Care Home: Parkfield House

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What the care home does well Prospective residents are fully assessed prior to admission and the processes in place ensure the home is able to fully meet their needs. Residents healthcare needs are addressed promptly. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity. The wishes of residents and their families in respect of health deterioration and end of life care are ascertained and recorded, and the home provides good end of life care in conjunction with the palliative care team. The activities provision is good and varied, and residents are encouraged to participate in a range of individual and group activities. The home has an open visiting policy and visiting is encouraged, with visitors being made welcome at the home. Information regarding advocacy services is available, thus ensuring residents rights to independent representation are respected. The food provision is good with choices being offered, and plans are in place to enhance residents experience at mealtimes. The home has systems in place for the management of complaints and safeguarding issues and these are followed. Procedures for infection control are in place and are followed, thus minimising risks. The home is appropriately staffed to meet the needs of the residents, and this is kept under review. There is an on going programme of training to include NVQ training and training in topics relevant to the diagnoses and care needs of the residents. Shortfalls in induction training have been commented upon below. The home is being effectively managed and the management style promotes an atmosphere of openness and good communication. There are clear systems in place for quality assurance and the Manager is implementing changes which will improve quality outcomes for the residents living at the home. Personal monies are well managed by the home. Comments received included the following: `We have had a lot of changes in the last year, all of which have been good for both staff and residents. We still have plans to improve. The challenge is exciting`. `Staff are welcoming and helpful`. `We are very happy with the care that our relative is given`. `I like working here and it is very good team work.The Manager is always helpful and understanding`. `I have been at the home for sometime and would recommend to anyone`. `Great overall care`. What has improved since the last inspection? The manager has introduced new service user plan documentation, which provides a good picture of each residents needs and how these are to be addressed. Reviews and updates are clearer and there is evidence of input from residents and their representatives. The Manager has identified that more work is required in this area and is working towards implementing a person centered approach to care planning. All assessments to include falls risk, moving and handling, continence and nutrition were available and up to date. Progress has been made in improving the environment with evidence of ongoing redecoration and refurbishment taking place. What the care home could do better: Whilst there has been an improvement in the service user plan documentation, the auditing process is not always robust. It is acknowledged that the Manager is aware of this and is continuing to work on improving the documentation. We identified some shortfalls with the management of some medications, and all staff must be diligent when recording receipts of medications and administering medications. The storage temperatures for medications must be reviewed to ensure they are maintained within safe range at all times. Ongoing issues with the bath provision were identified, and following the inspection the Manager has informed us that this is being promptly addressed to include the installation of new assisted baths. The television aerial for the home was problematic and needed addressing to ensure a clear television picture for all residents. More care is needed when labelling residents clothing. The induction training programme must be reviewed to cover the Skills for Care common induction standards. Some shortfalls were identified with staff employment records, plus we have recommended that the Manager keep a written notes of each staff interview to include any issues discussed during the interview. Fire drills are being undertaken and the importance of ensuring that these cover all staff to include night staff was discussed with the Manager. The Manager sent an action plan to address shortfalls identified shortly after the inspection, and it is clear she had taken on board the areas in need of improvement. We received some comments in the CQC surveys about communication issues with staff where English is not their first language. It is acknowledged that the Manager had organised English classes for several staff. These comments were fed back to the Manager in general terms. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Parkfield House Charville Lane West Hillingdon Uxbridge Middlesex UB10 0BY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rekha Bhardwa     Date: 0 7 1 0 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home Name of care home: Address: Parkfield House Hillingdon Charville Lane West Uxbridge Middlesex UB10 0BY 01895811199 01895811131 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): HALTON SERVICES LIMITED Name of registered manager (if applicable) Ms Penelope Chubb Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 44 The registered person may provide the following category of service only: Care home with nursing - Code N to service users 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 (maximum number of places: 31) Dementia - Code DE (maximum number of places: 13) Date of last inspection Brief description of the care home Parkfield House Nursing Home is a Georgian building, situated in a residential area in Hillingdon. The building has 3 storeys. It is registered to accommodate 44 people, 13 of whom are accommodated in a dementia care unit. The building is a listed building, and is a converted mansion. There are 36 single bedrooms (spread over the ground, Care Homes for Older People Page 4 of 32 care home 44 Over 65 0 31 13 0 Brief description of the care home first and second floor) and four double bedrooms (all situated on the first floor). All bedrooms are en-suite. There are 2 sitting areas on the ground floor and one sitting area on the second floor. There is a dining room on both the ground and first floors. The Home is near the local high street, public transport and local amenities. The fees range from £603 to £900 per week. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 last key inspection of this home was undertaken in October 2007. This was an unannounced inspection carried out as part of the regulatory process. A total of 35 hours was spent on the inspection process, and was carried out by 2 Inspectors. We were also accompanied by an Expert by Experience on the first day of the inspection. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. Residents, staff and visitors were spoken with as part of the inspection process. The pre-inspection Annual Quality Assurance Assessment (AQAA) document completed by the home, plus comment cards from residents and staff have also been used to inform this report. Care Homes for Older People Page 6 of 32 Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? The manager has introduced new service user plan documentation, which provides a good picture of each residents needs and how these are to be addressed. Reviews and updates are clearer and there is evidence of input from residents and their representatives. The Manager has identified that more work is required in this area and is working towards implementing a person centered approach to care planning. All assessments to include falls risk, moving and handling, continence and nutrition were available and up to date. Progress has been made in improving the environment with evidence of ongoing redecoration and refurbishment taking place. Care Homes for Older People Page 8 of 32 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home is kept up to date so that prospective residents and people living at the home are kept informed about the facilities and services available. Residents are fully assessed prior to admission to the home, to ascertain that the home is able to meet their needs. Evidence: We viewed the Statement of Purpose and the Service User Guide. These were available in the main entrance of the home and are also given t prospective residents and their representatives. The home has a pre-admission assessment that is carried out for all routine admissions to the home. These were seen in some of the service user plan documentation viewed and were comprehensive, giving a clear picture of the resident and their needs. Copies of Social Services and Primary Care Trust assessments, plus Care Homes for Older People Page 11 of 32 Evidence: hospital discharge information were also available. Where possible the prospective resident and their representative is encouraged to visit the home prior to admission. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service user plan documentation is comprehensive, providing a good picture of the resident and their needs. Although healthcare needs are being clearly identified, shortfalls in the auditing processes could lead to these needs not being fully addressed at all times. Although medications are being managed in the home, shortfalls identified could place residents at risk. Staff care for residents in a gentle, polite and professional manner, and show a high regard for their privacy and dignity. The wishes of residents and their families in respect of health deterioration and end of life care are discussed and recorded, thus ensuring these wishes are known and respected. Evidence: We viewed 5 service user plans. There were care plans available for each identified need and these had been reviewed monthly. There was evidence of input from residents and/or their representatives and people asked about this confirmed their involvement. The Manager has introduced a new service user plan format and these are comprehensive and provide a good picture of the resident and how their needs are to be addressed in an individualised manner. The current daily record document in use Care Homes for Older People Page 13 of 32 Evidence: has space for the nursing, care and multi-disciplinary team to record relevant information. Risk assessments for falls were in place and there was evidence that documentation for falls had been reviewed following a fall. Comment and a requirement has been made under Standard 8 in respect of auditing. We viewed wound care documentation. Waterlow pressure sore risk assessments were in place and had been completed. There was information stating the dressing products to be used for each wound and also a dressing regime. The wound care record of care document is used to record the condition of the wound each time the dressing is changed, and this also includes pain assessment information and the analgesia being given for pain management. Photographs are taken and a body map assessment is also done. In some instances the documentation had not always been fully completed, for example, the frequency with which the dressing is to be changed had not always been recorded, and some records of dressing changes were found in the daily record and not on the document identified for this purpose. On the first day of inspection some wound care and progress documentation could not be found, however it was found in the archive file and viewed on the second day of inspection. Nutritional assessments had been carried out and residents are weighed monthly unless an issue such as significant weight loss is identified, a weekly weighing regime may be implemented. The Manager reviews all the monthly weights and had clear documentation to show which residents are to be weighed weekly. In one instance the staff could not find the evidence to show that a resident had been weighed weekly, and the importance of ensuring that observations to include weights are carried out in accordance with assessment findings was discussed. Moving and handling assessments had been carried out and care plans for moving and handling needs were also in place. Continence assessments had been completed and care plans for continence care needs were in place. Risk assessments for the use of bedrails had been carried out. The home has a document for residents and/or their representatives to give written consent for the taking of photographs for healthcare purposes, for example, photographing wounds. This document also records written consents for the crushing of medication and for the use of bedrails. In all but one file these had been signed up appropriately. The Manager said that she would see that this was addressed. The service user plan documentation available for staff to complete is good, and in most cases had been well completed, however the auditing processes being followed were not robust, with some shortfalls, in this instance related to healthcare needs, not being picked up during the process and timescales for completion of the updates not being given. Robust auditing would ensure any shortfalls are identified and addressed Care Homes for Older People Page 14 of 32 Evidence: promptly. We sampled medication management and records on each floor. Lists of specimen staff signatures and initials were available. A photograph of each resident, a record of any allergies and other relevant information was available. Approved lancing devices for blood glucose monitoring were in use. Medications were being securely stored within the home. The home uses a 28 day monitored dosage system (MDS) and the majority of tablets are supplied in individual blister packs. Receipts for medication had been recorded in most instances, however we did note some gaps in receipt recording. In addition, where a supply of medication had been carried forward from one month to the next, the amount being carried forward had not always been entered. It was identified that the person completing the last medication round before the new 28 day cycle needs to record the carried forward amounts, and this is now being addressed. Administration and disposal of medications records had been completed. We carried out an audit of the controlled drugs stocks. We identified one discrepancy and on speaking with the nursing staff this had already been identified and reported to the Manager, who confirmed she had been informed. Following the inspection the Manager has ascertained that this was a dispensing issue and the situation has been rectified. In addition, the manager carried out an internal investigation without delay and has implemented new protocols to be followed for the receiving and recording of controlled drugs. For one other general medication 2 tablets were missing from one blister pack, which was a dispensing issue. We audited all of the morning medications plus some evening medications and we found 3 instances where medication had been signed for but was still in the blister pack. No administration notes were available to evidence why the medication had not been given. The importance of ensuring that all medication is checked when received by the home, given as prescribed and staff follow correct protocols in reporting any missing medication was discussed. For residents who self-administer their medication a risk assessment is carried out and medications are stored in a locked drawer in the residents room. Where medications had the instruction as directed written on the medication administration record (MAR), staff had handwritten the actual administration instructions to be followed, which is good practice. This should also be discussed with the GP so that full instructions can be included on the prescription, and thereafter printed onto the MAR. The fridge and room temperatures are recorded daily, and we noted that on occasion the temperatures for both had been somewhat high, usually related to a hot day. A system for keeping the room cool during hot weather needs to be considered. We discussed the recording of the fridge temperatures to include the minimum and maximum temperatures each day, and to ensure that the temperature remains between 2 and 8 degrees centigrade. The Manager confirmed that she does carry out a 2 weekly audit of the medications which was due to be done, and also said that she would be increasing the frequency of the audits plus introduce a daily stock check for boxed medications, in order to ensure Care Homes for Older People Page 15 of 32 Evidence: all medications are administered correctly. An action plan to address the shortfalls identified was received promptly following the inspection. In the AQAA the Manager had stated that she had implemented medication reviews with the GP and there has been a marked reduction in the amount of medication prescribed, which is very positive. For residents who are approaching their final days, systems are in place to ensure that appropriate medication is available at all times to keep residents them comfortable and pain free. Staff were seen caring for residents in a gentle and professional manner, respecting their privacy and dignity. Residents and relatives spoken with said that the care provision at the home is good and that residents are treated as individuals. It was clear from speaking with the manager that a lot of work has taken place to ascertain the expectations of the residents and their families, to discuss these in the context of a care home environment, and to, wherever possible, meet them and encourage feedback so that where any shortfalls are identified these can be promptly addressed. Residents and visitors spoken with confirmed that they feel able to speak with the manager and the staff to raise any issues and are confident that their views are listened to, discussed and acted upon. Bedrooms viewed had been personalised and residents can choose to have their own telephones, landline or mobile. Residents looked well groomed and were dressed to reflect individuality and choice. The Manager said that the home has a 2 weekly visit from the palliative care nurse. For residents whose condition has deteriorated, the wishes of the resident and their families are discussed and recorded, so that these can be respected. We saw evidence of care plans and other documentation that had been formulated for end of life care wishes. It is clear that the manager has a very good understanding of the importance of ensuring all residents are given the right to choose when it comes to any area of care. The home also focuses on supporting the families throughout this process. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activity provision for the home is good, stimulating activities and outings to meet the individual needs, abilities and wishes of the residents. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Advocacy arrangements are in place, thus ensuring the residents rights, choices and opinions are heard and respected. The food provision in the home is of a good standard, offering variety and choice, to meet individual needs and preferences. Evidence: Since the last inspection the home now has three activity co-ordinators in post. There was evidence of regular group and one to one activities taking place. An activities programme was available and is on display. Two of the staff are able to drive the minibus from Hillingdon transport and there was evidence of several outings taking place. Residents have access to a gardening and library club at the home. We were shown curtains that the residents had made. The Expert by Experience stated There are three enthusiastic activity ladies who loved their job and all bought different skills to the activities as well as assisting the care staff at mealtimes.The activities room was a pleasant room and was well used. Group activities are planned for each day but could be flexible if weather was not suitable. One to one was also considered important. All Care Homes for Older People Page 17 of 32 Evidence: the residents who had taken part in any of the activities had this logged in their care plan. The activity team was very adventurous with their charges with outings to Buckingham Palace, Windsor Castle, Kew Gardens, Imperial War Museum and London Eye to name but a few. These outings were well supported by residents and a book of photos provided a reminder of their day out. There is a gardening club but not many built up flowerbeds. Knitting and crocheting was being done in one of the lounges with the view to making a wool blanket for those in wheelchairs. Cake baking was done on one day in the dining room. The cakes made were then enjoyed by them all! Now that the days are not so suitable for outings, one activity co-ordinator is spending time with relatives, friends and residents to develop Life Histories for each person and get a better understanding of the likes (or dislikes) so as to tailor the activities to them. A PAT dog came to visit periodically but there were two very much loved house cats who could be found on a residents lap enjoying the attention. The home has an open visiting policy and visiting is encouraged. Visitors spoken with commented that they are made welcome at the home and kept up to date with any issues. The home tries to discourage families from visiting at meal times in order that the residents mealtimes are protected. Information regarding advocacy services to include Age Concern was on display in the home. We were informed that the Manager is aware of the Mental Capacity Act 2005 and Deprivation of Liberties, and appropriate referrals are being made for any residents where this has been identified as a need. We viewed the kitchen and it was clean and tidy. There was a good supply of fresh, frozen, tinned and dried foodstuffs, and evidence of stock rotation. Food is appropriately stored and a daily record of fridge and freezer temperatures is maintained. There is a rotating menu which provides a good variety of meals. The menus have been based on seasonal availability of goods and in consultation with the residents. Residents are offered a choice of meals each day, and a record of their choice options is made and sent to the kitchen so their wishes are known and catered for. Residents confirmed that they are offered a choice of meals and that they enjoy the meals provided at the home. We viewed the kitchen and residents likes and dislike lists were available. The home has been awarded a 4 star rating for the Scores on Doors scheme from the Food Safety Agency.Since the last inspection residents are encouraged to have their meals in the dining room. For those who do not wish to eat in the dining room they can have their meals in their bedroom. Within the AQAA the Manager has commented that the home has now introduced protected mealtimes in order that the residents have a good mealtime experience. Care Homes for Older People Page 18 of 32 Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear complaints procedure which is followed, thus ensuring any issues are being fully addressed. There are clear systems in place for safeguarding adults, to include ongoing training for staff, thus keeping them protected and informed. Evidence: The home has a clear complaints policy and this is available in the Statement of Purpose and Service User Guide. Residents spoken to said that they felt able to raise any issues they have and that there concerns are addressed. The home has received 30 complaints in the past year and documentation sampled showed that complaints are investigated and responded to in a timely manner. The home has procedures for safeguarding adults and also follows the Hillingdon Safeguarding Adults protocols. The Manager is clear to report all incidents and has a good understanding of safeguarding. We spoke with some of the staff and those spoken with confirmed that they understood safeguarding and were aware of Whistleblowing procedures. The Manager stated that issues related to safeguarding are discussed daily at the handover and when any incidents or accidents have happened. The AQAA states that there were 5 incidents which were reported under the safeguarding procedures. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being maintained, with evidence of redecoration and refurbishment taking place to bring the home back to a good environmental standard, to provide residents with a pleasant and homely environment to live in. Procedures are in place for infection control and these are practiced, thus minimising the risk of infection. Evidence: We carried out a tour of the home. There was evidence of redecoration and refurbishment in some areas, to include corridor walls, carpet replacement and redecoration of several residents bedrooms, which is ongoing and residents are encouraged to choose the colour scheme for their own room. Some of the bedroom doors were in need of redecoration and the manager had already identified this. The gardens are well maintained and provide a pleasant environment for residents and visitors to sit out in. The Expert by Experience wrote This home is a converted listed building which can take 44 residents. It caters for elderly residents and those diagnosed dementia. The home is tucked away in a residential road with a pleasant well maintained garden in which the resident are encouraged to join in the gardening club or to sit when the weather is fine and warm. The entrance hall is small but welcoming. The residents are housed on all three floors with a lift and stairs access. Security to the dementia wing Care Homes for Older People Page 21 of 32 Evidence: on the first floor, Rose House, was via keypad coded doors. There were lounges and dining room on the ground and first floor and access to them was easy. The first floor dining room in the dementia wing had a kitchenette for teas, coffees and light snacks. The main kitchen was housed next to the dining room on the ground floor. Not all the lounges were light and airy as one lounge did not have any windows but was cosy all the same. The bedrooms were pleasant and of good size and some of the rooms were shared. However some of the residents had personalised their rooms and many had their own TV and radio. The parker bath on the first floor continues to be a problem. Work has been done on this and the LOLER testing was carried out on 09/10/09. The bath looks worn and it was clear that it is difficult to clean effectively now. The bathroom needs to be refurbished with a bath that is suited to meet the needs of the residents accommodated at the home. The shower room on the mezzanine floor also needs attention. The curtain rail is precariously attached to the suspended ceiling and we were assured that this facility is not in use at this time, and requested that a notice to this effect be placed on the door. The shower facility also needs refurbishment to meet the residents needs. We were contacted by the Manager following the inspection with an action plan to refurbish 2 bathrooms, to include replacement of the baths with modern assisted baths, plus a refurbishment of the shower room. We noted that bedrooms are very personalised and each bedroom has a flat screen television. These work of a central digital aerial and during the inspection it became clear that there was a continuity problem, causing frequent interruptions in transmission, which was irritating to listen to and frustrating to those trying to watch their TV. We viewed the laundry room and it was clean and tidy. We noted that name tapes had been used to identify several residents clothing, in some cases names had been written across the inside of an item of clothing. Whilst this may be resident choice, we recommend that that the system of naming personal clothing be reviewed to ensure it is done discreetly. Staff had received training in infection control and protective clothing to include gloves and aprons were available. The home was clean and fresh throughout and the domestic staff were seen carrying out their work effectively. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is appropriately staffed to ensure that the needs of the residents can be met at all times. The systems in place for vetting and recruitment are in place to safeguard the residents. Overall training provision in the home is good, thus providing staff with the skills and knowledge to meet the residents needs effectively. Shortfalls have been identified with the Induction training and the Manager is addressing this. Evidence: The home was appropriately staffed on both days of the inspection. The Manager was clear that the staffing is reviewed on an ongoing basis to meet the changing dependency levels of the residents. Ancillary staff are employed in such numbers as to appropriately meet the needs of the home. The home has a maintenance person and where required external contractors are employed for specific pieces of work. We viewed the AQAA and this confirmed that the 6 staff have completed their NVQ level 2 or equivalent. We were informed that 8 more staff are due to complete their NVQ. We viewed 2 sets of staff records. In one instance it was not clear if a reference had been requested from the previous employer. It was clear that reasons for leaving had Care Homes for Older People Page 23 of 32 Evidence: not been recorded on the application form. For one member of staff there was no health declaration or photograph. Both had been obtained by the second day of the inspection. We discussed the shortfalls found with the Manager and recommended that she keep a record of the interview and any issues that are discussed at interview in relation to the application. The home has an induction programme. This did not meet the requirements of the Skills for Care Common Induction Standards. We were informed that staff work in a supernumerary capacity for 2 days and alongside other more experienced staff. Where required this period of time can be extended for the new starter. Staff spoken with confirmed that they had been receiving training and also training specific to some of the needs of the residents. In the AQAA the Manager informed us that all staff within the home have been reinducted and that she had also undertaken equalities and diversity training for the majority of staff. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager has the skills, experience and knowledge to manage the home effectively, and does so in an open and approachable manner and is clear in her vision for improving and thereafter maintaining good standards throughout the home. Systems for quality assurance are in place, thus providing an effective ongoing process of procedure and practice review. Resident monies are well managed and securely stored. Overall systems for the management of health and safety throughout the home are good, thus safeguarding residents, staff and visitors. Shortfalls identified in relation to fire drills should be easy to address. Evidence: The Manager is a first level nurse with a mental health qualification. She has also undertaken several post-graduate qualifications to include NVQ assessor training, diploma in management studies, dementia care mapping, the Registered Managers Award and other training relevant to her role and the needs of the residents. The Manager has an open and transparent manner and is focussed on enhancing the Care Homes for Older People Page 25 of 32 Evidence: quality of life experienced by residents in the home. Staff spoken with said that the manager is very approachable and works hard at addressing any issues raised. Residents and relatives spoken with were very positive about the manager and the changes being implemented throughout the home. Staff confirmed that they felt well supported. The Expert by Experience commented The Manager had been in post for one year and was keen to improve the home but realised that there was plenty more to do. The home has a system in place for quality assurance. Audits are carried out for several areas of the home to include documentation and the environment. A requirement has been made under standard 8 regarding the auditing of residents healthcare needs. The manager carried out a full care home audit in January 2009, which identified areas which required improvement. Resident and relatives meetings take place and minutes are recorded. There is a regular newsletter providing information about the home and the activities taking place. Regular staff meetings take place and minutes are recorded. The manager attends the morning hand-over meeting and also monitors work on the floors throughout the day to check on care practice and advise on any issues identified. Regulation 26 unannounced visits are carried out on behalf of the Registered Person. We noted that information regarding discussions with residents is not recorded in the recent reports of these visits, however the Manager assured us that such discussions do take place. We recommended that the visit reports are more detailed to include such information. It was clear that from the ongoing monitoring and auditing taking place, the Manager has a very good overview of the work needed to drive up and maintain good standards throughout the home. We viewed the management of residents personal monies. Clear records of income and expenditure are maintained and receipts are given for all transactions. We checked 4 sets of monies against the records, and with one exception the amounts were accurate. An excess of £2 was found for one resident, however this was investigated and a satisfactory explanation given. We sampled servicing and maintenance records. The majority were up to date and available to view. We identified that the legionella testing was overdue and the Manager arranged to have this carried out on 09/10/09, and has since confirmed this has been done. The fire risk assessment had been completed in December 2008. The fire drill records indicated that fire drills had been carried out in March and September 2009 and the importance of ensuring drills for all day and night staff are carried out in accordance with current legislation and good practice guidance was discussed. There was evidence that staff had received fire safety training. Risk assessments for equipment and safe working practices were not seen during the inspection, however Care Homes for Older People Page 26 of 32 Evidence: the Manager stated that these had been available and that she would find them and ensure they were up to date, plus that copies of the relevant assessments were placed in the kitchen and laundry areas. Staff had received training in health and safety topics and the Manager had carried out an audit and identified further training for all staff. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 17 Where an intervention is required within specific timescales in relation to wound care and weight monitoring, this must be carried out. To ensure that the needs of the resident are being fully met. 01/11/2009 2 8 17 The auditing of the service user plans must be carried out robustly and clear timescales for completion given for any shortfalls in documentation completion found. There must be a process for following up audits to ensure updates have been carried out. To ensure that all documentation for residents needs to include healthcare needs is up to date. 01/12/2009 Care Homes for Older People Page 29 of 32 3 9 13 All medications must be 19/10/2009 managed in accordance with current legislation and good practice. To safeguard residents. 4 9 13 The minimum, maximum and actual fridge temperatures of the medications fridge must be recorded daily. The fridge and room temperatures must be maintained within safe levels. To ensure medications are being stored at the correct temperature. 01/11/2009 5 19 23 The home must ensure that equipment to include the aerial provision for the televisions in the home so that it is maintained in full working order. To provide good television service for the residents. 05/11/2009 6 21 23 The bathing provision in the home must be reviewed and bathrooms and shower rooms refurbished. To provide assisted bathing and shower facilities to meet the residents needs. 01/12/2009 7 26 23 Residents clothing must be labelled appropriately. To ensure labelling is discreet and dignified for the resident. 01/12/2009 Care Homes for Older People Page 30 of 32 8 38 23 Fire drills must be undertaken at the required intervals. They must include all staff, including night staff. To ensure the safety of the residents. 01/12/2009 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 26 33 It is recommended that a discreet system of labelling personal clothing be suggested for all residents. The Regulation 26 Visit reports completed should detail discussions undertaken with residents at the visit. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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