Care Home: Pine Tree Court

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What the care home does well Care plans accurately reflect the individuals` needs and how they will be met. People who live in the home and their families are involved in this process wherever possible. Systems are in place to help ensure that there is consistency in assessing, planning, implementing and evaluating the care when required. We saw some improvements in people making choices about how they choose to live their lives, this is detailed in the care documentation and staff we spoke with told us about the people living in the home, their likes and dislikes and their preferred routines. The complaints policy and procedure in the home is effective and all concerns are taken seriously and acted upon efficiently. People can be sure that they will be listened to and that their thoughts and feelings are taken into account. Recruitment procedures has meant that vacancies have been filled with people that are suited to the job with the right skills, this will also help ensure more continuity of care to the people who use the service. At present the home is clean and comfortable. The additional work continues with the homes refurbishment and redecoration plan. This should provide a safe, peaceful and well maintained environment for everyone. The home now encourages and supports staff with training in order for them to develop their knowledge so that they have the required skills to meet the needs of the people. The home is well organised and managed by an effective, stable team that promotes the views and interests of all people who use the service. The home continues to improve and further examples are detailed throughout this report. What the care home could do better: We have detailed throughout the report about how the outcomes for people who use the service have improved during the last six months. The report tells us that Lifeline have an action plan whereby these outcomes will continue to improve and that new initiatives will be actioned in the coming months. Some of the outcomes have been judged as adequate because they are either not fully met or because we need to be satisfied that the improvements made will be sustained. We have only made two requirements as a result of this inspection because Lifeline have already identified where improvements need to be addressed and have already started to put some of their plans into practice. We look forward to seeing the progress made during our next visit. Key inspection report Care homes for older people Name: Address: Pine Tree Court 7 Larchwood Drive Tuffley Gloucester Gloucestershire GL4 0AH     The quality rating for this care home is:   one star adequate 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: Wendy Kirby     Date: 0 2 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Pine Tree Court 7 Larchwood Drive Tuffley Gloucester Gloucestershire GL4 0AH 01452385855 01452504705 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Life Line Nursing Services Ltd Name of registered manager (if applicable) Mrs Sharon Anne Morgan Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is 40 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia Code DE, maximum number of places: 40 Date of last inspection Brief description of the care home The home predominantly provides care people with dementia. It is registered as a nursing home and therefore has qualified nurses on duty at all times. Situated in a residential area approximately three miles from Gloucester City centre, there is a bus stop directly outside of the home with a regular service to Gloucester City centre and the Stroud area. Care Homes for Older People Page 4 of 31 Over 65 0 40 Brief description of the care home The home provides accomodation for up to forty people. There are lounges and dining areas on both the ground and first floor with bathrooms and toilet facilities on all three floors. A passenger lift provides access to all levels. There is an enclosed, private garden and ample parking at the front of the property. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced Key Inspection which included a visit to the home. The visit was completed by two inspectors and lasted approximately nine hours. Lifeline services became the new registered providers for the home in July 2009. They changed the homes name to Pine Tree Court. This was the homes first Key Inspection since being registered with the commission. Prior to the inspection we (The Commission) looked at various pieces of information to gather evidence in preparation for our visit, which included the following: The homes inspection record, which gives us an account of any information we have received about the home since the last inspection. The Annual Quality Assurance Assessment, known as an AQAA. The home is requested Care Homes for Older People Page 6 of 31 annually to complete and return this assessment to us by a specified time. We received the AQAA on time, which contained information about what the home considers it does well and what plans they have for further improvements in the coming year. We sent surveys Have Your Say to people who live in the home, staff and health and social care professionals. Comments received from the surveys will be referred to throughout this report. During our visit we spoke with some of the people who live in the home, visitors, the responsible individual, the manager, deputy manager and other staff members who were on duty. We also looked at how effectively staff engage with people in the home and how they were interacting and communicating with each other. We looked at four individuals care files, which included, pre admission assessments, care plans and risk assessments. We also looked at a number of records and files relating to the day to day running and management of the home. We spent time in all communal areas of the home and some of the bedrooms. 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: We have detailed throughout the report about how the outcomes for people who use the service have improved during the last six months. The report tells us that Lifeline have an action plan whereby these outcomes will continue to improve and that new initiatives will be actioned in the coming months. Some of the outcomes have been judged as adequate because they are either not fully met or because we need to be satisfied that the improvements made will be sustained. We have only made two requirements as a result of this inspection because Lifeline have already identified where improvements need to be addressed and have already started to put some of their plans into practice. We look forward to seeing the progress made during our next visit. 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. Peoples needs are assessed prior to admission to determine the suitability of placement. Evidence: We looked at the pre admission assessments, which were comprehensive covering all activities of daily living, a full health screen and personal history background. The format has been the modified to include sections that relate to The Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLs). The AQAA tells us, We have also improved the documentation relating to religious, social and recreational needs. The information gathered pre admission should provide a sound benchmark of the persons ability, state of health prior to admission and subsequent needs when they move into the home. People wishing to live in the home, family and carers are involved in the pre admission assessment wherever possible and all information is used to determine the suitability Care Homes for Older People Page 11 of 31 Evidence: of the placement. Where possible the manager also obtains comprehensive assessments and care plans from other health and social care professionals involved, for example, social workers and hospital staff. The manager clearly demonstrated the importance of thorough pre admission assessments in order to ensure that the home can meet individual needs. The Social and Health care professional surveys agreed that the care services assessment arrangements ensure that accurate information is gathered and that the right service is planned for people living in the home. Feedback from a family whose relative was recently admitted to the home was very positive, We are very happy that our relative is now close to home, receiving the best possible care, we are full of praise for Pine Tree Court. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been some steady progress made in these outcomes for all people who use this service. These will need to be monitored by Lifeline and the manager to ensure that these improvements are sustained. There are some safe systems of practice in place in receiving, storing, administering, and disposing of drugs which will help protect the health and wellbeing of people living in the home. We saw some good practice by staff in promoting peoples privacy, dignity and respect. Evidence: The manager and deputy have worked very hard to transfer all previous care documentation for people into a new format.The format is very detailed and of good quality it also demonstrates that the home takes an holistic approach to the provision of care for people living in the home. From the pre admission assessments a set of care plans based on identified needs are developed. During the first months trial Care Homes for Older People Page 13 of 31 Evidence: period the plans are reviewed weekly and developed accordingly. Care plans were completed with regards to health and social needs including, psychological, emotional, and cultural needs. The plans that we looked at were detailed and fairly person centered, including personal preferences and likes and dislikes. Plans told us that people had specific requests and routines, this is very good practice and helps demonstrate that people are involved in deciding how they wish to receive care. The manager told us that training in the MCA and DoLS will further support staff in understanding about empowering people to make choices about how they want to receive care, which in turn will help staff develop more person centered care plans. The plans showed consistency in assessing, planning and evaluating care as required. Regular care reviews take place for people living in the home, which include family members and Key Workers wherever possible. This allows the opportunity to discuss and evaluate care and any issues or concerns people might have. The manager audits the care files on a monthly basis and gives written feedback and any action required to staff members. There are various risk assessments in place and health care needs are monitored and documented in peoples care files. Nutritional assessments are completed on admission and reviewed monthly, people are weighed as part of this review. Care plans are written for people who are nutritionally at risk and how this is to be managed. People are having their fluid and nutritional input recorded daily and entries have improved since our last visit. Specialist health care support is often sought and referrals are made to community dietitians and the speech and language therapists. Records of General Practitioner (GP) visits and the outcomes were recorded. Specialist referrals and visits from other professional including, Chiropodists, Dentists and Opticians were also seen. Visiting health and social care professionals agreed that the care service seeks advice and acts on it in order to improve peoples well-being, they also told us that assessments provided by the home are accurate in order to ensure that appropriate care may be planned and that care needs are monitored, reviewed and met by the service. Staff agreed in their surveys that they are given up to date information about the needs of people in their care. Six out of eight people living in the home told us that they always receive the care and support they need and two said usually. Comments included, They are looking after Care Homes for Older People Page 14 of 31 Evidence: us all very well and The care of all the residents is excellent and the staff are always kind and caring to everybody. We spoke with and observed staff who demonstrated very good relationships with individuals and were knowledgeable about the care needs of those living in the home. The arrangements for medication storage,administration and recording were checked. Medication including controlled drugs were stored securely with appropriate storage temperatures being maintained for the medication storage room and the refrigerator. Bottles of liquid medication had been dated on opening as an indication of the expiry date. Although generally in good order there were some gaps in the recording of medication administration on the Medication Administration Records (MAR).This shows that an accurate record of medication given to people has not always been kept. There was also variable practice with signing and checking of handwritten entries on the MAR. Handwritten entries need to be accurate so that people receive their correct doses of medication at the correct times. Medication audits take place monthly although more frequent and targeted auditing should be considered given these findings. One person had been prescribed medication for anxiety on an as required basis. There was no protocol in place to guide staff in giving this medication, this should be included in any relevant care plan or a separate protocol drawn up. The home had recently notified us of a medication error involving controlled drugs. Looking at the information received we asked the home to carry out a full investigation into the circumstances. The home promotes privacy and dignity to all people who use the home. Staff attend training on induction, which covers aspects such as closing doors and pulling curtains when delivering personal care and knocking on doors and waiting for an invitation to enter before going in to their bedrooms. We saw staff knocking on peoples doors before entering, members of staff spoke respectfully about individuals needs and referred to them in the term of address that they preferred, this information was also recorded in the care files. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all the people in the home benefit from a varied activities programme, which is enjoyable, stimulating and meets individual preferences and expectations. People maintain family contact and staff encourage family and friends to join in with activities and any outings. Some evidence would suggest that the home actively promotes individuals to exercise choice and control over the lives they choose to live, however there is limited written documentation to support this. People receive a varied and wholesome diet that they are able to influence. Evidence: There does not appear to be any unnecessary rules in the home and it seemed that daily routines are flexible within the home. We saw some evidence that people can get up and go to bed when they like, have their meals in their bedrooms, and participate in activities they have a particular interest in. This was confirmed in discussion with individuals and through observation during our visit. Care Homes for Older People Page 16 of 31 Evidence: There is some information recorded about personal preferences; however this information is not available for all of the people living in the home. Although good progress has been made in the care file documents not all peoples wishes are recorded in individuals care plans which means that people may not always have their choices respected. Activities available in the home are posted on an information board and these include armchair exercises, a musical entertainer and a visiting pet dog. Examination of an activities and events schedule showed that there were film shows, quizzes and some specific activity session for the needs of people with dementia. In addition an area next to the ground floor dining room had been set aside as a memory room with displays relating to life and events in the past.There is also a gardening club for people who are able to make use of the new greenhouse. In the summer the home had held an opening ceremony with the Mayor of Gloucester attending and a Jazz band playing in the home. Various festivals at different times of the year had been celebrated in the home such as Harvest Festival and a Christmas Party. Although the above provisions are in place, evidence suggests that people at present are not always socially stimulated, individual preferences for activitys are not always recorded and current activitys do not meet expectations, preferences and individual capacity. We spoke with people who live in the home, relatives and staff, we observed people living in the home and we received comments about activities in our surveys. These are some of the comments we received, There are not enough activities to stimulate people. I have seen personally when I visit how much they enjoy individual stimulation, even just reading to them, The activity lady seems to try and include everyone, but its not always possible, It would be nice if someone could sit down and chat with me for a while rather than a quick in and out, People look bored, they either fall asleep or become fretful and start wandering, people often dont sleep at night because they have slept too much during the day and Some days it seems to be the same activity like throwing a ball. The activities are childlike and compromises peoples dignity at times. We spoke with the manager about the current activities provided in the home and we were told that it is something that needs improving and is on the action plan for the coming twelve months. Training which specialises in providing activities for people Care Homes for Older People Page 17 of 31 Evidence: with dementia is being sought and deployment of additional activity hours. The AQAA tells that plans to improve in the next twelve months include, improving links within the local community, develop activities which focus on person centered care and needs of individuals and to produce a monthly newsletter for all people who use the service. The size and layout of the dining rooms makes it possible for everyone to enjoy the social advantages of dining together. Both dining rooms have been recently redecorated and refurbished and are light and spacious with good quality dining furniture. Staff members supported people that required assistance with eating their meals in a respectful sensitive manner. Staff sat at the same level and assisted them without rushing. Meal times seemed a lot more relaxed than when we had previously visited the home and meal times are much more flexible to meet individual needs. We saw jugs of juices, beakers and glasses and these were being handed to people whilst waiting for lunch. Later when we visited people in their rooms we saw that jugs of fluid had also been provided for individual use. The home has a four weekly menu. At lunch there is a choice of main dish and at supper there is the option of a cooked snack. There was good up to date information on peoples special dietary requirements and nutritional needs and this information is available to be people who work in the kitchen. Current menus were displayed in both dining rooms. The four week menu displays traditional meals and menus are reviewed to reflect seasonal trends and availability of produce. Extras are ordered on request for birthdays and special occasions. People told us that they liked the food. Comments included, The cook cooks excellent first class, nutritional, tasty food, The cook is willing to cook anything different from the menu should someone request it and I have sampled some of the food and was delighted that it was delicious and nutritional. 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. There are good policies and procedures in place to manage complaints and people can be confident that their concerns will be listened to and acted upon. There are good arrangements in place for staff training and the awareness of protecting vulnerable adults so that people living in the home are further protected from abuse. Evidence: The complaints policy and procedure is detailed and contains all the relevant information required, this can be found in the service user guide, which is given to people on admission. It is also displayed on notice boards throughout the home. We would receive details from the home about any internal complaints investigations and safeguarding referrals. We know that any concerns raised are dealt with openly and effectively. The manager told us that she is committed to encourage an open culture within the home so that people feel comfortable and able to make a complaint or a suggestion without fear of reprisals. She makes every effort to see people living in the home Monday to Friday. Being available means that people can discuss any concerns or issues with the manager before they potentially escalate into complaints. Systems that are in place at the home such as regular care reviews, key workers and holding meetings for people Care Homes for Older People Page 19 of 31 Evidence: living in the home, relatives, and staff means that there is opportunity to communicate and share information. This further promotes people becoming less frustrated thus relieving anxieties and any potential complaint referrals. All surveys confirmed that people knew about the complaints procedure in the home and that there was always someone to talk to if they were unhappy. Comments included, All the staff are very willing to listen if you have any questions and try to help in any way they can, Im not quite sure how effective the message book is, sometimes information does not seem to get passed on to all staff, You can pick up the phone anytime and speak with staff on duty and The manager is good and we can always talk to her, I just wish sometimes when we see her we could sit down privately without the administrator there. There are policies and procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse. The availability of this information should increase staff awareness and the understanding of their role in protecting vulnerable adults who live at the home. Policies and procedures given to staff include, Whistle blowing, How to make a grievance and Harassment in the workplace. We were told that the home actively promotes staff training and education in the protection of vulnerable adults on induction and on an annual basis the staff receive an update. A number of staff have either completed or are enrolled on the National Vocational Qualification (NVQ) in care award and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and comfortable. Once the redecoration and refurbishment programme is completed it will provide a safe, peaceful and well maintained environment for the people living there. Evidence: Since Lifeline took over the home in July 2009 they have made extensive improvements throughout the home, including redecoration, refurbishment and provision of additional equipment. Further work continues identified in the homes environment improvement plan, which includes the provision of specialist baths to enable people with physical frailty to have a bath. We walked around the inside of the home and viewed most of the bedrooms and the communal areas including the dining rooms, lounges and bathrooms. Many of the communal lounges, dining rooms, hallways and corridors have either been redecorated since our last visit or are due to be completed this year. Various items of furniture throughout the home have been replaced as they were tired and shabby. Bedroom sizes are fairly spacious for their stated purpose. People are supported to personalise their bedrooms with pictures and ornaments and they are able to bring items of furniture should they wish. One person in the home had recently chosen to have their bedroom painted in the colours of their favorite football team with soft Care Homes for Older People Page 21 of 31 Evidence: furnishings to match. Profiling beds and divan beds are provided dependent on individuals need and choice. The manager has purchased some new bedding and is in the process of providing other soft furnishings to make the beds look more homely. Two lounge areas allow for people to be seated together enjoying the entertainment systems on offer and any group activities or events. The rooms are large and spacious and they have been redecorated and refurbished. The television in the lounge upstairs is too small for the size of the room and this is going to be replaced. The garden is private and secluded and well maintained. It provides a safe peaceful place for people to sit and enjoy the warmer weather. The home has a greenhouse and people are supported to grow flowers and vegetables. The plan for the coming year is to provide a sensory garden. Comments received about the home were, As an older building it is very hard to keep clean but it has improved a lot, The standard of the home has improved greatly, The general standard of cleanliness in rooms has improved and communal areas are looking much better, We are very pleased with the redecoration. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The relationships between staff and people living in the home are good and create a warm positive environment to live in. People are supported and protected by the homes recruitment policy. The people are cared for by skilled staff that are trained, supported and supervised by management. Evidence: Since Lifeline became the new registered providers of the home there has been a steady controlled process in place for new admissions. The manager has been vigilant in ensuring that they have enough staff with the required knowledge, expertise, resources and training in order to meet peoples needs. The manager told us that staffing levels are indicative of needs and the level of care required and confirmed that levels of staff would rise should dependency levels increase. We know that the home also increases the levels of staff at certain busy times of the day to ensure that needs are met. We know that the home recently made arrangements with a funding authority to provide a higher level of staff input for one person living in the home whose needs had increased. When there have been staff vacancies regular agency or bank staff have been used to provide continuity and the permanent staff will often cover extra shifts. Staff rotas are Care Homes for Older People Page 23 of 31 Evidence: developed to ensure an appropriate skill mix of staff is on duty. Since the takeover in July 2009 the home has had several recruitment campaigns. The home still requires a senior level structure beneath the manager and deputy, we know that this has restricted the home to be able to improve in some of the areas they had targeted in their action plan for the coming twelve months. Although they have interviewed several people for the posts not many have been suitable. The manager told us that it is paramount to find suitable staff in order to fulfill the roles and responsibilities expected of them. The home is vigilant in taking their time in this process so that they can find the right person for the job where they have the right skills and attitude to look after and care for people with dementia. There are some good procedures in place for recruitment, however a few shortfalls were found during our inspection and systems need to be tighter in order to further protect all the people who use the service. We looked at the records for four recently recruited members of staff. Two of the four had started work in the home after all the required information and documentation had been obtained. However one member of staff had started work in the home before a second written reference had been obtained. Another had only provided a brief employment history and checks should have been made at interview regarding this. The home is working hard to provide the staff at the home with training and development opportunities tailored to individual needs. The manager and all staff are conscientious in attending training relevant to the care needs of the people they are caring for and those relevant to the roles they perform. At the time of the inspection the home had not been providing induction training in line with the nationally recognised Common Induction Standards. The registered manager has identified this as an area for further development and we will look at this during future visits to the home. The home has a mentor system where all new staff are linked with and shadow a senior staff member during shifts to help with continued training throughout the induction process. We have received positive comments from visiting health and social care professionals about how staff and the improvements in the home. Comments included, They are providing specialist care to complex individuals, There is an improved consistency in the care provided, Staff continuity has recently helped and we have a good rapport with the new deputy, which has helped and The new deputy is an excellent nurse and very caring. Care Homes for Older People Page 24 of 31 Evidence: People that live in the home and their families also told us, The staff are friendly and striving to do a good job, they are dedicated staff members, Staff are friendly and welcoming, The staff are caring and dedicated and The maintenance man is brilliant, besides doing his job he cares about all the residents and relatives and always has a kind word to say. We spoke with most of the staff on duty and received comments from staff surveys. Comments included, Most of us as carers feel real affection for the people living in the home and they respond to this, I think the morale of staff has lifted considerably and Once all staff are on board, we will have the makings of a great care team, one to be proud of. I hope to remain a member of that team for some time to come. We saw that staff were respectful and sensitive towards the people they were caring for and the atmosphere was calm, happy and relaxed. It was evident that morale amongst the majority of staff had improved significantly and that the inter personal relationships between management, trained staff and care assistants had improved. 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. Peoples needs and best interests are central to the management approach in the home. The home continues to improve its quality assurance by introducing continuous monitoring of polices, procedures and practices in order to ensure that the home is run in the best interests of the people who use the service. The health and safety of people who use this service should be protected by systems in place. Evidence: The newly appointed manager has been registered by the commission. She demonstrated good management skills that relate to the aims and purpose of the home. The registered provider, manager, deputy and staff are very committed to the people living in the home and the roles and responsibilities expected of them. It was evident that since the takeover a lot of hard work and commitment had taken Care Homes for Older People Page 26 of 31 Evidence: place and that the manager, deputy and staff are developing into a stable team that are committed to providing quality of care for the benefit of the people in their care. We received numerous comments about how the home has improved in the last six months. These are just some of the comments we received, I have worked at the home for many years and I can see many improvements in the short time that Lifeline services has taken over, I have noticed a positive difference in the home since Lifeline services have taken over, There is a good level of communication between the manager and carers, Since Sharon has been the manager I feel very supported, most things have improved a lot and I am happy to work in the home now, Pine Tree has come a long way, I think things are so much better, To me the home is improving all the time, The management are taking far more interest in retaining staff, and I think under our excellent manager, we can only get better. The home continues to monitor and assess the quality of services provided by giving people questionnaires to complete, any weaknesses identified are put into an action plan. Regular audits are carried out in the home including health and safety, care documentation, medication and other procedures in the home to ensure that the home is run in the best interests of the people who live and work there. In addition unannounced visits are carried out and reports completed by a representative of the registered provider in line with the requirements of the Care Homes Regulations 2001. Although the reports were a good account of the state of the home at the time of the visit, they should be further developed to show that people living in the home, their representatives and staff have been consulted, in order for them to express an opinion about the standard of care provided in the home. The home has written policies and procedures in relation to the promotion of the health and safety for all people who use the service and associated training was provided for staff in all health and safety matters. Some of the Health and Safety records in the home were examined. Documentation showed that relevant checks were maintained correctly and at the required intervals including all fire alarms, equipment and emergency lighting. The homes records showed all necessary service contracts were up to date including, gas and electrical services and the passenger lift. 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 9 13 More attention should be paid to ensure that an accurate record is made by staff signing the medication administration record when giving people their medication. This is so that accurate record keeping will further evidence that people have received the medication that they have been prescribed. 21/04/2010 2 29 19 Before a person starts work 26/04/2010 in the home, all the information and documentation specified in Schedule 2 of the Care Homes Regulations 2001 must be obtained. This is to ensure that people are protected through robust recruitment procedures. Care Homes for Older People Page 29 of 31 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 9 Medication audits should be more robust with particular attention to gaps in the recording of medication administration and the standard of any hand written directions made by staff in the home. A check should be made to ensure that there are plans or protocols in place to guide staff in giving medication prescribed on an as required basis. Review current activity provision in light of comments received and contained in the report Consideration should be given to repainting the laundry wall surfaces. Continue to work towards a higher ratio of care staff with an NVQ level 2 or above. Induction training in line with the Common Induction Standards should be given to all staff new to working in care. Documentation that records visits by the responsible individual should be further developed to show that people living in the home, their representatives and staff have been consulted, in order for them to express an opinion about the standard of care provided in the home. 2 9 3 4 5 6 12 26 28 30 7 33 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. 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