Care Home: Palatine Lodge

What the care home does well The admission process included a thorough assessment of the residents` needs, prior to them moving into the home. This enabled the registered manager and prospective residents to determine whether or not their needs could be met within the home. New residents were also issued with a contract, which informed them about what they could expect from the service. All residents had a care plan based on their assessment of needs. The plans provided guidance for staff on how to meet people`s personal needs. Wherever practicable the residents and/or their relatives were involved in the care planning process, which meant that they had an influence on the level and type of care and support provided. The daily routines were flexible and designed to meet the needs and wishes of the residents. The residents could follow their personal routines and were encouraged to make decisions about their lives. Visitors were made welcome in the home and the residents were well supported to maintain important personal relationships. This enabled them to continue to play an active role in their family life. The residents had access to a clear complaints procedure, which provided them with the necessary information should they wish to raise a complaint or concern. The residents were provided with bright, clean and homely accommodation. The home was attractively furnished and decorated throughout and the residents could personalise their bedrooms with their own belongings. There was a good programme of staff training and staff had opportunities to attend training courses in line with their own needs and the needs of the residents. One member of staff wrote on a questionnaire, "Since I`ve been working in the home, I have done a lot of training courses and I`m doing well". The vast majority of staff had achieved NVQ (National Vocational Qualification) level 2. This qualification provided the staff with the necessary knowledge for their role within the home. Established arrangements were in place to promote health and safety, which included regular safety checks on appliances and installations. This ensured that the residents lived in a safe environment. What has improved since the last inspection? Since the last inspection, the care plan format had been updated to help staff gain easy access to information about the residents` needs. Various improvements had been made to the premises to aid the comfort of the residents. For example, two bedrooms had been redecorated, some windows had been replaced and a new large efficient dryer had been purchased to help with the laundry. Improved outdoor seating had also been bought for the residents` use in fine weather. According to information in the AQAA, a second cordless telephone had been installed with a separate number to enable the residents to make and receive personal and private phone calls.A new manager had been appointed who had registered with the commission. This meant there was a designated person to take legal responsibility for the day to day operation of the home. According to comments in the staff questionnaires, the staff welcomed the continuity of leadership. What the care home could do better: Staff working at the home should be aware of the location of key information such as risk assessments. This will ensure that the people using services are looked after appropriately. All information from the prescription labels must be recorded onto the medication administration record and stringent checks must be made on receipt of medication into the home. This is to ensure the residents are given their medication in line with the prescriber`s instructions and a clear audit path can be maintained of drugs handled in the home. The recruitment and selection process must include the collation of all relevant checks and records in line with regulatory requirements. This is to ensure all staff are fully vetted before commencing work in the home. Accurate records must be maintained of money deposited by or on behalf of the residents. This is to ensure the residents` financial affairs are safeguarded. Key inspection report Care homes for older people Name: Address: Manderley Residential Care Home 17/19 Palatine Square Burnley Lancashire BB11 4JF     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 Playfer     Date: 0 4 0 5 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) © 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 29 Information about the care home Name of care home: Address: Manderley Residential Care Home 17/19 Palatine Square Burnley Lancashire BB11 4JF 01282431450 01282431450 www.manderleycare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Morgiana Muni Nazerali Name of registered manager (if applicable) Mrs Theresa Rostron Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of people who can be accommodated is: 15. The registered person may provide the following categories of service only: Care home only - Code PC, to people of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Dementia - Code DE, Mental disorder, excluding learning disability or dementia - Code MD, Learning disability Code LD, of the following age range: 55 years and above Date of last inspection Brief description of the care home Manderley Residential Care Home is a large two storey Victorian style property, situated close to Burnley town centre and bus stops. The home is registered to provide accommodation and personal care to a maximum of 15 older people with a dementia, Care Homes for Older People Page 4 of 29 Over 65 0 0 0 15 15 15 2 0 0 5 2 0 0 9 Brief description of the care home mental disorder or learning disability. Accommodation consists of 11 single and two double rooms. The upper floor is accessed via a stair lift. There is equipment and adaptations available to assist people with mobility problems. Communal space is provided in three living rooms with dining areas. All rooms are linked to the call system. At the time of the inspection (May 2010) the scale of fees ranged from £426.00 to £498.00 There were no additional charges. Information was made available to people by means of a statement of purpose and service users guide. The service users guide was usually given to prospective residents and/or their relatives on viewing the home or at the point of assessment. Inspection reports can be viewed in the home or downloaded free of charge from the Commissions website on www.cqc.org.uk 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: A key unannounced inspection, which included a visit to the home was conducted at Manderley Residential Care Home on 4th May 2010. The inspection was carried out by one inspector, however, the report refers to we as it was written on behalf of the commission. The previous key inspection of this service was conducted on 20th May 2009. Following the last key inspection, the registered provider submitted an improvement plan, which set out their planned action to meet the legal requirements set out in the inspection report and the timescales by which the requirements would be met. At the time of this inspection, there were eight residents accommodated in the home. During the visit we spent time with the residents, looked round the home, read some of the residents care records and other documents and talked to the staff and the registered manager. We also consulted our records about the service and information Care Homes for Older People Page 6 of 29 we have received over the last twelve months. As part of the inspection process we used a method known as case tracking as a means of gathering information. This process allows us to focus on a small group of people living at the home, to assess the quality of the service provided. At the end of the inspection all the evidence and the findings were discussed in detail with the registered manager. Prior to the inspection, the registered provider completed an Annual Quality Assurance Assessment known as AQAA, which is a detailed self assessment questionnaire covering all aspects of the management of the home. This provided us with useful information and evidence for the inspection. Satisfaction questionnaires were sent to the home for distribution to the staff and the residents. Six questionnaires were returned from the staff and two were received from the residents. The responses from the questionnaires were collated and used throughout the inspection process. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? Since the last inspection, the care plan format had been updated to help staff gain easy access to information about the residents needs. Various improvements had been made to the premises to aid the comfort of the residents. For example, two bedrooms had been redecorated, some windows had been replaced and a new large efficient dryer had been purchased to help with the laundry. Improved outdoor seating had also been bought for the residents use in fine weather. According to information in the AQAA, a second cordless telephone had been installed with a separate number to enable the residents to make and receive personal and private phone calls. Care Homes for Older People Page 8 of 29 A new manager had been appointed who had registered with the commission. This meant there was a designated person to take legal responsibility for the day to day operation of the home. According to comments in the staff questionnaires, the staff welcomed the continuity of leadership. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process ensured the residents needs and wishes were properly considered and planned for before they moved into the home. Evidence: Current and prospective residents were provided with written information in the form of a service users guide and a statement of purpose. The service users guide was dated 2010 and was presented in an easy read format with pictures used to illustrate the text. Since the last inspection, the guide had been updated to include details about the new registered manager. A brochure had also been produced, which provided the residents with an overview of the services and facilities available in the home. Copies of previous inspection reports were accessible for reference purposes in the hallway. This meant the residents and their families were provided with and had access to suitable and relevant information to help them understand what amenities and services were provided in the home. Care Homes for Older People Page 11 of 29 Evidence: New residents were issued with a contract, which set out the rights and obligations of the residents and the role and responsibility of the registered provider. It also included details about what was included in the fee. The contract was presented in a clear format and was jargon free. This ensured that the residents and their representatives were aware of the terms and conditions of residence and knew what they could expect from the service. A copy of the contract was included in the service users guide. The personal files of two residents were looked at in detail as part of the case tracking process. The records showed that a full assessment of needs had been carried out prior to admission. The assessments were detailed and included information about the residents personal, social, cultural and healthcare needs, for instance past and present medical conditions. The assessment also sought details about peoples daily living needs including dietary needs and preferences, hobbies and interests and preferred routines. Wherever practicable, the prospective resident and/or their families had been involved in the assessment process, to ensure their views and wishes were considered and documented. This meant that the registered manager could be confident the staff had the necessary skills and knowledge to meet the assessed needs of people wishing to move into the home. The assessment information was made available to the staff team, so they were aware of the residents needs and preferences. Following the assessment of needs a letter was sent to prospective residents and their families to confirm the residents needs could be met in the home. This meant residents could be assured that the home was a suitable place for them to live. The registered manager confirmed that prospective residents were invited to spend as much time as they wished in the home prior to making the decision to move in. This enabled the person to meet other residents and staff and experience life in the home. Following admission, the contract stated that a trial period of four weeks was offered to every new resident, so both parties could make sure the placement was successful and the residents individual needs could be met. 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. Whilst the residents preferences were clearly recorded, the care plans did not always contain sufficient information about the residents healthcare needs. Some medication was not accurately recorded and handled in a safe and consistent manner. Evidence: We looked in detail at the personal files of two people, to assess the quality of the care planning documentation. From this we could see that both people had a care plan, which was based on their assessment of needs. Since the last inspection, the care plan format had been reviewed and revised, to help staff gain easy access to information about the residents needs. The plans were supported by risk assessments and personal preference day plan. The latter provided information about the residents preferred daily routines and their likes and dislikes. This meant the staff were provided with useful information about the residents needs. The plans seen contained some information about the residents religious and cultural needs. The plans were supported by records of personal care, which provided information about changing needs and any recurring difficulties. The records had been made on a Care Homes for Older People Page 13 of 29 Evidence: daily basis, to ensure staff were provided with ongoing details about the residents well being. Charts had been maintained for personal care and hygiene. This meant it was possible to determine the frequency and type of care provided to each resident. Written records seen on the personal files demonstrated that the care plans had been reviewed each month or more frequently in line with changing needs. Wherever practicable the residents and/or their relatives were involved in the care planning process, which meant they had an influence on the level and type of care and support provided. Healthcare needs were considered and documented during the assessment process. We noted that the care plan for one person contained limited information about conditions identified in the social work assessment. This meant that there was the potential for staff to have limited knowledge about how previous conditions could affect the residents daily life or impact on their care they needed. The care records indicated the residents had access to health care services and all were registered with a GP. Specialist advice was sought as appropriate from health care professionals, such as the District Nursing Team and Doctors. All residents were supported as necessary to attend medical appointments. Records had been maintained on a regular basis to monitor the residents weight, to ensure any significant fluctuations were noted and acted upon. Potential risks had been considered as part of the care planning systems and risk assessments were seen in respect of moving and handling, falls, nutrition and pressure sores. Information was contained within the individuals support plan in relation to the management of challenging behaviour. An assessment relating to the management of challenging behaviour of one of the people we case tracked was not available on the day of the inspection visit and the manager was not aware on her return from holiday that the risk assessment had been updated. Following our visit the registered manager informed us that the updated risk assessment had been found and that the previous risk assessment had been placed on a different file. Neither risk assessment was available at the time of the inspection but was made available within 48 hours of the inspection visit. We received two questionnaires from the residents, which had been completed with the assistance of either the registered manager or senior member of staff. The residents made the following comments in response to the question, What does the home do well? Good food, Look after me and Likes cooking. In relation to the question, What could the home do better? The residents responded, They cant do Care Homes for Older People Page 14 of 29 Evidence: any better than they do and Could help me more when I need to walk. During the inspection one resident said the staff were nice, however, one resident said that the staff could be a lot better. The person added that sometimes the staff were unhelpful and she did not like asking them for anything. The person repeated the same concerns to the registered manager, who immediately offered to investigate the issues under the homes internal complaints procedure. During the visit, the staff were observed to interact with the residents in a friendly manner and they referred to the residents in their preferred form of address. The staff also encouraged personal choice and helped the residents continue with their preferred routines. Policies and procedures were in place to cover the management of medicines and were available for staff reference in the staff station in the hallway. The home operated a monitored dosage system of medication, which was dispensed into blister packs by a local Pharmacist. Appropriate records were maintained in respect of receipt, administration and disposal of medication. However, we noted that one drug had not been signed as given on the medication administration record (MAR), handwritten entries on the MAR chart had not always been signed by two members of staff and not all instructions from the prescription had been entered onto the MAR chart. In addition, there was no prescription label on a controlled drug, there was some unlabelled medication in the trolley and there was not always a record of receipt of medication into the home. These findings were discussed with the registered manager who made arrangements to audit all the medication held in the home and consult the Pharmacist about any discrepancies. 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. The residents had appropriate opportunities to participate in activities and were supported to maintain good contact with their family and friends. The residents were provided with a nutritious and varied diet. Evidence: The residents preferences in respect of social activities and daily living routines were recorded and considered as part of the assessment and care planning processes. A range of activities were arranged and residents were able to join in as they wished. Individual activity records had been maintained to enable the staff to plan activities the residents enjoyed. Activities included music for health, colouring, crafts, listening to music, tabletop games and nail care. The residents had also enjoyed a trip to Blackpool. Information about forthcoming activities was displayed on a notice board in the dining room. The residents spoken to confirmed activities were available to join in and they could participate as they wished. The residents were supported to continue with their chosen form of religious worship. A representative from a local church visited the home for prayers and communion once a month. Care Homes for Older People Page 16 of 29 Evidence: The routines were flexible and were primarily designed to meet the needs of the residents. The residents spoken to said they had a choice in the times they got up and went to bed. We noted the residents got up at different times on the morning of the inspection. This meant that the residents were able to influence their lifestyle and choose their preferred routines. The residents had the opportunity to develop and maintain important personal and family relationships. There were no restrictions placed on visiting times and residents were able to receive their guests in private, should they wish to do so. Refreshments were offered to visitors, to ensure they felt welcome in the home. A visitor spoken to during the inspection was satisfied with the quality of care. The person commented, The staff are always friendly and the home is always fresh and clean. The residents spoken to said they liked the food provided. There was a choice of food each meal time and residents were asked prior to each meal what choice they wished to make. The food was mostly homemade and breakfast was served throughout the morning to suit the preferences of the residents, who wished to have a lie in. Since the last inspection, the dining arrangements had been altered to allow the residents to stay in separate lounges. The meals served on the day of inspection were plentiful and well presented. Residents were given appropriate support to eat their meals. Drinks and snacks were served throughout the day and at other times on request. 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. Residents were able to express their views and any concerns and had access to a clear complaints procedure. There were established ways of working to respond effectively to any suspicion or allegation of harmful practice. Evidence: Arrangements were in place to ensure the registered manager and staff listened to and acted on the views and concerns of residents. This was achieved during daily conversations, one to one discussion, satisfaction questionnaires and residents meetings. The residents spoken to said they were aware of whom to speak to in the event of a concern. The complaints procedure was included in the statement of purpose and service users guide. The procedure was illustrated with pictures and contained the necessary information such as the relevant telephone numbers should a resident wish to raise a concern. The registered provider had received one complaint since the last inspection, which had been directed through the commission. The complaint was investigated under the homes complaints procedure and a full report of the investigation was sent to the commission, within the designated timescale. There were procedures in place to respond to any allegation, suspicion or evidence of Care Homes for Older People Page 18 of 29 Evidence: abuse. However, these internal procedures did not include clear details that would assist staff in what to do at a local level. The registered manager therefore agreed to review and update the procedures immediately following the inspection. Safeguarding issues were incorporated into the induction and mandatory training and staff received specific tuition as part of their NVQ training. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents were provided with a clean, comfortable and well maintained environment. Evidence: Manderley Residential Care Home is a mature property set in its own grounds in a residential area in Burnley. The town centre is approximately half a mile away. The gardens are maintained by a gardener and could be used by the residents in fine weather. Accommodation was provided in 11 single rooms and 2 double rooms, none of the bedrooms had an ensuite facility. Screening was available in shared rooms. Communal space was provided in three lounges with dining areas, all of which could be used for various recreational activities. A stair lift was fitted to the stairs to ease access to the first floor. The residents had free access around the home and could choose where they wished to spend their time. Arrangements were in place for general repairs and maintenance and a record was maintained of the work carried out. This meant that any routine problems with the building could be promptly rectified. The registered provider had also produced a refurbishment plan. It was evident from a partial tour of the building that the residents had personalised Care Homes for Older People Page 20 of 29 Evidence: their rooms with their own belongings and decoration was a good standard throughout. The residents were satisfied with their rooms. Since the last inspection, various improvements had been made to the premises to aid the comfort of the residents. For example, two bedrooms had been redecorated, some windows had been replaced and a new large efficient dryer had been purchased to help with the laundry. Improved outdoor seating had also been bought for the residents use in fine weather. Appropriate aids and adaptations were provided to assist the residents mobility. This included various pieces of equipment for safe moving and handling. Assisted baths, raised toilets and grab rails were also available, to promote the residents independence. According to information in the AQAA, a second cordless telephone had been installed with a separate number to enable the residents to make and receive personal and private phone calls. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff were well trained and experienced. However, the recruitment process needed further attention to ensure all staff are thoroughly checked before commencing work in the home. Evidence: A staff duty roster was drawn up four weeks in advance and provided a record of the number of hours worked by the staff in the home. According to information in the AQAA, the registered provider had maintained the same level of staffing over the last year. All staff who provided personal care were aged over 18 and all staff left in charge of the building were aged over 21. The residents spoken to were generally satisfied with their care, however, as mentioned previously one person said the staff were sometimes unhelpful and difficult to approach. The registered manager agreed to investigate these concerns. A recruitment and selection procedure was available and a checklist was used to track documentation required for the recruitment of new staff. The file of one member of staff and the manager were looked at in detail. From this we could see the managers recruitment included the collation of the necessary records and checks in line with regulatory requirements. The staff members file included an application form and two Care Homes for Older People Page 22 of 29 Evidence: references. However, we noted the member of staff had commenced work before the receipt of other checks. This situation was confirmed by the registered manager following the inspection. This meant the member of staff had not been thoroughly vetted before having access to the residents. Arrangements were in place for all new employees to undertake induction training, which incorporated the Skills for Care common induction standards. The latter provided underpinning knowledge for NVQ level 2. According to information supplied by the registered manager, ten out of eleven care staff had achieved NVQ level 2 or above, which equated to 91 of the overall staff team. In addition one member of staff was working towards this qualification. This meant the vast majority of the staff team had achieved the necessary qualifications to enable them to carry out their role effectively. Staff attended both internal and external training courses and had at least three paid days training a year. Training certificates seen on the staff files demonstrated that the staff had received recent training on moving and handling, medication administration and first aid. Staff discussed their individual training needs during their supervision sessions and there was an overall staff training plan. The home was also linked to the LWDP (Lancashire Workforce Development Partnership), which is a staff training organisation. This meant the registered manager could readily identify future training needs for individual staff and for the staff team as a whole. Staff who completed a questionnaire made positive comments about the management of the home and the teamwork. For example one member of staff said, We all get on well together and there is always someone to turn to when help is needed. 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. The residents health and safety was promoted and appropriate systems were in place to monitor the quality of the service. Evidence: Since the last inspection, a new manager had been appointed and had registered with the Commission in April 2010. The registered manager had completed NVQ level 4 in Health and Social Care and held a Diploma in Management. The registered manager also had 20 years experience of managing care homes for older people in various residential settings. There was a programme in place for staff supervision and the topics discussed during supervision were recorded on a suitable format. In addition staff were given the opportunity to attend regular formal staff meetings and handovers. This meant that staff were able to share experiences and discuss future developments. The service had been awarded with an Investors in People Award in 2007, which is a Care Homes for Older People Page 24 of 29 Evidence: professionally recognised quality assurance award, and had Preferred Provider status with the Local Authority. Residents meetings were held at regular intervals, which provided the residents with the opportunity to express their views and opinions in a formal setting. Satisfaction questionnaires had been distributed to the residents in March 2010 and the results had been collated and analysed. The registered manager had established various audit tools to monitor the operation of the home, which included an admission checklist and a medication audit. An annual development plan and a refurbishment plan had been produced, which was linked to the improvement plan submitted to the commission by the registered provider following the last key inspection. The annual development plan set out the current situation within the service and the planned areas for development over the forthcoming year. Appropriate arrangements were in place for handling money, which had been deposited with the home by or on behalf of a resident. However, a random check of the records and monies deposited on the premises demonstrated that one residents records did not accurately correspond with the amount of money held. The registered manager offered to do an immediate audit of the money in order to account for the excess amount. There was a set of health and safety policies and procedures, which included the safe storage of hazardous substances and infection control. Staff received health and safety training, which included moving and handling, food hygiene, first aid, fire safety and infection control. Documentation seen during the inspection and information supplied in the AQAA indicated that the electrical, gas and fire systems were serviced at regular intervals. The fire log demonstrated that the staff had received instructions about the fire procedures during their induction and had participated in regular fire drills. Appropriate arrangements were in place to record accidents and incidents in the home. This ensured that the residents condition was closely monitored following an accident or incident. 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 9 13 All information from the prescription labels must be recorded on the medication administration record and stringent checks must be made on receipt of medication into the home. This is to ensure the residents are given their medication in line with the prescribers instructions and a clear audit path can be maintained of drugs handled in the home. 31/05/2010 2 29 19 The recruitment and selection process must include the collation of all relevant checks and records in line with regulatory requirements. This is to ensure all staff are fully vetted before commencing work in the home. 31/05/2010 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 3 35 17 Accurate records must be maintained of money deposited by or on behalf of the residents. This is to ensure the residents financial affairs are safeguarded. 31/05/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 All risks to the health or safety of the residents should be identified, assessed and so far as possible eliminated. This includes the risks posed by challenging behaviour. This is to ensure all such risks are managed in a safe and consistent manner. The care plans should provide details as to how the residents healthcare needs are to be met. This is to ensure the staff are aware of how to monitor and respond to these needs. Handwritten entries on the medication administration records should be checked and signed by two members of staff to minimise the risk of error. The safeguarding procedures should be updated to reflect the Lancashire Safeguarding Adults - Multi Agency Policy and Procedure. This is to ensure the residents are fully protected. 2 7 3 9 4 18 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. © 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. 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