Care Home: Oldfield Residential Home

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What the care home does well People we spoke with told us that they enjoy living and working at the home. Residents are encouraged to maintain important relationships with those close to them and their visitors are always made welcome. People`s health needs are well monitored and staff work well with community health care professionals to ensure their health and wellbeing is promoted. People told us the home does the following well: `The work of the care assistants` `Care assistants work well` `Generally they look after me well` `It`s a really friendly home, always a good atmosphere. The home is currently being redecorated which is looking really good` `The new manager is working hard to get the home to a high standard and seems to be making a positive impact`. `I am very happy within my job and feel all the staff work well as a team to provide a high standard of care for individuals within the home` What has improved since the last inspection? A number of permanent staff have been employed since the last key inspection therefore the service has become less reliant on using agency staff, providing continuity of care for the residents. The majority of care plans and risk assessments are now being updated at the required frequency to ensure staff have up to date information available to meet people`s individual needs. Shortfalls in care planning and risk management were identified at adult protection meetings and as a consequence the provider has taken disciplinary action against staff who have failed to keep records up to date. Staff appear aware of their responsibility in maintaining important records and are working hard to ensure these are updated at the required frequency so they know how to deliver people`s care in a way that they prefer. Staffing levels have increased on nights and both areas of the home are now staffed separately providing residents with greater supervision and increased access to staff. Staff have been provided with more service specific training so that they are better equipped with the skills and knowledge to meet the individual needs of the people in their care. Improvements to the environment are ongoing to ensure residents safety and provide people with a more comfortable and homely place to live. What the care home could do better: We continue to have concerns about the home`s recruitment practices. The manager must ensure that all of the necessary checks are undertaken prior to new staff commencing employment. This would make sure that prospective staff are suitable to work with vulnerable adults and that the residents are protected from the risk of harm or abuse. The provision of social and recreational activities could be further developed with regards to the needs, preferences and capabilities of people who use the service. These actions will help improve their quality of life by doing things they find enjoyable and stimulating. Quality monitoring of the service requires further development. For example residents and relatives meetings should be held in addition to staff supervision to gain peoples views and improve the overall service. Although the majority of staff have received training in adult protection the findings of this inspection evidence that managers are not fully conversant with the local safeguarding adult procedures. This needs to be addressed for the greater protection of people living at the home. People told us the home could make the following improvements: `Appoint more staff so that they can spend more time with the residents. `More activities need to be organised for the residents` `More staff needed then carers could spend more time with the residents. With the correct training and guidance it could be run a lot better` `The time taken to answer the call buzzer is not acceptable` Key inspection report Care homes for older people Name: Address: Oldfield Residential Home Derrington Road Ditton Priors Bridgnorth Shropshire WV16 6SQ     The quality rating for this care home is:   one star adequate 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: Becky Harrison     Date: 2 0 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Oldfield Residential Home Derrington Road Ditton Priors Bridgnorth Shropshire WV16 6SQ 01746712286 01746712411 oldfield@oldfieldcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Simon James Badland Name of registered manager (if applicable) Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 45. The registered person may provide the following categories of service only : Care home only Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places 45) Dementia - Code DE (maximum number of places15) Learning Disability - Code LD (maximum number of places 1) Date of last inspection 0 2 0 9 2 0 0 9 15 1 0 Over 65 0 0 29 Care Homes for Older People Page 4 of 31 Brief description of the care home Oldfield Residential Home is a care home for older people, registered to provide accommodation and personal care for up to 45 people. At the time of this inspection there were 41 people accommodated. The home is situated on the edge of the small Shropshire Village of Ditton Priors, which is in is in a rural location therefore there is limited access to it by public transport. The property is a purpose built single storey building, and offers both single and double bedroom accommodation, some rooms provide ensuite facilities. Communal rooms include two lounges, two dining areas and two sun lounges. The home has been extended in order to upgrade the living accommodation offered to the people who live there. The grounds are well-maintained with shrubs, mature trees, flower borders, lawns and woodland walks. Ample parking is provided to the front of the property for people visiting the home. People are able to gain information about the services provided at Oldfield from the Statement of Purpose and Service User Guide. Inspection reports are made available for people to read in the reception area of the home. These are also available on our website at www.cqc.org.uk The current fees charged range from £380.00 to £520.00 per person per week based on dependency needs and the accommodation provided. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The visit to the service was undertaken by one inspector over 6.5 hours. The people who live and work at the home did not know that we were coming. A range of evidence was used to make judgements about this service. We spoke with a number of residents and staff on duty, the deputy manager and the manager. We looked at some parts of the home and sampled a number of records to include staff training, recruitment, quality assurance and health and safety records. We received ten completed surveys from residents and staff informing us of their views of the home and some of the feedback gained has been included in our report. We looked at the outcomes for people living at Oldfield and information to produce this report was gathered from the findings on the day of our visit and also the information that we have received, or asked for, since our last key inspection undertaken on 2nd September 2009. A random unannounced inspection of the service was undertaken on Care Homes for Older People Page 6 of 31 9th February 2010 to check the providers compliance against the requirements and recommendations that we made at the last key inspection and to review recommendations following recent adult protection meetings. We considered that the provider had met the requirements previously made however some new recommendations were made to further improve outcomes for people living at the home. The care received by three people was looked at in detail. This included looking at personal records such as care plans, health records, daily records and discussing their care with them, where possible, and the staff who support them. We also had the opportunity to observe people being supported by the staff on duty in both of the lounges. This helps us gain information and understand the experiences of people who use the service and the quality of care they receive. The manager completed an Annual Quality Assurance Assessment (AQAA) document for us, as requested. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. This provided us with some information and informed us about how they are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? A number of permanent staff have been employed since the last key inspection therefore the service has become less reliant on using agency staff, providing continuity of care for the residents. The majority of care plans and risk assessments are now being updated at the required frequency to ensure staff have up to date information available to meet peoples individual needs. Shortfalls in care planning and risk management were identified at adult protection meetings and as a consequence the provider has taken disciplinary action against staff who have failed to keep records up to date. Staff appear aware of their responsibility in maintaining important records and are working hard to ensure these are updated at the required frequency so they know how to deliver peoples care in a way that they prefer. Staffing levels have increased on nights and both areas of the home are now staffed separately providing residents with greater supervision and increased access to staff. Staff have been provided with more service specific training so that they are better equipped with the skills and knowledge to meet the individual needs of the people in their care. Improvements to the environment are ongoing to ensure residents safety and provide people with a more comfortable and homely place to live. Care Homes for Older People Page 8 of 31 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the Oldfield is made readily available to help prospective residents make an informed choice about whether the home is suitable to meet their individual needs. Peoples individual needs are assessed prior to admission to ensure Oldfield is a suitable place to live and that the service can meet their identified care and support needs. Evidence: Prospective residents and their representatives are provided with information about Oldfield through the Statement of Purpose and Service User Guide, which have recently been updated. Most people who completed surveys for us considered they were provided with enough information to help them decide if Oldfield was the right place for them to live before they moved in. Care Homes for Older People Page 11 of 31 Evidence: The AQAA states We have a much more in depth pre-assessment form, which we use to assess each client prior to admission, to make sure all their needs can be met. Evidence of this was seen on the file of the person most recently admitted to the home and the staff member responsible for undertaking the initial needs assessment told us that the improved paperwork is more detailed and easier to complete. Observations made and discussions held with the staff on duty indicate that the person has started to settle into the home well. The home does not provide intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide staff with most of the information required to ensure peoples health and personal care needs are met in a way that they prefer. Staff support people with the management of their medication ensuring their health and wellbeing. The actions of staff and their approach to care ensures that residents are treated with respect and their right to privacy is upheld. Evidence: People we spoke with and who were able to express their views told us that they were satisfied with the care they receive. Residents who completed surveys for us told us that they always or usually receive the care and support they need including medical care. Comments include: Care Homes for Older People Page 13 of 31 Evidence: We are well looked after here, the staff are pretty good The staff are excellent. There isnt one I could fault and whatever I ask for I get We looked at the care plans for three people who live at Oldfield and have a range of support needs. Actions to be taken to meet peoples individual needs was documented with evidence of review although managers were aware that the review of one care plan sampled was overdue by two weeks. The care plans seen included information about peoples personal and health care needs, the management of risk such as falls, nutrition and moving and handling in addition to a range of tools to monitor peoples health for example fluid and food intake charts. Since the last key inspection managers are keen to develop more person centred care plans and involve residents and their representatives in the planning their care ensuring people receive their care in the way that they prefer. Managers acknowledged that although improving further work is required to improve record keeping overall to ensure all records are updated at the required frequency, cross referenced to other documentation, personalised, signed and dated. The care plans sampled evidence that people living at the home receive the necessary support with accessing the appropriate community health care services. Care records showed that the services of district and community psychiatric nurses, chiropodists and GPs were appropriately accessed. One person, whose care we looked at in detail, is currently receiving the support of a Community Mental Health Nurse however records designed and recommended to assist staff in monitoring the persons behaviour have yet to be implemented a week later. Managers committed to implement this so that they can better monitor the situation and provide a greater overview in the best interests of all concerned. During the inspection the health of one resident significantly deteriorated and staff were seen to take appropriate action and called 999 and the person taken to hospital. Staff were effective in dealing with the situation and provided reassurance to the individual and other residents. The member of staff with designated responsibility for the management of medication demonstrated an understanding of the medication procedure and reported that there have been no medication errors since our last inspection. Two staff spoken with confirmed that they receive training so that they are able to administer medication safely. One of the people whose care we looked at in detail is prescribed medication as required. Although the home has a generic protocol in place regarding this, we advised the manager to develop a protocol specific to the individual concerned. This will ensure staff know when they are to administer medication in the persons best interests. Another persons medication was not being stored secure as this was left out Care Homes for Older People Page 14 of 31 Evidence: on the persons table in their own room. Managers committed to review this. The AQAA states The home has a medication policy which has recently been updated, also I have now put rigorous auditing of drugs programmes into the home. All unused drugs are documented and returned to pharmacy. It was reported that the home has contacted the Medication Management Officer for the Primary Care Trust for advice on medication and that a visit is scheduled shortly. Observations evidence that staff are sensitive to the needs of the individuals in their care. Staff were seen promoting privacy and dignity and interacted with residents in a professional manner.People we spoke with were satisfied with the way staff cared for them and had confidence in the staff. We saw throughout our inspection staff attended to the people in a warm, friendly and kind manner. We heard staff asking whether they needed any help or whether they could help them. People we spoke with confirmed that personal care is always provided in private ensuring that their dignity and rights are respected and promoted. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The further development of social and recreational activities would enhance the quality of life of the people accommodated. People are supported to maintain important relationships and are generally provided with a varied diet according to their dietary requirements and choice. Evidence: The home employs a full-time Activity Organiser to arrange and provide people with a range of social and recreational activities. At the time of our visit the activity organiser was on annual leave and no cover had been arranged. Managers reported that the activities organiser is in the process of seeking life histories, goals and aspirations and other important information from residents and their families to provide staff with more information to help plan their daily lifestyles. Residents who completed surveys for us indicated the home usually arrange activities to partake in although other feedback gained indicate more activities could be provided. We observed people spending time, in between meals and care interventions, sitting in lounges or in their bedrooms. The television in both lounges was on and some residents were seen to occupy themselves by doing a jigsaw, Care Homes for Older People Page 16 of 31 Evidence: reading or coloring. A few residents were supported to sit outside in the garden and enjoy the sun. Staff were observed to spend time, on occasions, talking and listening to people who they were caring for. The interactions were friendly and courteous. The AQAA states We hope to raise sufficient funds for our mini bus, which will enable us to take our clients into the community more often. We are going to recommence resident/family meetings, rummage boxes in lounges, and comfort blankets etc. We have started a reminiscence wall where we have photographs of past farming life and equipment. The home has recently held a pyjama event to raise funds and a sponsored walk is planned. A local primary school recently visited the home to make Easter bonnets with the residents and it was reported the event was enjoyed by all. Observations made and daily records seen evidence that routines at the home are flexible and people can rise and retire to bed at times that suited them. People spoken with said that their visitors are made welcome and contact with family was seen recorded on the files sampled. Feedback from residents indicated that they generally enjoy the food provided. The care files sampled contained individual preferences so that staff have an understanding of individual likes and dislikes. People were provided with a choice of two meals at lunch time and the food appeared appetising. The manager has developed a pictorial menu of the meals provided and hopes to share these with residents. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives have access to a complaints procedure, which is accessible and ensures the views of people are listened to. Most staff have received training in adult protection however remain unfamiliar with the local procedures and the referral process, which potentially places people at risk. Evidence: Residents and their representatives have access to a complaints procedure, which is displayed in the home and included in the Statement of Purpose and Service User Guide. Three of the five residents surveys received indicate they know how to make a formal complaint and residents spoken with during our visit were aware of who to speak with if they were unhappy with the service provided. All five staff who completed surveys stated they know what to do if someone has concerns. We have not received any concerns or complaints about Oldfield since our last inspection. The home has received three informal complaints and these have been addressed, as confirmed by the manager. Staff have access to the local multi-agency policies and procedures in relation to adult protection and the majority of staff have recently received training in relation to adult protection so they have an understanding of abuse, ensuring residents wellbeing. There has been an increase in the number of residents being referred into local Care Homes for Older People Page 18 of 31 Evidence: safeguarding procedures over the last twelve months. As a result a number of recommendations have been made to include staff being provided with training in dementia care, engaging people in activities, reviewing care plans and risk assessments at the required frequency and the need for staff to report and record events. As a result of recent incidents the provider has increased night staffing levels and reviewed the deployment of staff providing greater supervision across all areas of the home. During this inspection we were advised that one member of staff had recently been suspended following allegations made. Although action has been taken to protect the residents the manager has failed to follow local safeguarding procedures and instead made a referral to Independent Safeguarding Authority (ISA). During the inspection we spoke direct to the local team and explained the misunderstanding and the manager later completed the referral as required and a meeting is now scheduled to take place shortly. We advised the manager to attend a protection of vulnerable adults course for managers to develop her knowledge of the local procedure and referral process. Although raised at previous inspections recruitment practices continue to make people vulnerable and these are referred to in the staffing section of this report. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Oldfield continues to be developed with the needs of the people who live there in mind so that they are provided with a safe, clean and comfortable home to live. Evidence: The AQAA states Oldfield is situated in the village of Ditton Priors overlooked by the Clee Hills and surrounding countryside. The home has a warm/odour free and friendly atmosphere. Since the last key inspection a number of environmental improvements have been made to enhance the living accommodation for people living at Oldfield. The property comprises of two distinct areas, the original building and the extension. Corridors in the original building have been redecorated, in addition to the dining area and a number of bedrooms. Light fittings in corridors have also been replaced. At the time of our visit one vacant bedroom was in the process of being refurbished and we were advised that handrails have been ordered and will be fitted shortly to assist people when moving from one area to another. Works to the bathrooms has been undertaken as required by the previous key inspection to ensure people are able to use these facilities safely. A coded lock system has recently been fitted to the internal door leading to the original building for the safety of one individual although we were advised that this does not restrict freedom of movement for other residents and that are able to access all parts of the home. We looked at the shared areas of the home and the bedrooms of the people whose Care Homes for Older People Page 20 of 31 Evidence: care we looked at in detail. The home was welcoming, and most bedrooms seen were personalised. People appeared comfortable and relaxed in their surroundings and residents we spoke with told us that they enjoy living in the home and are pleased with the accommodation provided. Photographs and names of residents are now available on most bedroom doors to help them with identifying their own personal space and some improved signage displayed around the home to better assist people with their orientation and maintain their independence for as long as possible. One member of staff stated Its a really friendly home, always a good atmosphere. The home is currently being redecorated which is looking really good The areas of the home toured were found clean although a slight odour was detected in one bedroom, which needs to be addressed. Completed surveys received from residents stated that home is usually clean. An infection control audit has been undertaken since the last key inspection by Shropshires Prevention and Control Training and Development Nurse and the home received a score of 81 . Matters arising are currently being addressed and training in infection control has been arranged for May 2010. Substances such as cleaning products that could cause harm to people are safely stored and the necessary data sheets on their safe use available. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff appear committed to their work and receive good training opportunities to equip them with the skills and knowledge to meet the individual needs of the people they care for. Continued shortfalls in recruitment practices do not fully ensure that the home only appoints people who are suitable to work with vulnerable people living at Oldfield potentially placing them at risk of harm. Evidence: Residents are cared for by a team of staff who appear committed to their work and know them well. Of the 24 permanent care staff employed, nine have obtained a nationally recognised care qualification known as NVQ at level 2 and above in care and six carers are currently working towards the award, helping to provide a qualified workforce. In the AQAA the manager states I believe our residents are given a high standard of care and treated with dignity and respect as individuals. I have a good team of staff around me to help deliver care to a high standard. Observations made indicate staff have developed positive working relationships with the people they care for and feedback from the residents spoken with was positive. Comments received include: Care Homes for Older People Page 22 of 31 Evidence: The staff are excellent, there isnt one I could fault The staff are pretty good. We are well looked after The care assistants work well Feedback gained from staff was mixed with staff reporting morale as really good not good and quite low. The main reason given was staff sickness placing pressure on other colleagues. They reported that training has improved, that handovers and meetings are regularly held but that they do not receive formal supervision at the required frequency, which is an area identified in the AQAA for improvement . Comments include: I am very happy within my job and feel all the staff work well as a team to provide a high standard of care for individuals within the home Staff get on well and Im confident that we meet the needs of the residents here At times its a rush to get things done Staff spoken with demonstrated a good understanding of the needs of the three people whose care we looked at in detail and confirmed that they have received training appropriate to their role such as the management of potential aggression, dementia, deprivation of liberty safeguards and protection of vulnerable adults in addition to training in safe working practices which helps to keep people safe for example moving and handling, health and safety, food hygiene, first aid and fire training. As previously stated training in infection control and prevention is due to take place shortly. It was reported that senior carers who are responsible for developing care plans have also received training in care planning following failures in ensuring care plans are detailed and reviewed at the required frequency. We made a requirement as a result of our last inspection that care and ancillary staff must be provided in sufficient numbers to ensure that the care needs of people who use the service are met. It was reported that following a recruitment drive the home is now fully staffed although awaiting checks for one applicant. Records also demonstrate a continued decline in the use of agency staff, providing continuity of care for residents. As previously stated waking night staffing levels have been increased to provide greater staff supervision to residents throughout the night. Staff spoken with considered that staffing levels are sufficient to meet the individual needs of residents currently accommodated. Care Homes for Older People Page 23 of 31 Evidence: The previous key inspection identified shortfalls in the homes recruitment procedures, potentially placing people at risk of harm. We returned to the home in February 2010 to check compliance against the requirements made and although some improvements were identified we still had some concerns about the robustness of procedures and a recommendation was therefore made. Although the manager committed to reviewing recruitment procedures to provide greater safeguards for people living at the home and the AQAA stating Recruitment has been tightened and staff pre-employment checks are more rigorous, further shortfalls were identified during this inspection when we sampled the records of five new staff employed since our last visit in February 2010. Records sampled evidenced that two of the five staff had commenced employment following an Independent Safeguarding Authority (ISA) Adult First Check, whilst waiting for a CRB certificate. Even though we advised the manager in February 2010 that this is only permissible where it is necessary to take such action because of a real danger that staffing levels will fall below statutory obligations and that such staff must be supervised at all times until the CRB check is returned. CRB checks help providers make informed decisions when recruiting people to work with vulnerable adults and are a requirement by Law.Two staff had also commenced work before two written references had been received and a full employment history was not available on all of the files sampled. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a committed management team however action needs to be taken to improve some processes in the best interests of people living at Oldfield. The home is generally maintained in a manner, which ensures the safety of people using the service and the staff team. Evidence: The current manager of the home has been in post since August 2009 and has implemented some changes and addressed the requirements previously made in the best interests of people living and working at the home. When we arrived at the home the manager was out purchasing new pictures for the corridors but returned to assist with the inspection. The manager has the required qualifications of her position and has attended relevant training appropriate to her role and is currently undertaking an accredited course in looking after people with dementia care needs. The manager confirmed that she has completed her application for registration and will therefore submit this to CQC. Care Homes for Older People Page 25 of 31 Evidence: The AQAA states I offer an open door policy and am available for staff and family/residents at all times during the day. I have an experienced deputy manager who is supportive in my role and a team of good staff working with me. Staff and residents spoken with were complimentary about the manager and felt that she is approachable and provides good leadership to the home. Comments include: The new manager is working hard to get the home to a high standard and seems to be making a positive impact. The manager is brilliant, the management of this home is the best its been. Problems are not brushed under the carpet but dealt with The manager is very professional; she really cares about the home and makes a difference. She has the residents best interests at heart Although the manager has the skills and experience to provide effective management of the home it is crucial that she is fully aware of her responsibility to safeguard the people living and working at the home by ensuring recruitment procedures are robust and that new staff receive induction to the required specification, receive formal supervision at the required frequency and complete mandatory training in safe working practices at the earliest opportunity. It was reported that the majority of staff have recently undertaken training in the Deprivation of Liberty Safeguards and information about this legislation was available in the office. It was reported that no application for authorisation have been made to the local authority on behalf of any current resident. There are procedures in place to help ensure that where money is held on behalf of people using this service that this is done safely and securely. It was reported that only minimal amounts of monies are held for the purposes of hairdressing, shopping and activities and that records are maintained. Records seen on behalf of the three people whose care we looked at in detail indicate that audits are regularly undertaken. Information regarding financial management should also be recorded in peoples care plans. The AQAA states Quality assurance is on-going within the home to maintain high standards of resident care. The manager reported that satisfaction surveys for this year have yet to be distributed but that she plans to implement residents meetings shortly so that they are involved in the running of the home and their views acted Care Homes for Older People Page 26 of 31 Evidence: upon. Managers have undertaken unannounced spot checks, one in the early hours of the morning and another of a weekend to check staff practice and are satisfied with their findings. Given the number of safeguarding referrals the provider has been forwarding us copies of reports for monthly visits undertaken to the home. Reports evidence that a number of care plans are audited in addition to any complaints, accidents and improvements to the premises. A full-time handy man is employed to attend to any maintenance issues and was on site of the time of our visit refurbishing a bedroom. Maintenance records seen indicate repairs are carried out in a timely manner. People we spoke with indicated that they satisfied with health and safety matters and a record of dates for the servicing of equipment is maintained and actioned to ensure its safety. Staff spoken with confirmed that they have either received training or are booked to attend training in safe working practices for example moving and handling, food hygiene, fire safety and infection control to ensure peoples safety. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 All of the necessary checks 21/05/2010 required by Law must be obtained for all new staff prior to their commencement of employment. This is to ensure safety and protection of people who use the service. 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 7 All care plans should be developed adopting an individualised approach and reviewed and updated at the required frequency. This is to ensure people receive their care in the way that they prefer and their needs are appropriately addressed. Assessments should be undertaken for staff responsible for administering medicines to ensure ongoing staff competency. The home should ensure that people are involved with developing a programme of activities, based on the needs, preferences and capabilities of people, including people Page 29 of 31 2 9 3 12 Care Homes for Older People 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 with dementia. The effectiveness of these activities should be evaluated on an ongoing basis to ensure they are appropriate and meet with peoples expectations and needs. 4 18 The manager should attend safeguarding adult training for managers so that she is fully aware of the local procedure and referral process. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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