Care Home: Penhellis Nursing Home

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What the care home does well The home provides a comfortable homely environment that is clean and safe for residents, staff and visitors. There is ample communal space and suitable washing and toilet facilities. The whole home has been decorated and furnished to a very high standard. The grounds are beautiful with walkways and seating areas accessible to residents. People say they are happy living in the home and they say the staff are very kind and caring. They say their independence is respected and they can choose how to live their lives. One survey stated "I`m very happy here and couldn`t be anywhere better". People are only admitted following a thorough assessment to ensure the home can meet their needs. People`s healthcare needs are met and specialist healthcare professionals visit the home when required. Some nurses have their own special interests and link with the specialist teams. Appropriate equipment is provided for pressure relief and moving and handling purposes. There is a suitable system for medications that ensures peoples safety and only qualified nurses administer medicines. Each resident has an individual care plan, designed to meet their specific needs. Individual risk assessments are undertaken to enhance people s care and welfare. All of the people spoken with said the care is very good and their individual preferences are respected. Social activities take place, organised by a carer. Time is spent on one to one sessions when staff and residents get to know each other. There is a nutritious menu and people generally felt the food is good. Fresh fruit and vegetables are included and drinks and snacks are available at all times. There is a system in place that ensures that complaints are dealt with promptly and records are kept. There is a suitable policy for the prevention of abuse and staff have received training in the protection of vulnerable adults and the procedure to be followed. Staffing levels are suitable for the number of people accommodated and there is a registered nurse on duty at all times. 71% of care staff have an NVQ qualification in care and others are working towards a qualification. Money is not held on behalf of residents, hairdressing, chiropody and newspaper charges are invoiced to residents. There is a quality assurance system in place that allows people to air their views. The management strive to review and continually improve the service. The management try to make sure that working practices are safe. Relevant service checks take place as required and are kept up to date. What has improved since the last inspection? There has been substantial work undertaken in the grounds to make them more accessible, with walkways and seating areas included. The decoration of the home has been ongoing and remains looking very fresh and well maintained. The pre-admission assessment documentation has improved and nurses now assist with this process. The care planning system has also been improved and now provides more direction for care staff. The manager stated he is still going to review the system further to prevent so much duplication. There have been improvements to the medicines system to make the process safer for residents. Although the home has been unable to employ an activities co ordinator they have made efforts to ensure that activities and social events are being provided. They are in the process of accreditation for the Gold Standard Framework, end of life care programme. Several new assessment tools have been introduced and the AQAA states that great links have been established with the multi disciplinary team. More staff have been employed and the level of care staff with an NVQ qualification has increased. Training for staff in general has been increased and record keeping has been implemented to evidence that staff are kept up to date. What the care home could do better: The manager and the registered provider were given feedback throughout and at the end of this inspection. They are aware that regulations have been breached in respect of recruitment of staff and agreed to address the issues. Staff must not be employed unless satisfactory checks have been undertaken and at least a POVA first check and two references received. Even then staff must work under supervision until a satisfactory CRB check has been received. The details of supervision and who is responsible should be evidenced in the records. Some changes to the statement of purpose are necessary to ensure it fully informs people and complies with legislation. The manager s details and some staffing details need updating. Any risk assessment scores need to be included in the care planning as they denote a level of risk, this may mean specific directions for staff. The care plans should be agreed and signed by the resident or their representative so that they know the care they will receive is appropriate for them. Two members of staff must always sign handwritten instructions on the medicine charts and the manager said he would ensure this was done.Records of activities are maintained, however individual sheets for each person that detail their involvement and emotional reactions would provide evidence that activities are appropriate and fulfil peoples preferences. A suitable and reliable system of communication between the home and the laundry worker needs top be established for safety reasons. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Penhellis Nursing Home Cross Street Helston Cornwall TR13 8NQ     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: Diana Penrose     Date: 0 9 0 4 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 27 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 27 Information about the care home Name of care home: Address: Penhellis Nursing Home Cross Street Helston Cornwall TR13 8NQ 01326565840 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Penhellis@gofast.co.uk Glencare Homes Ltd care home 26 Number of places (if applicable): Under 65 Over 65 26 0 old age, not falling within any other category physical disability Additional conditions: 0 5 The maximum number of service users who can be accommodated is 26. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender 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 26 places Physical disability (Code PD) maximum 5 places Date of last inspection Brief description of the care home Penhellis House is situated in the centre of the town of Helston. The building is a period house, which is listed, with modern day extensions that sits in extensive grounds that are beautifully maintained. There is a tarmacadam driveway, footpaths through the trees, well-tended flowerbeds, walkways and fishponds. The home is registered to provide accommodation, personal and nursing care to 26 elderly residents, 5 of whom may have a physical disability. Accommodation is on two floors with a lift provided. There are 20 single bedrooms, 11 of these have en-suite Care Homes for Older People Page 4 of 27 Brief description of the care home facilities, and 3 double bedrooms with en-suite facilities. All rooms are provided with call bells, internet access, telephone points and a television. The home is decorated and furnished to a high standard in keeping with the house. The home provides dining facilities that cannot accommodate 26 people in one sitting, however the home offers two sittings. The kitchen is fitted with stainless steel fittings. There is a large lounge on the ground floor and a smaller lounge upstairs. Another room upstairs has been provided for hairdressing and chiropody services. There are two bathrooms, one with a Parker bath and one with an overhead hoist; there are separate toilet facilities. There is also a wet room shower provided. Information about the home is available in the form of a brochure that includes the statement of purpose; a copy can be supplied to enquirers on request. Fees range from 655 - 895 pounds per week. More complex care needs may incur higher fees; this information was supplied to the Commission on the day of inspection. Any personal items purchased are invoiced to the resident or their representative. Care Homes for Older People Page 5 of 27 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: An Inspector visited Penhellis House Nursing Home on 09 April 2009 and spent eight and a half hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that peoples needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that peoples placements in the home result in good outcomes for them. All of the key standards were inspected. On the day of inspection twenty people were living in the home. The methods used to undertake the inspection were to meet with people using the service, staff and the manager to gain their views on the services offered by the home. Records, policies and procedures were examined and the inspector toured the building. The previous Care Homes for Older People Page 6 of 27 manager returned a completed Annual Quality Assurance Assessment, which has informed this inspection. Also CSCI surveys have been returned in respect of 5 residents, 2 staff and 1 healthcare professional, these have also informed this inspection. This report summarises the findings of this key inspection. The people using this service expressed satisfaction with the care and services provided at the home and said they were treated with kindness and respect. What the care home does well: The home provides a comfortable homely environment that is clean and safe for residents, staff and visitors. There is ample communal space and suitable washing and toilet facilities. The whole home has been decorated and furnished to a very high standard. The grounds are beautiful with walkways and seating areas accessible to residents. People say they are happy living in the home and they say the staff are very kind and caring. They say their independence is respected and they can choose how to live their lives. One survey stated Im very happy here and couldnt be anywhere better. People are only admitted following a thorough assessment to ensure the home can meet their needs. Peoples healthcare needs are met and specialist healthcare professionals visit the home when required. Some nurses have their own special interests and link with the specialist teams. Appropriate equipment is provided for pressure relief and moving and handling purposes. There is a suitable system for medications that ensures peoples safety and only qualified nurses administer medicines. Each resident has an individual care plan, designed to meet their specific needs. Individual risk assessments are undertaken to enhance people s care and welfare. All of the people spoken with said the care is very good and their individual preferences are respected. Social activities take place, organised by a carer. Time is spent on one to one sessions when staff and residents get to know each other. There is a nutritious menu and people generally felt the food is good. Fresh fruit and vegetables are included and drinks and snacks are available at all times. There is a system in place that ensures that complaints are dealt with promptly and records are kept. There is a suitable policy for the prevention of abuse and staff have received training in the protection of vulnerable adults and the procedure to be followed. Staffing levels are suitable for the number of people accommodated and there is a registered nurse on duty at all times. 71 of care staff have an NVQ qualification in care and others are working towards a qualification. Money is not held on behalf of residents, hairdressing, chiropody and newspaper charges are invoiced to residents. There is a quality assurance system in place that allows people to air their views. The management strive to review and continually improve the service. The management try to make sure that working practices are safe. Relevant service checks take place as required and are kept up to date. Care Homes for Older People Page 8 of 27 What has improved since the last inspection? What they could do better: The manager and the registered provider were given feedback throughout and at the end of this inspection. They are aware that regulations have been breached in respect of recruitment of staff and agreed to address the issues. Staff must not be employed unless satisfactory checks have been undertaken and at least a POVA first check and two references received. Even then staff must work under supervision until a satisfactory CRB check has been received. The details of supervision and who is responsible should be evidenced in the records. Some changes to the statement of purpose are necessary to ensure it fully informs people and complies with legislation. The manager s details and some staffing details need updating. Any risk assessment scores need to be included in the care planning as they denote a level of risk, this may mean specific directions for staff. The care plans should be agreed and signed by the resident or their representative so that they know the care they will receive is appropriate for them. Two members of staff must always sign handwritten instructions on the medicine charts and the manager said he would ensure this was done. Care Homes for Older People Page 9 of 27 Records of activities are maintained, however individual sheets for each person that detail their involvement and emotional reactions would provide evidence that activities are appropriate and fulfil peoples preferences. A suitable and reliable system of communication between the home and the laundry worker needs top be established for safety reasons. 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 10 of 27 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 11 of 27 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 residents are provided with information about the home; some additions are necessary to fully inform people and to comply with regulations. Residents are only admitted to the home following an assessment of their needs to ensure the home can provide suitable care. Evidence: The registered provider said the statement of purpose had been updated since the last inspection. However the copy shown to us had not been changed. It did not contain the homes fire precautions and there is no information regarding the homes policy in respect of resident s money. The registered manager has left and some of the staffing details need changing. The registered provider agreed to address the issues. The manager said that he or one of the nurses visits prospective residents to assess their care needs. The care files of two people admitted since the last inspection were Care Homes for Older People Page 12 of 27 Evidence: examined and contained detailed assessment information. Other information from external agencies was also seen in peoples files. Care Homes for Older People Page 13 of 27 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. Each person using the service has a written care plan that reasonably directs staff to ensure that healthcare needs are met. There is an appropriate system for the use of medicines that safeguards people using the service. Evidence: Three peoples files were inspected; each contained a care plan, various risk assessments, pre-admission assessment details and other care information. The care planning documentation is more detailed than at the last inspection and reasonably informs and directs staff in the care to be provided. A concise care plan is at present written for the care staff which is a duplication of paperwork, the manager is reviewing the system. Some risk assessments have a scoring system which denotes the level of risk, these scores have not been included in the care plans to explain the level of care required. The manager said that care plans are compiled with the people using the service but none were seen signed by them. The nurses write daily records and care staff inform the nurses if they need anything to be recorded. Care staff have their own paperwork to complete each day regarding personal care. Care Homes for Older People Page 14 of 27 Evidence: People said that doctors and other healthcare professionals visit when required and records are kept. They said their healthcare needs are met. The manager said that specialist community nurses visit as required and that some nurses employed act as links with them. Staff said there is sufficient equipment for moving and handling and pressure relief in the home. The manager stated that they are working towards accreditation for the Gold Standard Framework. There is a medicines policy for the home. The medicines system was inspected and found to be appropriate. An monitored dose system is in use. Storage of controlled medicines and those requiring refrigeration is satisfactory with appropriate records maintained. No residents are self-administering at the moment. Records are kept of all medicines entering and leaving the home, the inclusion of medicines received on the medicine administration record charts was discussed with the manager. There were no gaps observed in the administration records. Two members of staff must always sign handwritten instructions on the charts and the manager said he would ensure this was done. There is a homely remedies policy and a list approved by a doctor. There are relevant reference books, Nursing and Midwifery Council guidelines and palliative care guidance for staff. Patient information leaflets are also available for staff or residents to refer to. We were told that care staff receive medicines training on induction and medicines awareness courses are provided. Peoples privacy appeared to be upheld during the inspection and they are free to move around the home as able. They said they are treated with respect and their privacy is maintained at all times. They said they receive their post unopened and the telephone arrangements in the home are satisfactory. Shared rooms have appropriate screening. Care Homes for Older People Page 15 of 27 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. Efforts have been made to improve the activities and entertainment provision, visitors are welcomed and residents are encouraged to live a life of their preference. Evidence: The AQAA states that problems have been encountered in respect of recruiting an activities co-ordinator. At present a care assistant is organising activities and events in the home on a part time basis. The manager is seeking training for her appropriate to the role. Records of activities are maintained, however individual sheets for each person that detail their involvement and emotional reactions would provide evidence that activities are appropriate and fulfil peoples preferences. Activities taking place in the home include bingo, games, playing ball, music for health and a tea dance with Colin. Care staff said they spend one to one time with people using the service when they chat, do manicures and nail painting. We were told that massage and facials are planned. The AQAA also states that residents meetings have commenced and that they aim to develop a Friends of Penhellis Committee. The manager said he is hoping to arrange transport so that residents can go on trips out. Care Homes for Older People Page 16 of 27 Evidence: People using the service said that some activities take place but some were content to stay in their rooms and this was respected. Several people talked about Flora day and they were looking forward to the celebrations. The visitors records show that people come to the home regularly. People using the service said they could receive visitors in private and at any time. People spoken with said their individual preferences are respected and they are supported to maintain their independence. They said they get up and go to bed when they like and are free to move around the home as they wish, if able. Peoples rooms were personalised with their own belongings and furniture. We were told that some people control their own money. Staff said residents choose what they do each day. The menu shows that choices are available. The manager told us that there is a menu that spans four weeks. He said it is in the process of being reviewed and there will be seasonal menus. The menu seen was handwritten and looked nutritious and varied. At the moment the menu is not displayed, but it is intended to have the menu on the dining tables again once reviewed. Homemade soups, cakes and puddings are on offer. One resident said the soups are lovely. Fresh vegetables are included and a bowl of fruit and an array of drinks were seen in the dining room. Refreshments were available to people throughout the day. People using the service made varying comments about the food, several said it is good but not as good as it was. They acknowledged that this was probably due to a change in cooks and that new people were settling in. Care Homes for Older People Page 17 of 27 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. There are suitable policies and processes in place for complaints and adult protection to ensure that people using the service are safeguarded. Evidence: There is a suitable complaints policy in place that is included in the statement of purpose. The inclusion of reporting complaints to department of adult social care, in the policy, was discussed with the manager. There have been two complaints to the home, one of which was upheld. Residents said there are no barriers to raising concerns with the staff or the manager. CSCI surveys show that people know the complaints procedure and feel confident they will be listened to. The abuse policy is appropriate and the training records show that staff have received abuse training. There has been one appropriate safeguarding referral to the department of adult social care to safeguard peoples interests but there have been no abuse allegations at the home. Care Homes for Older People Page 18 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable, well furnished, very clean and well maintained making it a safe homely place for people to live and work in. Evidence: The home provides a very comfortable, warm clean environment and people using the service said they are very happy with their surroundings. It is furnished, decorated and maintained to a very high standard and is in keeping with the age of the building. There is plenty of communal space and assisted bathing facilities; one bathroom has an overhead hoist. There is a salon for hairdressing and chiropody services; the hairdressers visits are a social event. The grounds are beautiful with trees, lawns, ponds and colourful flowers and shrubs, further work has been undertaken since the last inspection to improve the grounds with walkways that are suitable for wheelchairs and two patio areas developed. The old greenhouse is used at the moment to house peacocks and chickens, long-term plans have not been decided on yet. People said they like their rooms and that the owners keep the home looking and smelling fresh. Care Homes for Older People Page 19 of 27 Evidence: The laundry facilities are situated in a converted outbuilding some distance from the main building. There is a walky talky system for communicating with the home but the battery has not been kept on charge. This was discussed with the manager who agreed to ensure that a suitable communication system is established. There are two washers and two driers, which the laundry person thought was suitable. There is ample space for working and storage. People had no complaints about the laundry service. We saw appropriate hand-washing facilities for staff throughout the home and alcohol hand cleansing gel is in use. Protective clothing is provided and was seen in use. There is a sluice on each floor and infection control training has been addressed. Care Homes for Older People Page 20 of 27 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. There are suitable staffing levels for the number of residents, 71 of care staff hold NVQ qualifications and staff receive regular training to update their knowledge and skills. Recruitment procedures are not robust enough to ensure that people using the service are safeguarded. Evidence: The manager said there are no staff vacancies. The staffing rota shows that a qualified nurse is on duty at all times and as a minimum there are 5 carers in the mornings, 4 in the afternoons, 3 in the evenings and 2 awake overnight. Some carers have been given the role of team leader and supervise the other carers on the shift. The manager stated that he is reviewing the rota to improve the skill mix and make weekends off more fairly distributed. He said agency staff are only employed when really necessary, he is trying to set up a bank system for the home. There are a suitable number of ancillary staff employed for cleaning and catering. People living in the home said the staff are very caring and they are well looked after. CSCI survey comments include Staff are all very caring and attentive and Some are better at listening than others. Staff surveys comment Penhellis employs a very good mix of staff, a lot of thought is put into who they hire. The management are good at ensuring high staffing levels at all times to provide a high level of care. Care Homes for Older People Page 21 of 27 Evidence: 71 of care staff are qualified to at least NVQ level 2 in care some of these have achieved level 3. Three staff are working towards NVQ level 2, one to level 3 and two to level 4. There is a recruitment policy and an equal opportunities policy in place. Seven staff files were examined and held most of the records required by legislation however relevant employment checks have not been undertaken appropriately. One person had no current references they were old copies addressed to to whom it may concern and four peoples references were received after they had commenced work. All staff commenced work prior to a satisfactory POVA and CRB check being received. It did state in three files that people were supervised but no detail as to how or by whom. When staff have been promoted there is no evidence of an application for the post, that an interview has taken place or that a repeat CRB and POVA check has been carried out. Some interview records were evident and supervision records and training certificates were seen. The registered provider said he was unaware that recruitment checks had not been correctly dealt with by the registered manager in post at the time. A new manager is now in post and he agreed to ensure that the process is completed appropriately. An induction pack was seen that is in line with the skills for care standards. We were told that packs in use are kept by the employee. Posters were seen in the staff room advertising various training courses. The manager told us that staff are up to date with statutory training; new employees have been booked onto sessions. He said that some training is done in house and some externally. A list of training that has been booked was seen. Records are maintained and a training matrix was seen, recording the actual dates of training attended would be more beneficial than the tick boxes currently in use. Certificates for training attended were seen in staff files. Staff said they received induction training and that there is a good amount of training on offer. Some people said they had undertaken courses other than statutory training; these included conflict resolution, tissue viability, syringe driver and Mental Capacity Act. We were not shown a training and development plan for staff. Care Homes for Older People Page 22 of 27 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 management team appear competent to run the home and systems are in place to monitor and improve the service for residents and staff. Training and safety checks are undertaken to ensure the health, safety and welfare of residents, staff and visitors. Evidence: The registered manager has resigned from her position. A new manager has been in post since 23/03/09 and has worked in the home since October 2008. He said he is going to apply to the Care Quality Commission for registration. He is a Registered General Nurse with 18 months experience in care of the elderly. He said he is going to undertake the Leadership and Management for Care Services Award. Training undertaken includes Mental Capacity Act, Deprivation of Liberties, PEG, moving and handling, medicines review and provider manager training. He said he keeps up to date by using the Internet and reading the nursing press. Staff and residents said the manager is approachable and has a very calm manner. They told us the registered providers spend time in the home and contribute to the management. Care Homes for Older People Page 23 of 27 Evidence: The registered provider said there was a development plan for the home, provided for registration, there has not been an updated version but informal plans are evident. Quality assurance surveys were distributed in February and November 2008, reports were seen and were positive about the service. CSCI survey results were also positive. Some auditing was being done by the registered manager and includes medicines, training, cotsides and accidents. Various staff and residents meetings take place with minutes kept. The registered manager completed and returned the Annual Quality Assurance Assessment (AQAA) to the Commission and supplied the data requested. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. No money is managed for people using the service. Each person has a locked facility in their room for storage. The manager told us that hairdressing, chiropody and newspaper purchases are paid for by the home and residents are invoiced. Three people have money held for them, in case they need it, in sealed envelopes in the safe. The manager said he hopes to discontinue this practice as there is always petty cash available. There is evidence that health and safety and fire precautions are in place. Relevant service checks take place and certificates are held. Staff receive statutory training regularly and kitchen staff receive food hygiene training. The environmental health officer has not visited since the last inspection. The five yearly hardwire test was done in November 2008 and the PAT testing is due to be done this month. Accident reporting complies with data protection, there were 2 accidents in February and 15 in March, the manager was aware of the reason for the increase. Accidents do not appear to have been audited since October 2008 and there is no evidence that a risk assessment takes place following an accident. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 29 13, 19 All staff must have a 15/04/2008 satisfactory POVA check prior to employment and only work with full supervision until a CRB disclosure is received Care Homes for Older People Page 25 of 27 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 29 19 All staff must have two 29/05/2009 satisfactory references and a satisfactory POVA check prior to employment and only work under full supervision until a CRB disclosure is received. This will help to ensure that people using the service are safeguarded from possible harm or abuse. 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 Care Homes for Older People Page 26 of 27 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). 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. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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