Care Home: Park View Rest Home

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What the care home does well All comments received from service users were positive, they told us they felt members of staff listened to them and acted on what they said. Service users can expect to be well supported when they move into the home. We have been told that welcome packs are in place for the service users arrival and staff allocated to make sure the moving in process runs smoothly for the benefit of the service user. Systems were in place which makes sure service users have their health care needs met. They are provided with escorts for medical appointments when family members are unavailable, which means service users have someone with them who knows them and can pass on relevant information if required. What has improved since the last inspection? Upgrading of the home is currently underway. Bedrooms have been prioritised with new furniture, fixtures and fittings being provided and redecoration completed. This means service users have homely and comfortable private space which they can furnish as they desire with their own belongings from home. The registered provider has taken responsibility for the day to day management of the service and become the manager and a new deputy manager post has been created. Even though not required because the registered provider is also the manager he continues to conducts Regulation 26 visits each month. These visits include looking at records to check their accuracy, observing practice, talking with service users and members of staff and inspecting the building. Because he does this we know he is monitoring the home and that any failings found are put right in a timely manner. The AQAA told us that service users have been given more opportunities to visit outside places of interest and have more involvement within the Local Community. The activities co ordinator continues to develop activities within the home so that service users are given a stimulating environment which supports them to maintain a positive outlook and supports their mental well being. What the care home could do better: We have made two requirements which relate to administration on medication in particular the accurate recording of when creams are applied, and the the submission of an application to us to register the manager. We have made a number of good practice recommendations where we think practice could be further developed for the benefit of service users. We advise the reader to read the full report for full details or refer to page 31 for a comprehensive list of the recommendations made. Key inspection report Care homes for older people Name: Address: Park View Rest Home 56 Clayton Hall Road Clayton Manchester M11 4WH     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: Sylvia Brown     Date: 1 0 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 35 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 35 Information about the care home Name of care home: Address: Park View Rest Home 56 Clayton Hall Road Clayton Manchester M11 4WH 01612232099 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Russley Care Homes Ltd care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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: - Old age not falling within any other category - Code OP. The maximum number of people who can be accommodated is: 24 Date of last inspection Brief description of the care home Parkview is a residential home providing care for older people and is situated in Clayton, north of Manchester City Centre. Public transport links into the city centre are within easy reach. The home is a two storey converted house, set in its own grounds, which are accessible to residents. Parking space for visitors is available at the side of the building and on the road at the front of the house. There is a passenger lift to enable access to the first floor for those with poor mobility. Accessible toilets and bathrooms are located on both floors of the home. There is a large, bright, lounge dining area. There are 4 single bedrooms, with an en-suite toilet and washbasin, 14 single and 3 double rooms all with a hand washbasin. Double rooms are provided with Care Homes for Older People Page 4 of 35 Over 65 24 0 0 4 1 1 2 0 0 9 Brief description of the care home privacy screens. There are gardens to the front and side aspect. Care Homes for Older People Page 5 of 35 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: The quality rating for this service is 2 star. This means the people who use this service would experience good quality outcomes. The inspection report is based on information and evidence gathered by the Care Quality Commission (CQC) since the last key inspection, which was completed in September 2007. This was a key inspection which included two site visits to the service commencing on the first day in the afternoon until late evening and on the second day commencing early morning. The site visits were unannounced which means the manager and staff were not told that we would be visiting. For reporting purposes the preferred term to be used for people living and receiving a service at Park View is service users. As part of the inspection process we gathered information from a number of people which included talking with and seeking the views of service users. Prior to the site Care Homes for Older People Page 6 of 35 visits we also sent out surveys to service users and members of staff. This gave them an opportunity to tell us about their opinions on the services provided at the home. Comments received are included within the report. We case tracked two service users which means we looked in depth at their records, observed them as they went about their daily routines and evaluated the support they received from members of staff. The deputy manager completed a self assessment form, which is called an Annual Quality Assessment Audit (AQAA). This document should tell us in detail what the manager who is also the registered provider has done since the last key inspection to meet and maintain the National Minimum Standards. It should also tell us what they felt they were doing well, how they had improved within the past 12 months and plans to develop in the next 12 months. The AQAA received was completed well and gave a good overview of how the service was operating. We also gathered information from general contact with the home through their reporting procedures which are called Notifications and information we may have received from other people, such as the general public and professional visitors. We have received two complaints about this service within the previous 12 months which we gave the registered provider to investigate under their own procedures. We have also been informed of two safeguarding alerts which were appropriately referred to the Local Authority who investigated them following their own safeguarding procedures. For reporting purposes the term we, us and our is used when referring to the CQC or their representatives. This report is a public document and should be on display within the home and can be made available for reading upon request. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 35 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 35 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 35 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. Prospective service users can have confidence that the care home can support them. This is because the manager assesses their individual needs and makes sure they can be met before any decisions about moving in are made. Evidence: The manager of the service has a pre admission procedure in place which includes the assessment of the prospective service users needs and personal requirements before they move in. The AQAA also told us about the pre admission process and stated that the home operates a comprehensive questionnaire which is completed by a member of the management team. During the course of the inspection we looked at two service user files and found that the pre assessment process had been completed for one service user whilst the other, who was admitted as an emergency, had had their needs assessed at the time of admission into the home. Care Homes for Older People Page 11 of 35 Evidence: The pre admission details were brief and the home could not demonstrate the reason for admission and the aim of the short term placement. When we spoke with the deputy manager and manager they gave differing reasons for the service users admission. Whilst the daily records gave an overview of the service users first day, we are recommending that in cases of emergency admissions, more detailed records are kept to make sure the service users needs were kept under assessment and more information gathered. The reason for the placement should be recorded and care planning processes should show how the service user is supported to reach the set goals. We spoke with the service user who told us they were very happy with the way they had been supported and though they were looking forward to returning home stated I would come back again if I need more help The manager stated that when referrals are made from the Local Authority he makes sure he receives information from them about the service users, which includes their own assessment of the service users needs. The pre assessment process for planned admissions means service users have the opportunity of meeting someone from the home to ask any questions they may have about the service before they make any decisions about their future. The assessments also enable the registered manager to evaluate if they are able to meet the identified needs and general requirements of the service user before offering them a place at the home. The assessments we looked at were completed by the deputy manager on behalf of the manager. We found the assessments lacked detail and mainly consisted of ticked boxes. There was minimal recorded information to enable the home to demonstrate that they had consulted the service user or their representatives about their needs and preferences for care support. There was no recorded evidence to support that the manager of the home had seen the information and agreed that the home could meet the needs of the service user. Prospective service users are invited to visit the home before they or their representative make a decisions to stay. This gives them the opportunity of speaking with others who live at the home, observe daily routines and see vacant rooms. The AQAA stated potential residents can choose from the available rooms, which room they prefer. We have trained staff at hand to help new resident adjust to moving in the home. The key worker system is now in place at the home. Care Homes for Older People Page 12 of 35 Evidence: Each service user receives a welcome gift pack, card, service user guide and statement of purpose and other information on the day of their admission. We are recommending that all information provided to service users is in a user friendly format. The service users guide is a lengthy document and not always in plain English. Furthermore the current type set or font size could make it difficult for service users with failing eyesight to read. Returned surveys from service users told us they received enough information about the home. Care Homes for Older People Page 13 of 35 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. Service users receive support to maintain good health as far as possible. The home has plans of care in place for each service user which they or someone close to them has been consulted about. Evidence: Each service user had a written care plan in place which was kept up to date. We looked at a sample of care plans, two of which were in in depth. The home could demonstrate that service users had received support to maintain good health as far as possible. Care plans included assessments of risk and some care plans contained signatures of service users which indicated they had been consulted and informed about what was written about them and agreed to the care plan. Care and support was provided discreetly to those service users who received visits from medical professionals. Staff meeting minutes identified that members of staff had been informed to support service users to their room to receive all professional visitors in private and make sure records were made readily avialable. This means service Care Homes for Older People Page 14 of 35 Evidence: users received treatments privately and in a timely manner with no delays whilst information was found. We spoke with a professional health care visitor who told us that they had no concerns about the conduct of the home and that in their opinion improvements had been made recently and that the home was managed effectively. They told us that service users were always supported appropriately with personal care and hygiene and wore clean well maintained clothes. Care plans demonstrated that service users had access to dental, optical and hearing services and that they routinely received chiropody treatments. Records identified that where health care checks were required plans were in place to provide them. Care plans and care files contained lots of information about service users, we would advise that once all the information is gathered it is put into an easy read format for staff members to follow when providing support. Best practice care plans should clearly and concisely detail the specific needs of service users, how they would like them met and introductions for practice for members of staff to follow. This would enable service users to have easy to understand information and members of staff would have the quick information they require. We looked at medicines administration. We saw that records were referred to and completed at the time of administration helping to ensure they are given correctly. Staff spoken with knew that some medicines needed to be given before food, but agreed that arrangements needed to be formalised to help ensure these special instructions were not accidentally missed. We were concerned to find that staff trained in medicines administration were not always on duty at night but were told that training was planned to address this, ensuring choice and flexibility in the times medicines are administered. We saw that breakfast medicines were given until quite late in the morning and recommended that the times medicines were administered were monitored to help ensure that when doses of the same medicine were repeated throughout the day they were not given too closely together. We saw that people who wished to, and where able were supported to self-administer medication. But, we found that there could be clearer written guidance for staff about any support people may need to safely manage their medicines. A written assessment had not been completed for one person who managed their own tablets. Care Homes for Older People Page 15 of 35 Evidence: We looked at a sample of medicines stocks and records. We found that the medicines administration records were generally clearly and accurately competed enabling medicines to be accounted for (tracked). and regular medicines audits (checks) were carried out to help ensure that should any weaknesses arise they will be promptly identified and addressed. However, we were concerned to see two examples where staff had not applied a prescribed cream and there was no evidence that this had first been discussed with the prescriber. We also found that there could be more supporting information in peoples care plans about the use of prescribed creams. We saw one example where someones care plan had not been updated following advice from the doctor about reducing the risk of spreading a now treated infectious skin condition. Similarly, although it was evident that advice had been sought about the use of thickened fluids for another person, this had not been fully recorded. Staff explained that they sometimes gave unthickened fluids but risk assessments had not been completed. We had the opportunity of sitting and consulting with service users all of whom were very positive about their care. One service user told us about their visits with the dentist to have new dentures . Surveys returned from service users told us staff were attentive and that service users felt they received all the support they needed. We were informed that one service user is supported to attend a monthly group within the community to meet with others to specifically regain their communication skills. The home keeps us informed about any significant events relating to service users including any visits to hospital as a consequence of an accident or unexpected illness. Records kept at the home demonstrated that escorts were provided to service users when they attended hospital. The deputy manager takes the main responsibility for supporting the service users to appomitments. This means service users are not left alone and that hospital staff receive the information they require from someone who knows the service user and their needs well. This supports the service user to receive the care they require. Care Homes for Older People Page 16 of 35 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. Each person has the opportunity of joining in some activities provided by the home and visit places of interest within the community. Whilst meals served were said to be good by service users the manner in which service users independence at mealtimes is promoted could be improved. Evidence: We had the opportunity of observing late evening and early morning routines within the home , watching service users as they went about their daily routines and sharing one mealtime with them and view another. Prior to the inspection we had received reports that service users were being got up early, as a consequence we monitored early morning routines, arriving at 6:55am. At that time we noted that nine service users were up, some were sleeping in chairs and some were walking around the home or watching early morning television. The night staff gave good accounts of why service users were up and stated they were not instructed to get people up unless otherwise directed by the service user themselves. When we spoke with two service users they told us they had wanted to get up whilst Care Homes for Older People Page 17 of 35 Evidence: another stated they had been asked if they would like to get up and though they felt they could stay in bed they thought they might as well get up. The home could not demonstrate what checks are done to observe early morning routines and even though the manager was at the home early on the day of the site visit, members of staff stated this was not common practice. We had received reports that service users do not always have a supper option before they go to bed other than a biscuit. We observed that crumpets and toast were served whilst we were on the inspection but two service users and members of staff told us this was not always in place. Though service users had no complaints to raise about the supper snacks they stated they really enjoyed the toast. We had been told prior to the inspection and again when inspecting that some night staff bring in nice supper snacks for service users enjoyment. When we informed the manager of this , he stated that he had no knowledge of such practice or of the reason for this as he expected supper snacks to offer a variety. We had also been informed that often service users were offered left over sandwiches from tea. Whilst this is permissible other food options should also be offered. Though we asked for copies of the current menu they were not provided. We were told that they had been withdrawn as they were under review as a consequence the manager could not demonstrate what food options were routinely provided for service users. There was no clear recording of food served to service users and daily records did not always state the time service users rose or went to bed. Because of this the home was not able to demonstrate that service users who retired early received supper and that they did not go without food for more than twelve hours. Even though many service users were up at 7am they were collectively invited to sit for breakfast at approximately 8:15am. There they were served cereals and later drinks of tea and coffee. When we asked staff why service users had to wait for breakfast we were told that they had to wait for the cook to arrive who prepared the hot food items. Best practice would be to offer service users breakfast cereals when they wished and give them the opportunity of receiving hot additional items when the cook has prepared them. We also think that a review of the cooks hours could be undertaken to make sure routines are set around the needs of service users and not around members of staff. We observed that drinks of tea and coffee were routinely served to service users by staff who also added the milk and sugar. No service users were given the opportunity of serving themselves or others. One service user who was to return home stated they Care Homes for Older People Page 18 of 35 Evidence: could pour their own drinks and staff members informed us that there were several service users who had the ability to pour their own drinks. Service users independence was further compromised when toast was served, this came already buttered and with preserve. Lunchtime meals were also severed ready plated rather than offering service users the opportunity of serving themselves. All service users commented favourably on the meals served and hot food items were served at breakfast and lunch time. The home employs an activities co ordinator who takes responsibility for providing social stimulation to service users. When we asked service users what activities were provided some were able to state quizzes and bingo . Most could not remember. Service users were unaware of any set routines and stated we just wait and see whats on. All activities were recorded as was service users participation. Prior to the inspection the manager has recognised that recordings should be individual rather than collective. This will ensure that an assessment of service users participation in activities can be more accurate. The activities co ordinator has attended training and visited other establishments to broaden her knowledge and gain new skills. We would advise that the co ordinator has additional time to develop the homes weekly programme. The service users did not have daily opportunities to join in social events. A number of the records stated pamper day which was not defined other than some service users received a manicure. Whilst this was enjoyed by service users, nail care including putting on varnish could be completed by care staff routinely as they support service users with bathing and personal care. There was no indication what was provided for men on such days. Currently there is extensive activity products available which are more suited to meeting the needs of older people, we would advise that such activities are sourced and considered and added to the activities programme. Service users files did not detail any social profiles which would give the activities co ordinator an overview service users preference for such things as preferred type of film, past and present hobbies and interests, places to visit and music. We would also advise that the service users notice board is placed in a more convenient location. Its current position prevents service users from seeing the information. We would also advise that all information for service users is in a format which they can see and understand and which will engage them. Care Homes for Older People Page 19 of 35 Evidence: We have been informed that six service users have been to a valuing older people event in September 2009. We have been provided with information about future events at the home which include outings to the local cinema, bowling alley, meals out to celebrate St Patricks day and swimming. The manager has informed us that service users will have the opportunity of joining in an activity outside of the home each month. The manager told us that hairdressing services are provided weekly at the home and is paid for by the service users. We were told that some service users visit their own hairdresser in the community. From what service users, staff and records told us we know that birthdays are celebrated at the home with parties and that at Christmastime service users from Parkview went to another of the providers homes to join in their party and that likewise other service users joined in at the party held at Park View. This means that service users continue to meet with others outside of the home and are able to develop new friendships. Service users have the opportunity of meeting with the deputy manager as a group. Service user meetings are held periodically and records demonstrated that they are consulted and that their opinions are considered. We found that follow up meetings identified action taken to improve aspects of the service as a consequence of service users suggestions. The manager has supported service users to have pets and currently one service user has her own dog and there is a budgerigar. Care Homes for Older People Page 20 of 35 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. If service users have concerns with their care, they and people close to them know how to complain. Any concern is looked into and action taken looked into. The manager has systems in place to safeguard service users from abuse or neglect and takes action to follow up any allegations. Evidence: The home has a written complaints procedure wich service users are informed about. Service users meeting records identified that service users were able to raise any concerns or issues as a group and in private if they wished. The AQAA stated that the home had received four complaints during the last twelve months which had been investigated under their own procedures. It also stated that one safeguarding alert had been made which was investigated by the Local Authority under their Protection of Vulnerable Adult procedures. We have in the last twelve months received two alerts regarding safeguarding and one complaint. All safeguarding matters have been investigated by the Local Authority under their procedures and the complaint was referred to the provider for investigation, elements of which we further monitored at the inspection in order to assure ourselves that service users are not placed at unnecessary risk of harm. Care Homes for Older People Page 21 of 35 Evidence: Staff meetings identified that members of staff have the opportunity of raising any concerns and they are aware of their roles and responsibilities for safeguarding service users. Training records identified that three staff required refresher training in the Protection of Vulnerable Adults, which was planned for autumn 2010. The manager and deputy manager has additional alerter training planned for which ensures they are aware of the actions to be taken should an allegation of abuse arise. The manager has received training in the new framework for implementing the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (MCA DOLS) and has plans to discuss this with members of staff. At the time of our visit no one living at the home was subject to an application being made under these requirements. Care Homes for Older People Page 22 of 35 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. Service users live in a home which is well maintained , homely and clean. Evidence: The upgrading of the home continues, we looked at a sample of bedrooms, some of which were occupied and some of which were vacant. Those occupied by service users were furnished to varying degrees, and we could see that service users had been given the opportunity to bring in items of furniture from their own home and personalised bedrooms as they wished. Bedrooms which had received upgrading had been completed to a relatively good standard. New fixture and fittings were in place with some rooms receiving new beds. All bedrooms received new bedding and curtains. A new shower room was in the process of being completed and the manager informed us, that once the room had been finished work would commence on the upgrading of bathrooms and toilets areas to make sure they were of an appropriate standard and reflect a homely environment. The lay out of the communal lounge is unusual in that there are two areas which contained televisions. There are also an additional two areas within the room for quiet sitting. During the course of the inspection a service users told us that they enjoy the Care Homes for Older People Page 23 of 35 Evidence: lounge and the various seating areas. However, at one point a disagreement among service users, commenced as one television could not be heard over the other. There is little that can be done to change the seating arrangements if service users preferences are to have two televisions in the room. Service users are able to have televisions in their bedrooms if they wish. The dining area is also incorporated into the lounge area although separated by room dividers. we could see from service user meeting records that new furniture had been put into place in the dining room area following disputes about seating from residents. The dining tables and chairs were of sturdy wood and appeared of good quality. However, three service users were observed sitting at the dining room table in wheelchairs. When we asked about this staff informed us that the service users require additional support as they lean to one side, and currently the dining chairs do not have armrests. Furthermore, we observed that all seats in the dining room fail to have seat cushions, which meant that service users were sat on hard wood. When asked service users about this,they stated that sometimes it is uncomfortable, but we are not sat here for long. We are recommending that additional seating is added to the dining room, which meets the needs of all service users. All areas of the home was bright and lit and free from any offencive odours during the time of our inspection. We have received information which identifed that infection control procedures may be failing at the home. We are aware that the local authority has undertaken a full infection control review of the service over the last six months and that it is reported there has been significant improvements made. The AQAA identified that over the last 12 months the following action has been taken by the manager to make sure infection control standards are maintained appropriately he stated we have replaced older hand wash and soap dispensers and added more around the home. We have provided plastic aprons dispensers and vinyl gloves have been put into place and we now have colour co-ordinated cleaning brushes, dust pans, mops, mop buckets, and cloths to help stop cross infection. During the course of the inspection we had a look around the kitchen area and found that colour-coordinated cleaning equipment was in place. However, when we looked within the refrigerator we observed that opened food products had not been labelled correctly. Many items were catering sizes and once opened their used by date reduced. The items we we observed did not stae the date they were opened or their Care Homes for Older People Page 24 of 35 Evidence: used by date. We were informed that all kitchen staff have been trained to the appropriate standards in respect of food hygiene and kitchen management and were completing records as required. Food temperatures were recorded as were cleaning schedules. Care Homes for Older People Page 25 of 35 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. Service users can expected to be support by staff who have the skills, training and experience required. Recruitment procedures were in place but were not constantly followed. The staffing rota did not contain sufficient information to enable the registered provider to demonstrate sufficient numbers of staff were deployed at all times. Evidence: The AQAA identified that over the last twelve month there has been there have been five members of staff who have left. We are told that most of those staff went on to pursue careers in other fields. There has also been a change in the management of the home with initially the deputy manager taking over the day to day running of the home and then the registered provider taking on that role. Both the manager and deputy manager have the skills and qualifications for their management position. Members of staff informed us that things are improving within the home and that they received good support and supervision. Of the sixteen members of staff eight have achieved a National Vocational Qualification at level 2 or above, this means the home has met the standard to have Care Homes for Older People Page 26 of 35 Evidence: at least 50 of its workforce trained to NVQ 2 or above. When we asked members of staff if they had been recruited correctly some were vague in their response about the interview process with one saying it was just a chat and another saying they were not really interviewed. When we looked at a sample of staff files we identified that recruitment procedures were not always followed as expected. The manager stated he expected that interviewees would be asked questions to ascertain their knowledge,skills, and suitability for the post they were applying for and records of the interview process maintained. We found that this had not been carried out at some interviews. Furthermore we could find no information about the recruitment of the deputy manager who for a while was employed as the manager at the home. Whilst we know she was employed at one of the providers other homes, there was no indication that she had completed an application for the managers or deputy managers post and there were no records to support the internal transfer process undertaken. The manager could not demonstrate that full induction procedures had been put into place for either positions or that support and guidance had been given at the commencement of taking up the roles. There was no formal recording to support that the deputy manager had received supervision, though she did tell us that she often met with the manager. The manager recognised that formal recording procedures were absent but gave assurances he met with the deputy manager regularly. Other aspects of the recruitment process was completed correctly in that appropriate statutory checks were made and application forms completed. The home provided us with information which stated that fifteen of the sixteen workers had completed the Skills for Care Common Induction. We looked at the training and development plans for all members of staff and can confirm that the training organiser has reviewed the training needs of all members of staff and has plans in place to make sure they have up to date training where gaps in their skill base is identified. The rota provided to us did not contain all the details required. Whist staff names were recorded their staffing position was not, which meant we were unable to always identify if a senior member of staff was on duty at all times, furthermore the managers hours were not recorded. Codes used such as C or K were used without definition. Care Homes for Older People Page 27 of 35 Evidence: We were informed that the cook finishes at 2pm and that members of the care staff team take over to complete the teatime meal, we were also told that care hours are further depleted because care staff complete all laundry duties. The rota did not define who was responsible for such tasks on any given shift or the time allotted. As a consequence we can not be sure the appropriate care staff hours and ancillary support is provided . When asked what could the home do better two staff surveys stated provide more support with cleaning another said provide more support staff. During the course of the inspection members of staff stated they felt they managed and juggled their role however they felt support to service users would improve if the care staff did not have to spend time completing ancillary tasks. Care Homes for Older People Page 28 of 35 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. Service users Live in a home which is safe and run in their best interest. Evidence: Since we last conducted a key inspection there have been a number of changes in management. The registered provider recruited a new manager who was known to them and employed in one of their other homes. That manager has now taken the deputy managers position and the registered provider has told us of his intentions to become registered with us and to manage the day to day running of the service. The manager has not submitted an application for registration, which means the home is not currently being managed on a daily basis by someone who is registered to do so. Staff have told us that they have confidence in the manager and the current management structure is working well. Service users told us that they were happy with how things were at the home and had no issues of concern to raise with us. Care Homes for Older People Page 29 of 35 Evidence: From what the AQAA stated, through information provided to us from service users, members of staff and the manager we conclude that the home is generally run in the best interest of service users. Although no formal quality assurance procedures are completed, service users are consulted about their opinions of the service, they meet periodically as a group with the deputy manager and have their placements assessed annually by the Local Authority who also seek their opinions on the service. Financial records were in place where the home took responsibility for safeguarding service users finances. auditing systems were in place and balances checked against expenditure to make sure there were no financial inaccuracies. The home has a written supervision policy in place and records identified that staff receive supervision and annual appraisals which enable them to share any issues in private with the manager and deputy manager. Periodic staff meetings were held , however it was not clear what supervision and staff meetings were provided to night staff. When asked about this they stated they could go to staff meetings. We were provided with a number of staff meeting minutes and found that they identified some good management procedures. We could see that failing care practises had been noticed and checked, that development of the key worker roles and daytime occupation of service users was underway and that members of staff were given clear directives about best practice and the standards required. The AQAA identified that all required safety checks to and servicing of equipment and utilities were completed as required. We looked at a sample of the health and safety checks and certificates and can confirm that all aspects of health and safety were maintained. Significant improvements have been made regarding infection control procedures and service users and staff have received medical treatments for reoccurring skin infections. We have looked into these matters on a number of occasions and find that despite medical interventions and support from the Local Authority specialist the cause for the conditions can not be found. Care Homes for Older People Page 30 of 35 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 31 of 35 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 Medicines including external 15/03/2010 preparations must be administered as prescribed. Where they are not used the reason should be recorded. to help ensure peoples health and well being is best protected. 2 31 9 An application for the registration of the manager should be submitted to us without delay. This is to make sure the home is managed by a person who is fit to do so. 31/03/2010 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 2 1 3 All information provided to service users should be in an easy read format. To make sure that thorough and accurate needs Page 32 of 35 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations assessments are in place for service users admitted for short term support or as an emergency, systems should be introduced for initial and ongoing assessments . This will enable accurate care planning and an ongoing assessment process which will determine if the service user is able to return home safely or identify further support required. 3 3 Consideration should be given to completing pre assessments in more detail. To do this would ensure that all the needs and preferences for care of the service user are known before any decisions are made about the homes ability to meet the requirements of the service user. The manager of the service should demonstrate that they have reviewed the pre assessment information and made the decisions about the homes capacity to meet the assessed needs of service users (including specialist needs) of individuals at the home. To make sure all the needs and preferences for care support of service users are known to staff, they should be fully recorded within the care plan. This would support the service users to know what support they should expect and inform members of staff on what is required and how it should be provided. Service users may benefit from the opportunity of joining in planned daily activities which suit their individual and collective social aspirations. Early morning routines could be reviewed and monitored to make sure that that service users are not woken and are given the option of returning to bed after they have received personal care support. Systems are introduced which supports service users to retain their independance as much as possible particularly at mealtimes. This includs the opportunity of pouring drinks. Service users should have access to an easy read menue which offers them variety and choice at each mealtime. Systems should be in place to support the more dependant service users to make individual choices for their meals. Systems should be in place to make sure service users always receive the option of a supper snack and that they do not go more than twelve hours without food. 4 4 5 7 6 12 7 14 8 15 9 15 10 15 Care Homes for Older People Page 33 of 35 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 11 19 Kitchen routines should include the opening and use by dates of all open food stocks which have a stated life span once opened. Additional seating is provided which supports service users to seat at the dining table in dining chairs which are able to support their individual needs. In order to demonstrate that their is sufficient care hours allocated each day , the staffing rota should clearly demonstrate how members of staff are deployed , their staffing position and hours on duty including their start and finish times. After a review of ancillary staffing hours has been completed, consideration should be given to increasing ancillary support within the home to prevent depletion of the allocated direct care support hours. Persons with the responsibility for recruiting and selcting new staff should be appropriately trained. To make all staff are treated equally at interview the registered provider should make sure robust recruitment procedures are followed at all times. Employment files should contain all the required information including the process undertaken when internal transfers and promtions of staff members occur. To make sure the deputy manager is aware of her role and responsibilities full management induction procedures should be in place and completed in a timely manner. Annual quality audits should be completed and a report of the outcomes made public. A copy should be provided to us. To make sure all members of staff including night staff receive information about their practice, have the opportunity of speaking with the manager in private and have their training and development needs assessed, they should receive formal supervision and guidance from the manager. 12 25 13 27 14 27 15 16 29 29 17 29 18 30 19 33 20 36 Care Homes for Older People Page 34 of 35 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). 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. 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