Care Home: Park Hall

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What the care home does well The home has managed the intake of new people to the service well. Admissions have been on a phased basis to allowing both newly admitted people and staff a settled period of orientation before further admissions take place. 2-3 people have been admitted at a time with gaps between the new intake of people. Recruitment and training commenced in December 2009. The admission of people started in late January 2010. At the time of this inspection 27 people were in residence the recent 3-4 people being admitted onto the first floor of the home. We spoke with 3 people recently admitted to that floor and they said that staff had been very supportive and helpful in receiving them and helping them to settle into the home. Good recruitment procedures mean that a varied and diverse group of staff have been recruited at different levels and with a varied range of experience and qualifications. Good training programmes have provided the necessary induction, statutory and service specific training to be undertaken without undue pressures upon staff. The high quality environment is evident and clearly enjoyed with pride by people using the service, staff and visitors. There is always a Deputy Manager on duty throughout the 24 hour period who takes responsibility for the operation of the home. The Manager and Senior Staff are readily available to both people living at Park Hall and to visitors. The District Nursing service report already well-established positive and professional working arrangements between nursing and care staff. A visiting District Nurse described staff as "Amenable, friendly and well-trained" - a good start for a new service establishing first-time relationships with other professionals. The care planning format is comprehensive and provides all the required information to meet the needs of people in the service if completed in full. The unique and outstanding glass roofed central courtyard provides a safe and pleasant area where people can walk or sit and can access from any part of the home building that surrounds it. What has improved since the last inspection? This new service was registered in January 2010. This is the first inspection of the service. What the care home could do better: Care planning information should be completed at the point of admission to ensure staff have all the necessary information and instructions to be able to meet peoples assessed needs. Some improvements can be made in medication administration - Medication must be signed for at the point of administration as proof that people are given the medication prescribed to ensure their health and well being. It is important that instructions for the use of prescribed creams are provided for staff stating when, where and how often creams are to be administered. This will ensure people have the correct treatment prescribed for them. It is good practice when handwritten additions are made to MAR sheets, that another member of staff checks and witnesses additions or changes. This provides additional security to ensure people have the correct medication. Plans for training for remaining staff in Moving & Handling and Deprivation of Liberty Safeguards should be carried out to complete the training programme for existing staff. Where references from previous employers are not completed and potential concerns may be indicated, these must be further clarified with the person providing the reference. This will fully protect people using the service. Some improvements could be made in recording and quantifying food and fluid intake charts. Key inspection report Care homes for older people Name: Address: Park Hall Park Hall Ubberley Road STOKE ON TRENT Staffs ST2 0QS     The quality rating for this care home is:   two star good 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: Peter Dawson     Date: 0 6 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: Park Hall Park Hall Ubberley Road STOKE ON TRENT Staffs ST2 0QS 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ideal Care Homes Name of registered manager (if applicable) Miss Mandy Jackson Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum numbers of service users who can be accommodated is:60 The registered person may provide the following category of service only: Care Home only PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Dementia DE 60 Date of last inspection Brief description of the care home Park Hall is a purpose built service providing specialist care for up to 60 people who have dementia care needs. The services was registered in January 2010. The building, furniture, fittings and equipment is to a high standard. 60 single bedrooms have state of the art equipment with en-suite facilities including showers. There is an outstanding gloss-roofed courtyard, located centrally and accessed from all areas of the home that surround it. Lounge and dining facilities offer a choice of location for people and there is an impressive cenema with surround sound forming part of the homes reminiscence activities. The builiding is on 2 floors with shaft lift access to the first floor. Care Homes for Older People Page 4 of 29 Over 65 60 60 Brief description of the care home Park Hall is set in the heart of the Bentilee community with easy access to the Potteries towns. Public transport access is good and there are parking facilities in the grounds. Weekly charges recorded in May 2010 are £450 per week for private fee payers. Other charges can be obtained by contacting the home direct. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is the first inspection of this new service that was Registered and opened in January 2010. All new services are inspected in the first 6 months of operation. This unannounced key inspection was carried out by one inspector on one day. This means the service did not know we were coming. The home provides a specialist service for up to 60 people with dementia and the National Minimum Standards for Older People were used as the basis for the inspection. An Annual Quality Assurance Assessment (AQAA) was completed and returned to us by the Registered Manager prior to the inspection and provided comprehensive information about this new service. The AQAA is a legally required self-assessment document containing information about what the service think they do well, what Care Homes for Older People Page 6 of 29 progress they have made over the past year, what they think they could do better and their plans for improving the service over the next 12 months. Some information from the AQAA is included in this report. There were 27 people in the home at the time of this inspection. We saw most of them and spoke with 10-12 of them. We had conversations with 3 visiting relatives and spoke with staff on duty who expressed their views about the service and the progress being made. We were able to observe interactions between people living in the home, staff and visitors. Those conversations and observations are also included in this report. We looked at care plans, risk assessments, health care and medication records and a range of other records relating to the inspection process. All required records were readily available in the home. Some records are computer based and these were made available to us. We were able to inspect the environment, including all communal areas and a sample of bedrooms. 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: Care planning information should be completed at the point of admission to ensure staff have all the necessary information and instructions to be able to meet peoples assessed needs. Some improvements can be made in medication administration - Medication must be signed for at the point of administration as proof that people are given the medication prescribed to ensure their health and well being. Care Homes for Older People Page 8 of 29 It is important that instructions for the use of prescribed creams are provided for staff stating when, where and how often creams are to be administered. This will ensure people have the correct treatment prescribed for them. It is good practice when handwritten additions are made to MAR sheets, that another member of staff checks and witnesses additions or changes. This provides additional security to ensure people have the correct medication. Plans for training for remaining staff in Moving & Handling and Deprivation of Liberty Safeguards should be carried out to complete the training programme for existing staff. Where references from previous employers are not completed and potential concerns may be indicated, these must be further clarified with the person providing the reference. This will fully protect people using the service. Some improvements could be made in recording and quantifying food and fluid intake charts. 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. Adequate information available prior to admission ensures people are able to make an informed choice. Pre admission assessments ensure needs can be met and placements are successful. Evidence: Information about the service is displayed in the reception area of the home. This includes printed brochures and a copy of the My Information Guide that includes the Statement of Purpose and Service Users Guide. Copies are also provided in all bedrooms. All the necessary information about the service is included including scale of charges and charges for additional services. A computerised information system provides information on large screen in the reception area giving details of menus, activities and photographs of staff on duty. This information can also be accessed via the internet from any computer. Care Homes for Older People Page 11 of 29 Evidence: Pre admission assessments are carried out by the homes senior staff when a person is considering admission to the home. We saw this information in the sample of care planning information we examined. Good, comprehensive information about health, social and recreational needs of the person were recorded, together with a multiagency assessment. These assessments provide the basis for establishing a care plan for each person. Following pre-admission assessments people are informed in writing that, based upon the assessment, the persons needs can be met by the home. Information in the AQAA states All residents are admitted on a trial basis - a resident has 6 weeks in which to decide if the placement is right for them. Contracts are provided and copy kept with individual financial records. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are met. Shortfalls in aspects of care planning and medication provide additional safeguards for them. Evidence: A detailed Person Care Profile (Care Plan) is in place for each person. The format is comprehensive covering 16 areas including: Daily communication, life history & aspirations, communication & respect, personal hygiene, continence and toileting needs, medication, personal safety, sleep & rest, short term care plan, health & wellbeing, skin assessment & risk, food nutrition & mealtimes, mobility & falls risk, memory & understanding, family and social contacts and care plan review. We saw a sample of 4 care plans and found information provided the detail to enable staff to meet identified needs. Good pre-admission assessments had been carried out and multi-agency assessments obtained prior to admission. These provided the basis for establishing the care plans. In relation to a couple admitted 5 days prior to the inspection a good pre-admission Care Homes for Older People Page 13 of 29 Evidence: assessment had been carried out but this information had not been transposed into the care plan. Areas not completed in the care plan included: Hygiene & Personal Care, Toileting & Continence and Mental Capacity Assessment -although this information had been provided in the pre-admission assessment. Risk assessments in relation to Falls and medication had not been completed. We saw a risk assessment for food and nutrition that had been given a medium risk, although information showed this should be high risk. These shortfalls seemed to relate to the member of staff responsible for the person at the time of admission, then being off-duty for several days and information not being processed to ensure staff had all required information to provide care to meet needs. There were other good assessments and information relating to Life History, Pain, Skin assessment and the support required to meet nutritional and food and fluid intake needs. In relation to a person admitted as an emergency it was positive to see that a preadmission assessment had been carried out on the same day and the social workers multi-agency assessment had been obtained. This information provided the basis for a good initial care plan with clear instructions to staff. We saw detailed information about personal care needs and there were regular recorded weights to monitor aspects of health care. People had been referred to GP/Dietitian where weight loss had occurred. Food and fluid intake charts had been established where required. We looked at one chart and found that there were some omissions, we also suggested that daily fluid intake is quantified to monitor hydration. Accidents are recorded and we saw a plan for observations and checks, initially hourly, for the following 24 hour period. We were able to speak privately with the visiting District Nurse, who knows the home well and was visiting to see 4 people. She spoke very positively about the excellent cooperation between the nursing service and staff. She described staff as Amenable, friendly and well trained. She said staff had high awareness of health care needs, making early referrals and were keen to carry out instructions to promote good health. She exampled a person with an horrendous skin condition of her legs a month ago, saying that staff had followed treatment advice closely resulting in a vastly improved and less painful condition. The homes GP visits weekly. We were able to speak with a visiting GP who acts as locum. Unfortunately it was his first visit but he confirmed the surgery practice had no Care Homes for Older People Page 14 of 29 Evidence: concerns about working arrangements. He said he had been given the required detailed information to refer a person for psychiatric re-assessment that day. The AQAA states that their is a choice of male or female staff. In relation to a recently admitted lady, information indicated that she preferred a female carer, although we saw she was receiving personal care from a male carer. The member of staff had asked her if she was happy about this and she said that she was. We recommend that gender preferences for care are included in care plans to avoid any confusion. We looked at the medication system in the home and identified some areas for improvement. Some photographs with medication records were poor photocopies and did not identify the person. We found several gaps on MAR sheets (Medication Administration Records) where medication had been given but not signed for. Prescribed creams on MAR sheets stated as directed - this is inadequate. It is important that clear instructions are provided for staff stating when, where and how often creams are to be administered. There were a lot of duplicate entries by the Pharmacy on some MAR sheets that could lead to confusion. We suggest this is discussed with the pharmacy and they should not be repeated. Some entries had inevitably been handwritten by staff on MAR sheets where people were newly admitted or additional medication prescribed. It is good practice to ensure that all handwritten entries on MAR sheets are checked and countersigned by another member of staff to ensure accuracy. 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 live in a comfortable pleasant environment with a range of choice and activities available to them. Evidence: This new purpose-built environment provides an open, spacious and comfortable setting, geared to the needs of people with dementia. People can walk safely within the home, there are choices of lounge/dining areas, separate lounges and a cinema for films. The unique advantage is that people can wander safely in the large glass roofed central courtyard with exotic tropical plants, raised flower beds and sensory garden. This area is central to the home. It is bright, pleasant and has seating. Allowing people to walk/wander with safety and providing a safe protected area considered an external garden area. Activities are provided on a daily basis involving all care staff and include small group or individual activities. A range of social events are provided involving those living in the home, staff and relatives. Entertainment is provided in the large main lounge/activity area. Individual records are kept of activities undertaken and recorded with photographs on the virtual notice board. Care Homes for Older People Page 16 of 29 Evidence: The AQAA information states: Life History and Aspirations are used to link activity planning by considering past, present and future interest, past times and hobbies. For instance one gentleman likes to watch his favourite football team and having a memory impairment needs only support and prompting to continue his interest All people at Park Hall were seen and many spoken with. Those able to express a view spoke highly of staff and facilities. Comments included I like it here, people are very friendly. I have a very nice room and can choose where I spend my time. this is a wonderful place to live and we are lucky to be here. People clearly make choices about rising and retiring times, bathing and where they spend their time. They are encouraged to participate in the daily running of the home where possible, examples being preparing vegetables, light dusting, laying tables and folding their own luxury. We saw many examples of this during the inspection. Pet therapy has been introduced - a rabbit is now kept in the covered central garden area providing a focus for daily interest and activity. Some people wander and wait for visitors that are not going to arrive. We saw staff diverting and encouraging alternative distractions. Some become upset and we saw very sensitive support given to a lady wishing to go home. Staff spoke with patience and understanding encouraging her into the office where she was able to speak to her relative by phone and became a little reassured. We spoke with two visitors who spoke enthusiastically about the high standard environment and also the commitment of staff. We saw friendly and open exchanges between visitors and staff. Visitors made welcome with offer of refreshments and update on their relatives progress if they wished this. We were told that Relatives are invited to a monthly chefs buffet evening with entertainment, giving the opportunity for families to socialise and become involved in aspects of the running of the home. People told us that the food was good. We saw 4 weekly menus offering choices of hot and cold selections at all mealtimes. Visual selections are provided for people unable to make verbal choices. People are involved in making choices for menus. People are encouraged and supported to maintain their personal appearance by means of bathing/shower choices and times, hairdressing salon on site, choosing own clothing, encouraging make-up and jewellery, attention to person grooming such as shaving, hair removal etc and complimenting people upon their appearance. Your Choice - monthly meetings are held where people can express their opinions and their views sought in relation to food, activities and daily routines. Actions taken Care Homes for Older People Page 17 of 29 Evidence: to improve the service where possible. Care Homes for Older People Page 18 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. A complaints procedure and safeguarding procedures are in place to ensure people are safe and protected. Evidence: There is a complaints procedure in place available to all people living in the home and visitors. A copy is available in the reception area and in all bedrooms. In the 4 months the home has been open there have been no complaints. Five compliments have been received mainly about the quality of care provided. Complaints are monitored monthly by the Company. All staff have safeguarding training upon induction and this is to be updated annually. There has been one referral under Safeguarding procedures, referred by the home. This related to a vulnerable lady going into the bedroom of a male and resulting in a personal approach. This was referred immediately by the home to the Safeguarding team. Fifteen minute checks were established for the gentleman and close 1:1 supervision for the lady. The home Manager attended a strategy meeting and there has been a referral for physchiatric assessment. The home acted swiftly in this matter to ensure the safety of the people involved. Safeguarding procedures were followed correctly. Care Homes for Older People Page 19 of 29 Evidence: The rights of people are maintained. It was general election day when this inspection was carried out. We were told that some people had postal votes and others were being taken to the polling station by relatives later in the day. People have been supported in this process by families where appropriate. Assessments are made for people under the Mental Capacity Act and recorded in care plans. Where people do not have capacity or there is doubt Relatives or Advocates are involved following the Best Interests decision making process. Training in the Deprivation of Liberty Safeguards is planned to ensure all staff have undertaken this important training. The AQAA stated The use of equipment that can restrain residents, e.g. bed rails, recliner chairs etc is actively discouraged and used only whe abolutely necessary following a suitable risk assessment. At the time of this inspection no bedguards were in use in the home. Care Homes for Older People Page 20 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. A spacious, high quality environment providing a comfortable and pleasing place for people to live in offering good facilities. Evidence: The home was purpose built and opened in January 2010 following approval of registration. The building is built to a high specification and provides a luxurious and comfortable environment geared to the needs of people living with dementia. 60 single bedrooms have state of the art equipment with en-suite facilities including showers. There is an outstanding glass-roofed courtyard, central to the home. Dining room and lounge facilities offer a choice of location for people and there is an impressive cinema with surround sound forming part of the homes reminiscence activities. At the point of registration two recommendations were made. One has yet to be actioned. It was recommended that an area accessed by a door off the main corridor area that included a medication room and key-code lock on a door leading to a stairwell and presented a confusing dead end for people with dementia should have the keypad removed to the main corridor door. This would eliminate the confusion for people who wander within the home. This has not been done but we were told that a quotation had been obtained and approved with the work to be completed soon. A Care Homes for Older People Page 21 of 29 Evidence: recommendation to carry out an infection control audit was carried out in March 2010. There are regular checks and audits in place to ensure maintenance of the environment. We noted that a bath lift in an assisted bathing area on the ground floor was not operational. We were told that this had been out of commission for about 2 weeks and a part was awaited. Fortunately there is an identical alternative facility available but the replacement should be pursued. Care Homes for Older People Page 22 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. A well trained and committed staff group ensure that peoples needs are known and met and they benefit from a quality service. Evidence: Current staffing numbers are as follows: 8am - 8pm 1x Deputy Manager, 2 Senior Carers and 5/6 Care Assistants. 8pm - 8am 1x Deputy Manager and 3 Night care staff. There is always a Deputy Manager on duty. This means there is a senior manager on duty responsible for the home at all times. The number of people using the service at this time is 27 (there is an ultimate maximum of 60 people). Staffing numbers have been increased alongside the phased increase in the number of people in residence. The Registered Manager is supernumerary to the above numbers and there are adequate numbers of support staff including; catering, housekeeping and maintenance staff. There is a receptionist on duty each day (7 days) providing a focal point for telephone calls and people visiting the home. Care Homes for Older People Page 23 of 29 Evidence: Recruitment and selection of staff has been ongoing, commencing prior to registration and opening of the home. All staff have received Dementia Care training, accredited by the Alzheimers Society including distance learning courses. The training programme has been good and comprehensive. The only shortfalls at this time are 3 people who need Moving & Handling training and other staff who require training in Deprivation of Liberties Safeguarding. We understand that arrangements are in hand to provide this training. Staff have been recruited providing a range of people with experience, training and qualifications. This provides a skill mix of people who have also had training in Equality and Diversity. Staff on duty were relaxed and working together as a team. They were rightly proud of the environment and the quality of care being provided for people with specific dementia care needs. We observed good engagement between staff and people living in the home, including many examples of patient and sensitive approaches to people with repetitive behaviours and needing warm and positive reassurance. The impression was of a well informed and committed staff group. We were told that the majority of staff have completed NVQ training. We looked at a sample of staff records to assess recruitment procedures. Records contained the required documentation and checks, although there was one exception that related to a blank reference received from the last employer where the answer to the question would you re-employ this person was answered No. This should have been followed up to find the reason for this. We found that police and checks and checks of the Protection of Vulnerable Adults register had been carried out prior to employment. Certificates to evidence training were in place and all staff had been given contracts of employment and staff handbooks. Staff meetings are held approximately 2 monthly and there is a system in place called Your Say allowing staff to express their views on a daily basis about the service. This is included in the staff handover file. Care Homes for Older People Page 24 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. Management systems are in place to monitor the good standards of care established in the first few months of the operation of the home. Evidence: The Registered Manager has the required experience and qualifications to run the home. She has sound knowledge of the National Minimum Standards for Older People and also the operational strategy of Ideal Care Homes (Providers of the service). There are a range of checks and audits to monitor the effective running of the home. There are opportunities for staff to express their views on a daily basis and also in regular staff meetings. Monthly audits include: Incidents of pressure sores, weight loss, accidents, complaints, use of bedrails, care plans and medication audits. These are completed and returned to the Provider. Action plans are produced to address any shortfalls and reviewed by the Manager and Head of Operations. Consistency of service is and Care Homes for Older People Page 25 of 29 Evidence: leadership is provided by a Deputy Manager on duty at all times and responsible for the daily operation of the home. We saw that risk assessments in relation to the service to ensure safe working practices and individual risk assessments for people using the service were in place and reviewed. Visits required under Regulation 26 by Responsible Individual have taken place monthly and we saw that reports of visits were provided to the Manager with any necessary action plans. An annual development plan has been completed and is available in the home. Ideal Care Homes Managers meet monthly and include workshops on practice and operational issues. All training, supervision and appraisals are recorded on the homes computerised care home management system. This provides information to monitor all areas of training and supervision. From records seen it was clear that regular 2 monthly supervision for all staff was in place and operating effectively. People living at Park Hall have regular monthly meetings. They lead the meetings and encouraged to provide feedback. Care Homes for Older People Page 26 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 27 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 Medication must be signed for at the point of administration. This will ensure people have the medication prescribed to maintain good health 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 Gender preferences for personal care should be recorded in care plans. This will ensure peoples choices are known and met. Care plans must be established for each person at the point of admission. This will ensure staff have clear instructions to meet peoples assessed needs. Handwritten additions to MAR sheets should be checked and countersigned. This will reduce the potential for medication errors. Staff references from previous employers must be pursued where there are doubts about the information provided. This will ensure people are protected. 2 7 3 9 4 29 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. 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