Care Home: Pool Cottage Care Home

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What the care home does well People told us they were encouraged to visit the service in order to familiarise themselves with the building, and to enable them to make a informed choice about their future. People told us they thought the service was "homely with a relaxed atmosphere". People said the routines were flexible and they could choose how they wished to spend their day. People told us they are "well looked after". They told us the staff team were: "friendly", "caring" and "responsive" and provided "good care and support ". People told us they were satisfied with the food provided, and they "had enough to do in the service to keep their mind active". People are supported by a stable and trained staff team who are dedicated to ensuring peoples needs are met to a good standard. People have opportunities to provide feedback about the service, through the quality assurance systems in place. The service has also received a number of thank you cards and some of the comments receive include some of the following: "Many thanks for looking after my relative" "I would like to thank all of the staff for their care of my relative, we really appreciate of all that you have done" "Many thanks for all of your care and kindness shown to my relative" What has improved since the last inspection? The service had one requirement from the last report in relation to the financial viability of the service. This is an area in which compliance is ongoing, and therefore it is an area we will continue to monitor. What the care home could do better: Each person who lives in this service must have a detailed, person centred care plan. This is to ensure the staff have access to information to direct and guide them on how to deliver care and support. Each person must have risk assessments completed in areas such as mobility, pressure area care, falls and nutrition. This is to ensure any risks are identified. A plan of care must then be implemented to monitor and reduce these risks. Some of the staff team need to have training and refresher training in some of the main areas such as Food Hygiene, Moving and handling and safeguarding adults from abuse. This is to ensure they are trained in all mandatory areas in order to fulfill their roles. The service must be able to demonstrate that staff are not employed until all of the required checks have been undertaken and received. This is to ensure the staff member is suitable to work in this service and to safeguard people. Arrangements need to be made to register the manager of this service. This is to ensure the service is managed in peoples best interests. Key inspection report Care homes for older people Name: Address: Pool Cottage Care Home Pool Road Melbourne Derbyshire DE73 8AA     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: Claire Williams     Date: 0 8 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 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 33 Information about the care home Name of care home: Address: Pool Cottage Care Home Pool Road Melbourne Derbyshire DE73 8AA 01332863715 01332863715 poolcottage@clara.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mutebi Blessious Kalemeera care home 17 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 Pool Cottage is a detached property, which has been adapted and extended to provide personal care for up to 17 people aged 65 years and over, and day care for up to 3 persons. The service overlooks Melbourne lake and is close to the town centre, local shops and a bus route. The home has 11 single and 3 double bedrooms located on the ground and first floor, 7 bedrooms have ensuite facilities. Access to the first floor is by stairs and a stair lift. There are 2 lounges, a conservatory and a dining room on the ground floor. The service has an accessible garden. Information about the service is provided through the Statement of Purpose and Service User Guide, both of which are made available to individuals. The current fees for this service are £392.00 to £417.06 per week. 0 6 0 1 2 0 0 9 0 Over 65 17 Care Homes for Older People Page 4 of 33 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: The quality rating for the service is One star. This means the people who use the service experience Adequate quality outcomes The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who use the service and their views of the service provided. This process considers the services capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This key inspection was unannounced and took place over a period of a day. In order to prepare for this visit we looked at all of the information that we have received since our last visit. This may include notifications from the provider, surveys, and complaints or concerns. We looked at the pre-inspection annual quality assurance questionnaire, which the provider is required to complete, prior to our visit to the service. This assessment gives the provider an opportunity to let us know about their service and Care Homes for Older People Page 5 of 33 how well they think they are performing. During the site visit case tracking was included as part of the methodology. This involved the sampling of a total of two people representing a cross section of the care needs of individuals within the service. Their care planning, and associated care records were also examined and their private and communal facilities inspected. Discussions were also held with staff about the arrangements for their deployment, recruitment, induction, training and supervision, and records examined to support the procedures in place. Care Homes for Older People Page 6 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Each person who lives in this service must have a detailed, person centred care plan. This is to ensure the staff have access to information to direct and guide them on how to deliver care and support. Each person must have risk assessments completed in areas such as mobility, pressure area care, falls and nutrition. This is to ensure any risks are identified. A plan of care must then be implemented to monitor and reduce these risks. Some of the staff team need to have training and refresher training in some of the main areas such as Food Hygiene, Moving and handling and safeguarding adults from abuse. This is to ensure they are trained in all mandatory areas in order to fulfill their roles. The service must be able to demonstrate that staff are not employed until all of the Care Homes for Older People Page 7 of 33 required checks have been undertaken and received. This is to ensure the staff member is suitable to work in this service and to safeguard people. Arrangements need to be made to register the manager of this service. This is to ensure the service is managed in peoples best interests. 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 8 of 33 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 9 of 33 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. People have access to information, to assist them to make an informed choice about moving into this service. Evidence: People told us they have access to information about the service, and they confirmed they had been provided with a copy of the service user guide. The feedback we received in the surveys also confirmed this, and people said they had sufficient information to decide if this service was right for them. However this document has been updated due to a change in the manager who was appointed in February 2009. People have not yet been provided with this revised information, to ensure they are clear about who is now managing this service. In the self assessment the acting manager told us pre-admission assessments are undertaken on all people before they are admitted to the service. We looked at the Care Homes for Older People Page 10 of 33 Evidence: records for two people who had recently moved into the service. The records in place confirmed assessments had been undertaken and a judgement had been made to confirm that the service is able to meet peoples assessed needs. People who we spoke with, told us they were encouraged to visit the service in order to familarise themselves with the routines and to meet the staff and people. One person told us: I lived locally and have visited people in this service. I decided a long time ago this would be the home I wanted to move into. Here I am now and I am glad I came here as the views are lovely. People told us they had agreed and signed a contract in relation to the terms and conditions of living in this service. People do receive a copy of this document to enable them to refer to the contents when required. One person raised concerns and was unclear about the provision of escorts being provided to support people to attend appointments. This information is provided in the contract so people are aware of the procedure in place. Care Homes for Older People Page 11 of 33 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. Although peoples health and personal care needs are met, the support people required is not clearly set out in a written plan of care and risk assessments. Evidence: People we spoke to told us they were happy living in this service and that the staff team met their needs to a good standard. People told us they were well cared for and the staff were kind, respectful, caring and did a good job. Information within the surveys received from people using the service and their representatives said that their needs were met and staff demonstrated a friendly and caring attitude to them. People told us the staff were supportive and listened to them and were responsive to their needs. In the information provided by the service the acting manager told us that the care plan documentation has been revised and nearly half of the people have a new plan of care in place. The acting manager told us the plans were person centred and provided information for care staff to action, and they include risk assessments on all aspects of Care Homes for Older People Page 12 of 33 Evidence: health, personal and social care. The acting manager told us the plans are reviewed monthly or when necessary with people and relatives or representatives. We looked at two peoples care more closely and looked at their care files. Each file we looked at contained a plan of care, but the information provided was limited in detail. For example under the washing section for one person it stated: - able to wash self but needs one carer to have a bath or shower. Under the section about teeth it just stated dentures. No other information was recorded as to the level of support this person required in these areas. Although staff do not have access to detailed information, we found (in our discussions with them), that staff were able to think in a person centred way and they were able to demonstrate how to meet peoples needs. The files did contain some additional information in relation to peoples preferences about their dietary requirements, and their past lives and hobbies. The care plans that we sampled did not contain all of the required risk assessments that should be undertaken to monitor peoples mobility, pressure areas, nutrition and falls. Assessments were in place in relation to Moving and handling, and an assessment of capabilities had been completed. However an outcome had not been recorded on this assessment in order to direct staff about the action that should be taken in relation to the overall score. There was evidence to support that monthly reviews were completed but the information recorded was a general overview of the persons wellbeing, and not a review of the full care plan. We found information recorded on these monthly reviews that should of been included as part of the care plan. For example, a person had to go into hospital due to having a chest infection, and they was prescribed anti-biotics. This information was not transferred or included in that persons plan of care in order to inform the staff team, about this change in need. The care records that we sampled and discussions with people confirmed that contact with external health care services is routinely made. All of the people we spoke to told us they receive support which is provided in a safe, respectful and dignified manner, and our observations, supported this. People we spoke to made the following comments about the care they receive: The staff are very kind and gentle when they support me with my personal care, they never rush me and are very patient. The care we receive is very good, and they encourage us to do things for ourselves Care Homes for Older People Page 13 of 33 Evidence: which is good, I am happy with everything We looked at the arrangements for the handling and management of peoples medicines by the service. This demonstrated that people received their medication as prescribed. However we did find a couple of gaps on both persons Medication sheet. This was due to a code not been used to record that a person did not want their medication, and a staff member had not signed to confirm the medication had been administered. Although medication audits should be undertaken on a weekly basis, these had not been completed since 9th November, and these shortfalls had not been identified and addressed. Information provided in the self assessment told us that staff had received medication training, and the records we looked at confirmed this. An assessment of competence has not yet been undertaken to ensure staff are following the procedures in place. Care Homes for Older People Page 14 of 33 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. People who use services are able to make choices about their life style. Social educational, cultural and recreational activities meet peoples expectations. Evidence: In the information supplied about the service, the acting manager told us that peoples wishes are taken into consideration making routines in the home as flexible as possible. They said people have the choice of joining in with leisure and social activities. A weekly activity sheet has been put into place to let people know what is happening giving encouragement but choice to join in. The feedback in the surveys, and the people we spoke to told us, we have enough to do in the service. People told us they were happy with the provision of activities provided, and they confirmed they were consulted about what activities they would like to participant in. This ensures their social needs and preferences are met. People told us they really enjoyed the recent carol service where children came and sang for them. People said it was lovely and they sang very well, I really enjoyed the service is was beautiful People have access to a notice board, which tells them what is happening in the Care Homes for Older People Page 15 of 33 Evidence: service, and the weekly timetable of internal activities is displayed. This told us people have activities they can access both in the morning and afternoon on a daily basis. In addition to this a newsletter is completed every month informing people of external activities or entertainment that has been planned. People told us they were looking forward to going Christmas shopping, and they were looking forward to the next carol service that was planned for peoples family and friends. We observed people listening to music during the morning of our visit. However most people were asleep in the lounge as the staff were not present apart from when supporting people with their personal care. In the afternoon Pat the dog visited and people told us they enjoy his visits. The files we looked at did not contain a care plan in relation to peoples social and cultural needs. Some information was provided in their files about their likes, dislikes and their religion. However this was not provided in sufficient detail to direct staff on how these needs should be met in accordance with peoples preferences. People told us they were able to choose how they wished to spend their day, and if this resulted in them remaining in their room, this decision was respected. People told us they are able to use the quiet room for when their guests visit, and people said We like this room as the views over the pool are lovely. We joined people for their lunch-time meal. The tables were set with tablecloths and condiments so people could help themselves. People told us they have choices, at each meal time and observations supported this. We visited the kitchen and spoke with the catering staff who were able to show us records of peoples dietary requirements. We looked at training records which demonstrated that the main cook did not hold an up to date Basic food hygiene certificate as this elapsed in May 2008. We was told training would be organised as a matter of priority. Care Homes for Older People Page 16 of 33 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. Systems in place ensure people have confidence to raise their concerns and are safeguarded from harm. However some staff practices may compromise this. Evidence: In the self assessment, the acting manager told us a clear and available complaints policy, and procedure is available. She said any complaints will be dealt with promptly and effectively and relatives are aware of the open door policy. During our discussions with people they told us they knew how to complain and they said they would not hesitate to raise any issues with the staff team or the acting manager. The feedback provided in the surveys also confirmed that people was aware of how to raise any concerns. People told us they have access to the complaints procedure in the information they have been provided with and the procedure is displayed on the notice board. The service has received 1 complaint since our last visit. The complaint was in relation to people not being clear about the procedure for an escort to support individuals to attend appointments. Although this issue was responded to, it was not clear from the records what action had been taken as a result of this complaint. The staff we spoke to demonstrated their awareness of both the complaints procedure Care Homes for Older People Page 17 of 33 Evidence: and their role and responsibilities concerned with dealing with any potential abusive incidents. The records we looked at demonstrated that six staff have not yet completed safeguarding adults training. The service have not had any safeguarding incidents since our last visit. However records demonstrated that incorrect procedures and techniques, were followed when a person displayed verbal and physical behavior. The training records and discussions with people told us that staff have not yet received training in relation to Mental Health Capacity Act, and Deprivation of Liberty. This training would be beneficial to ensure staff are aware and promote peoples rights to make decisions and ensure they are clear about how to safeguard people. Care Homes for Older People Page 18 of 33 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. Although people live in a homely environment, risk assessments have not been completed to ensure all areas are safe for people, and promote their privacy and dignity. Evidence: The acting manager told us the following in the information we received about the service: Pool Cottage is a small but homely partly listed building with a newer extension. The grounds are surrounded by a pool on 3 sides. Our Reception, Lounge & dining area have just been refurbished. We undertook a brief tour of the building and most areas we visited were found to be clean, comfortable, homely, warm and well lit. We found the areas specified in the self assessment had been upgraded. During our tour we found the temperature in the conservatory and small lounge varied to the rest of the building. People who were using these areas told us it does seem colder in here than the lounge I think it could be warmer, I dont think the radiator is working properly. The acting manager is aware of this and she has informed the provider. We also found that the door has been taken off from one of the toilets in the conservatory. This action was taken in order to make the toilet more accessible for people and their mobility equipment. However another toilet faces this toilet, therefore Care Homes for Older People Page 19 of 33 Evidence: this has the potential to compromise peoples dignity if two people wish to use these toilets. There was no evidence that a risk assessment had been undertaken in order to demonstrate the reasons for this action, and the potential dignity issues. People we spoke to and feedback in the surveys confirmed people are encouraged to personalise their bedrooms and those visited reflected peoples preferences. People told us the building suited their needs, and they confirmed they had access to equipment which encouraged and promoted their independence. People told us: I love my room I have excellent views, and I have brought my photos to make it as homely as possible. The building is very homely and I really like the original features. We have space to move about in, and I love the views of the pool and the wildlife. I like the views here and the location is great. But I would like to get out more. I have a scooter but no-where to put it as the garage is full of items. I would like to be able to go out around the pool, and be independent People told us they enjoy sitting outside in the patio area, in the summer months to watch the wildlife. A ramp is available to ensure all people can access this area. In the self assessment the acting manager told us that the Fire Service & environmental health, do checks of the building and the service complies with all regulations set. However we looked at the recent environmental health report and this identified an area which had not been addressed from the previous inspection report. This related to a seal on the fridge that must be replaced. Care Homes for Older People Page 20 of 33 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. People are supported by a competent staff team. However the recruitment practices and lack of updated training has the potential to place people at risk. Evidence: The acting manager told us in the information supplied about the service, that Pool cottage has a good staff mix, and at busy times they try to put extra staff on duty. During our visit the acting manager was working with people as a care assistant alongside two other staff one of whom finished at noon, leaving two staff on duty. There is currently one person living in this service that requires two people to support them with personal care tasks. This means that when staff are supporting this person, their is no staff support for the other people. Discussions with staff members told us that at times the staffing levels are not always sufficient. This is due to additional staff not always being available during peak times during the day, because of vacant shifts or sickness that has not been covered. This has the potential to impact on the delivery of care as some people are then unable to have a bath due to limited staff support and supervision. This was supported by comments in the surveys from both staff and people who live in the service. We received positive feedback in the surveys and in the discussions we had with people, about the staff and some of these include: Care Homes for Older People Page 21 of 33 Evidence: The staff are very good, they are so friendly and respectful The staff are very helpful and kind We have very pleasant and caring staff The staff do a good job, they look after me well. There just needs to be more of them: they work very hard.. The information provided by the acting manager told us that all staff are recruited through the correct procedures ensuring the welfare of the people living in the service. It said that all new employees receive training before they commence work, and handbooks in health & safety, employment and adult protection. We looked at two newly employed staff members recruitment files, and found shortfalls in the way people had been employed. We found that a full employment history had not been obtained for both staff members. We found that one staff member had commenced employment before the second reference, and a CRB had been received. References had not been obtained in relation to a staff members previous employment in care settings. These shortfalls have the potential to place people at risk. Discussions with the staff team demonstrated their enthusiasm, commitment and motivation to ensuring they support people to a good standard. Staff told us they do have access to some training opportunities in the mandatory areas. Staff members told us in both the surveys and in our discussions, that they would like to attend other service specific training, but opportunities for this was limited. We looked at the staff training records and this demonstrated that not all of the staff have completed all of the required mandatory training. Some staff members are overdue refresher training in some of the mandatory areas, such as moving and handling. No training was planned and a training programme was not in place. It was stated in the self assessment that all new staff receive induction training. We was told that a recent staff member has completed this training but her certificates has not yet arrived. A food hygiene certificate was available in their file. However the skills for care documents were blank, so there was limited evidence available to support what training this staff member had completed. Care Homes for Older People Page 22 of 33 Evidence: The training matrix demonstrated that staff have the opportunity to undertake National Vocational Training. Over half of the staff team had achieved this, or they are currently undertaking this training. This ensures staff have the skills to fulfill their role. Care Homes for Older People Page 23 of 33 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. The management of the home ensures the views of the people using the service are heard. But the lack of records in areas such as care planning, staff training and recruitment demonstrates that their are shortfalls in some areas of management. Evidence: The acting manager told us in the information supplied about the service; she has 17 years experience of working in care, and is qualified for her role. She has completed the leadership in management award and an NVQ level 3 and 4 in care. She told us the service work as a team, listening to people and obtaining their views and wishes. The acting manager has worked in this service since February 2009. An application to registered with us has not yet been processed. The acting manager works alongside her team supporting people for one shift per week. This leaves 23 hours per week supernumerary time, to focus on and complete management tasks. However the acting manager feels this is not sufficient amount of time to complete all tasks, and as a consequence we have found shortfalls in the record keeping and recruitment Care Homes for Older People Page 24 of 33 Evidence: practices. We was told that half of the staff team have received one supervision session since the acting manager had commenced employment. This was confirmed by discussions with staff and in the feedback from the surveys. Staff did tell us that the manager was always available for support and advice. People, and feedback provided in the surveys told us that the acting manager has settled in well and is doing a good job. People told us she was approachable and listened to them. Staff told us they felt supported by the manager who they said was approachable and helpful. People told us they are consulted about all aspects of the service delivery, both informally and formally at the monthly meetings and by completing the annual quality assurance survey. People said they raise any comments in the meeting and discuss anything they are not happy with or advise staff on any improvements they think could be made. We looked at the minutes of these meetings which supported these comments. There is a suggestion box in place, and there was evidence to support what action has been taken in response to the comments made by people and their families. These quality assurance systems enable people using the service to have an opportunity to have their say in the running of the home and in the planning of future events. People said they were happy with the way their personal money was managed. We looked at the systems in place and these were satisfactory. In the information provided by the service it stated that the maintenance of the equipment was maintained and kept up to date. However when we sampled some of these records, an up to date gas certificate could not be located. Their was no evidence to support that any action had been taken to renew the electrical wiring certificate which had expired in October 2009. These issues have the potential to place people at risk if the appliances are not in good working order. We have contacted the provider to discuss what action would be taken in response to this. It was identified earlier in this report that the training records demonstrated that not all of the staff have completed all of the required Mandatory training or had updated training so they are working to current practice. An example of this is the main cook and some staff members not currently holding an up to date food hygiene certificate, and some staff not accessing training in Moving and handling training. This means that staff may not have knowledge of up to date practices, which could have compromised Care Homes for Older People Page 25 of 33 Evidence: the practices in place. The provider undertakes monthly visits and completes a report of his findings. This is to monitor the standards in the service and to ensure it is meeting peoples needs. The reports covers the required areas (although some areas were brief in detail), and indicated that standards have been maintained on a monthly basis. In the self assessment and during our visit we was told that the service was financially viable, but at times cash flow issues were causing limitations at the service. Therefore we will continue to monitor the viability of this service. The service completed their self assessment within the timescale provided and nearly all areas were completed in sufficient detail. However some areas were left blank or the information provided was brief in detail. Care Homes for Older People Page 26 of 33 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 27 of 33 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 Each person must have a 11/03/2010 detailed care plan which covers all of their holistic needs completed upon their admission to the service. This plan must be developed in consultation with individuals and be kept under review. The plan must include reference to the individuals ability to make decisions under the requirements of the mental capacity Act. This is to ensure staff have the information to meet peoples needs in a person centred way. 2 8 17 People must have risk assessments completed in order to assess and minimise any potential risks to their health 11/03/2010 Care Homes for Older People Page 28 of 33 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 This is to ensure people receive appropriate support and intervention. 3 18 13 A policy must be developed 26/02/2010 in relation to how staff should respond to people who have the potential to be verbally and physically abusive. This policy must include information about whether restraint is used and if so the techniques staff are trained in. This is to ensure both staff and people are clear on the procedure to follow when incidents occur. 4 29 19 New staff must not commence employment in the service until all of the required legal recruitment checks have been received and deemed satisfactory. This is to ensure staff members are suitable to work with people, and to safeguard them from any potential risks. 5 30 18 All staff must complete the 31/03/2010 required Mandatory training. Evidence must be in place to demonstrate this has been undertaken. 14/02/2010 Care Homes for Older People Page 29 of 33 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 This will demonstrate that staff have the necessary skills and knowledge to undertake their duties safely following up to date practices. 6 31 8 Arrangements must be made to register the manager for this service This is to ensure the service is managed in accordance with the standards and in the best interest of people that live here. 7 38 16 Staff working in food 28/02/2010 preparation areas must have undertaken the relevant food hygiene training and have evidence of this. To ensure they are working to current practice. 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 31/01/2010 1 1 People who live in the service should be provided with a copy of any information that is revised and updated due to changes in the service. People should be provided with a copy of their contract. Information about the provision of escorts to support people to attend appointments should be made available to all people who live in this service. 2 2 Care Homes for Older People Page 30 of 33 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 3 7 Staff should access training in relation to record keeping. This is to ensure they record factual and accurate information. Staff should use the codes detailed on the medication sheet to record the reason a person has not had their prescribed medication. All staff that administer medication should be assessed to ensure they are competent in these tasks and follow the procedures in place. People should have care plans completed in relation to their social and cultural needs. This will ensure staff have access to information to ensure these needs are met. The action taken in response to a complaint should be recorded. This is to ensure it is clear what the service has done in order to improve procedures for people. All staff who work in this service should access training in relation to safeguarding adults from abuse. All care staff should have training on how to respond to people who have the potential to be verbally and physically abusive. The service should comply with the requirements of the Fire Service and Environmental Health. This is to ensure people live in a safe environment. A review of the staffing levels should be undertaken to ensure the staffing levels are sufficient to meet the assessed needs of people that use the service. An ongoing training programme should be in place to demonstrate that training has been planned for the staff team. Evidence should be available in staff training files to support they have completed an induction. The registered provider should continue to ensure the service is financially viable and provide sufficient investment to meet the requirements of the renewal programme and daily running of the service. Staff should receive formal supervision 6 times a year, and an annual appraisal. This is to ensure they receive appropriate support. Page 31 of 33 4 9 5 9 6 12 7 16 8 9 18 18 10 19 11 27 12 29 13 14 30 34 15 36 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 16 38 Arrangements should be made to ensure all staff have access to refresher training in all mandatory areas. Evidence should be available to support this. This is to ensure they are working in accordance with current practices. A repair and maintenance book should be implemented to enable all repairs to be recorded and monitored. 17 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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