Care Home: Penny Pot Care

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What the care home does well The home has a stable, committed staff team who know people well and treat them as individuals. One relative said the home "They treat people as individuals and the care is very good." One service user also stated "It isn`t like being at home but it is friendly and the meals are good." The registered provider works well with the manager to ensure the home maintains a friendly atmosphere. Relatives and other visitors are made welcome and are happy with the family atmosphere that Penny Pot Care provides. They also speak highly of the care their relatives receive. The menu in the home provides people with a well-balanced and varied diet. Staff provide good home cooked food that is enjoyed by people living in the home. What has improved since the last inspection? The home has introduced individual training and development programmes for all staff. Basic training courses covering health and safety issues were highlighted as requiring immediate attention by the home and this has been addressed. The introduction of a quality assurance and quality monitoring system has been implemented, whereby people living at Penny Pot Care are able to speak with staff should they have a complaint, and express their views through more positive channels. The premises were clean and tidy overall. A good deal of decoration and refurbishment has been done and further decoration and upgrading of the building is planned in communal areas, bedrooms and bathing facilities. What the care home could do better: The home`s statement of purpose and service users guide should be updated to reflect current changes and to ensure that prospective residents have sufficient information to make an informed choice. Penny Pot Care under the manager is currently reviewing and revising care planning documents. A person-centred approach is being adopted, which should ensure that the home has detailed individual information on which to formulate a comprehensive care plan. Any transcribed medications must be clearly documented with evidence of two signatures to ensure the risk of medication errors being made are reduced. There is a need for a programme of activities for it was noted that some people living in the home lacked active stimulation. It was evident from observation, speaking to residents and survey work completed by the Commission that some people living at Penny Pot Care would like more planned activities. See `Daily Life and Social Activities` section of this report. The home should ensure that care staff have clear safeguarding adults information to make a referral as needed. Where there are gaps in training relevant to staff development and the understanding of their role these should be addressed and relevant training organised so the service users may be assured staff have the sufficient skills to understand their needs and know staff are appropriately trained. Notifiable incidents should be documented fully and reported to relevant bodies where necessary to ensure service users can be confident that their health and welfare is safeguarded fully. Key inspection report Care homes for older people Name: Address: Penny Pot Care 8/16 Alton Road Clacton on Sea Essex CO15 1LB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Helen Laker     Date: 0 2 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Penny Pot Care 8/16 Alton Road Clacton on Sea Essex CO15 1LB 01255424077 01255473096 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Integrity Care Services Ltd Name of registered manager (if applicable) Mrs Kausar Jehan Sadiq Type of registration: Number of places registered: care home 38 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 38 The registered person may provide the following categories of service: Care Home - PC to service users of the following gender: Both whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - code OP Dementia - code DE Date of last inspection Brief description of the care home Penny Pot Care provides care for up to 38 OP with DE category. The accommodation is provided in a property refurbished from five adjoining houses. There is a range of communal areas on the ground floor. Bedroom accommodation is on the ground and first floor and there are staircases and a passenger lift. Care Homes for Older People Page 4 of 31 Over 65 0 38 38 0 Brief description of the care home The accommodation comprises of one double and thirty-six single rooms. The one double room has en-suite facilities of bath, wash hand basin and toilet and six of the single rooms have en-suite facilities of a toilet and a wash hand basin. Within the home there are five bathrooms, which are located on the ground and first floor. Catering and laundry services are in-house. The home is located close to the sea front with local shops; GP surgeries, churches and a hospital close by. The property has gardens to the front and rear of the property, with some car parking on a forecourt. The current range of fees, as at the site visit were said to be 390.04 pounds per week to 520.00 pounds per week. Toiletries, newspapers magazines, hairdressing and chiropody are an extra cost. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this home is two star. This means that people who use this service experience good quality outcomes. This key unannounced inspection looking at the core standards for care of older people took place on a weekday between 09:30 and 16:00. The registered manager and proprietor were available on the day of inspection and the staff present throughout the day assisted with the inspection process by supplying records and information. This report has been compiled using information available prior to the visit such as surveys sent out, evidence found on the day of inspection and the annual quality assurance assessment (AQAA), which is required by law and is a self assessment completed by the service. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. This document will be referred to as the AQAA throughout the report. During the day the care plans and files for six of the residents were seen as well as four staff files, the policy folders, the medication administration records (MAR sheets), Care Homes for Older People Page 6 of 31 some maintenance records and the fire log. The manager also supplied a copy of the duty rota, the menus, and other pertinent documentation which was required. A tour of Penny Pot Care Home was undertaken and eight residents, four members of staff as well as the domestic staff were spoken with. The home was clean and tidy offering homely accommodation to the residents. The residents seen were relaxed and clearly felt at home in the environment using all areas of the building. All the records and files were generally well maintained and easily accessible. Interactions between staff and residents were friendly and appropriate. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The homes statement of purpose and service users guide should be updated to reflect current changes and to ensure that prospective residents have sufficient information to make an informed choice. Penny Pot Care under the manager is currently reviewing and revising care planning documents. A person-centred approach is being adopted, which should ensure that the home has detailed individual information on which to formulate a comprehensive care plan. Any transcribed medications must be clearly documented with evidence of two signatures to ensure the risk of medication errors being made are reduced. There is a need for a programme of activities for it was noted that some people living in the home lacked active stimulation. It was evident from observation, speaking to residents and survey work completed by the Commission that some people living at Penny Pot Care would like more planned activities. See Daily Life and Social Activities section of this report. The home should ensure that care staff have clear safeguarding adults information to make a referral as needed. Where there are gaps in training relevant to staff development and the understanding of their role these should be addressed and relevant training organised so the service users may be assured staff have the sufficient skills to understand their needs and know staff are appropriately trained. Notifiable incidents should be documented fully and reported to relevant bodies where necessary to ensure service users can be confident that their health and welfare is safeguarded fully. Care Homes for Older People Page 8 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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. This judgement has been made using available evidence including a visit to this service. Prospective residents can expect to have an assessment and assurances that their needs can be met prior to entering the home. Evidence: The assessment documents of three people who were most recently admitted to the home were considered at this inspection visit. These included the social workers initial assessment (COMM 5) of the person that detailed the basic reasons why the person needed to move to a residential care setting and gives some background to their previous history. This information is supported by the services own assessment which has been reviewed since the last inspection with new documentation now in place. It is divided into sections covering physical health and mental health. This form covers essential Care Homes for Older People Page 11 of 31 Evidence: admission information about the individual and their needs in terms of daily living including such issues as mobility and skin health and the service users own perception of their health. In one of the three records reviewed some areas of the assessment could have been completed with more specific detail. The format used by the service would provide sufficient information to determine the suitability of the persons admission to the service, although this could be undermined by a potential lack of consistency in their completion. The manager stated that consistency in documenting care was an area being addressed via training and supervision and the AQAA identifies a need to Continue to develop skills, within the home, in customer satisfaction and communication. The intention of a full assessment is to ensure that the service themselves is satisfied that they can meet the persons needs, that there are the resources in staff and equipment to support their needs, and where these need to be arranged prior to admission time is given to do so, and that the existing group of people living at the home will not be disadvantaged by the admission. This provides a well-planned and positive admission, however this could be reduced where all the information known about the person is not included. The services Annual Quality Assurance Assessment says that they provide prospective residents with their brochure and encourage people to visit the home to look around and to ask staff any questions they may have. They also encourage people to stay for coffee or lunch to familiarise themselves with the home. They feel they have received positive feedback about their admission processes in the past. The AQAA does describe the assessment process and how this provides assurances about the quality of the admissions to the home. As part of the inspection process, the Commission sent surveys to people living at the home and their supporters. Four surveys returned by people living at the home all indicated that they felt they had received enough information about the home before they moved in, and in discussions with people on the day of inspection they said that either they or their relative had visited and gained information that they brought back to them. Three relatives surveys returned indicated differing views with one saying yes they did get enough information about the home another saying sometimes and another stated usually. Most people recalled being visited at their previous residence by the manager to discuss how they lived and what they liked and didnt like. One surveys returned by a relative stated It would be my residential home of choice, were I ever to require residential care. The service does not provide intermediate care. Care Homes for Older People Page 12 of 31 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. This judgement has been made using available evidence including a visit to this service. Residents can be confident that staff understand how to support them consistently. Evidence: Six care plans were sampled and inspected at this inspection. The care plans of the most recent admissions were inspected. It was noted that when service users entered the home, a good basic care plan had been developed within the first week. The manager said that this document was added to as needed and this wuld then expand this document to a full comprehensive document. The manager said that they are currently reviewing and revising the care plans of all the service users. A person-centred approached is being adopted and an example revised documention was seen. A new computerised care planning system has also been purchased which will be operational for all residents care planning by the end of January 2010. Care planning needs such as personal care; physical well-being, physiological well-being and nutritional needs were detailed in this format. Care Homes for Older People Page 13 of 31 Evidence: Recommendations were made as to the presentation and separation of the different personal care needs in this document e.g. bathing, washing and dressing. It was agreed that a detailed plan of action is required to ensure that the independence of the person living at the home is not compromised and the carer is fully aware of their duties. This was not completely clear in all the care plans sampled. In addition there is a need for the development of the care plan needs to cover all aspects of health, personal and social care needs, for whilst some account had been taken of personal and health care needs, little consideration was given to social care needs or the involvement of relatives in their formation. The AQAA states A full and comprehensive care plan is formulated covering personal hygiene, food and drink, immobility, night care, elimination, social, communication, interests and medical awareness is complied. This is supported with relevant risk assessments and information around day to day living. This plan is then reviewed on a regular basis, at least every 28 days or sooner if dictated by an event. The AQAA does not mention the implementation of the new Caredoc computerised system. This system is expected to address all the points discussed and the variation in recording as it will prompt mandatory fields to be completed such as personal care, bathing and social interaction. Records relating to health care needs were seen within the care plans and in separate record sheets e.g. nutritional needs, medication assessments and Waterlow pressure area assessments. Record keeping in these areas was generally detailed and comprehensive and a clear picture of each persons care needs was found. At the last inspection of the home in January 2008 the providers said that they anticipated conducting a through review of aspects of care to ensure that residents needs are met. Quality assessment forms seen that had been sent out to people who use the service were overall happy with their choice of home, and felt a natural, relaxed environment and surroundings. One serice user survey returned to the CQC stated I feel treated like an individual and the home is definitely people centred. Many of the people living at Penny Pot Care had been able to stay with the GP they had had prior to coming into the care home and one person said that they found this very reassuring, as they knew them well. A question relating to medical support and care was asked in the survey work conducted by the Care Quality Commission (CQC). Four people living at the care home who had completed these surveys said that they always received the medical support they needed. At the site visit medication administration, storage and record keeping was sampled and inspected. A senior carer assisted with this aspect of the inspection. They had a good understanding of the processes and procedures involved in medication administration and were confident in dispensing medication. The dispensing of medication was observed at lunchtime.Records were seen of medication coming into the home and leaving the home and we were informed that the home conducts both a Care Homes for Older People Page 14 of 31 Evidence: weekly and a monthly audit of medication procedures in the home. Records in place supported this. Overall medication records were seen to be in good order. An exception was found in some of the Medication Administration Records (MAR) sheets where it was noted that handwritten transcribed signatures were not signed by two persons and that some as required medication was just being omitted on an ongoing basis and had not been reviewed to ensure the prescription was still currently required. Medication storage is in two medication trolleys, which are secured and locked in the dining room. The home has a controlled drugs cabinet, but at the time of the site visit was not holding or administering any controlled drugs. During the visit to the home we observed staff being both supportive and sensitive to residents needs. Words of encouragement were given as a resident was supported to walk to the dining room and assistance offered as required with feeding. Within the survey work conducted by the Commission a relative spoken to said that the care home was good and had improved now a new manager was in place and four people who live at Penny Pot Care who had completed a survey said that staff generally listen and acted on what they say. Care Homes for Older People Page 15 of 31 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. This judgement has been made using available evidence including a visit to this service. Residents can expect the service to provide opportunities for stimulation and occupation that suits their abilities and preferences. Evidence: People spoken to during the visit to the home were generally happy and contented. Observation, discussion and some records seen detailed some activities, which people had enjoyed. Photographs of some activities such as parties and entertainment were on display and A4 pictorial posters were on display on an activity Board located in the hallway close to the dining room. The manager said that this board is used to offer and encourage activities to residents. At the time of the last inspection improvements had been begun to be made to activities available in the home and this continues to be the case. The AQAA states that activities have been extended and there are now more one to one activities taking place, including shopping and music to movement and people are encouraged to get involved in household tasks such as folding the laundry and laying tables. People spoken with confirmed they do things around the home; one person said they help with laying the tables. Care Homes for Older People Page 16 of 31 Evidence: Although there were no organised activities taking place on the day of this inspection, people were socializing and the atmosphere throughout the home was relaxed. Records examined such as care plans indicated that although new documentation was in place for recording person participation, these were not being utilized to their full potential and did not provide a clear picture of individual choices and social interaction. The Annual Quality Assurance Assessment (AQAA) stated that they will consult with the people living at Penny Pot Care and activities will be offered on a one to one and in groups. It was acknowledged that staff require training to offer suitable activities and stimulation and record keeping within care plans. One relative spoken with stated they are always keeping people busy and active and a visiting professional said, Residents are encouraged to engage in activities within/outside the home. However, one survey received from a person living in the home said, They would like more activities and outings and another said, Sometimes staff are so busy but they always have time to stop and listen Overall activities offered meet most peoples needs, but some people may benefit from more stimulation or different activities. The AQAA confirms that Activities for certain service users could be better in general Service users could be given more choice, participation and inclusion in their lives. Assessments of need should include consideration to individual capacity or ability and there should be an increase in structural activities for service users. The home plans to introduce pictorial menus and get service users to access the community more frequently. The AQAA also confirms We will continue to encourage our service users to speak up and tell us what they want to do, and what changes they would like in order to enhance their daily lives. Visitors spoken with all said they are made welcome in the home. There is a conservatory that can be used to meet visitors in private if people wish. The AQAA states that families are regularly invited to attend functions. People spoken with said they can choose what they want to do. One person said that you have to accept that things are different than in your own home, but even if you lose your independence there are still things that you can make choices about such as when you go to bed or what you eat. Overall the person was very positive about being able to make choices in the home. As at the last inspection the home continues to offer a varied diet that is well cooked and enjoyed by the people who live there. A new chef has been employed. Menus examined are worked out on a three to four weekly rotational basis. All the food is home cooked and the emphasis is on traditional meals such as shepherds pie, Care Homes for Older People Page 17 of 31 Evidence: omelettes, roast beef or sausages with onion gravy. The evening meal is a choice of sandwiches, soup or a light meal such as burgers. The cook leaves prepared cakes and snacks out for supper. Food stocks and storage were examined during a tour of the premises and there is evidence that plenty of fresh vegetables and meat are used. People spoken with confirmed that the food is good. One person said that if a particular meal is not to their taste, there is always an alternative. Dining rooms are pleasantly appointed and spacious. Surveys completed by people living in the home are complimentary about the food. One person said, Good food and another, the menu is similar to the food we enjoyed at our own home. Care Homes for Older People Page 18 of 31 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. This judgement has been made using available evidence including a visit to this service. Residents can feel confident they will be listened to and their concerns acted upon and also be assured that carers are adequately trained to safeguard their welfare. Evidence: Integrity Care Services Ltd already have in place a complaints procedure for Penny Pot Care. It is to be found in the Service Users Guide of the care home. Within this document it is agreed that an acknowledgement is to be made within 24 hours and the complainant should expect a response within 7 days. Previous details of the Commission for Social Care Inspection (CSCI) are to be found in this document. This should be updated to reflect the changes to the Care Quality Commission (CQC). The manager said that the care home has a Complaints Record Form and an example of this form was seen. Since the homes last key inspection in January 2008, Integrity Care Services Ltd has dealt with a four complaints, two of which were originally forwarded by the Commission to the home and two safeguarding referrals. These all have supporting documentation within the home and have been investigated appropriately. A temporary embargo was previously placed on the home due to one of the safeguarding referrals which has now been lifted and all the requirements made by the ECC safeguarding team met by the home. Integrity Care Services Ltd had looked into all these matters and advised the Care Quality Commission (CQC) of the problems Care Homes for Older People Page 19 of 31 Evidence: they had experienced and how this had been overcome. Their responses had all been submitted within the required timescale. The home and manager are aware of all the homes complaints, however no central log is in place for their recording. Within the AQAA it was said that any complaints received will be regularly monitored to ensure that the care home is addressing any shortfalls in their service. Without a central logging system this would be difficult. This was discussed with the manager at the time of inspection. Three people spoken to at the inspection said that if they had a complaint they would raise it with senior staff or the manager. Survey work completed by two people using the care service said that they would talk to the manager should they have any complaints. All the returned survey forms from relatives had answered the question, Do you know how to make a complaint about the care provided by the home or agency if you need to? confirmimg also that they did know how to make a complaint. Penny Pot Care has Safeguarding Adults policies and procedures. These documents detailed the different types of abuse and outline the procedure of what to do should a staff member witness abuse. Whilst these documents were detailed and comprehensive, little information was given as to contact details for the Essex Social Care Direct Safeguarding Adults team. Contact details were given to the manager and the care home might benefit from producing written documents that sets out a step by step guide for staff to refer to in the event of the manager being absent from the home. Whilst three care staff spoken to had some understanding of the need to raise concerns with the manager, they did not have a full understanding of Safeguarding Adults referral procedure. The last SOVA course held for staff had been on the 27/07/2009 with a few staff noted to still need an update. The format for the policies and procedures of the care home are such that they are to be found in a large file and rather than being separated, each policy runs on from the previous. Both an index and separation of each policy would make each policy easier to find. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is well maintained and encourages their independence. Evidence: Information received in the AQAA states that the home has undergone significant refurbishment. A tour of the premises confirms that improvements have been made since the last inspection and the work is continuing to the outside of the home. The AQAA states We keep premises clean and tidy and manage odour well. We sustain a homely, comfortable setting and give the service users a choice of rooms to relax in, as well as the use of a well tendered garden area. We make provision for residents with poor mobility throughout the home, inclusive of lifts, ramps and handrails and regualarly carry out routine maintenance throughout the home. All external grounds are kept in good order and we are continually striving to provide a homely environment. We listen to service users requests for change. An example of this is the changes to the front garden and service users choose their own colour schemes in their rooms. The front garden now has an enclosed area for service users to sit and safely enjoy the outdoors with a key coded gate. This was assessed as part of a deprivation of liberty issue with regard to one resident who before this was in place could only look out of the window at the front outdoor area as it was not safe for them to go out alone and sit in the front on a busy road. Care Homes for Older People Page 21 of 31 Evidence: Furnishings throughout the home are domestic in nature and overall there is a homely feel throughout. People spoken with said they like the homely atmosphere. There is new furniture in communal areas and evidence that many rooms have been redecorated and others are in the process of being painted. In addition a family room is being developed, a music room with piano as one service user loves to dance, a sensory room and a wellbeing room for those who may be sick and need one to one care. Facilities in the toilets and bathing areas could be better and the AQAA agrees with this stating there are plans to Improve bathing facilities check all lavatories are in good, working order and improve specialist equipment provsion so that service users can maximise their independence. Whilst it was noted as we toured the home that there were sufficent bathing facilities for the current number of residents i.e. two walk in baths and one bath with a bath chair, the need to review bathing facilities throughout the home is being considered.The current bathrooms look old and worn and the manager said that other bathing facilities not currently in use will be reviewed to ensure that Penny Pot Care has sufficient and suitable toilet, washing and bathing facilities to meet the needs of the people living at the care home. People living in the home would benefit from having the toilets and bathing areas updated. A tour of the premises shows that there are appropriate adaptations and equipment in place including hoists and assisted baths. Individual bedrooms are well furnished and contain ample evidence of personal possessions. A tour of the premises shows there is a good standard of cleanliness throughout the home. There are only a few isolated odours and this we were told was due to the carpets waiting to be cleaned but overall the majority of areas were free from odours and clean. The laundry is suitable for the size of the home and contains appropriate equipment. The flooring is impermeable to help ensure good infection control and there are handwashing facilities. The laundry sited in an outbuilding at the rear of the property has been decorated, new work surfaces and new flooring fitted. Within the laundry there are two industrial dryers, three washers, one professional and two domestic. The laundry person told us that with the current level of occupancy they said that they were able to complete the laundry daily. Overall, residents spoken to said that their laundry was completed well and in a short time span. It was acknowledged that occasionally items of clothing go missing, but normally they are found and returned. The cook is using the Safer Food Better Business pack provided by environmental health to record kitchen activities such as cleaning and maintenance. Kitchen records Care Homes for Older People Page 22 of 31 Evidence: such as fridge temperatures were examined and are completed appropriately. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents are looked after by a staff team who are aware of their needs and wishes and are subject to a thorough recruitment process and can be confident that the staff that have sufficient skills to support them. Evidence: Staff rotas were seen and inspected at the inspection. The manager said that staffing levels are calculated on the needs of the people living at Penny Pot Care. They said that additional staff are on duty at mealtimes between 08.00 am and 11.00 am and 16.00 pm and 19.00 pm and this was seen on the rotas. They did recognise, that in determining staffing levels they should consider the dependency needs of each individual resident. At the site visit staffing levels were found to generally be sufficient to meet the needs of the people living at the home and three people living at the home said that they receive assistance, as they required it. The manager said that there are currently fourteen members of staff of which five carers have a National Vocational Qualification (NVQ) Level 2 in care or above. Two staff spoken to at the inspection said that they were keen to undertake further training. Within the AQAA the new providers acknowledged that they have developed a more concise training programme, for it was recognised that refresher training in Care Homes for Older People Page 24 of 31 Evidence: basic training topics such as moving and handling, food hygiene, infection control, first aid and adult protection require updating. The AQAA also states We have employed an activities co-ordinator and quality manager. Inductions are undertaken according to skills for care. Dementia learning is provided for all staff and sensory impairment training. completed for all staff. We now provide in house training which fits in with the personal lives of individual staff and these improvements have resulted in high attendance levels. During the inspection the Responsible Individual visited the home and said that Integrity Care Services Ltd. have employed a quality manager, accounts manager and home manager since the last inspection and a training matrix for courses planned for the forthcoming year was seen. They said that they are continually looking to develop individual training and development programmes for each staff member and all staff members spoken with confirmed that training issues had been considered in recent supervision sessions. One staff survey completed and returned to the Commission said that they felt that they received training relevant to their role. The majority of care staff have received training in dementia care and one carer said that they had missed this training, but they were hoping to complete this in the near future. Recruitment files were sampled and inspected at the inspection. It is acknowledged that there have been changes to the paperwork used in recruitment and the manager said that further changes are planned. The home has an appropriate recruitment process in place. A sample of three staff files examined contain all the required documents including photographs, proof of identity, two written references and Criminal Records Bureau (CRB) checks. Staff files were generally tidy, however a checklist at the front would ensure all records were better organised and accessible. A discussion took place also regarding some recent staff problems which had been dealt with appropriately and some vacancies were yet to be filled. Overall surveys completed by people living in the home are positive about the staff. One said, The manager and staff very kind and helpful. Another commented, all the care staff carry out their duties to the best of their abilities however there sometimes appears to be a lack of staff which can make life a little difficult for all. On the day of the inspection, staffing levels were observed to be appropriate. Care Homes for Older People Page 25 of 31 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. This judgement has been made using available evidence including a visit to this service. Penny Pot care is well run by a competent management team. Residents and relatives can be confident in the operation of the service and people living there can be confident that there are health and safety systems in place to ensure the welfare of both individuals and staff. Evidence: Since the last inspection a registered manager has now been appointed to run the home. The manager is able to demonstrate an awareness of good management practices and also an enthusiasm and commitment to continuing to raise standards in the home. She is appropriately trained in care and dementia, and has relevant previous experience in the management of care establishments. The manager has completed NVQ level 4 Registered Managers Award and discussions on the day of the inspection confirm that the manager is well supported by the proprietors. Care Homes for Older People Page 26 of 31 Evidence: People spoken with feel the manager is very approachable and runs the home well. One person said, The manager and staff very kind and helpful. One survey received from someone living in the home confirmed The home has improved since we have had a new manager in place The homes quality assurance process has been further developed since the last inspection. Records examined show that the home consults people living there and their relatives and are using the feedback to make improvements to the home. The AQAA states that their regular meetings with people living in the home and staff do not identify any major faults or lack of quality provision. This was confirmed in conversations with service users on the day of inspection. As at the last inspection, the home does not manage the finances of anyone living there and only small amounts of money are handled. Records examined confirm that all monies are kept individually and securely and there is appropriate documentation and receipts for amounts spent. As previously reported, the home has processes in place to ensure people living there are protected by safe working practices. Health & Safety records examined confirm that appropriate checks are carried out such as Portable Appliance Testing (PAT), servicing of gas appliances, lifts, hoists and fire fighting equipment. The manager is able to demonstrate a good awareness of the homes responsibilities in keeping people safe. Regulation 37 reporting of notifiable incidents was noted to have a few gaps in some areas, whereby issues which should have been reported to us (CQC) had not been. This was discussed with the manager and it was agreed this was an area that would be addressed and monitored. The AQAA states that the manager carries out weekly audits to ensure the home is safe and all equipment is regularly serviced and maintained. the manager also states in th AQAA I will ensure all experience and knowledge gained is utilised to ensure a service is maintained, which is continuingly improved. Care Homes for Older People Page 27 of 31 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 31 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 7 15 Staff need to ensure that 26/02/2010 residents care plans are a clearly documented daily record of the care delivered and be person centred to evidence that staff appreciate the diversity of individual residents. Staff must also ensure that where possible residents and/or their representatives have input into the care planning system. So that residents can be confident that staff understand how to support them consistently. 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 1 The homes statement of purpose and service users guide should be updated to reflect current changes and to ensure that prospective residents have sufficient information to Page 29 of 31 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations make an informed choice. 2 9 Any transcribed medications must be clearly documented with evidence of two signatures to ensure the risk of medication errors being made are reduced. People living in the home should have access to a range of social and recreational activities that will provide stimulation and improve their lifestyle. this should be documented in full in their care notes, to ensure that individual service users choices and social needs are being met and that staff are clear about the care required to meet individual goals. The home should ensure that care staff have clear safeguarding adults information to make a referral as needed. Where there are gaps in training relevant to staff development and the understanding of their role these should be addressed and relevant training organised so the service users may be assured staff have the sufficient skills to understand their needs and know staff are appropriately trained. Notifiable incidents should be documented fully and reported to relevant bodies where necessary to ensure service users can be confident that their health and welfare is safeguarded fully. 3 12 4 18 5 30 6 37 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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