Care Home: Pine Trees

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What the care home does well The home has a comfortable homely environment that is clean and well maintained. There is ample sitting and dining space and spacious grounds. Staff are perceived as kind and caring and the home has a relaxed and welcoming atmosphere. Doctors, nurses and other healthcare professionals visit the home to provide care when necessary. Suitable equipment is provided for moving and handling purposes and for the prevention of pressure sores. There is a suitable and safe system for the administration of medicines. Prospective residents are assessed prior to moving in to ensure the home can meet their needs. A care plan is compiled for each resident and signed by the resident or their representative. Residents told us their privacy and dignity is respected and this appeared to be so during this inspection. A good range of entertainment and activities are on offer and people can join in as they wish. People using the service are able to maintain contact with their family and friends according to their wishes. Visitors are welcome in the home and some people go out with their families and friends. The food served is to a good standard with homemade cooking, fresh fruit and vegetables. Special diets and individual needs are catered for. People using the service said the food is good. There is a robust recruitment system in place with checks to safeguard the residents. 53% of care staff have achieved an NVQ qualification to at least level 2 in Care. A quality assurance system is being developed to enable improvement of the service. Health and safety precautions are well maintained and help to safeguard people using the service and staff who work in the home. What has improved since the last inspection? The manager is now registered with the Care Quality Commission (CQC) and she is being supported in her role by more senior Guardian Care managers. All prospective residents are assessed to ensure the home can meet their needs. Written records are maintained of these assessments. All of the people using the service have a written care plan and staff have received training in respect of the care planning system. The daily records no longer have gaps to be completed retrospectively. The medicine administration record charts have been kept up to date. Assisted bathing and showering facilities have been provided that enable residents to have a choice and ensure their privacy and dignity are respected. The extension to provide ten new bedrooms is nearing completion. Recruitment procedures and subsequent record keeping has improved. Some training has been provided for staff since the last inspection. What the care home could do better: The registered manager must ensure that the care plans are more detailed to fully inform and direct staff on the specific care needs of each individual resident. The daily records need to be more informative and detail the rationale of care and the care delivered. Complaints and disciplinary issues need to be managed more efficiently with the record kept in chronological order with documentation dated and signed appropriately. A copy of letters sent from head office should be maintained. The final outcome should be evident in the files. The registered manager must be mindful of the Working Time Directive legislation when organising the duty rota to ensure that a rest period of at least eleven hours is maintained between shifts. There needs to be a training plan in place to ensure that all staff are kept up to date with statutory training and that other training relevant to their roles is undertaken to improve their knowledge and skills. Staff who handle food must undertake food hygiene training. Staff should avoid working in the kitchen during a shift that involves care or cleaning duties, to prevent cross contamination. Key inspection report Care homes for older people Name: Address: Pine Trees 15 Horsepool Road Connor Downs Hayle Cornwall TR27 5DZ     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: Diana Penrose     Date: 2 4 1 1 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 32 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 32 Information about the care home Name of care home: Address: Pine Trees 15 Horsepool Road Connor Downs Hayle Cornwall TR27 5DZ 01736753249 01736759261 pine_trees@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Guardian Care Home Ltd Name of registered manager (if applicable) Mrs Tara Hughes Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Pine Trees Care Home is situated in the village of Connor Downs between the towns of Camborne and Hayle. There is ample car parking at the front of the home and a footpath that leads to the main entrance. Well-maintained grounds with colourful flowers surround the home. The building is a detached bungalow with a modern extension. There are 23 single rooms and one shared room. Accommodation and facilities are on one floor. All bedrooms have a door opening onto a walkway surrounding the building. These cannot be accessed from the outside when closed. Suitable ramps and grab rails are in situ. Meals are prepared in a well-equipped kitchen and served in the spacious dining room, or individual bedroom if preferred. There is a large lounge with an adjacent conservatory. There is a patio outside with garden seating and tables. The home provides residential care for up to twenty-five Care Homes for Older People Page 4 of 32 2 8 0 5 2 0 0 9 0 Over 65 25 Brief description of the care home elderly people. The home also provides day care and respite facilities. The Manager and a team of care staff provide personal care within a relaxed and friendly atmosphere. Information about the home is available in the form of a residents guide, which can be supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees are from 515 pounds per week; this information was supplied during this inspection. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: Two Inspectors visited Pine Trees Care Home on the 24 November 2009 and spent seven hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that peoples needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that placements in the home result in good outcomes for people. All of the key standards were inspected. On the day of inspection 18 people were living in the home. The methods used to undertake the inspection were to meet with people using the service, the registered manager, staff and visitors to gain their views on the services offered by the home. Records, policies and procedures were examined and the inspectors toured the building. We had received CQC completed surveys from residents and staff prior to this inspection and these were used to inform this report. The manager returned an Annual Quality Assurance Assessment (AQAA) which was also used to inform this inspection. This report summarises the findings of this inspection Care Homes for Older People Page 6 of 32 Residents expressed satisfaction with the care and services provided at the home and said they are treated well. The registered manager is aware that there have been breaches of the Care Home Regulations 2001 and these were discussed during this inspection. She has agreed to ensure that shortfalls are addressed however requirements and recommendations have been set. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? The manager is now registered with the Care Quality Commission (CQC) and she is being supported in her role by more senior Guardian Care managers. All prospective residents are assessed to ensure the home can meet their needs. Written records are maintained of these assessments. All of the people using the service have a written care plan and staff have received training in respect of the care planning system. The daily records no longer have gaps to be completed retrospectively. The medicine administration record charts have been kept up to date. Assisted bathing and showering facilities have been provided that enable residents to have a choice and ensure their privacy and dignity are respected. The extension to Care Homes for Older People Page 8 of 32 provide ten new bedrooms is nearing completion. Recruitment procedures and subsequent record keeping has improved. Some training has been provided for staff since the last inspection. What they could do better: If you want to know what action the person responsible for this care home is taking 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 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is suitable information about the home available for prospective residents that enables them to decide if the home is the right one for them. People are assessed prior to moving into the home to ensure that their needs can be met. Evidence: We were shown the statement of purpose and service user guide which were informative about the home and the services provided. The manager told us that some updating is needed and this was in hand. We looked at the care files of two people that had moved into the home since the last inspection. We saw that needs assessments had been carried out by the manager prior to their admission to the home. She told us that she visits people in their home and also encourages them to visit the home before deciding to move in. She said that sometimes people come for a trial visit or have a period of respite care in the home prior to deciding to move in. The deputy manager told us she was going out to assess Care Homes for Older People Page 11 of 32 Evidence: a prospective resident on the afternoon of this inspection. She told that she enjoys doing assessments in peoples homes as it enables her to gather a lot of useful information about the person when seeing how they live. Assessments undertaken by the Department of Adult Social Care were seen in care files but had not always been received prior to the person moving into the home. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service feel their healthcare needs are met, however, care plans do not inform and direct staff on the care they have to provide to meet specific needs which could put residents at risk. There is a safe medicines system in place and staff have received training to ensure their knowledge and skills are updated. Evidence: The manager told us that the care plans for all of the people using the service had been reviewed and updated and that she audits them every month. She said that staff had received training on care planning and were now responsible for writing the plans and ensuring they were kept up to date. She said it had been difficult as there had been five different regional managers in the past 15 months and each one had different views on care planning. We looked at three care files and each contained a written care plan. The plans had been signed by the resident or a representative. There were individual hand written plans for each need and relevant risk assessments and other information pertaining to that need were held behind each sheet. The care plans were variable in content and Care Homes for Older People Page 13 of 32 Evidence: did not cover all needs, for example emotional/mood issues, risks of falling, wound care, dementia and medicines were not included where needed. The plans were not up to date as one person was recorded as mobilising alone but was in fact using a wheelchair. Another person had an assessment undertaken by the Speech and Language Therapist but her findings and recommendations were not in the care plan. There were no instructions for staff on any specific diet issues or if assistance was required. The care plans we saw were factual but did not inform and direct staff on the care to be provided. Daily records were seen and again were variable in content. Issues were not always followed up in the records and sometimes there was little recorded for the shift. Night staff often wrote slept well but nothing else. The ambulance crew had recorded information on a sheet in one file but this had not been included in the daily records. We saw records which show that doctors, nurses and other healthcare professionals visit the home. Residents told us that their health needs are met and the care provided in the home is very good. Suitable equipment was seen for moving and handling purposes and pressure relief. We were told that no residents had pressure sores but some had special mattresses and cushions. The manager told us that the continence assessments had been completed and pads were provided as necessary. She said that no Mental Capacity Act assessments had been necessary and there were no Deprivation of Liberty issues. We inspected the medicines system in the home and found it to be good. One person was self administering her medicines and she explained to us how this worked. She had a lockable drawer for storing her medicines. There were no residents with diabetes. We were told that one person used an oxygen concentrator. We were shown this in her room and there was suitable signage displayed. The home had a suitable medicines policy in place and there was a copy of the Handling of Medicines in Social Care document and various reference books for staff to refer to. All medicines were stored appropriately and the records of receipt, administration and disposal of medicines were up to date. The issue of transcribing onto the medicine administration record charts had been addressed and two signatures were recorded. The temperature of the medicines fridge was monitored and was running within safe limits. The manager told us that all of the senior care staff had received advanced medicines training provided by Boots the chemist. One carer told us this was a very good course Care Homes for Older People Page 14 of 32 Evidence: and she felt more up to date now. Peoples privacy appeared to be upheld during this inspection. Staff were seen knocking on doors prior to entering. People using the service said they were treated with respect and their privacy was maintained. The manager told us she had been on a dignity course which she found really useful. She said that as a result of this course she had stopped the use of bibs at mealtimes and had got rid of the old plastic beakers. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Entertainment and activities are on offer, visitors are welcomed and residents are encouraged to live a life of their preference. A varied and nutritious menu is on offer that suits the preferences of people living in the home. Evidence: We were told that the part time activities co-ordinator was not working on the day of the inspection but that she had developed the activities further and improved the records maintained. We saw posters on a notice board in the main corridor near the entrance displaying the activities on offer along with photographs of residents participating in activities. We also obtained a copy of the activities plan for the current week. Activities included reminiscence, arts and crafts, bingo, sing a longs, quizzes, mobile shop and cooking. People using the service told us about the activities provided and they seemed very fond of the co-ordinator. They told us that some entertainers come in on the days the co-ordinator does not work but the care staff do not have time to do activities. Some people said that staff chat with them but it tends to be whilst providing care. We saw that staff interacted well with residents and one carer sat in the lounge talking to a resident for a while. There were six people in the lounge in the morning but only one in the afternoon. Care Homes for Older People Page 16 of 32 Evidence: One lady was seen knitting and another was reading a book. The hairdresser was in the home during this inspection and residents told us they enjoy having their hair done. There was meant to be an entertainer visiting during this inspection for a singa-long but he rang to cancel his visit. Records of activities undertaken by residents were seen in the care files. They were informative and included their enjoyment and so on. Surveys received from residents told us there are always/usually activities they can take part in. We were told at the last inspection that outings would be beneficial but there have not been any since then. Surveys received from residents and staff told us that trips out would be nice. The AQAA told us that this is an area the manager hopes to improve on. Other comments include I enjoy the social life, bingo etc., The activities organiser is very well liked by the residents. She keeps them well occupied and arranges entertainment for them; many a happy hour is spent, The activity coorrdinator is a great asset to the home. My mother enjoys most of the activities arranged by her and she makes each resident feel special. People told us they could receive visitors in private and at any time. The visitors book was seen and showed that people visit the home regularly. We spoke to one visitor who had travelled some distance to visit and she told us she is always made very welcome in the home. People using the service told us that their individual preferences are respected and they are supported to maintain their independence. We were told that residents can go out as they wish and some people go out with relatives. We were told that the daily routines are flexible and suit the residents, for example going to bed and getting up in the morning (their preferred times are written in their care files). We saw from the daily records that one mans decision to lie in was respected. We were told that all of the people using the service control their own money, with the help of their families and everyone has their own belongings in their rooms. The manager told us there was a four week menu in place with a choice of two main meals at lunchtime. The lunchtime meals were displayed clearly on a wipe board in the dining room; chicken curry or lamb stew with rice pudding for sweet. Staff told us that there is always fresh fruit or yogurts available. We saw homemade buns were on offer with the afternoon tea and we saw a homemade birthday cake with candles on it in the kitchen. We were told this was for a lady who was 100 years old. We heard no negative comments from residents about the food, during this inspection. Surveys told us that residents always/usually like the meals on offer. A member of Care Homes for Older People Page 17 of 32 Evidence: staff told us there had been complaints about the food and she did not think it was always good. We were told that a cook who had worked in the home for a long time had left and the manager was awaiting recruitment checks for her replacement. At present the teatime cook and other members of staff were cooking the meals. The dining room is a pleasant room with enough seating for all residents. We were told that new dining tables and chairs had been ordered. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies in place for complaints and adult protection but not all staff have received abuse training. Complaints are documented but the file is disorganised it is difficult to find the sequence of events and the final outcome of the complaint. Evidence: The complaints and safeguarding policies were not seen on this occasion as they were suitable at the last inspection. We were told that the updated details of Care Quality Commission had been included. Surveys received from people using the service told us that they know how to raise a complaint should the need arise. The Care Quality Commission had not received any complaints about this service since the last inspection. The manager told us that she had received twelve complaints over the past year. We saw the complaint record file which showed that all complaints were documented. There were statements and letters included but there appeared to be documents missing. Some documents were not dated/signed. It was not clear if the complaints were upheld, resolved or in progress. Some complaints had resulted in the disciplinary procedure being implemented and records were seen. Again these were disorganised and some documents were not dated or signed. Letters were out of sequence or appeared to be missing. The manager told us that sometimes letters are sent from head office and she does not always get a copy for the files. She said that recently a letter was sent to an employee Care Homes for Older People Page 19 of 32 Evidence: and she only knew because a relative told her. We were told there had been no safeguarding referrals since the last inspection, however we saw records that show that the manager sought advice from the Department of Adult Social Care in respect of a complaint from a relative. Staff told us they had received training in respect of abuse and the safeguarding of vulnerable adults. The manager told us that eleven staff had received training in March this year, provided by Guardian Care, she told us that all staff had also been given a safeguarding booklet. She said she has a training video for the Mental Capacity Act but has not used it yet. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is a pleasant environment for people to live in although there has been some disruption due to the building work in progress. Staff have worked hard to minimise any risks to people using the service and to keep the home clean and hygienic. The bathing facilities have improved immensely and people can now enjoy a bath or shower that respects their privacy and dignity. Evidence: We toured the building and people told us that the home is a homely, comfortable place to live in. We sat in the lounge for part of the inspection and found the waterproof covering on the chairs to be uncomfortable when sitting for any length of time. This was mentioned to the manager. We were told there have been disruptions due to the extensive building work in progress. This has mainly been due to intermittent high noise levels, a large amount of dust, a lack of central heating, and periods when the call system has not been fully working. People using the service told us that the noise had been terrible at times but the new facilities would make a better home. They were very appreciative of the staff in particular the domestic staff who have kept the home very clean despite the amount of dust. We saw that some people had portable heaters in their rooms as the central Care Homes for Older People Page 21 of 32 Evidence: heating was not working in one area of the home. We had been informed about the heating and the disruption to the call system prior to this inspection, we were told that portable heaters were in use and that the most vulnerable residents always had a call bell. We were told that half hourly checks were undertaken for people in their rooms to ensure they were safe; we saw that staff had completed sheets to record these checks. Some of the ceiling tiles around the home were very stained and we were assured that these will be replaced. The manager told us that new fire doors had been fitted and that all of the external doors in the bedrooms had been fitted with alarms for security. We saw that the plans for the building work were displayed in the home for residents and visitors to see. We saw that the bathing facilities had been vastly improved since the last inspection and that the medi bath had been removed. There were now two assisted baths and two wet room shower facilities that were fully tiled with hand rails in situ. At present the grounds around the home cannot be used by residents because of the building work and the amount of rainfall recently. The manager told us there were plans to landscape the gardens when the building work was completed. We saw that there was a large amount of garden around the home despite the extension to the home. The home was clean and generally free from offensive odours,we noted that one room smelt of urine and we were told that every effort was being made to eliminate this. The laundry facilities were unchanged and were suitable for the present number of residents with one washer and one drier. People told us that the laundry system works well. Suitable hand washing facilities were provided for staff along with hand sanitising gel and protective clothing for infection control purposes. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There appear to be suitable numbers of staff on duty to meet the needs of people using the service, however, staff do not always have sufficient rest time between shifts which is not safe. Recruitment procedures are robust to protect people using the service. Efforts are being made to ensure that staff training is up to date so they have the knowledge and skills to care for people using the service. Evidence: The manager told us there were no staff vacancies at the moment. She told us there were sufficient staff employed to meet the needs of the people accommodated. We saw the duty rota which showed that staffing levels had not changed since the last inspection however staff did not appear to be working so many extra hours. The rota showed that generally there were three care staff in the mornings, three in the afternoons and two awake at night. We noted that one carer was due to work a night shift that was to end at 08:00 hours, he was then due to return to work at 14:00 hours the same afternoon. This was an issue at the last inspection. It is not safe practice as it does not allow for a suitable rest period between shifts. This arrangement is not in accordance with the Working Time Directive. There were separate domestic and catering staff, a maintenance man and an administrator employed. As previously mentioned the cook had left, the administrator was not at work and the manager was covering her role. Care Homes for Older People Page 23 of 32 Evidence: People using the service told us that there were usually enough staff on duty and that they were kind and caring. Half of our surveys from residents told us there were always enough staff the rest said usually enough staff. A majority of surveys from residents told us that staff usually listen to them and that care and support is usually good. Comments from residents include Of course you take to some more than others, Some staff have been so kind to me in my circumstances and The majority of the staff are excellent and have a good manner when dealing with residents. Staff told us that at least three residents require two care staff to meet their needs but the manager told us that two people were only needed when the hoist was used. Four surveys were returned to us from staff working in the home there were varying views on the staffing. When asked if there were enough staff one said always, one usually, one sometimes and one never. Comments from staff included There are always the right amount of staff for the amount of residents in the home, We need to work like a team, not just a few staff always running around, Some staff need to show more respect and patience towards residents and We are less busy now because there are less residents I hope we get more staff when the new rooms are in use. The manager told us that eight care staff have an NVQ qualification to at least level 2 in care (53 ) and that five others are enrolled on the course. Six staff files were inspected and the records required by legislation were all included. Interview records and job descriptions were also included. Some completed induction checklists were seen and most files held forms which indicate that staff had been given the skills for care induction books. One new member of staff told us she is working through her book but did not have it in the home for us to see. A training matrix was seen, it showed who had attended training and when. We saw from this record that twenty seven staff were employed, including the manager, and that not all training was up to date. 7 staff had completed moving and handling training in the past month, the rest was over a year ago or there was no record. It showed that 19 staff had attended fire training in the past year (17 in November) and 6 had attended health and safety training since January 2009. 10 had attended POVA training in March 2009 and 4 had attended Deprivation of Liberties training this year. 6 had attended medicines training in November 2009 and 8 had done first aid training since January 2009. 8 staff had attended food hygiene courses this year, one cook had Care Homes for Older People Page 24 of 32 Evidence: no record of an update since 2005 and the deputy manager had no record of attending this training although we were told she cooks meals for residents. 7 had attended infection control training this year and 11 had attended care plan training this year. The manager told us that dementia training had commenced and the records show that 7 staff did this in November 2009. Mental Capacity Act training had not yet commenced. Staff training was an issue at the last inspection and needed to be addressed. The manager told us that the Company had employed a new training manager and she was arranging training for all staff in the home. She must ensure that training needs are met and that statutory training in particular is kept up to date Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a Registered Manager in post who has been supported in her role to lead the staff team and develop robust systems to ensure that the home runs well. Quality assurance and health and safety systems are in place for improvement of the service but statutory training for staff has not been kept up to date and could put the safety of residents at risk. Evidence: The registered manager has been managing this home since December 2007, she was registered with the Commission on 10 October 2009. She told us she had completed the Registered Managers Award and had recently received certification for this. She also told us she had NVQ qualifications in care at levels 2, 3 and 4. She said she keeps up to date with issues regarding her client group by attending meetings, and using the internet. She told us that she had undertaken medicines, COSHH, Deprivation of Liberties, care planning and first aid training this year. She said she has felt more supported in her role since the last inspection; she said it has been difficult with the number of changes in higher level management since she has been in post. She told Care Homes for Older People Page 26 of 32 Evidence: us that meetings with other managers are helpful but she has such a long way to travel it means that she is out of the home for two days each time. She told us she had been addressing the issues in the last report. Although she had undertaken care planning training further work is required to ensure that the plans are detailed to direct staff. The records show that she has not always managed complaints, staffing and disciplinary issues well. Training had improved but she was aware that further work was needed. She told us that staffing had also improved and that higher level managers were meeting with staff more frequently to share corporate policy and so on. Staff told us during this inspection that they felt supported by the manager and we saw supervision records in staff files that show that the manager meets with staff individually. Our surveys asked staff if the manager gives them enough support and meets to discuss how they are working. They said usually or sometimes. Residents told us that the home runs well and they see the manager when she is in the home. Comments include Usually runs efficiently, I have been very happy since Tara has been here. She is so kind, also she always welcomes all my friends when they come to see me and The manager takes time to talk to residents and makes sure there is plenty of entertainment and she puts their needs first. She also listens to staff and tries to keep a happy staff so all the residents are happy too (but their needs come first). We saw the quality assurance surveys recently returned to the manager from residents, relatives and healthcare professionals. These were generally positive about the home and the services provided. Issues raised were in respect of the lounge furniture being uncomfortable, communication problems with health professionals, the manner of a staff member and a resident being unhappy that other residents were using his wheelchair. The manager told us she will be addressing the issues. We were told that staff meetings take place regularly but attendance is not good as staff do not get paid to come in. Staff told us that the meetings were to tell them what they should be doing rather than a time for airing their views. We were told that residents meetings take place monthly and there was a notice about these on a board near reception. We were shown the results of a quality assurance audit undertaken by the Company earlier this year. The score was 80.4 and the manager told us that most of the action points had been addressed. We were shown a file that held various audit forms completed by the manager, they included accidents, infection control, environment, care plans, medicines and meals. The audit results were recorded on a spreadsheet which the manager told us was sent to Head Office regularly. We were shown a file containing reports about the home undertaken monthly by the Care Homes for Older People Page 27 of 32 Evidence: Regional Manager. These were in line with Regulation 26 of the Care Homes Regulations 2001. The manager returned an Annual Quality Assurance Assessment (AQAA) following the last inspection which was reasonably detailed. It gave us information about the home, improvements made and plans for the future. We saw a Company policy for dealing with residents money at the last inspection. We were told that no valuables or money was held on behalf of people using the service. The manager said that all residents control their own money or their family takes care of it for them. We were told there had been no changes to the health and safety policies in place. We were told that the maintenance man was responsible for fire safety in the home and he provides training for staff. We were told there was a fire risk assessment and that the fire safety procedures and checks were kept up to date. The AQAA told us that equipment and servicing checks were up to date and the manager confirmed that the small electrical appliance testing had now been completed. We saw that accident reporting complies with data protection legislation and that the home has very few accidents. We saw the training records which showed that statutory training had not been kept up to date, see the previous section of this report. The manager told us that the Company had employed a new training manager who will be addressing this. We were told that the Environmental Health Officer had not visited since the last inspection and that cleaning and fridge/freezer temperatures were recorded as before. We saw that the domestic on duty spent the second part of her shift assisting in the kitchen. Although she changed her clothes and wore an apron it is not good practice to move from cleaning or care duties into the kitchen. A full shift worked in the kitchen is preferable for hygiene reasons. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The care plans must be detailed, regularly reviewed and kept up to date. This will ensure that staff are aware of the changing needs of people using the service and are well informed on how to care for them. 28/06/2010 2 18 12 All staff working in the home 29/03/2010 must receive relevant training in respect of safeguarding adults. To ensure that they are knowledgeable on what to do to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. 3 38 13 Staff must receive regular statutory training, for example infection control, food hygiene, fire, health and 29/03/2010 Care Homes for Older People Page 30 of 32 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 safety and moving and handling. To comply with the law and to ensure staff are updated on their knowledge and skills to protect people using the service. 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 16 Complaint investigations should be detailed with the documents dated and signed and information included as to the action taken and the final outcome Care Homes for Older People Page 31 of 32 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. 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