Care Home: Poplars

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What the care home does well People said that the staff are kind, they have no complaints but feel confident to raise concerns. One person said that the home has "good food and everything is clean". Another said that they "have everything they need in the home" and can follow their own pursuits. Staff said that the home does well by, "giving people best care and a choice of food", "a clean home and family atmosphere", "it improves the quality and service for the residents", "it supports the residents" and "the Manager supports the carers and residents and is very helpful". We saw that people are enabled to spend their time where they wish to do so. People were complimentary about the food. What has improved since the last inspection? Carpets and floor coverings have been renewed in a number of areas. Blinds have been provided in the garden room. The fire protection improvements have been carried out. New washing, dish washing and drying equipment has been provided. What the care home could do better: To ensure that people admitted to the home can have their needs met, the Registered Providers need to ensure that the information in the Statement of Purpose reflects the needs of people who can be accommodated by the home in line with its registration. The Service Users` Guide needs to be amended to correct any changes and errors, and to include all of the information people, and their representatives, need to know. The Registered Manager needs to ensure that staff are fully aware of their health and safety responsibilities, such as ensuring medication is secure. In particular, she must ensure that staff do not put residents, and people visiting the home, at risk. To ensure that any cultural, religious and personal wishes are discussed and recorded, part of the care planning should include end of life care. The training programmes must be improved to ensure that new staff are fully trained within a reasonable time of commencing and all staff have access to good quality training. The recruitment information must be completed fully and all relevant checks made before staff are in post. The Registered Provider must ensure that, in order to demonstrate that the home is run in a satisfactory manner, the monthly unannounced visits are undertaken and recorded. To promote the safety of the residents and people visiting the home, the Registered Provider must ensure that there is new fire risk assessment completed. Key inspection report Care homes for older people Name: Address: Poplars Poplars 15 Ickenham Road Ruislip Middlesex HA4 7BZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Collisson     Date: 2 5 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 30 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 30 Information about the care home Name of care home: Address: Poplars Poplars 15 Ickenham Road Ruislip Middlesex HA4 7BZ 01895635284 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Appcourt Limited Trading as: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 27 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home The Poplars is a care home registered for 27 older people. The home is on three floors and there is a lift to all floors. The home is situated in the centre of Ruislip, close to shops and public transport. There is a large rear garden and a large parking area to the front of the home. All bedrooms are single and have their own en suite toilets. Two rooms have their own shower. The staff room and laundry are to the rear of the property. The weekly fees for the home range from £450 - £640 per week. There are additional charges for hairdressing, chiropody, toiletries and newspapers. Care Homes for Older People Page 4 of 30 Over 65 27 0 0 4 1 2 2 0 0 8 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We commenced this unannounced inspection on Monday 16th November at 10.35am. The Registered Manager was present. There were five staff on duty, including one senior care worker, and twenty four residents in the home. There were three vacancies. We have sent surveys to the people living in the home, staff and professionals who visit the home. We received four from residents and five from staff. We also received two from social and health care professionals. People were complimentary about the home. The Administrator was on holiday during our first visit, and not all of the records we required were available, so we returned on 23rd November and met with the Registered Provider and the Administrator. We discussed the outstanding issues with the Provider, including the provision for training. The inspection took a total of eight Care Homes for Older People Page 5 of 30 hours. During the course of the visits, we met most of the residents and talked to some in private. We also spoke to two visitors. Staff were supporting some of the residents with activities, including a quiz and the making of Christmas cards. The Christmas Programme had been prepared and was being advertised to the residents and their families and friends. There are some residents who prefer to spend their time in their rooms but there are two areas in the lounge, one with a television and one overlooking the garden, where most people choose to spend their time. We toured the home and found it to be fresh and clean. Since the last inspection, carpets had been replaced in the lounge, in two of the bedrooms, and blinds have been installed in the garden room. We checked a number of records, including care plans, staff recruitment, training records medication and complaints. The Manager has been working to improve the record keeping. We made fourteen requirements at the last inspection in December 2008 which have been met. However, some of the nine requirements we have made do cover some of the same subjects, so the Registered Providers need to ensure that these are now fully met. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: To ensure that people admitted to the home can have their needs met, the Registered Providers need to ensure that the information in the Statement of Purpose reflects the needs of people who can be accommodated by the home in line with its registration. The Service Users Guide needs to be amended to correct any changes and errors, and to include all of the information people, and their representatives, need to know. The Registered Manager needs to ensure that staff are fully aware of their health and safety responsibilities, such as ensuring medication is secure. In particular, she must ensure that staff do not put residents, and people visiting the home, at risk. To ensure that any cultural, religious and personal wishes are discussed and recorded, part of the care planning should include end of life care. The training programmes must be improved to ensure that new staff are fully trained within a reasonable time of commencing and all staff have access to good quality training. The recruitment information must be completed fully and all relevant checks made before staff are in post. The Registered Provider must ensure that, in order to demonstrate that the home is run in a satisfactory manner, the monthly unannounced visits are undertaken and recorded. Care Homes for Older People Page 7 of 30 To promote the safety of the residents and people visiting the home, the Registered Provider must ensure that there is new fire risk assessment completed. 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 30 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 30 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 the information to help them to make a decision about the home but it is not easily accessible. The needs of the people who can be accommodated is not sufficiently clear. People have their needs assessed before being admitted and the opportunity to visit the home. Evidence: We were provided with a copy of the Service Users Guide and Statement of Purpose, which is a combined document. The information is comprehensive but would provide a very bulky document if provided in larger print. We recommended that the part of the document which forms the Service Users Guide is made more user friendly. It could then be produced in a larger print but be easier to read. The home also provides an illustrated brochure. There are some factual inaccuracies in the information which need to be amended. Information about the management of peoples money, personal allowances and Care Homes for Older People Page 10 of 30 Evidence: additional charges needs to be explained. The information on admitting people with dementia is not clear. The home does not have a registration for dementia, although there are people in the home who have this diagnosis. Some people have developed dementia since being in the home and others have been admitted with early stage dementia. We discussed this with the Registered Provider and a decision will need to be made if the home wishes to continue to admit people with dementia. The home needs to demonstrate that it has the staffing levels, environment, training and activities to suit people with dementia and it is clear on its Statement of Purpose who can be accommodated The home has the facilities to accommodate people with some physical disabilities as there is a lift to all floors and suitable bathing facilities. The home does not currently accommodate anyone who requires the use of a hoist. We saw that there are contracts/term and conditions in the files we examined. People completing our questionnaires confirmed they all had a copy of the contract and a copy of the Admission Agreement is included in the Service Users Guide. The Manager carries out an assessment of people who wish to be admitted to the home and we saw samples of these. People are able to visit the home, if they wish, in advance. We spoke to a visitor who confirmed that relatives had visited on the persons behalf. A policy on visiting is included in the Service Users Guide. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments are in the process of being improved and making more person centred. Peoples health needs are met by good community services. People say their dignity and privacy is respected and they have control over their lives. Evidence: We looked at a sample of four care planning files. We saw that there was a range of care plans to support people with their personal care needs and other activities of daily living. In between our visits, the Manager started to put in to place a new style of care plan, which was typed in an easy-to-read format, and clearly showed the areas of support. We saw in the same files we examined that care plans had been reviewed regularly. We saw that care plans are signed by the residents or their families. However, the new style plans will make it easier for the residents and families to understand and agree them. It will also ensure that they can be updated easily. Although risk assessments are in place, we did see that not all had been fully Care Homes for Older People Page 12 of 30 Evidence: completed and some were quite short. However, the Manager is also in the process of improving the risk assessments and showed us a copy of the format she intends to follow. This gives a clearer indication of the nature of the risk, who is affected, and what steps are in place to minimise the risks. The home uses two local general practitioner centres. The staff said that they provide a good service. One general practitioner was due to visit during our first visit. One of the health care professionals, responding to our surveys, said that the home always passes information on regarding the general practitioners and district nurses. Another said there is effective communication with nurses. Both said that there is always accurate information gathered, peoples health information is always monitored and reviewed, and the service acts to meet peoples care needs and improve their wellbeing. There is only NHS chiropody for those who are diabetic or on Warfarin medication. It is arranged privately for other people. We advised that the cost to the residents should be detailed in the Service Users Guide. We checked the medication. There is a weekly dosette system provided from a local pharmacy and the administration record is stored in each dosette box. The majority of the medication is in the boxes, and the records describe the medication should any be refused or dropped. We checked a sample of non-dosetted medication and found that, although the medication was being counted on a weekly basis, this was not checked against that being administered. A large stock was being held elsewhere in the home but was being counted with that in the medication trolley, so it was not easy to carry out an audit. We advised that, when stock is placed in the trolley, the amount needs to be recorded as being transferred and an audit can then be easily carried out. The Manager provided, by the second visit, a new auditing book which records the amount in the trolley and the amount in stock. The Manager said that there had been no medication errors. The medication trolley is kept securely in the dining area but we found that staff had left the keys on the top of the trolley. It is in an area accessible to all residents and visitors, but the staff we spoke to were not aware of this as a potential hazard. The person responsible for administering the medication on the shift needs to ensure that the keys are kept with them at all times. The Manager needs to ensure that staff understand the potential danger is leaving medication accessible. People told us that their privacy and dignity are respected and that staff are kind. They have en suite toilet facilities and additional toilets are located on each floor, and Care Homes for Older People Page 13 of 30 Evidence: there are also toilets close to the lounge. At the request of the residents, the two toilets near the lounge were both made accessible for them, one for the male residents and one for female. There are no shared rooms. All staff are female, so same gender care is always available to the female residents. There is limited information regarding end of life wishes and choices. This should be recorded where people have expressed wishes or if they do not wish to discuss. Any special cultural and religious needs should be noted to ensure that these can be carried out appropriately. Care Homes for Older People Page 14 of 30 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 have the freedom to decide where to spend their time. There are activities, but there is room for improvement, particularly for outings. People say they enjoy the meals but the choices could be better advertised. Evidence: We saw, during the course of the inspection, staff supporting people with activities which included a quiz with six of the residents and the making of Christmas cards with two of the residents. Other residents were in the lounges, reading their papers or a book, and some were in their rooms. There is no Activities Organiser and care staff provide the activities, in addition to their care duties. Cookery is provided twice a month by a volunteer. The home is close to the shops of Ruislip High Street and some residents told us they go to the shops occasionally, but with family and friends. Although staff said that it is difficult to engage everyone in activities, we felt that an Activities Organiser would be able to concentrate on providing individual activities such as a regular outings to the shops and we recommend that the home continues go look at this possibility. One person said that there were no outings arranged but was occasionally taken out locally. People mentioned that they were happy with the hairdresser. Care Homes for Older People Page 15 of 30 Evidence: People are able to maintain contact with their families and friends and we spoke to two visitors during our inspection, who were happy with the support the home provides. There is a church next door to the home which can be attended. There are no other specific cultural needs to be met at present. We spoke to people who confirmed that they were happy in the home and able to follow their own pursuits. Where people wish to stay in their rooms we saw what they are enabled to do so. There is a board in the dining room which has the menu for the day. On our first visit, the menu displayed was not that for the day. It was not easy to read and the writing, on a black board, was too small. This was discussed with the management of the home who said that they will provide an easier to read board. A copy of the three week menu is provided in one area of the home and one resident had their own copy in their room. The provision of easy read menus would be a useful addition to enable people to know the choices and make a decision about their meals for the day. A meal of gammon, or fish in parsley sauce, was being served with potatoes but only one vegetable, which was green beans. The dessert was apple crumble. The cook said that he usually served two vegetables. People we spoke to were complimentary about the food but one person said that they would enjoy peas more often, for instance. We asked the cook about special diets. The cook showed us a cook book which he uses to make items for the diabetic residents. He said that one person has some cultural needs with regard to their food and he is able to provide this occasionally. The evening meal, on the first visit, was cheese on toast or a choice of sandwiches and there was also cake. People told us they can have sandwiches during the evenings if they wished, and one person has their own fridge in their room so they can store their own snacks. We found the kitchen to be clean and tidy, and the home was awarded 4 stars at the last visit of the Environmental Health scheme. A new dishwasher had recently been installed. Care Homes for Older People Page 16 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People said they know how to complain and would do so if they felt it was necessary. The procedures are in place to do so. Staff would benefit from more in-depth training in safeguarding to ensure it is fully understood. Evidence: There has been one complaint made in the home and none received through the Commission for Social Care Inspection or Care Quality Commission. The procedure is detailed in the Service Users Guide. The people we spoke to, and most who responded to our surveys, said that they were aware of how to make their concerns known, although one person said that they did not know. One person we spoke to said that it is always possible to raise your concerns and that staff listen to you. There have been no issues raised with either Commission regarding safeguarding. Not all of the staff have attended training on safeguarding and some have only used a DVD and test for training. One of the areas for improvement noted in the Annual Quality Assurance Assessment, prepared by the Manager, has been the improvement of safeguarding training. This needs to be carried out within a reasonable time. Care Homes for Older People Page 17 of 30 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. People benefit from a comfortable enviroment. Rooms are personalised to suit the individual. There is a choice of facility for personal care, fitted with suitable aids. The home is clean and fresh. Evidence: The home has two interconnecting lounges and a dining room. One area has a television, and the other area faces the pleasant garden. The dining room was seen to be used for activities. The carpets have been replaced and the rooms are comfortably furnished. An assortment of books are available in one area and there is a pay phone situated on the first floor, with comfortable seating, for the use of the residents. At the last inspection, blinds or curtains were required in the garden room as residents complained of the bright sunshine. Blinds were fitted and were in use. The dining tables were seen to be nicely laid. Although the home has bathrooms on each floor, one was not in use and was being used for storage. Although a walk in shower and a sit-in bath are available, the Manager said that the ground floor assisted bath is the most popular and therefore most regularly used. This had been serviced in September 2009. There are two toilets near to the lounge which, at the request of the residents, are used for male and female residents. Care Homes for Older People Page 18 of 30 Evidence: It was a requirement that the water temperatures are checked and the Manager showed us the record of the tests. There is a lift to both floors. No one at present needs support with a hoist. All of the bedrooms are single, are over 11 sq. metres, and those we saw were nicely furnished. Two rooms have had new carpet. The Manager said that bedrooms are decorated when they are empty and there is a rolling programme of decoration. The people we spoke to were happy with their rooms and said that they suited their needs. People had their own possessions, including photographs and pictures. One person has pictures provided by the home but said that they were happy with this and did not want to replace them. We found the home to be clean, pleasant and hygienic. We looked at the laundry room, which is situated in an out-building in the garden. The washing machines and dryers have been replaced and new flooring has been laid. There are instructions around for the home for using hand gel for hygiene. Care Homes for Older People Page 19 of 30 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 satisfied with the support the staff provide. The provision of training is not always of a standard to ensure staff have the required knowledge to meet statutory requirements. New staff are not trained sufficiently quickly. The recruitment processes are not robust enough to ensure that there is good protection in place. The opportunity for NVQ training needs to be extended. Evidence: The Manager was, at the time of this inspection, actively recruiting as two staff were leaving. She provided a copy of the rota, which showed that there were five staff on all but one of the four weeks early shifts, and four on all of the afternoon shifts. However, we did note that several of the staff work early and late shifts each day, for up to four days in succession, and the Manager needs to look at the health and safety implications of this. The Manager provided us with a list of training, completed in 2009. We saw that the last moving and handling training was carried out December 2008 and the Manager was trying to make arrangements for the annual training to be carried out for this year. The new staff, who have commenced since last year, have not been on practical training courses, until the recent fire course, and only had DVD training. We discussed with the Registered Provider that all new staff should undertake a training course, within a reasonable time of starting work, with an external training company if Care Homes for Older People Page 20 of 30 Evidence: necessary. Some of the training is undertaken using DVDs and tests rather, than by trainers. First aid is also trained using a DVD. The home needs to have a regular programme of good quality training to ensure that all of the staff have the basic and advanced training that they require. Two staff have National Vocational Qualification Level 2. Three staff have just completed the qualification at Level 2. Four staff are booked on Level 3. When these are completed over 50 of the staff team will have the qualification. However, as there is a staff turnover, it must be an ongoing training programme to ensure that the 50 level can be maintained. It was a requirement that staff had all of the required checks prior to employment. We checked a sample of four records. There were still some areas where improvements are required. All of the staff had Criminal Records Bureau disclosures, or POVA 1st checks. However, there were some gaps not shown to be explored, in employment histories. One person had worked in a care capacity for a number of years but a reference had not been sought from them. Another file did not have up-to-date information on a staff members right to work. The Manager undertook to get this information and it was obtained. The Administrator and the Manager must ensure that all of the recruitment information is in place before staff are employed. Care Homes for Older People Page 21 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager has the qualifications and experience to manage the home satisfactorily. The home has a relaxed and pleasant atmosphere. Staff are supported through regular supervision. Peoples money is managed by themselves, families or representatives. Health and safety checks are carried but more attention must be given to fire risk assessments. Evidence: We found that the home has a friendly and relaxed atmosphere and people were positive about the staff. We saw that staff were engaging the residents in conversation appropriately and they enjoyed the activities we observed. We discussed with the Registered Provider that the provision of a computer for the Manager would support her with administration. In particular,the keeping of information, such as the self assessment for the Care Quality Commission, care plans and other typed information, could be kept in good order. This would also enable her to keep in touch with the Care Quality Commissions information and the good practice Care Homes for Older People Page 22 of 30 Evidence: from other organisations. The Manager has an open door policy and the staff confirmed that the Manager supports them with their work. As present, the Administrator has a computer and although this is available to Manager would not allow for her to continue to be accessible to residents, staff and visitors as she is now. It is strongly recommended that this is considered. We asked on the first visit to the home to see the Regulation 26 month unannounced visits made by the Registered Provider or their representative. These were not available and we spoke, at the second visit, to the Registered Provider who said that, although weekly visits are paid the home, no written reports have been made for some time. He agreed that these would be recommenced. The Registered Provider, or their representative, needs to demonstrate that they have regular discussions with residents, and staff, as well as checking on a range of records to ensure that the home is running well. The Manager showed us that she had compiled a report from the surveys given to people about their views of the home. She has also completed a handwritten Annual Quality Assurance Assessment. This had been filled in but did not give a great deal of information about the improvements for the next twelve months. Any future assessments will need to be more comprehensive, and show all aspects of the homes improvement plans, and their evidence of good management and development. The home has a policy of not holding money for people or managing their finances. Money for hairdressing, newspapers, chiropody or other items is paid for by the residents, their families or representatives. The information on additional charges needs to be clarified in the Service Users Guide. Staff say they are supported by the Manager and we saw samples of the written supervision sessions she has held with staff. She is currently undertaking all of the supervision of the staff. The home has senior care workers and it is recommended that one of the seniors is given the responsibility of supporting the Manager with this, and other work, after appropriate training. The Manager was able to supply us with the records we required, with the exception of the Regulation 26 reports, as discussed previously. These were kept in a satisfactory order. We did note that many of the policies and procedures of the home had not been reviewed since 2006 or 2007 and these need to be reviewed and amended regularly, in line with changes in legislation and good practice. Care Homes for Older People Page 23 of 30 Evidence: It had been a requirement in 2008 that the fire risk assessment was carried out. A thorough assessment had been made of the home in February 2009 which identified a number of areas which needed improvement, including replacement of fire doors and the replacement of seventeen of the magnetic door closures. The Administrator said that all of the work had been carried out. However, the fire risk assessment has not been updated to show the reduction in the risk since the work had been done. The individual assessments for the residents had also not been carried out. In particular, these need to be done to assess the risks for those people who would be unable to use the stairs in the event of a fire. Staff need to be aware of the procedures should this occur. It is recommended that the risk assessment for this is undertaken with each person as part of their admission documentation. The Administrator said that they would arrange for the Fire Risk Assessment would be updated by the company who provides the fire protection. The last fire drills had taken place on 24th October 2009. The required weekly fire alarm checks were seen. The Manager said that checks are made of the fire escapes and battery operated devices on the doors, which are activated when the fire alarm is tested, as are the fire doors. The extinguishers were last checked in September 2009. We sampled a selection of the maintenance records. The small electrical appliance testing was carried out in March 2009 and October 2009. The Manager said that this was repeated as new residents had brought in electrical items. The lift and the assisted bath were serviced in September 2009. There is no hoist used at present and the Manager said it is stored away. Clinical waste is collected fortnightly. The Manager said that the five year electrical tests had recently been done. Care Homes for Older People Page 24 of 30 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 25 of 30 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 1 5 The Registered Providers must ensure that the information in the Service Users Guide is accurate and contains all of the required information. To ensure that people are fully aware of operation and management of the home. 31/01/2010 2 4 4 The Registered Providers 31/01/2010 must ensure that the information in the Statement of Purpose reflects the needs of people who can be accommodated by the home in line with its registration. To ensure that people admitted to the home can have their needs met. 3 9 13 The Registered Manager must ensure that the staff are fully aware of the health and safety reasons for ensuring that the keys to 31/12/2009 Care Homes for Older People Page 26 of 30 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 the medication cabinet are kept securely. To ensure that residents and people visiting the home are not put at risk. 4 11 12 The Registered Manager 31/01/2010 must ensure that the wishes of people, with regard to their end of life care, is discussed and recorded wherever possible. To ensure that any cultural, religious and personal wishes are recorded 5 18 13 The Registered Manager must ensure that all staff have suitable training in safeguarding and whistle blowing. To ensure that the staff have a thorough understanding of the safeguarding procedures. 6 28 18 The Registered Manager must ensure that newly recruited staff attend the basic training courses within a reasonable time of appointment which are required to meet the needs of the residents. 31/01/2010 31/01/2010 Care Homes for Older People Page 27 of 30 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 To ensure staff have the skills and knowledge to perform they work they are required to do. 7 29 19 The Registered Manager must ensure that the recruitment documentation is all completed fully before staff are recruited. To ensure that people are protected by thorough recruitment processes. 8 33 26 The Registered Provider must ensure that the month unannounced visits are undertaken. To ensure that the Registered Provider is confident of the running of the home 9 38 23 The Registered Provider must ensure that there is a new fire risk assessment completed. To promote the safety of the residents and visitors to the home. 31/12/2009 31/12/2009 31/12/2009 Care Homes for Older People Page 28 of 30 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 2 1 12 That the Service Users Guide is produced in a more user friendly style which could be made available in larger print. That the Registered Providers consider the employment of an Activities Organiser to facilitate a range of activities and outings. That the policies and procedures are reviewed annually. That the manager is provided with a computer in the office to support the recording of information, communcation with outside bodies and keeping up-to-date with the CQC and other relavant organisations. That, as part of the assessment process for new residents, an individual fire assessment is carried out to assess the assistance people require. 3 4 36 37 5 38 Care Homes for Older People Page 29 of 30 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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