arranges outings for residents. Residents are able to go out during the week for shopping or to places of interests mostly in small groups. During the weekend a mini bus is arranged to take residents out for drives or to places of interests. We were informed that the home plans an outing to the seaside. The home is close to local churches and we were informed that representatives from the main religious denominations regularly visit the home. With regards to other religions and cultures we were told that staff and the relatives of the residents support the residents in meeting their spiritual needs. Staff who work in the home come from within the local multi-cultural community of Brent and at least a few will be familiar with a particular culture or ethnic minority. All the major cultural festivities are celebrated in the home. On the first day of the inspection lunch consisted of lamb curry, spinach (callalou), rice and carrots and peas. For desert there was peach and cream instead of lemon pie. We also did not see salt fish and the pasta bake that were also on the menu. We were told that the items that were not available as these were not in stock in the home. There were however other meals that some residents requested that were not on the menu. For example one resident had sandwiches. The home has a four weekly menu, but we noted that only the Bluebell unit had the right menu on display. staff on the other units were not sure of the menu for the week. Choices of residents were recorded on the menu choice sheets that were sent to the kitchen at the beginning around breakfast time. We however noted that the choice sheets were kept in the kitchen instead of being sent back to the floors to relate the meals that were sent on the trolley with the choices that residents had made. We noted from the menu choice sheet that was completed on the day of the inspection that a significant number of residents had requested for the second choice. This was not provided for the reason above. There are separate dining areas in each unit. On the day of the inspection we Care Homes for Older People Page 19 of 34 Evidence: observed that these were appropriately prepared and the tables were set except on one unit where the tables were not set because of one resident. Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home takes complaints seriously and make sure that these are addressed appropriately. People can be confident that the home has procedures in place and that staff are appropriately trained to prevent and address allegations and suspicions of abuse of people who live in the home. Evidence: A copy of the complaints procedure is available in the foyer of the home and in the service users guide that is offered to all residents. We looked at the complaints register and noted that there have been 4 complaints during the past year. All were appropriately recorded and investigated. In cases where the complaints were substantiated the home offered redress as required. Residents and visitors said that they would speak to the nurses on the floor if they were unhappy about something and staff also knew that they would try and resolved any minor informal issue but would contact the person in charge when people are complaining about the service. There have been 2 allegations of abuse that were referred to the safeguarding adults team of the Local Borough. All the allegations were investigated as required and addressed. Staff that we spoke to were aware that they have to report all reports and suspicions of abuse to the person in charge. Care Homes for Older People Page 21 of 34 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. The home generally provides a pleasant and maintained environment for residents to live in. Evidence: The grounds in the front of the home appeared tidy but could have been more inviting. There were weeds in the flower beds and the shrubs and bushes could have been trimmed more neatly. The lawns also did not look healthy and could have been better maintained as there were weeds in them. The manager stated that the gardener was in the process of addressing these issues. There was evidence that some branches have been cut to provide a tidier and sunnier area. There were seating areas on either side of the home for residents to sit out when the weather is nice. There were also areas for residents to grow vegetables or flowers. The passage way from the fire exit from the first floors have been replaced and were now in good condition. There was evidence on ongoing maintenance. the corridors have been redecorated and the carpet has been changed. A number of bedrooms have also been re-carpeted and in some cases lino was used to provide a more hygienic set up for residents as this could be more easily cleaned than carpet. The carpet in a few areas was however bubbling up and needed to be repaired or re-glued to offer a flat surface for residents. Care Homes for Older People Page 22 of 34 Evidence: The communal areas were appropriately furnished and have been redecorated. Special seating arrangements were in place for residents if that was required to make sure that they could come to the communal areas to socialise with other residents and staff. Bedrooms of residents were on the whole appropriately decorated and personalised. The manager stated that the home has an ongoing plan for the decoration of bedrooms. Items of furniture were in a good state of repair and fixtures and fittings were also in good condition. Since the last inspection the previous managers office has been converted into an en-suite bedroom with a shower and toilet. The home plans to reduce the number of double bedrooms by one. Sluices were kept tidy and kept locked when not in use. The laundry was also kept tidy and clean.All laundry equipment was in working order. The home employs ancillary staff in appropriate numbers to ensure that the laundering of linen and residents clothes are carried out to a good standard. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides staffing levels that are appropriate to meet the needs of residents. The recruitment procedure was not always strictly complied with, particularly with regards to ensuring that appropriate employment references are received. Training is provided to staff to make sure that they are skilled and competent to care for residents. Evidence: There is 1 trained nurse and 3 carers during the day and 1 trained nurse and 1 carer at night in Ivy Unit. The Dahlia Unit is staffed by 1 trained nurse and 2 carers during the day with an additional carer from 1200 to 1800 and at night by 1 trained nurse and 1 carer. The Bluebell Unit is staffed by 2 trained nurses and 5 carers during the day and at night by 1 trained nurse and 2 carers. There are additional staff that are provided for some residents who require one to one supervision because of their needs. In addition to nursing and care staff the home also provides ancillary staff such as cleaners, handyman, and kitchen staff to ensure that the home runs smoothly and that the service can be delivered effectively. The personnel files of 4 members of staff were inspected. They all contained an application form and a contract of employment. Application forms were generally well completed but we noted that there was a gap in the the work history for one applicant. CRB checks were carried out and there was proof of identity and of Care Homes for Older People Page 24 of 34 Evidence: eligibility to work in the UK. References were however lacking. Two of the applicants did not have references from their last employers. Once staff start work in the home, they are offered induction according to the companys policy. The induction package is comprehensive and incorporates the common induction standards as per Skills for Care. Certificates of staff, who have completed the induction were available on file. The manager kindly provided us with a copy of the training matrix. We noted that training was generally well provided except for fire (39 out of 69 members of staff have not had the annual update) , manual handling (41 out of 69 members of staff have not had the annual update), infection control and abuse training (27 out of 69 members of staff have not had these annual updates). We also noted that although the home looks after residents who have mainly dementia care needs, only about half of its care staff (27) have had dementia care training. We discussed in the section under Health and Personal Care the quality of the care and support that some members of staff give to residents. We identified that this could be improved by the provision of training and closer supervision by trained nurses and by motivating care staff. Members of staff that we spoke with told us that they receive supervision. We looked at the supervision records that were kept and noted that supervision of staff does take place, but not always every two months or six times a year. Some members of staff have had supervision once since the beginning of the year, some twice and one member of staff has not had supervision since the beginning of the year. According to the AQAA the home has 48 bank and permanent care staff and out of this number, 24 have at least an NVQ level 2 in care and 21 are training for this qualification. The home therefore has more than 50 of its care staff trained to at least NVQ level 2 in care. Care Homes for Older People Page 25 of 34 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. The manager is qualified and experienced to run the home and involves staff, residents and their relatives in this process. The home has a quality management system to monitor the quality of the service that is provided. The personal money of residents is managed to a good standard to ensure the protection of residents finances. Health and safety issues are addressed appropriately and in a timely manner to ensure the safety of all people who use the premises. Evidence: The manager started work in the home in September 2008. She stated that she has more than 12 years experience managing care homes and has been registered in respect of other care establishments. She is now in the process of being registered for Ogilvy Court. She is a trained nurse and has the Registered Managers Award. Minutes of general staff meetings were available for inspection as well as minutes for Care Homes for Older People Page 26 of 34 Evidence: unit staff meetings. In addition there there were trained nurses meetings and night staff meetings. Minutes of residents and relatives meetings were also available for inspection. Care UK has a quality assurance procedure and quality management system. It has a clinical governance department responsible for the monitoring of the quality of the service that is provided by the various Care UK establishments. Questionnaires for a satisfaction survey went out in May and the manager stated that the head office was compiling the data from the returned questionnaires. A copy of the report summarising the survey was kindly provided to us by the manager. The home carries out a monthly audit on a key area of the service that is chosen by the head office. Each month a different key area is chosen such as catering, health and safety, care plans and medication. In addition to these there is an annual audit that is carried out by the clinical governance department. The findings of the audits are incorporated in the homes action plan. We looked at the management of the personal money of residents by sampling the records of two residents. The home has a separate bank account for residents personal money and each resident who has money with the home normally has a subaccount that also bears interest. These accounts can only be accessed by head office staff. The home keeps some money for individual residents for day to day expenses. We noted that the money is kept separately for each resident and that individual records are available for each resident. Any top-ups to residents personal money is requested either from the head office, if the head office keeps the money of residents, or from residents representatives if they are overall in charge of residents personal money. Expenses that are made on behalf of residents are backed by receipts and any withdrawal of money for or by a resident to spend, is signed by two persons, one of which could be the resident if the latter has capacity to understand this process. We noted that the home has property sheets to record the property and valuables that residents bring in the home when they are admitted or when new things are brought for them. We noted that one resident has not had the property sheet updated since 2006. Another two residents did not have a property sheet on file and those who had one did not always have these agreed, signed and dated. The home had all the necessary maintenance certificates such as an electrical wiring certificate, portable appliances test certificate and gas safety certificates. There was also evidence that all lifting equipment was maintained and tested as required to Care Homes for Older People Page 27 of 34 Evidence: make sure that these were safe to use. A chlorination certificate was available to show that the water system in the home has been treated to prevent legionella. Fire detector tests, fire emergency lights test and fire drills were carried out at intervals that was described in the homes fire procedure. Water temperature checks were carried to make sure that the thermostatic valves were working appropriately. There was a fire risk assessment, fire emergency plan and a health and safety risk assessment available for inspection. Training of staff in mandatory areas including health and safety subjects was provided as required to make sure that staff were up to date in these areas. We observed that the home had the necessary resuscitation equipment in place and that items of equipment were prepared and were ready to use in an emergency. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15(1,2) That care plans about 31/10/2007 managing challenging behaviour are clear about the action to take to manage the challenging behaviour to ensure the safety of residents and staff. That the plan of care for residents who are supervised on a one to one basis be clear about how they are being managed and whether restraints are used, the acceptable form of restraints that can be used and the length of time that these could be used. The registered person must 30/09/2007 review the provision of meals in the home to ensure that the individual needs of residents, including the cultural and ethnic needs, are being met (Repeated requirement-timescale 31/12/06 not fully met). The registered person must ensure that nutritious and wholesome meals are provided to residents at all times and that the menus are complied with as required. Changes in the menus must be communicated to care staff, so that they are able to inform residents of the Page 29 of 34 2 15 16(2)(i,j) Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action changes and record the choices of residents accordingly. 3 15 12(3) That the choices of residents 30/09/2007 about the meals are sought and recorded as far as possible. Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The care plans of residents 18/09/2009 must comprehensively address the needs of residents and must be clear about the action to take to meet these needs. Care plans must be ammended when the needs of residents change or new care plans must be drawn up when new needs are identified. Care plans and risk assessments must as far as possible be agreed with residents and their representatives. To make sure that the needs of residents will be met. 2 8 18 Training must be provided to 18/09/2009 staff for them to fully understand dementia care and for positive interaction and engagement to be in place between members of staff and residents. Care Homes for Older People Page 31 of 34 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 To make sure that staff fully understand how to interact and engage with residents. 3 9 13 All medicines must be administered as prescribed. The amount of medicines that is brought forward when a new medicines cycle is started must be recorded. To make sure that medicines are administered safely. 4 15 16 The home must ensure that 17/08/2009 there is a stock of all the ingredients to prepare the meals that are on the menu. This is required to demonstrate that residents are being offered real choices with regards to their meals. 5 29 19 The home must carry out all the employment checks robustly, including ensuring that there are 2 references in place with one from the last employer. To demonstrate that residents are not being put at risk by inadequate employment practices. 15/08/2009 15/08/2009 Care Homes for Older People Page 32 of 34 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 6 30 18 All members of staff must be 30/09/2009 up to date with all mandatory training including fire training and manual handling training. For all staff to be skilled and competent to do their job to the highest standard. 7 35 19 The property and valuables that residents bring into the home must be recorded as appropriate. To prevent financial abuse as much as possible. 15/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 9 10 The instructions to administer topical medicines must be clear about the location to administer these. The TV and radio should not be on at the same time in the same area. Music that is played should as far as possible be according to the tastes of residents. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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