Care Home: Paddock Lodge Care Home

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What the care home does well The home was being run by a team of staff who were keen to provide a good service, the residents said, " I would recommend Paddock Lodge to anyone looking for a home"- "If you need anything staff are always willing to help"- "Its a lovely place, good food, nice residents, good staff". A comment from one relative was -"I feel that the home provides good quality care in a homely environment". One staff member made the following comment on what they felt the home did well - "Good home to work at, staff and residents are happy here, management good easy to speak to" People living at Paddock Lodge were mostly happy with the care and support they received, they were getting attention for their health care needs, they were being treated with dignity and respect. Visitors were being made welcome and daily routines at Paddock Lodge were flexible. One relative wrote, "Staff are all very friendly to everyone visiting residents at Paddock Lodge". Positive comments were made about the homes catering arrangements, people`s food likes and dislikes were known, choices were routinely offered and specific diets could be catered for. To help make sure staff provide good care, progress was being made with staff training and development. The residents expressed an appreciation of the staff team, describing them as, "Helpful" and "Good". The home was clean and fresh smelling, furnishings and decor were of a good standard, providing a comfortable place for people to live. What has improved since the last inspection? This was the first inspection since the change of ownership. What the care home could do better: Some improvements were needed in finding out about peoples` individual needs and wishes, before they moved into the home and assuring them that their needs can be met. Progress was needed with the residents care plans, to make sure staff know exactly what to do in order to provide people with individual care and attention. Reviews of peoples` care and circumstances needed to be more effective in responding to changes and ensuring care plans are appropriately updated. To make sure people are properly and safely supported with their medication, some medication practices needed attention. To help ensure people have interesting and stimulating lifestyles, the plans to improve activities and outings need to be put into practice. To ensure people receive good quality care, staffing levels should be continually monitored to make sure there are enough staff on duty. To make sure people using the service are properly protected, better recruitment practices were needed. To help provide a safe environment, some matters needed attention to help reduce risks to the residents and staff. The problem with the gas supply needed to be resolved as soon as possible, to ensure the residents have more suitable heating and hot water supplies. To make sure the home is run in the best interests of the residents, Paddock Lodge needs to introduce better ways of reviewing the service and making plans for improvement. The manager needed to be become more familiar with her role and responsibilities, and be supported to further develop her skills and abilities. Key inspection report Care homes for older people Name: Address: Paddock Lodge Care Home 1 The Paddock Highfield Avenue Burnley Lancs BB10 2PS     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: Jeffrey Pearson     Date: 1 7 0 2 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Paddock Lodge Care Home 1 The Paddock Highfield Avenue Burnley Lancs BB10 2PS 01282420501 01282420501 paddock@highfield-avenue.eclipse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Devikees Limited Name of registered manager (if applicable) Mrs Marie Metcalfe Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered provider may provide the following type of service: Care home only Code PC To service users of the following gender: Either Whose primary needs on admission to the home are: Old age, not falling within any other category - code OP The maximum number of service users to be accommodated is: 16. Date of last inspection Brief description of the care home Paddock Lodge is detached property set in its own grounds, with outdoor seating areas and car parking facilities. It is located in a residential area approximately two miles from the facilities within Burley town centre. Accommodation is provided on two floors in sixteen single bedrooms. There is a stairlift providing access to the first floor. The home offers a lounge, dining room, conservatory and quiet lounge. Furnishings and decoration are domestic in style and of good quality. Staff are on duty to provide care and support throughout the day and night. Care Homes for Older People Page 4 of 29 0 Over 65 16 Brief description of the care home The home had a Statement Of Purpose and Service User Guide providing information about the services provided. A copy of the homes Guide was available to prospective residents and their relatives. This should help them make an informed choice on whether to move into the home. At the time of this inspection visit, the range of fees was between £419.00 and £433.90 per week. Care Homes for Older People Page 5 of 29 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: An unannounced inspection which included a visit to the service was conducted at Paddock Lodge on the 17th February 2010. The visit took over 8 hours and was carried out by one inspector. This was the first inspection since the home had changed ownership in June 2009. Prior to the inspection visit, people using the service were invited to complete surveys, to tell the Commission what they think about the support and care provided at the home, 11 were returned to us. We also received completed surveys from 7 relatives and 10 staff. Before the visit the owner was asked to complete and return to us an Annual Quality Assurance Assessment (AQAA). This was to enable the service to show how they were performing and provided details about arrangements, practices and procedures at the Care Homes for Older People Page 6 of 29 home. The files and records of 2 people were examined as part of case tracking, this being a method of focusing upon a representative group of people using the service. We spoke with people living at Paddock Lodge, the owner, manager and staff. Various documents, including policies, procedures and records were looked at. Parts of the home were viewed. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Some improvements were needed in finding out about peoples individual needs and wishes, before they moved into the home and assuring them that their needs can be met. Progress was needed with the residents care plans, to make sure staff know exactly what to do in order to provide people with individual care and attention. Reviews of peoples care and circumstances needed to be more effective in responding to changes and ensuring care plans are appropriately updated. To make sure people are properly and safely supported with their medication, some medication practices needed attention. To help ensure people have interesting and stimulating lifestyles, the plans to improve activities and outings need to be put into practice. To ensure people receive good quality care, staffing levels should be continually monitored to make sure there are enough staff on duty. Care Homes for Older People Page 8 of 29 To make sure people using the service are properly protected, better recruitment practices were needed. To help provide a safe environment, some matters needed attention to help reduce risks to the residents and staff. The problem with the gas supply needed to be resolved as soon as possible, to ensure the residents have more suitable heating and hot water supplies. To make sure the home is run in the best interests of the residents, Paddock Lodge needs to introduce better ways of reviewing the service and making plans for improvement. The manager needed to be become more familiar with her role and responsibilities, and be supported to further develop her skills and abilities. 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 29 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 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process did not always ensure peoples needs, abilities and preferences were known and planned for before they moved into the home. Evidence: The manager said that the homes guide and statement of purpose had been updated to include the details of the new owners, copies were available in the the homes entrance hallway. The manager said each resident had also been given their own copy of the homes revised guide. Most residents completing surveys indicated they had received sufficient information about the home before moving in, some indicated they were not aware of their contracts of residence, this matter should therefore be given attention. There was an indication in the AQAA (Annual Quality Assurance Assessment) that systems were in place to support an effective admission process, for example, mention was made of encouraging people to visit the home and gathering information Care Homes for Older People Page 11 of 29 Evidence: from relatives and health and social care professionals. The manager explained the action taken in relation to a recent admission. The person had been visited in their then environment, the manager said she had assessed their needs, making notes in a notepad, using the homes assessment form for reference. Some relevant information had also been obtained from health care professionals. We looked at assessment information and found it had not been been completed by the manager, who had carried out the assessment. The assessment was lacking in detail and did not describe specific needs and care responses, for example, entries stated needs some help and full help. Some parts of the assessmnet form had not been completed, such as,daily living and social interests. Specific assessments, in relation to risk of falls and nutrition had not been carried out.This meant it was not clear all needs were known or properly considered, to make sure they could be met at the home. Also, this lack of detail means peoples needs may not be effectively communicated to the staff team. At the time of this inspection visit, Paddock Lodge did not provide intermediate care. Care Homes for Older People Page 12 of 29 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. Health and personal care practices and procedures, were not always effective in ensuring peoples individual needs are appropriately met. Evidence: Eight residents completing surveys, said they always get the care and support they need, one indicated they sometimes did, one that they usually did, comments made were, they look after me well, and staff are always ready to help. People spoken with during the inspection visit, made positive comments about the care they received at Paddock Lodge. Relatives completing surveys indicated they considered the home usually or always met the peoples needs, most said the care and support given was always as they expected and that they were being kept up to date about important issues. Comments made were, My mother is very happy and well looked after- Staff all seem to be focused on providing a good standard of care individualized to each resident The AQAA (Annual Quality Assurance Assessment) indicated that care plans were Care Homes for Older People Page 13 of 29 Evidence: being updated to provide more extensive and detailed information. However, we found one person did not have a care plan, with care instructions being reflected in daily records and dependent upon staff memory. Completed care plans seen provided some good information and they were sensitively written. However, they did not always give clear directions for staff to follow to ensure peoples needs were met, in the way the person preferred. We found some needs in relation health and personal care had not always been included. Emotional needs were not effectively reflected in care plans. The manager and staff spoken with had an awareness of peoples individual needs, however, having detailed care plans in place ensures all members of staff have the information they need in order to provide person centered care for people living at the home. Good systems were in place to review peoples care needs, however, we found changes in care needs and circumstances had not always been appropriately identified and care plans had not been updated accordingly. Residents completing surveys indicated they always get the medical care they need. Records and discussion showed people were getting visits from health care professionals such as GPs and District Nurses. One resident said, They are very good at getting medical attention for us - A relative commented that the home was good at liaising with GPs etc. In the care records looked at, specific assessments for health care needs, for example in relation to risk of falls and pressure areas had not been completed and we found a nutritional assessment had not taken appropriate account of weight loss. These matters were discussed with the manager and owner who gave assurances that action would be taken to rectify them. Staff training had been arranged on malnutrition in the elderly and the AQAA indicated further health care training was to be arranged. Some health care policies and procedures were seen to be available. The AQAA indicated all relevant polices and guidance was in place, but the manager was not sure if they were all up to date or available. Most staff, including the manager had previously received medication training and arrangements were being made to update this. Medication storage was seen to be clean, a new lockable trolley had been provided, however, it was not being kept secured, also some items were being kept unsecured in the fridge, the manager agreed to take action to address these matters. The AQAA showed the medication policies and procedures had been reviewed in March 2009, however, the policies seen were not dated and there was no evidence to show Care Homes for Older People Page 14 of 29 Evidence: they had been reviewed which would be good practice. Practice guidance was available from The Royal Pharmaceutical Society, however, it was advised their more up to date guidance - Handling Medicines In Social Care be obtained for reference. One person using the service was responsible for administering some of their own medication. A risk assessment had been carried out to ensure this could be done safely, however, it was not clear this had not been reviewed in the last 12 months. Also, there was no written guidance in the care plan for staff to follow about the support this person might need, or how they should check that medication had administered correctly. Some residents were prescribed medication to be taken when required there was some guidance for staff to follow about such medication, but it was not specified if the person would ask for the medication or if it was to be offered. We found one person did not have any instructions about a when required item. Having clear written instructions for the administration of when required medication ensures people are given their medication only when they need it. We found policies, procedures and practices needed improvement in relation to homely remedies, as there are risks that over the counter medicines can interact with prescribed items and cause harm. Records of medicines given to people were not always signed and there were numerous gaps on the medication administration records. If the medication had been omitted the reason for this was not recorded for example, if the person had refused. One person had been prescribed medication to be given one every other night, but records indicated this was being given every night, the manager said this instruction had come from the GP, but there was no record in support of this change and action had not been taken amend the written instructions. Insufficient record keeping and failing to follow correct procedures when handling medicines can result in mistakes, which could affect a persons health and wellbeing. Observations of care practices, showed peoples privacy needs were respected, personal care was carried out in the privacy of the persons own bedroom, or bathrooms. People were being supported to take an interest in their appearance a hairdresser was visiting the home on a regular basis. Staff were seen to provide support and interact with people in a very friendly and courteous manner. The staff are very respectful, said one resident spoken with. Care Homes for Older People Page 15 of 29 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 living at Paddock Lodge had lifestyles which generally matched their expectations and plans were being made to further improve social activities and outings. Evidence: People spoken with during the inspection indicated they were mostly content living at Paddock Lodge, comments made were, Its very nice living here - Things are fine I am generally satisfied- Everyone seems to get on so well. There was a very homely atmosphere at Paddock Lodge, routines seemed very flexible, it was apparent people could spend time in their bedrooms as and when they wished. People spoken with said they could get up and go to bed whenever they wanted. There are very few rules here, was one comment made. Residents meetings were being held, records showed most people had been involved with the last discussion before Christmas. The changes management at the home and activities had been discussed. People had also been asked if they had any complaints, none had. It was suggested meetings could be held more often, as an activity, to keep people involved in the general day to day matters which affect them. Care Homes for Older People Page 16 of 29 Evidence: Residents spoken with mentioned the contact they had with relatives and friends. Visiting arrangements were outlined in the homes guide, people could visit at any time. One relative wrote, Staff are all very friendly to everyone visiting residents at Paddock Lodge. Some residents said they went out with their relatives on a regular basis. Arrangements were in place to offer group and individual activities, including sing a longs, card games, bingo and reading. However, social and spiritual care, also family relationships needed to be properly included in the care planning process to promote a more effective response to peoples individual needs and preferences. Some people completing surveys indicated they considered activities at the home needing some improvement, two relatives said they thought activities needed attention, one comment was There is very little stimulus. Some residents spoken with thought there should be more things to do. Several staff also indicated in surveys they felt there should be more suitable activities and outings for the residents. However, the AQAA (Annual Quality Assurance Assessment) did show that activities at the home were to be due to be reviewed and improved in consultation with the residents, their relatives and friends. Eight people indicated in surveys that they always liked the meals at Paddock Lodge, two said they usually did. Everyone spoken with during the inspection visit, indicated they were satisfied with the variety and quality of food provided. The cook spoken with was very much aware of peoples individual likes and dislikes, specific diets could be catered for. Breakfast was offered flexibly, in response to individual preferences, a cooked breakfast was offered at weekends. Menus were being devised weekly. The residents were being given choices alternatives were also available. The menu was not on display in the dining room, which would remind people of the days options and provide a topic for discussion, it was therefore advised action be taken in response to this matter. Promoting further choices and independence at mealtimes, was discussed with the cook. The dining room provided pleasant place for people to eat and socialise. Staff were seen to be attentive and sensitive in their approaches when serving meals and providing support at mealtimes. Care Homes for Older People Page 17 of 29 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. Most polices, procedures and practices supported the complaints process and provided safeguards for people living at Paddock Lodge. Evidence: All residents completing surveys indicated they had someone thy could speak with if they were not happy at the home, eight said they knew how to make a formal complaint. One resident told us, If I was not happy with anything I would tell whoever is in charge, they would do something about it. Four relatives said they were aware of the homes complaints procedure, three said they were not aware. One relative commented, Problems are dealt with quickly and appropriately The complaints procedure was displayed in the homes hallway. The manager said it was also included in the homes guide and that a copy of the procedure had been placed in each persons bedroom. The procedure explained how to raise concerns, included expected timescales and the appropriate contact details of the Commission. The owners contact details had not been included in the complaints procedure, we noted this information was displayed separately in the home. However, it was suggested the contact details, along with information about Social Services be included in the procedure. This will help make sure people have clear information on how to raise concerns. There had not been any formal complaints at Paddock Lodge in the last twelve months. Care Homes for Older People Page 18 of 29 Evidence: There had not been any recent training for staff on safeguarding and protection matters, however, the manager said this was in the process of being arranged, the AQAA (Annual Quality Assurance Assessment) indicated such training was to be provided on an ongoing basis. The manager said the staff whistle blowing (reporting bad practice) policy was in the process of being reviewed to include more up to date information and the contact details of the owner. It was advised clear contact details of the Commission and Social Services be included also. The safeguarding policies seen included some useful information such as definitions and indicators of abuse. However, the referal procedure indicated the Commission was to be contacted in the first instance, rather than Social Services. The manager agreed to rectify this matter. The manager and staff spoken with, expressed an awareness of the action to take in respect of any incidents, suspicions or allegations of abuse. Care Homes for Older People Page 19 of 29 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. The accommodation at Paddock Lodge provided people with a clean and comfortable place to live. However, some improvements were needed for the wellbeing and comfort of the residents. Evidence: People spoken with were generally happy with the accommodation provided at Paddock Lodge I like my bedroom very much said one person. The lounge dining room and conservatory provided comfortable and pleasantly decorated communal accommodation. Furnishings appeared to be of a good standard and arrangements were in place to attend to minor repairs. The owner said they had invested a lot of money in the home, some rooms had recently been redecorated. One relative considered that, Outside space - garden areas could be brightened up or used more, however, the AQAA (Annual Quality Assurance Assessment) indicated this matter was being addressed. We found some information for care staff on display in the kitchen, including the residents GP contact details etc, it seemed the kitchen was being excessively used as a staff area which could compromise health and safety and food hygiene practices. The appropriateness of this practice was discussed with the owner, who said they had already considered it to be a matter in need of attention. Care Homes for Older People Page 20 of 29 Evidence: The heating and hot water supply was insufficient, we had been made aware in December 2009 that the gas supply to part of the home had been cut off. Action had been taken to provide additional heating in five bedrooms and interim arrangements were in place to supply the rooms with hot water. Several residents spoken with expressed some dissatisfaction with the gas problem at Paddock Lodge, in particular the lack of hot water in the bedrooms they felt the situation had gone on long enough, Its was not fair on the staff having to bring hot water to our bedrooms, was one comment made. The owner provided assurances that every effort was being made to rectify this matter as soon as possible, the Care Quality Commission will continue to monitor this situation. Most residents completing surveys said the home was always kept fresh and clean, residents spoken with were keen to express their appreciation of the cleanliness at the home. One relative made the following comment, It never smells of unpleasant odours its kept very clean with a welcoming atmosphere. On the day of the inspection visit, the home was found to be clean and free from odours. Infection control policies and procedures were available and eight staff had received training in the prevention and control of infection. The laundry facilities included suitable washing and drying equipment, there were no facilities for washing hands, but liquid hand wash had been provided. The laundry area was very small, as a result we found that residents clean clothing was being sorted on the corridor, which was not best practice, it was therefore suggested consideration be given to improving the laundry facilities. Care Homes for Older People Page 21 of 29 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. Most staffing arrangements ensured people received effective care and support. Recruitment practices needed attention for the protection of people using the service. Evidence: Five residents completing surveys indicated staff always available when needed, three said they usually were, and two said sometimes. Comments about the staff team included, Staff are helpful and kind- Happy with the staff- If you need help at night there is always someone on duty. One relative wrote, Staff are polite and friendly and helpful and pleasant, hard working and willing. Most residents spoken with during the inspection visit also expressed an appreciation of the staff at Paddock Lodge, one commented, The staff are lovely I couldnt criticize them at all. We have a great working team who always deliver the best care possible, wrote one staff member. Staffing levels seemed to be satisfactory, records and discussion showed there was usually a manager or senior staff and two carers on duty throughout the day, also a cook and cleaning staff. Half of the staff completing surveys considered there were always enough staff on duty to meet peoples individual needs, half said there usually were enough. There had been a reduction in the numbers of staff employed at the home which had meant existing staff having to cover extra shifts and the manager had been helping out with care tasks. A deputy manager was being recruited. Staffing Care Homes for Older People Page 22 of 29 Evidence: levels were discussed with the manager, in particular ensuring that there are sufficient staff for care planning and activities. The manager said additional staff could be brought in to work when required, in response to the residents changing needs, however, it was advised staffing levels be continually monitored, reviewed and adjusted accordingly. The staff recruitment records seen were well organised and indicated that most of the required checks had been carried out. The manager said gaps in employment had been checked, but an explanation for gaps had not been recorded. The POVA (Protection Of Vulnerable Adult) check seen, was not specific in indicating there was no match on the register. Records had not been kept to show specific matters had been explored and rationalized. Applicants had not been asked for details and evidence of registration with, or membership of any professional organisation. It was advised records be routinely kept of interview questions and applicants responses. It is important to thoroughly check all new staff prior to employment, to ensure they are suitable to work with vulnerable people. Good recording practices will show all required checks have been carried out. New staff had been given initial training, records showed an induction programme was being completed which included a comprehensive range of training topics. Most staff completing surveys considered their induction training had covered everything well. Staff training and development was on going at Paddock Lodge. All the the carers had NVQ (National Vocational Qualifications) level 2, some staff had progressed to NVQ level 3. Most staff indicated in surveys they had received suitable training. The manager explained that staff development was being given attention and training updates were being arranged and planned for, including in safe working practices such as moving and handling and health and safety. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most management and administration practices were effective in ensuring the home is run for the benefit of people using the service. Evidence: Paddock Lodge had a change of ownership in June 2009. The manager said good working relationships were being established with the new owners. The manager had been recently registered with the Commission, having previously been deputy manager at Paddock Lodge for several years. She had relevant recognised qualifications in care and management. The manager said she was still becoming familiar with her new role and responsibilities and was unsure about some aspects of her work. She also considered a reduction of care staff and a lack of a deputy manager had impacted upon her effectiveness in managing the home, but progress was now being made. The manager had not had any training in recruitment practices and employment law, therefore it was advised this matter be pursued. Care Homes for Older People Page 24 of 29 Evidence: As previously mentioned in this report, residents meetings had been held at the home and it was apparent from observation and discussion, the residents were being consulted with informally on a regular basis. The manager said she had not been involved previously with quality assurance surveys and processes at the home, this matter was discussed further and suggestions were made on introducing effective quality monitoring systems. Reports were available showing the owners had carried out monthly unannounced monitoring visits at Paddock Lodge. As previously indicated, training in safe working practices was ongoing or being arranged. The AQAA (Annual Quality Assurance Assessment) showed the servicing and checking of equipment and installations. However, we noted the Electrical Installations certificate available, was out of date. The manger said she would pursue this matter and arrange for another inspection as necessary. Some health and safety risk assessments had been completed, not all had been dated therefore it was not clear if they were still current. One was dated 2003 but it did not include a review of the situation. The manager said she was not happy with the risk assessments and considered they should be more detailed. There were no health and safety risk assessments in relation to the recently provided portable fan heaters. There were some completed risk assessments in relation to individual residents, they were not dated and there was no evidence of them being reviewed. There was no clear indication of the likelihood or severity of the risks, or any rationale for the actions being taken. We considered some of the individual risk assessments needed to be incorporated in the care planning process, to ensure staff are given clear instructions on providing appropriate support. Care Homes for Older People Page 25 of 29 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 26 of 29 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 A care plan must be in place for each person using the service. All care plans must accurately identify and address the health and social care needs of each person using the service. This will ensure staff will know what to do to fully meet the needs of each person. 26/03/2010 2 9 13 Records of medicines received into the home and given to people must be clear, accurate and complete. This will make sure all medicines are properly administered and can be fully accounted for. All relevant recruitment documentation must be collated in line with legal requirements. 26/03/2010 3 29 19 26/03/2010 Care Homes for Older People Page 27 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to show that staff are fully checked, to protect people using the service, before the commence work in the home. 4 38 13 Effective arrangements must 30/04/2010 be made to identify and reduce risks and hazards in the home. This will promote the well being and safety of people using 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 3 A way of more effectively assessing and recording peoples needs, abilities and preferences should be introduced, this will ensure all needs are identified, known and planned for before they move into the home. Care plans should be sufficient in detail to provide clear instructions to staff, of the actions to be taken to meet the residents, personal, health and social care needs. They should be effectively reviewed and updated, in response to changing needs. This will ensure that members of staff know what they need to do in order to meet the needs of each person. To ensure medication is appropriately and safely managed for the well being of the residents, action should be taken to ensure the auditing system effectively identifies and resolves inappropriate practices. The laundry facilities and arrangements should be improved, to promote better hygiene and laundry practices. 2 7 3 9 4 26 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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