Care Home: Orme House Residential Home

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What the care home does well The interaction between staff and the people that lived at the home was friendly, respectful and professional. Staff were attentive to the needs of the people that lived at the home. People`s visitors were made welcome in the home, which provided people with the opportunity to maintain their chosen contacts. People were provided with a nutritious and appetising diet. What has improved since the last inspection? The statement of purpose and the service user guide had been updated and amended to provide people who used the service with the current information about the services that were provided at the home. People that moved into the home were provided with a needs assessment and they were consulted with about the care that they needed and preferred prior to moving in. The care plans had been reviewed and showed the current needs of the people that lived at the home, however, shortfalls remained which is explained in the next section of this summary. The activities programme in the home had improved, which provided people with the opportunity to participate in activities that were of interest to them. There were improvements in the back yard, which provided a more pleasant and safe environment for people to use, the gate had been secured, the broken furniture had been removed and there were several potted flowering plants and vegetables around the yard. There were improvements to the environment, which provided people with a more pleasant environment to live in. Examples of the environmental improvements included redecoration of parts of the home, the communal toilets had been made good and were safe to use, a running tap had been repaired and it was noted that there were no offensive odours. Staff were provided with updated training, such as in manual handling, and supervision meetings to ensure that they were appropriately trained and supervised to meet people`s needs. The home`s management notified us of events such as death, illness and other events as laid out in Regulation 37 of the Care Homes Regulations 2001, which identified the actions that they had taken to ensure that people were safeguarded. What the care home could do better: The care plans must be further improved to show how people`s specific needs were to be met in areas such as with personal care and with dietary needs. When people`s weight is checked, it needs to be clearly recorded in a manner in which fluctuations in weight can clearly be identified and actions taken to ensure that people are provided with the support that they need. Communal toilets and privacy screens needed to be kept clean to ensure that the risks of cross infection is minimised. People`s continence pads must not be left opened in the communal toilets to ensure that the risk of cross contamination is minimised and that people`s privacy and dignity is respected. Key inspection report Care homes for older people Name: Address: Orme House Residential Home 59 Kirkley Cliff Lowestoft Suffolk NR33 0DF     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: Julie Small     Date: 2 6 0 7 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 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) © 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 32 Information about the care home Name of care home: Address: Orme House Residential Home 59 Kirkley Cliff Lowestoft Suffolk NR33 0DF 01502574068 01502574068 sandy@sahadew.fsnet.co.uk Noneavailable Anglia Care Homes Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Shriraj Sahadew Type of registration: Number of places registered: care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1 The home may accommodate one person, whose name was made known to the commission in June 2005, who is over 65 years and requires care by reason of dementia. Date of last inspection Brief description of the care home Orme House is registered as a care home providing personal care for 19 older people aged over 65 years. One of whom has dementia. Care assistants staff Orme House on a 24-hour basis. One of the registered proprietors, Mr Sahadew is also the registered manager. The layout of the home is on 3 floors with level access provided in most areas by means of a shaft lift. Rooms 5, 6 and 11 are not accessible by the shaft lift. A stair lift can be used to access rooms 5 and 6, but to access room 11 the occupant needs to use stairs. Single bedrooms and shared accommodation are available. The Care Homes for Older People Page 4 of 32 Over 65 1 19 0 0 0 7 0 4 2 0 1 0 Brief description of the care home home looks out to Kirkley Cliff, a busy one-way thoroughfare. Kensington Gardens, with its many attractions and sea front. Parking is on the road. The deputy manager told us that the fees for the home were £365 per week. 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: 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 unannounced inspection took place Monday 26th July 2010 from 8.40 to 14.15. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by compliance inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The registered manager was present for the inspection and they provided us with the requested information. The care of three people that live at the home was tracked, which included viewing their care plans and medication records. Further records viewed are detailed in the main body of this report. Observation of work practice was undertaken and five people that lived at the home, one visitor to the home and two staff members were spoken with. The last key inspection was undertaken 7th April 2010 and the home was rated as 0* Care Homes for Older People Page 6 of 32 which means that people who used the service experienced poor outcomes. During this key inspection it was noted that there were improvements made to the outcomes for people and this is reflected in the improved rating of 1* adequate. However, shortfalls were identified during this inspection, which are identified in the following sections of this report. 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: The care plans must be further improved to show how peoples specific needs were to be met in areas such as with personal care and with dietary needs. When peoples weight is checked, it needs to be clearly recorded in a manner in which fluctuations in Care Homes for Older People Page 8 of 32 weight can clearly be identified and actions taken to ensure that people are provided with the support that they need. Communal toilets and privacy screens needed to be kept clean to ensure that the risks of cross infection is minimised. Peoples continence pads must not be left opened in the communal toilets to ensure that the risk of cross contamination is minimised and that peoples privacy and dignity is respected. 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. People who use this service can expect to have their needs assessed prior to moving into the home and to be provided with the information that they need to enable them to make decisions about if they wish to use the service. Evidence: Since the last key inspection the homes statement of purpose and the service user guide had been reviewed and amended which provided people with up to date and factual information about the services that were provided at the home. The provider had sent us an improvement plan following the key inspection which stated the statement of purpose has been reviewed with up to date information and they sent us a copy of the document. The statement of purpose was viewed and it was noted that it provided information of the services that were provided at the home such as activities, staffing, organisation structure, staffing arrangements, how to make complaints and the current contact Care Homes for Older People Page 11 of 32 Evidence: details of CQC (Care Quality Commission), should people wish to contact us. The service user guide was viewed and it was noted that it had also been updated to show the services that were provided at the home and the current contact details for CQC. The statement of purpose and service user guide was present in the entrance hall of the home, which provided the people that lived at the home and their visitors to view if they chose to. At the last key inspection it was noted that all of the peoples care plans that were viewed did not hold a needs assessment which had been undertaken prior to moving into the home. A requirement was made which stated that people must be provided with a needs assessment prior to moving into the home and that they must be consulted with about the support that they needed to ensure that their assessed needs and preferences were met. The provider sent us an improvement plan which stated the home will ensure that all future suitable service users will be assessed first prior to their admission and to ensure that their needs will be met at the home and the family will be consulted regarding the planned care needs. An evidence of this will be kept in the care plan. All senior staff has been informed of this, that no service users to be admitted to the care home without being assessed for their need first. We tracked the care records of a person who had moved into the home after the key inspection and it was noted that a needs assessment had been undertaken prior to them moving into the home and a care plan was in place which identified how their needs and preferences were met. The care records of two other people that lived at the home were tracked and they held an updated needs reassessment which identified their needs and preferences and there were care plans in place to show how their needs were to be met. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect to be protected by the homes medication procedures and processes. They cannot be assured that their care plans clearly identify the specific care needs that they have and to have their dignity and privacy fully respected. Evidence: The care of three people was tracked, which included speaking with the people and viewing their care plans and risk assessments. It was noted that since the last key inspection needs reassessments had been undertaken which identified peoples current care needs and preferences and the care plans had been updated to show the support that they needed to meet their needs. The improvement plan which had been sent to us following the last key inspection stated all care plans have been currently reviewed and updated and the owners will ensure that this is carried out by reviewing all the care plans on a monthly basis. Whilst it was noted that the care plans had improved, there were some short falls identified that needed to be addressed to ensure that peoples specific needs were Care Homes for Older People Page 13 of 32 Evidence: appropriately met. For example a person was diabetic, their care plan identified that their condition was controlled with medication and there were references to them being a good eater, however, there was no further information which showed the specific support that they needed relating to their condition and the signs and treatment that the staff should be aware of if the person became ill. One person that was spoken with told us that they always used a wheelchair and their care plan that was viewed stated that they should be encouraged to walk, there was no further explanation of how the person was supported to maintain their independence regarding their mobility. The care plans made statements such as good weight, that a person ate good portions and that a person needed to be assisted with regular toileting, there were no clear information that specified what was good and what was regular to ensure that people were appropriately supported. The manager told us that they had planned to further improve the care plans and they showed us the templates that they were going to use. Three people that lived at the home who were spoken with told us that they had been consulted with about the care that they were provided with and that they felt that their needs were met. A persons relative that was spoken with confirmed this and they said that the care provided to their relative was spot on. The care plans that were viewed included risk assessments in areas such as falls, MUST (Malnutrition Universal Screening Tool) and manual handling, which identified the methods of minimising the assessed risks. There were plans in place that identified peoples wishes that were to be followed at the time of death. People were provided with the support that they needed to ensure that their health care needs was met, such as appointments with health care professionals. People that were spoken with told us that the doctor was always called if they felt unwell, this was confirmed by a persons relative. During the inspection we observed a staff member support a person to visit the local dental practice and a staff member advised a person that they had made an appointment with their doctor, which had been requested by the person. A district nurse visited a person in the privacy of their bedroom during the inspection. There were details in the care plans that were viewed which identified where people had been supported by health care professionals and the treatment that they had been provided with. There were records of peoples regular weight checks, however, it was noted that some were recorded in kilograms and some in stones and pounds, this did not provide clear information of weight gain or loss that could be followed up to ensure that that people were provided the support that they needed with nutrition. Care Homes for Older People Page 14 of 32 Evidence: The care plans that were viewed included information about how the staff should ensure that peoples privacy and dignity was maintained when being supported with personal care and how they should be supported to make choices about the clothing that they wore. People that were spoken with told us that they always chose their own clothing and that they felt that their privacy was respected and that the staff knocked their bedroom doors before entering them. They told us that the staff treated them with respect, this was confirmed by our observation during the day of the inspection, the interaction between staff and the people that lived at the home was friendly, respectful and professional. We observed good practice from a staff member when they reassured a person who had become upset following a dispute with their relative, the staff spoke with them in a kind and gentle manner. During a tour of the building it was noted that the shared bedrooms were provided with privacy screens, one of which was in need of cleaning, this is further discussed in the environment section of this report. It was noted that there were two bags of continence pads in one of the communal toilets on the ground floor, which did not respect peoples privacy and dignity. It was not clear if the pads were for the use of all people or if they had been allocated to one person. At the last inspection we had made a requirement following reports that were made to us that peoples bedrooms had been used for other peoples meetings. The improvement plan that was received after the key inspection stated all staff including the owners of the home has been informed not to use service users bedrooms for any meeting unless its concerning them. The manager showed us an updated medication procedure that had been completed, which identified the methods for the safe storage, administration and handling of medication. The manager said that they had not yet rolled this out to the staff that worked at the home but that they were planning to do in the near future. People that lived at the home were protected by the homes procedures and processes for the safe administration, storage and handling of medication. The medication in the home was administered from a secured medication trolley that was attached to the wall in the staff office when not in use. Controlled medication was stored in an appropriate controlled medication cabinet. Part of the morning medication round was observed and it was noted that the staff member offered the people their prescribed medication after checking their MAR (medication administration records) charts and their MDS (monitored dosage system) Care Homes for Older People Page 15 of 32 Evidence: blister packs. Three peoples MAR charts were viewed and it was noted that all the medication was accounted for, the MAR charts had been signed when the medication had been administered and codes were used when medication had not been administered, for example if the person had refused their PRN (as required) pain relief medication. Records of regular medication audits were viewed, which showed where shortfalls and been identified the actions that had been taken to address the issues. 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. People who live at the home can expect to be supported to maintain their chosen contacts and to be provided with a nutritious diet. Evidence: At the last key inspection it was noted that the people that lived at the home were not provided with the opportunity to participate in a meaningful activities programme and a requirement was made. The improvement plan that was sent to us following the inspection stated all residents have been assessed for what activities they like to do and this will be discussed with the resident whether they are happy with the activities that were provided by the home and it will be documented as evidence in their care plan. This was confirmed in the care plans of three people that were viewed, the needs reassessments that were in place included information about what the people had said that they enjoyed to do. There were also records of activities that they had participated in, which included watching a film on TV, prayer readings, going out to the local shops, playing games and discussing their memories. There were two notices posted on the homes front door which invited peoples relatives to join the people that lived at the home to a planned pub lunch and a visit to the Lowestoft air show. A Care Homes for Older People Page 17 of 32 Evidence: person that was spoken with told us that they were looking forward to the pub lunch and they said that there was plenty of things to keep them occupied, such as playing board games and singing. They told us that they were supported to maintain their regular visits to a local place of worship. They said that the staff at the home escorted them to the church and their friend returned them to the home. A persons relative told us that a staff member had supported their relative to attend a recent family function. During the inspection we observed two people participating in art work, two people sat outside enjoying the good weather and one person entertained their visitor. Two staff members told us that a karaoke machine had been purchased for peoples use. People that were spoken with told us that their visitors were always made welcome and a persons relative that was spoken with told us that they were always made welcome and that they could make themselves a drink when they visited. People that were spoken with told us that the food that they were provided with was good. They told us that they were always provided with a choice of meals and enough to eat and drink. During the inspection we observed people enjoying a choice of breakfast, which included toast, cereal and egg on toast. When people arrived at the dining tables they were asked by the staff what they wanted to eat, which showed that they were provided with a choice of meals. Following breakfast a person had told a staff member that they were hungry, and they were asked what they wanted. They asked for a banana, which was provided to them from the kitchen. It was noted that since the last key inspection there was a bowl of fresh fruit in the lounge area that people could help themselves to. Lunch was a choice of home made meat pie or sausages, new potatoes and fresh vegetables. People told us that they had chosen what they wanted before lunch. We observed a staff member talking to a person who said that they had changed their mind about what they wanted to eat and it was noted that they were provided with what they had asked for. Lunch looked and smelled appetising and a person told us that their meal was lovely. People were provided with aprons if they wanted to wear one to ensure that their clothing was kept clean and people were provided with aids, such as plate guards, which ensured that they could maintain their independence and dignity when eating their meal. Care Homes for Older People Page 18 of 32 Evidence: People were provided with their choice of drinks throughout the day and there were jugs of cold drinks that they could help themselves to. 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. People who live at the home can expect to be protected from abuse and to have their complaints acted upon. Evidence: The manager told us that there had been no complaints received since the last key inspection. The complaints book was viewed and it showed that the last complaint that had been received by the home was 2008. The complaints procedure explained how people could make complaints and how they were addressed. The statement of purpose and service user guide summarised the complaints procedure which ensured that people were informed of how they could make a complaint about the service that they were provided with. People that were spoken with told us that they knew how to make a complaint if they were unhappy. A relative of a person that lived at the home who was spoken with told us that they knew how to make a complaint and they told us that when they had raised informal concerns to staff members they had been addressed promptly. At the last key inspection it was noted that the staff team had been provided with updated safeguarding training March 2010. Two staff members that were spoken with at this inspection were aware of their roles and responsibilities regarding the safeguarding of the people that lived at the home. Care Homes for Older People Page 20 of 32 Evidence: The manager told us that there had been no safeguarding alerts made since the last key inspection. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be provided with a comfortable environment to live in. They cannot be assured that they are protected from cross contamination by the homes infection control processes. Evidence: Since the last key inspection there had been several improvements made to the homes environment, which provided people with a more comfortable and pleasant environment to live in. A maintenance book had been introduced in which staff identified the areas for repair in the home and when the repairs had been undertaken. It was noted that the unpleasant odours that had been identified at the last key inspection had been eliminated. The home was tidy and the redecoration of some areas, such as peoples bedrooms and the stairs ensured that the areas for improvements that was identified at the last key inspection, such as peeling wallpaper had been addressed. The communal lounge and dining area was clean and tidy, and provided sufficient seating for the people that lived at the home. The dining tables and chairs were clean. The broken furniture in the back yard that had provided a fire hazard had been removed and the broken lock on the back gate had been repaired to ensure that the Care Homes for Older People Page 22 of 32 Evidence: home was secure. There had been several improvements in the back yard which provided a more pleasant environment for people to use. There were two benches that people could sit on and a garden table and chairs had been donated by a persons relatives. The bin area had been concealed with a garden trellis and there were several attractive flowering plants and tomato and strawberry plants. Peoples bedrooms that were viewed were personalised with their items of memorabilia and they were clean and comfortable. The broken tap in a persons bedroom had been repaired. The broken towel rail, one of the plastic ends of one part of the metal towel rail was missing, in a persons bedroom which posed a risk if they fell onto it had not been repaired, however, the manager told us that it would be. The shared bedrooms were provided with privacy screens, it was noted that one of the screens needed cleaning to ensure that cross infection was minimised, it had marks on it which looked like body waste. We told the manager about this and they said that they would ensure that the cleaning of the privacy screens would be included on the homes cleaning schedule. The laundry was viewed, which was clean and tidy and it was noted that the broken machines had been removed. A persons en-suite toilet had been repaired. A communal toilet that had been out of use due to a leak from the neighbouring building had been repainted and was in use. However, when we looked into the toilet it was noted that the toilet seat was stained with urine and the toilet bowl was full of body waste, it was not clear of the time that this had occured. This was reported to the manager who advised that it would be dealt with. Another communal toilet that was viewed held two opened bags of continence pads, one was on the floor and the other was on a shelf that was level with the toilet, we spoke with the manager about the storage of continence pads and that this did not respect peoples dignity and that there was a risk of cross contamination. The laundry and the communal toilets provided liquid hand wash and disposable towels which minimised the risk of cross contamination. Staff were observed to wear disposable aprons and washed their hands when working with food and medication, which minimised the risk of cross infection. Staff that were spoken with told us that they had been provided with infection control training and this was confirmed in the training certificates that were viewed. 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. People who live at the home can expect to be supported by staff that are trained to do their jobs and to be protected by the homes recruitment procedures and processes. Evidence: The manager told us that the home was fully staffed and that there had been no new staff employed at the home since the last key inspection. At the last key inspection we had viewed the recruitment records of three staff and the inspection report stated it was noted that the appropriate checks had been undertaken to ensure that the people that lived at the home were safeguarded. The checks included identification, a photograph of the staff member, CRB (Criminal Records Bureau) checks, two written references and their work history, which was included in their application form. The staffing rota was viewed and it was noted that the home was staffed on on a twenty four hour period. The staff on the rota was confirmed by the staffing levels that were seen during the inspection, which was three staff, with support from the cook and domestic on the morning shift. Since the last key inspection the times and days of when the registered manager was on duty had been included in the rota. People that were spoken with told us that the staff were available when they needed them and that call bells were answered promptly. During the inspection we observed that the staff were attentive to peoples needs and that requests for assistance were Care Homes for Older People Page 24 of 32 Evidence: addressed promptly. The home had met the target of 50 of staff to have achieved a minimum of NVQ (National Vocational Qualification) level 2 as identified in the National Minimum Standards relating to older people. The statement of purpose was viewed and it stated that there were twenty two staff that worked at the home and one had achieved the Registered Manager Award (RMA), five had achieved an NVQ level 3, ten had achieved an NVQ level 2 and five were working on their awards. At the last key inspection it was noted that staff had been provided with safeguarding, infection control, fire safety, death, dying and bereavement training in 2010. We had identified that there were shortfalls in the provision of manual handling training and that staff were not provided with regular updated training to ensure that peoples needs were appropriately met. Since the last key inspection there had been improvements in the staff training to ensure that staff were trained to meet peoples individual needs. The improvement plan that was sent to us following the last key inspection stated all staff have received manual handling training. We spoke with two staff members and they told us that the staff team had watched a training video on manual handling and completed a test paper, then they had received training from the homes provider in using the manual handling equipment, such as the hoists. A staff member showed us a persons care plan that showed diagrams of the hoist that they used and how it was to be used in a safe manner to ensure that people were supported appropriately. The further shortfalls in training that were identified at the last key inspection were in the process of being addressed in a training programme to ensure that staff were trained to meet peoples needs. The improvement plan stated scheduled training and supervision has been arranged to ensure that staff are properly trained to undertake activities. We viewed training certificates and one to one themed supervision meeting notes, which showed that the staff had been provided with MUST training the week before the inspection and the themed supervision training included nutrition, fluid intake, safeguarding peoples money and turning people and completing the turning charts. Care Homes for Older People Page 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect that their finances are safeguarded and that staff are appropriately supervised. They cannot be assured that the home is fully run in their best interests. Evidence: The registered manager was present during the inspection and they were spoken with about the management arrangements of the home, as we had previously been told that there were plans for the deputy manager to make a registered manager application with CQC. The manager told us that they were remaining as the registered manager of the home and that they worked at the home on a full time basis. The rota was viewed and it showed that the manager worked at the home three to four days each week. The manager told us about the improvements that they had made since the last key inspection, which are discussed in this report, and the plans for further improvements that they had panned to make. Whilst it was positive to note the improvements made, Care Homes for Older People Page 26 of 32 Evidence: such as in the environment, staff training, staff supervision and in peoples care plans, shortfalls remained, which are explained in the health and personal care and environment sections of this report, in areas such as infection control and peoples care plans to ensure that their specific needs were met. Since the last key inspection there had been an improvement in the provision of staff supervision which showed that they were provided with the opportunity to discuss the ways that they were working. The staff that worked at the home had been provided with one to one supervision meetings where they were trained and advised in the ways that they should meet peoples needs, in areas such as nutrition and safeguarding peoples finances. At the last key inspection we viewed the finance records in the home and it was noted that they were appropriately safeguarded. The report stated The records of three peoples spending money were viewed, which was kept in the home for safekeeping. It was noted that the running total matched with the stored money and that a record and receipts were kept of all transactions. Since the last key inspection we had received notifications regarding peoples deaths from the homes management, which provided us with the information that we needed regarding notifiable incidents that had occurred in the home and the actions that were taken by the providers and the homes management in ensuring that people were appropriately safeguarded. At the last inspection we had been informed that the manager visited the home on a weekly basis and we made a requirement that the provider should ensure that monthly Regulation 26 visits were undertaken to ensure that the running of the home was appropriately monitored. The manager told us at this inspection that they had not yet started completing the visit reports and they showed us a template for the visit reports that they planned to undertake. They explained that they were also a director of the organisation and were unsure if the visits were to be undertaken as they managed the home on a day to day basis. We explained that it is good practice for a representative of the organisation to undertake the Regulation 26 visits to monitor the running of the home, identify areas of improvement and to provide the people with an opportunity to express their views about the service that they were provided with during the visits. We viewed the annual satisfaction surveys that had been completed by the people who used the service and their relatives, which provided them with an opportunity to state their views about the home. At the last key inspection it was identified that the hoists and lift were regularly Care Homes for Older People Page 27 of 32 Evidence: serviced to ensure that they were safe to use. During this inspection we viewed the fire safety records, which showed that checks were regularly undertaken to ensure that people were safeguarded in case of a fire and it was noted that a fire risk assessment was in place. There were risk assessments in place which identified the methods of minimising the risks to staff and the people that lived at the home in areas such as with manual handling. Care Homes for Older People Page 28 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 29 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 1 7 15 Peoples care plans must identify the specific support that they need. To ensure that peoples assessed needs and preferences are met. 15/08/2010 2 10 12 Continence pads must not be left opened in communal areas. To ensure that peoples privacy and dignity is respected and to ensure that the risks to cross contamination is minimised. 01/08/2010 3 19 13 Privacy screens must be kept clean. To minimise the risk of cross contamination. 05/08/2010 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 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. 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