Care Home: Old School House And Courtyard Nursing Home

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What the care home does well People have a full care needs assessment prior to their admission to the home, and information gathered at the time of admission is used to develop an individual person centred plan for the person concerned. Person centred plans are a thorough record of a person`s individual health and social care needs and how these should be met by staff, as well as information about the person`s lifestyle choices. People tell us that staff respect their privacy and dignity. Meal provision at the home is good and people have a choice of meal at each mealtime. People are able to visit the home at any time and relatives tell us that they are kept informed about important issues. Staff tell us that they know what action to take should someone express concerns about the home and people living at the home tell us that they know how to make a complaint. The home is well maintained and furnished and provides a comfortable environment for the people who live there. Staff are recruited via robust employment practices and this protects people living at the home from the risk of harm by ensuring that only people considered suitable to work with vulnerable people are employed. The home is well managed, including the use of a quality monitoring system that gives people the opportunity to affect the way in which the home is operated. Health and safety systems at the home are monitored consistently to ensure that a safe environment is provided for the people living and working there. What has improved since the last inspection? The staff rotas now record the role of each member of staff on duty. On the day of the site visit work was being undertaken on the provision of a new wet room - this will increase shower facilities at the home and provide additional choice for the people who live there. What the care home could do better: Staff references should be dated on receipt so that there is a record that all safety checks are in place prior to people commencing work at the home. There should be no gaps in recording on medication administration records. Receipts should be given to people when they hand money to the home for safe keeping, to protect all parties concerned from any misunderstandings. All staff should have training/refresher training on dementia care, infection control and safeguarding adults from abuse to ensure that they have the skills to support the people living at the home. The training and development plan should be kept up to date at all times. Key inspection report Care homes for older people Name: Address: Old School House And Courtyard Nursing Home Main Road Gilberdyke East Yorkshire HU15 2SG     The quality rating for this care home is:   three star excellent 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: Diane Wilkinson     Date: 0 8 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 32 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 32 Information about the care home Name of care home: Address: Old School House And Courtyard Nursing Home Main Road Gilberdyke East Yorkshire HU15 2SG 01430441803 01430448394 steve@shelphengroup.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Old School House Ltd Name of registered manager (if applicable) Mrs Shirley Milson Type of registration: Number of places registered: care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability terminally ill Additional conditions: No change Registration includes 1 day place Date of last inspection Brief description of the care home The Old Schoolhouse and Courtyard Nursing Home is privately owned and provides nursing and residential care for up to 46 service users with dementia related conditions, physical disabilities and those requiring palliative care. The home is situated on the main road in the small village of Gilberdyke, in the East Riding of Yorkshire. It is within walking distance of village amenities and on bus and rail routes Care Homes for Older People Page 4 of 32 Over 65 46 46 46 46 0 0 0 0 Brief description of the care home into Hull and Goole. The home has ground floor access throughout and easy access to the grounds outside. The home is divided into three small units. The original building consists of The Old School House and has twelve single bedrooms, ten of which are en-suite and one shared bedroom. This was extended with The Courtyard, which has thirteen single bedrooms and five shared bedrooms. A further extension was The Bungalow, which has eight single bedrooms, all en-suite. There are five lounges in the home and dining space is included in some of them. The home also has a separate dining room in one of the units. There are sufficient bathrooms and toilets throughout the home. The home has a secure courtyard and ample car parking facilities. There is also a loop system fitted to assist the hard of hearing. Care Homes for Older People Page 5 of 32 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: three star excellent 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 inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Inspection of the home on the 20th February 2007, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day. It began at 9.30 am and ended at 4.40 pm. On the day of the site visit the inspector spoke on a one to one basis with a visitor, a member of staff, the registered manager and a director of the company as well as chatting to people living at the home. Inspection of the premises and close examination of a range of documentation, including four care plans, were also undertaken. The registered manager submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Care Homes for Older People Page 6 of 32 As part of the inspection process we sent survey forms to people living at the home, to staff and to health/social care professionals. Responses in surveys and comments from discussions with people on the day of the site visit were mainly positive, for example, the standard of care often exceeds my expectations and paperwork is always available and updated. Other anonymised comments are included throughout the report. The homes administrator told us that the current weekly fee for residential care is from £377.04 to £430.20 per week. At th end of this site visit feedback was given to the registered manager on our findings, including any requirements and recommendations that would be made in the key inspection report. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Staff references should be dated on receipt so that there is a record that all safety checks are in place prior to people commencing work at the home. There should be no gaps in recording on medication administration records. Receipts should be given to people when they hand money to the home for safe keeping, to protect all parties concerned from any misunderstandings. Care Homes for Older People Page 8 of 32 All staff should have training/refresher training on dementia care, infection control and safeguarding adults from abuse to ensure that they have the skills to support the people living at the home. The training and development plan should be kept up to date at all times. 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 32 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 32 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. We looked at outcomes for Standard 3. Standard 6 was not assessed on this occasion as there is no intermediate care provision at the home. People have a full care needs assessment prior to their admission to the home and are only offered a place if it is considered that their needs can be met. Evidence: We received seven surveys from people living at the home. Six people told us that they had received enough information at the time of their admission to help them decide if the home was the right place for them. Health and social care professionals who returned a survey told us that the assessment arrangements at the home ensure that accurate information is gathered and that the right service is planned for people. We checked the care records for four people living at the home, including someone who had been admitted very recently. These included a new client referral form, Care Homes for Older People Page 11 of 32 Evidence: admission particulars, a care needs assessment and an admission checklist and we found that these documents included all of the required information. When the placement is commissioned by a local authority, a copy of the community care assessment and care plan is obtained from care management. This is used along with information gathered at the time of the initial assessment to develop an individual plan of care for the person concerned. The manager told us that, apart from in emergency situations, a senior member of staff always visit prospective residents prior to their admission to undertake an assessment of their needs so that they can be sure that their individual needs can be met by the home. Care Homes for Older People Page 12 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 7, 8, 9 and 10. People tell us that their personal and health care needs are met by staff at the home and that this is done in a way that respects their privacy and dignity. Some minor improvements were needed to medication practices to fully protect people from the risk of harm. Evidence: We looked at the care plans for four people living at the home. There were already thorough care plans in place but the home is in the process of developing a person centred plan for each person who lives there. This includes questions such as, What is important to x, What those who know x best say they like and admire about him/her and How can we best support x. We could see that this information provided staff with a good insight into the individuals likes, dislikes, strengths, needs and wishes, and should enable each persons identified needs to be met in an individualised way. Each person centred plan is accompanied by a photograph of the person concerned; Care Homes for Older People Page 13 of 32 Evidence: this is useful in helping new staff with identification and in assisting the emergency services should someone go missing from the home. We noted that people have signed an agreement that records that they understand that they have access to their care records, that they have assisted in the development of their person centred plan and that they agree to the content. Person centred plans include a personal profile and life history, information about a persons strengths and needs, a manual handling care plan, a social services user plan (i.e. information about a persons social and leisure needs) and a variety of assessments/risk assessments. These include a pressure care assessment, a nutritional assessment and a client fall/injury assessment chart. Plans cover all identified needs and include clear information for staff on how to assist or support the person concerned with personal care and other tasks. One relative told us, the standard of care often exceeds my expectatons. The staff are happy which reflects in their attitude to the job. The home is as near to home from home as you can get. Details of a persons named nurse, assistant named nurse, key worker and assistant key worker were seen to be recorded in each person centred plan; these arrangements ensure that there is usually someone on duty at the home who had a good knowledge of the persons individual needs and who would spend one to one time with them. We noted that the plan was reviewed in-house on a monthly basis and that plans were updated as a result of this to ensure that staff are working with current information. Formal reviews are held in addition to these in-house reviews. We saw evidence that a copy of the persons care plan and risk assessments were sent to the Care Coordinator organising the review to assist them with their preparation. We received surveys from two health/social care professionals and both told us that peoples social and health care needs are properly monitored, reviewed and met by the home. One person added, paperwork is always available and updated. All of the people living at the home who returned a survey told us that their health care needs are being met. Each person centred plan included a medical history that had been requested from the persons own GP; this is good practice. All contact with health care professionals is recorded, including the reason for the contact and the outcome. Assessments for pressure care, nutritional needs and mobility (including falls) are thorough and result in a score to identify the level of risk - these were seen to be reviewed and updated as needed and to include information on how to reduce or manage the risks appropriately. We saw in one persons records that a mental capacity assessment had been undertaken and that the outcome was that the person may lack capacity to make Care Homes for Older People Page 14 of 32 Evidence: more complex decisions but is able to make less complex decisions - this was dated and recorded appropriately. We saw that there is equipment in place to promote independence and to assist staff to handle people safely, and that a special chair has been obtained for someone with specific mobility needs. Pressure care equipment is obtained when this is an identified need. Some people have been provided with a bed rail and they sign their consent to this provision. A monthly summary for one person recorded, bed rails still required and in situ as per the Medicines and Health Care Regulatory Agency (MHRA) guidelines. We saw evidence that people have access to a range of health care services such as physiotherapy and the manager had contact with the GPs surgery whilst we were present to arrange for people to have a flu vaccination. We examined the systems in place to support the safe administration of medication. The storage arrangements for medication, including controlled drugs, are satisfactory; there is a dedicated medication room. There is a medication fridge in use and we noted that this is locked and that fridge temperatures are taken and recorded daily. The storage arrangements for controlled drugs are satisfactory and we examined the controlled drugs book and found the entries to be accurate. Only registered nurses have responsibility for the administration of medication; there is a record of all PIN numbers and sample signatures for these staff to enable records to be verified. We examined the medication administration record (MAR) sheets and noted that each persons MAR sheet is accompanied by a record of their date of birth, any known allergies and a photograph. We saw that there is a signed and dated record of the medication received from the pharmacist and that two staff sign any handwritten entries made on MAR charts. There were a small number of gaps in recording and this should be addressed by the home. None of the people living at the home have chosen to self medicate but there is a consent form in place should this be requested by anyone. We discussed the arrangements in place for the disposal of unused or contaminated medication. The home use a disposal unit that is collected by a clinical waste company. The pharmacy that supply the home with medication had informed them that they do not need to keep records of all medication disposed of; we advised the home that this information was incorrect and they took action immediately by obtaining a returns book and recording details of all medication to be disposed of by Care Homes for Older People Page 15 of 32 Evidence: the clinical waste company. People told us in surveys that staff at the home respect a persons privacy and dignity. Most bedrooms are single so people can receive assistance with personal care in their own room. There are areas of the home where people can see health care professionals or other visitors in private if they do not wish to use their own room. We saw that there are very clear signs on bathroom and toilet doors to indicate whether the room is vacant or engaged. We saw that people wear own clothes and person centred plans include such information as, x is proud of the way she is dressed and ask x what she would like to wear. Care Homes for Older People Page 16 of 32 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. We looked at outcomes for Standards 12, 13, 14 and 15. People tell us that meal provision at the home is good and that there is ample choice. Visitors are made welcome at the home and are kept informed about their relatives welfare. There is recognition that activities need to be more frequent and more stimulating and action to try to make improvements has already been taken. Evidence: Person centred plans identify a persons social and cultural needs and record information about a persons life history so that efforts can be made to ensure that people continue to live their chosen lifestyle. Records include information such as, loves music, enjoys a visit to the hairdresser and likes to talk about her life as a landlady. Social/health care professionals who returned a survey told us that the home supports people to live the life they choose and that the service responds to the diverse needs of individual people. People told us that the home arrange activities that they can take part in, although some people told us that they would like to see more stimulating activities arranged by the home. The manager told us that they recognise that they could make Care Homes for Older People Page 17 of 32 Evidence: improvements in this area and that they have recently introduced a wider range of activities. There is now a white board displayed that records an activity for each day of the week, such as a musical quiz, christmas card and calendar making and How we used to live. Activities will change over a four week period but each week there will be a visit from the hairdresser. On the day of the site visit there was a sing along session in the afternoon. A member of staff told us that people living at the home would benefit from more trips out. We observed that visitors were in and out of the home throughout the day. One visitor who was at the home to attend their relatives review told us that they were kept well informed of events concerning their relative. One visitor was present over lunchtime to assist their relative with eating their meal; this had been agreed in their person centred plan. Key workers spend two hours one to one time each week with people and information about what they have done during this time is recorded in a personalisation folder. The manager told us that they intend to take photographs of people whilst they are taking part in activities to go into this folder so that they can show relatives who only visit in the evenings how their relative spends their days. People told us that they were happy with their bedrooms and we noted that some people spent their day in their room and others spend their day in one of the lounges. We noted that peoples bedrooms were personalised to the extent chosen by them. We saw evidence in care plans that people are told about their right to access their own care records. Four members of staff returned a survey. When asked what the home does well, one person responded, the food that is presented within the home is balanced and nutritious and always enjoyed by all who participate in meals being served. The seven people living at the home who returned a survey told us that they enjoy the meals at the home. There is a menu displayed that records the main meal for breakfast, lunch and tea. No alternative is recorded on the menu but on the day of the site visit we saw that people had a variety of meals. Staff told us that someone speaks to people the previous evening and their choices for meals the next day are recorded. Some people are provided with liquidised meals - some people have just the meat liquidised and some people have the meat and vegetables liquidised depending on their individual needs. The manager told us that they have made changes to the menu following suggestions Care Homes for Older People Page 18 of 32 Evidence: made by people living at the home. The meals seen looked appetising and we noted that people were encouraged and assisted appropriately by staff to eat and drink. We did note that a lot of people need assistance with eating and drinking and the manager told us that they make every effort to ensure that there are enough staff on duty to assist with this task. Care Homes for Older People Page 19 of 32 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. We looked at outcomes for Standards 16 and 18. People tell us that they know how to make a complaint and there are appropriate systems in place to manage any complaints made to the home. Evidence: The home has a complaints procedure that was displayed in the entrance and on other notice boards throughout the home. The manager told us that the complaints procedure is also included in the Service Users guide. Staff members told us that they know what action to take if someone has concerns about the home and all of the people living at the home who returned a survey told us that they know how to make a complaint. We examined the complaints log and noted that there had been no formal complaints made to the home since 2007. There is a record of the action taken but we advised that it would be useful to use a log sheet to record the details of the complaint and the outcome should the home receive any complaints in the future. This assists with the monitoring of any complaints made to the home. There are policies and procedures in place on safeguarding adults from abuse. The manager has undertaken managers awareness training on safeguarding and the training and development plan evidences that most staff have undertaken training on Care Homes for Older People Page 20 of 32 Evidence: this topic. A further training session was booked for the month of the key inspection and the manager told us that would leave a small number of staff who still needed training. Some care staff have achieved NVQ Level 2 or 3 in Care and have undertaken training on abuse as part of this training. Staff told us in surveys that they feel that they receive sufficient training; we advised the manager that staff needed regular refresher training on safeguarding adults from abuse to ensure they know what action to take should they become aware of any poor practice issues. The recruitment and selection practices at the home are robust and this helps to safeguard people living at the home from the risk of harm. Care Homes for Older People Page 21 of 32 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. We looked at outcomes for Standards 19 and 26. The home is well decorated and furnished and maintained in a safe and hygienic condition. Evidence: The home is built on one level and has wide corridors with grab rails throughout. There are five lounges in the home and some include dining space. One of the units includes a separate dining room. There is a programme of routine maintenance and redecoration in place and we noted that the home was well maintained, decorated and furnished throughout. On the day of the site visit work was taking place to create a new wet room. There is already a walk in shower in place and this will provide additional choice for people regarding bathing and shower facilities. Some bedrooms have en-suite facilities and there are ample toilet and bathing facilities in addition to this. There is an enclosed courtyard and this provides a safe area for people to sit out or take a walk in the better weather. In addition to this, lounges provide ample access to sunlight and fresh air. Care Homes for Older People Page 22 of 32 Evidence: On the day of the site visit we noted that all areas of the home were clean and that there were no unpleasant odours. People living at the home told us in surveys that the home is always or usually fresh and clean. We saw that laundry facilities are satisfactory. There are appropriate policies and procedures in place on the control of infection and the training and development plan evidences that about 50 of staff have undertaken training on infection control; we recommend that all staff undertake training on this topic to ensure that good hygiene practices are followed consistently. We did observe that staff follow good hygiene practices on the day of the site visit and that protective clothing was used appropriately. Care Homes for Older People Page 23 of 32 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. We looked at outcomes for Standards 27, 28, 29 and 30. Staff working at the home are recruited safely and this protects the people living there from the risk of harm. They receive thorough induction training that prepares them for their role but there needs to be more evidence that training on health and safety topics is undertaken on a regular basis to ensure that staff keep their practice up to date. Evidence: There are separate rotas in place for day staff, night staff and ancillary staff and all record the role of the staff member. The care staff rotas evidence that there is always a registered nurse on duty and in addition to this, they record the different levels of care staff on duty. Four staff returned a survey and when asked if there are enough staff on duty to meet the individual needs of the people living at the home, two responded always and two responded usually. A member of staff told us, everybody works well as a team within their job role and works 100 to make sure all day to day tasks are met. Almost 50 of care staff have achieved NVQ Level 2 or 3 in care and this training should continue so that the 50 requirement is achieved. Care Homes for Older People Page 24 of 32 Evidence: We examined the recruitment records for three members of staff. We saw that people complete an application form that records their employment history, the name of their current employer, the names of two referees, a criminal record declaration and details of relevant training. When nurses are employed at the home, a record is kept of their PIN number and we noted that this is checked on an annual basis. When overseas staff are employed, there is evidence that the home has obtained a copy of their work permit and that other checks have been undertaken. We saw that Protection of Vulnerable Adults (POVA) first checks are in place prior to people commencing work at the home and that people start induction training whilst they are waiting for their Criminal Records Bureau (CRB) check to arrive. We saw that two written references are obtained prior to the person commencing work at the home and the manager was advised that all written references should be dated when they are received by the home to evidence that they were in place prior to the person commencing work. One of the directors of the company showed us the health and safety induction training and policy and we noted that this provides a thorough induction for new staff. This is followed up by a competence log that people complete to check their understanding of the policies and procedures in place. We saw some training information held at the home and the manager forwarded us an updated training and development plan following the day of the key inspection. This shows that most people have undertaken training on moving and handling, health and safety, fire safty, infection control and safeguarding adults from abuse. We would expect that all staff should have training on these topics, both when they first start to work at the home and then as regular refresher training. The most recent fire safety course was held in October 2009 and we noted that this had not been recorded on the training and development plan so it may be that other training information is missing from the plan. All of the staff that returned a survey told us that they received induction training that covered everything they needed to know when they first started work, and that they are being given relevant training. One member of staff told us, I have attended several courses that are relevant to my role as registered nurse, i.e. deprivation of liberty, infection control, protection of vulnerable adults and stroke management. We did note that there was a moving and handling training session taking place on the afternoon of our site visit. Care Homes for Older People Page 25 of 32 Evidence: We noted that the training and development plan only records that a small number of staff have undertaken training on dementia awareness; many of the people living at the home have a dementia related condition and we would expect all staff to have training on this topic. The manager told us that training is arranged for the near future and that they have had training from Community Psychiatric Nurses on dementia and other mental health conditions; it may be that this has not been recorded on the training and development plan. Care Homes for Older People Page 26 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 31, 33, 35 and 38. The home is well managed and the quality monitoring systems give people the opportunity to affect they way in which the home is operated. Health and safety systems ensure that people living at the home and staff are in a safe environment. Evidence: The registered manager is a registered general nurse and has achieved the NVQ Registered Managers award. Feedback about the homes management arrangements from people living at the home, staff and health/social care professionals is positive. One person said, all the staff are friendly and the manager is always approachable and a member of staff told us, the management and all staff work as a team and are very supportive in all aspects of work related matters. The manager has recently undertaken training on personalisation and is due to attend managers awareness refresher training on safeguarding adults in January 2010. She Care Homes for Older People Page 27 of 32 Evidence: attends meetings with other managers from the organisation every three months and has been involved in the development of the new person centred plans. Discussion with the manager evidenced that she has sound knowledge of the health and social care needs of older people and it is clear that she is proactive in promoting positive links with health and social care professionals. There is a quality assurance system in operation at the home. Monthly satisfaction surveys are distributed to people living at the home, staff, relatives and health/social care professionals. Comments are collated and an action plan produced. Feedback is given to people living at the home at residents meetings and to staff at their meetings, and information is placed on the notice board. We suggested that giving feedback to relatives would further improve the quality assurance system. The manager told us that the responsible individual undertakes unannounced visits to the home and completes a report (as required under Regulation 26 of the Care Homes Regulations). In addition to this, a health and safety audit takes place every two months and a medication audit takes place each month. This evidences that the registered persons are monitoring that the systems in place are being adhered to; this is good practice. We saw the monies held on behalf of people living at the home and associated records. A sample of these were checked and found to be accurate. Financial transaction forms held record money in, money out, the balance and all entries are signed. We noted that these records are checked by the manager and a senior carer periodically to ensure that they are accurate. The manager told us that the hairdresser and chiropodist send individual accounts to the persons family or on occasions the chiropodist gives the home a list of monies owed and the manager is able to cross reference this to individual accounts. We recommend that a receipt is given to relatives when they hand money over for safekeeping to protect all parties from any misunderstandings. The health and safety audit covers the nurse call system, laundry facilities, hoists, accident reporting, fire safety, electrical safety and first aid, as well as more general issues such as window opening restrictors, water temperature records, protective clothing and the control of substances hazardous to health (COSHH). Environmental risk assessments are in the process of being undertaken by the home. We saw the homes fire safety risk assessment and noted that it is reviewed on an Care Homes for Older People Page 28 of 32 Evidence: annual basis. One of the directors who was present on the day told us that the Fire Officer who visited the home in January 2009 was very happy with the fire safety arrangements in place at the home. The fire alarm system and the emergency lighting were checked by a contractor in October 2009. The most recent fire training for staff took place in October 2009; three sessions were held to enable all staff to attend. The electrical installation was checked in October 2008 and is valid for 4 years. Portable appliances are checked on an annual basis; the home use their own equipment to undertake these tests. A gas safety certificate was obtained in March 2009 and all mobility hoists were serviced in November 2009. Care Homes for Older People Page 29 of 32 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 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 9 18 26 There should be no gaps in recording on medication administration record (MAR) sheets. Staff should have regular refresher training on safeguarding adults from abuse. All staff should undertake training on infection control to ensure that good hygiene practices are followed consistently. National Vocational Qualification training should continue so that the 50 requirement is achieved. All written references should be dated when they are received by the home to evidence that they were in place prior to the person commencing work. All staff should have training on health and safety topics and dementia awareness so that they are able to meet the assessed needs of the people living at the home. A receipt should be given to people when they hand money to the home for safe keeping to protect all parties concerned from any misunderstandings. 4 5 28 29 6 30 7 35 Care Homes for Older People Page 31 of 32 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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