Care Home: Prospect House Care Home

What the care home does well We looked at the admission process and the assessments that are made. These were appropriate and provided a good baseline of care needs. This ensures that the persons care needs are identified and a care plan can be drawn up which is used to carry out and monitor the care. Residents spoken with said that staff where helpful and respectful. We observed staff interacting well and supporting people which maintains their dignity. We saw that people were dressed appropriately and that they were clean and had good standards of personal care. We spoke with relatives who confirmed that these standards were maintained. We were advised that activities take place after tea and biscuits at 11am and then after lunch. We saw residents taking part in activities and the staff interaction was good so that people felt stimulated and relaxed in the home. We observed meal times. The meal was well paced and relaxed so that people could enjoy the social aspects of this time. Staff were on hand to assist with people who needed help with feeding. We found that the manager investigated and responded to any complaints in an open manner so that redress for people was apparent. Relatives generally said that the manager was approachable and they could raise any concerns. Staff were spoken with and had a good understanding of how to identify both good practice and also how abusive situations may arise. All staff have some training and awareness raising sessions. This helps ensure that peoples rights and safety are maintained. The management of the home continue to develop the home positively and have shown some consistency in this over the past two inspections. They have now emplyed an external quality assurance process which should further develop the home in line with good practice so that Prospect House is run in the best interests of the people living there. What has improved since the last inspection? We asked for a copy of the homes information guide and staff were able to show a number of copies available. This is an improvement from the last inspection and the guide is now readily available for people. The home meets with current legislation by providing disability access at all internal areas and since the last inspection the exterior grounds have been made safe and accessible. This shows that the home are considering a diversity of care needs and are trying to meet these. What the care home could do better: We discussed the need to assess peoples mental capacity at the point of admission to the home following the advent of the Mental Capacity Act. This helps to ensure that peoples ability to make a judgment about moving in to the home is recorded and also assists with daily care decisions once admitted to the home. When we looked at the notes of the nurses visiting we saw that dates of visits were recorded but still no notes of any instructions or feedback. Feedback information is important in order to make any changes to the care plan. We would recommend that some feedback notes are therefore made to evidence the homes duty of care. Care plans were rather lengthy and it was difficult to be clear about current care needs as some needs had been met but were still on the plan. Some assessed needs had rather brief interventions planned. For example one person who has very challenging behavior had only brief planned interventions. We discussed this in some detail and would strongly recommend that all risks are assessed appropriately in the context of the persons mental capacity and clear interventions are recorded on the care plan so that staff are clear about ongoing management and review. The manager reported that the care planning format was under review. We looked at the new format being introduced and piloted for one resident and this seemed to be clearer and easier to follow. We would recommend this is further developed. We looked at the medicines and from the records and observations made it is clear that these are generally managed safely. We have made some recommendations to further improve standards. A recent complaint raised some some issues around the homes pets. We would recommend that the homes pets are highlighted in the information guide [SUG] so that people are aware before being admitted to the home. We looked at how staff are made aware of keeping people safe and recognizing and reporting abuse. Any in house training needs to reference the local policies and the `wider picture` in terms of how abuse is reported and investigations are carried out by external bodies such as social services. We would also recommend that the local safeguarding contact number is included in the homes polices for staff to be made more aware. We saw that not all bathrooms and toilets had appropriate hand washing provision and liquid soap and papers towels must be consistently available. This is to ensure good hygiene and reduce the risk of infection. We looked at how staff are recruited to the home and this was generally satisfactory. We have made some recommendations so that the process can be further improved. Key inspection report Care homes for older people Name: Address: Prospect House Care Home Blundells Lane Rainhill Merseyside L35 6NB     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: Michael Perry     Date: 0 8 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 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 28 Information about the care home Name of care home: Address: Prospect House Care Home Blundells Lane Rainhill Merseyside L35 6NB 01514931370 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: maureen@malkhandy.com Ms Maureen Bromley,Mr Neil Malkhandi care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: 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: Dementia - Code DE The maximum number of service users who can be accommodated is: 24 Date of last inspection Brief description of the care home Prospect House is a care home for 24 older people with dementia, and the registered manager is Mrs. Maureen Bromley. The home is a large converted dwelling house, which has been extended. Prospect House is set in its own grounds a short car journey from local amenities and bus routes. The home provides single accommodation and is staffed throughout the day and night. All residents are registered with a local G.P. and the service includes personal care, home cooked meals and a laundry service. The grounds include a car park, paved areas and gardens with views of the countryside. The fees in the home are 419.60 pounds per week. 1 1 0 2 2 0 0 9 24 Over 65 0 Care Homes for Older People Page 4 of 28 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: Before we visited the home the manager filled out a form ( called the Annual Quality Self Assessment, or AQAA) we sent and returned this. It had a lot of information about the home and how the people are supported to live their lives. We visited the home without telling the staff we were coming so that we could see how things work normally. We spoke with people who live there and observed how they spend their day and how the staff support them. We also spoke with relatives. We looked at the records kept on people who live in the home and other records that show how the home is run. We looked around the home to see if it was clean and a nice place to live and some of the people living in the home showed us their bedrooms. As part of the inspection we were accompanied by a person who has had previous experience of care services. This person is called an expert by experience and assists the inspector by making observations and speaking to staff and people in the home and then providing some feedback. Comments by the expert are included in the report. Care Homes for Older People Page 5 of 28 Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: We discussed the need to assess peoples mental capacity at the point of admission to the home following the advent of the Mental Capacity Act. This helps to ensure that peoples ability to make a judgment about moving in to the home is recorded and also assists with daily care decisions once admitted to the home. Care Homes for Older People Page 7 of 28 When we looked at the notes of the nurses visiting we saw that dates of visits were recorded but still no notes of any instructions or feedback. Feedback information is important in order to make any changes to the care plan. We would recommend that some feedback notes are therefore made to evidence the homes duty of care. Care plans were rather lengthy and it was difficult to be clear about current care needs as some needs had been met but were still on the plan. Some assessed needs had rather brief interventions planned. For example one person who has very challenging behavior had only brief planned interventions. We discussed this in some detail and would strongly recommend that all risks are assessed appropriately in the context of the persons mental capacity and clear interventions are recorded on the care plan so that staff are clear about ongoing management and review. The manager reported that the care planning format was under review. We looked at the new format being introduced and piloted for one resident and this seemed to be clearer and easier to follow. We would recommend this is further developed. We looked at the medicines and from the records and observations made it is clear that these are generally managed safely. We have made some recommendations to further improve standards. A recent complaint raised some some issues around the homes pets. We would recommend that the homes pets are highlighted in the information guide [SUG] so that people are aware before being admitted to the home. We looked at how staff are made aware of keeping people safe and recognizing and reporting abuse. Any in house training needs to reference the local policies and the wider picture in terms of how abuse is reported and investigations are carried out by external bodies such as social services. We would also recommend that the local safeguarding contact number is included in the homes polices for staff to be made more aware. We saw that not all bathrooms and toilets had appropriate hand washing provision and liquid soap and papers towels must be consistently available. This is to ensure good hygiene and reduce the risk of infection. We looked at how staff are recruited to the home and this was generally satisfactory. We have made some recommendations so that the process can be further improved. 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 28 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 28 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 are assessed appropriately so that care needs can be identified. Evidence: The home have produced some information for anybody who wishes to look around or is admitted. This is called the Service User Guide SUG. We asked for a copy of this and staff were able to show a number of copies available. This is an improvement from the last inspection and the guide is now readily available for people. We looked at the admission process and the assessments that are made at this time. We saw a recent care file of a person who had been admitted as an emergency. The deputy manager had visited the person in hospital to complete an assessment. There were copies of professional assessments such as social work and health care workers. We looked at another person who also had had appropriate assessments carried out and these had been extended once admitted to include further assessments covering various activities of daily living. This ensures that the persons care needs are identified and a care plan can be drawn up which is used to carry out and monitor the care. Care Homes for Older People Page 10 of 28 Evidence: We discussed the need to assess peoples mental capacity at the point of admission to the home following the advent of the Mental Capacity Act. This helps to ensure that peoples ability to make a judgment about moving in to the home is recorded and also assists with daily care decisions once admitted to the home. We would recommend that managers and staff review this and ensure that such assessments are built into the admission and ongoing assessments. Staff were able to talk about some of the residents who had come to have a look around the home before moving in. This helps ensure that people can settle into the home effectively. Care Homes for Older People Page 11 of 28 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. The management of health and personal care ensures that people are generally well cared for so that their rights and dignity are preserved. Evidence: The last inspection report carried out in February 2009 contained comments around the need to ensure care plans are easier to reference and follow particularly with respect to recording of health care input from visiting professionals such as district nurses. In November 2009 a social worker who reviewed a person in the home was concerned that the care documentation was not up to date and some care needs had not been reviewed. We looked at the care records and care plans on the inspection. These records are important as a record of the care delivered as well as acting as the main means of communication in the home with respect to the individuals care needs. We looked at two in some depth. One person had a leg wound that was being treated by the district nurse with twice weekly visits. This was clearly mentioned in the care Care Homes for Older People Page 12 of 28 Evidence: plan. The person had been seen by the GP and prescribed medication for a possible infection. During the inspection visit the staff noted that there may be a possible adverse side effect to this medication and had referred this back to the GP and had, meanwhile, withheld the medication. This shows that staff are communicating effectively and responding to health care needs as the arise. When we looked at the notes of the nurses visiting we saw that dates of visits were recorded but still no notes of any instructions or feedback. The manager said that the nurses make their own notes in a separate record . This was discussed as the concern would be that these notes may well be moved on in the future at some point and the home would not have their own record. Feedback information is also important in order to make any changes to the care plan. We would still recommend that some feedback notes are therefore made to evidence the homes duty of care. Residents have a plan of care so that care staff could follow the care for each resident. They are reviewed monthly and ongoing. The care plans were rather lengthy and it was difficult to be clear about current care needs as some needs had been met but were still on the plan. Some assessed needs had rather brief interventions planned. For example one person who has very challenging behavior and is leaving the home on occasions and putting himself at risk had a brief statement to reassure that he doesnt need to sleep rough. It was clear that there was good liaison with the social worker regarding his person but the care notes where not clear about the extent of the risks and how care staff should intervene. There was no guidance around boundarys for reporting concerns; for example at what point to alert authorities if missing from the home. We discussed this in some detail and would strongly recommend that all risks are assessed appropriately in the context of the persons mental capacity [see choice of home] and clear interventions are recorded on the care plan so that staff are clear about ongoing management and review. [During the inspection the manager drew up a care plan and risk assessment for the person concerned which was clear and structured]. The manager reported that the care planning format was under review following the issues raised earlier by the social worker [November 2009]. We looked at the new format being introduced and trialed for one resident and this seemed to be clearer and easier to follow. We looked at the care of one person who has poor mobility and found the care plan supported independence by ensuring the provision of disability aids [hoist and wheelchair]. The home meets with current legislation by providing disability access at all internal areas and since the last inspection the exterior grounds have Care Homes for Older People Page 13 of 28 Evidence: been made safe and accessible. This shows that the home are considering a diversity of care needs and are trying to meet these. We observed a resident being moved in a wheelchair. The wheelchair had footrests in place and the person was moved correctly and transfered to seating in the day areas. This is an improvement from the previous inspection where we had concerns regarding use of wheelchairs. Residents spoken with said that staff where helpful and respectful. We observed staff interacting well and supporting people which maintains their dignity. We saw that people where dressed appropriately and that they were clean and had good standards of personal care. We spoke with relatives who confirmed that these standards were maintained. We looked at the medicines and from the records and observations made it is clear that these are generally managed safely. Medication administration records were generally clear and recorded that residents received their medications on time. Staff reported that they are trained in medicine administration by completing an external course and also by being shadowed by the manager for an extensive period before being considered competent to administer medicines so this area of care is carried out by competent staff. One person is prescribed medication to be given when necessary [PRN]. The recording and instructions for this were still unclear although we were advised that there was some reference in the general care plan. We discussed ways that this could be made more explicit on the medication record. This is important so that all staff can be aware of why the medicine should be given and it can also be regularly reviewed. We looked at one person who is prescribed a cream to be applied daily. some times this cream is applied by care staff who do not record this fact. We discussed ways to record this and recommend that this is carried out so that an accurate record of who and at what time the cream is applied. Care Homes for Older People Page 14 of 28 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. The social life in the home continues to be developed so that people with dementia can remain engaged with their surroundings. Evidence: We were advised that activities take place after tea and biscuits at 11am and then after lunch.We saw residents taking part in a game of snakes and ladders. [A huge snakes and ladders mat on the floor]. There was a good level of interaction and some residents were directly involved while others looked on. In better weather trips to a garden centre via taxis are organised.The home have upgraded the garden area which is accessible from the dining room so that people can sit out. The area has been risk assessed and changes made so that the risk of falls is now minimal. On Sundays we were advised that two visitors from a local church came and talked with all of the residents. Everyone would then enjoy a sing along. There are a variety of animals about the place. I.e. two cats, at least one dog and goldfish, two donkeys, close to, outside. We found that people living in the home Care Homes for Older People Page 15 of 28 Evidence: enjoy this aspect although a recent complaint by visiting relatives highlighted that not all people welcome animals in such close proximity. We would recommend that this is highlighted in the homes information so that people are aware before being admitted to the home. We saw that the environment in the day areas has been improved with pictures and plants and some orientation aids such as the days menu displayed. Likewise bedroom doors have peoples names on and their are signs on toilets and bathrooms. This helps people with demetia to orientate themselves. There appeared to be a good choice of food. One resident had a bacon sandwich for breakfast and ordered a poached egg for the following day. Frozen vegetables were used as well as fresh vegetables. Mainly food for easy eating is produced so that people can continue to be independent. One visitor was pleased to tell us that on Christmas day he had lunch with his resident wife. We sampled lunch. The meal was sliced cold corned beef, mashed potatoes and frozen vegetables. The meal was nicely presented.We found the meal to be well paced and relaxed so that people could enjoy the social aspects of this time. Staff were on hand to assist with people who needed help with feeding. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are procedures available for raising concerns and managers act appropriately to keep people safe. Evidence: There is a complaints procedure available for people in the home. Those people observed were very relaxed around staff and were reassured by them so that they felt safe. Relatives spoken with said that the managers were approachable so that any concerns could be addressed. The complaints procedure is available in the guide for the home. We looked at the complaints recorded. There were three complaints recorded since the last inspection that have been investigated by the manager. The first concerned a resident went missing for a brief time from the home due to a fault on the front door. The managers response was open and the failings were corrected regarding the door. Another concern was expressed by a visiting social worker who was conducting a review of a person in the home but found that care records were not up to date raising concerns whether care was being delivered appropriately. The manager gave a very full response to this and is now is in the process of reviewing the care planning system so that records can kept up to date and act as a better communication tool. This has Care Homes for Older People Page 17 of 28 Evidence: just started to be piloted. There is a recent complaint which is currently ongoing. The issues are around the admission process for the home, personal care standards and staff competency. All of these have been looked at on this inspection. Again, the manager has produced an investigation and findings of some depth. This shows that the management of the home take complaints seriously and are willing to make changes to meet any failings. We were shown policies and procedures around the recognition and management of allegations of abuse. Copies of the locally agreed procedures were also available. Since the last inspection the home has now updated policies and procedures and have produced a whistle blowing policy that is in the newly devised staff handbook. Staff spoken with have received training in how to recognize and report abuse and were knowledgeable about identifying abuse and said were confident about this to the manager. Staff were not really aware of the wider picture in terms of understanding how investigations are conducted and the role of statutory agencies such as social services. It would be recommended that future training includes these elements so that staff are more aware of the broader picture in terms of safeguarding of vulnerable adults. The local contact number of safeguarding at social service could be added to the whistle blowing procedure so that staff are fully aware. Managers did display some understanding of what to report through the safeguarding process and have completed appropriate referrals previously and liaised with social services so that people in the home are protected. There have been no referrals to safeguarding since the last inspection. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to be developed in line with good practice so that people with dementia can live comfortably. Evidence: We toured the home and found the entrance, visitors lounge and TV lounge to be clean bright and well furnished. There were no offensive odours. A passenger lift is available so that there is level access to both floors. We were shown several of the bedrooms and here again they were clean and bright with evidence of peoples own past lifestyles and personalization. For example photographs and furnishings. The bedrooms have views out to the countryside and this was commented on by residents and relatves. Most of the people living in the home congregate in the dining area and this room has been improved since the last inspection with more pictures and plants so that is more homely. The carpet has been renewed / cleaned which was a previous requirement. There is now some orientation aids such as signs and a menu board which was up to date so that people with dementia can find their way around the home and recognise the time and day. The external grounds are now accessible for people as they are enclosed and the ground has been leveled to avoid any falls. Care Homes for Older People Page 19 of 28 Evidence: The home has been improved environmentally over the past few inspections and the managers should continue to develop the home in line with good practice in dementia care. There are suitable bathrooms and toilets available to meet the needs of disabled people. In some of these there was no hand towels available for people to dry hands. We also observed that in the laundry area there was no hand washing facilities. The manager explained that this area had been decorated and the usual hand washing facilities had not yet been replaced. The need for this is obvious in terms of infection control and must be monitored consistently. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited and trained appropriately so that care needs can be met. Evidence: The staffing in the home has improved overall over the last two inspection visits. Numbers are now consistent and that there is now a regular core of ancillary staff such as domestic staff and a laundry staff. There have also been some key care staff in post for over a year. We had some discussion around the need to maintain the current level of staffing as this will help ensure a consistent standard of care. We found evidence of ongoing training for staff. For example all new staff who have previously lacked experience are referred to an induction program run by the local authority. Staff spoken with had clearly benefited from this as it prepared them for working with vulnerable people. Some of the senior staff in the home have also attended training courses in dementia care over the past year so that they are better able to understand the care needs of people in the home.We spoke with some staff who have attended an advanced dementia course. They told us that this has helped them understand peoples care needs in more depth. The AQAA document returned by the manager states that the percentage of staff with National Vocational Qualifications [NVQ] in care has improved so that currently 6 staff have this qualification and another 2 are undergoing training . Again this is an improvement and shows that a good many of the care staff [nearly 50 ] have the Care Homes for Older People Page 21 of 28 Evidence: basic skills to carry out care. We observed the staff interacting with people in the home and found them to be supportive. We observed staff moving people and assisting with feeding as well as other care needs. The level of interaction was good and people who were able told us that staff supported them well. We looked at staff records for those staff more recently employed [since the last inspection]. We found that the staff files were generally consistent and the checks necessary to safely employ people to work in the home had been carried out. We did discuss some anomalies with the manager and have made recommendations that any gaps in employment should be recorded at interview. Also one reference was not dated and another was not clear in that the person supplying the reference did not identify in what capacity they knew the member of staff. One staff had worked in a care setting a number of years ago but not since. The references were from recent non care employment. It is important to try and get a reference from a care setting if the person has previous worked in such. This helps give a full picture of the persons fitness to work with vulnerable people. Care Homes for Older People Page 22 of 28 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 home is managed with approbate policies and systems in place so that the home can be run in the best interests of the people living there. Evidence: The homes proprietor, Mrs Maureen Bromley, is the registered manager. She has many years experience in the home and also has a nursing qualification. The deputy manager plays an important role in the day to day running of the home. There has been progress overall since the last visit and managers have been able to evidence that they have met some of the outstanding requirements. For example The staff recruitment procedures have improved and the general staffing of the home remains more consistent. This was a major concern previously and the main barrier to any progress being made with standards of care in the home. The training of staff is also now more consistent and some of the general policies and procedures have been improved and made more accessible with the input from an ISO quality assurance process. The external grounds are now accessible which, again, Care Homes for Older People Page 23 of 28 Evidence: meets a previous requirement. These all show that the management are able to work at developing standards and meeting statutory requirements. We looked at accident records and these are well recorded. We also spot checked some safety certificates such as gas and electrical and fire safety and these were up to date. The AQAA tells us that other safety certificates are all up to date. There have been some complaints since the previous inspection [see complaints and protection] but the manager as responded to each appropriately and could evidence any changes that need to be made. This shows that managers are open to criticism and respond appropriately so that the service can develop with the needs of the people living in the home in mind. Care Homes for Older People Page 24 of 28 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 28 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 26 13 All communal bathrooms and toilets as well as the laundry must have suitable hand washing facilities maintained. This is to ensure good hygiene and reduce the risk of infection. 16/03/2010 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 3 We would recommend that assessments for peoples mental capacity are introduced to the pre admission and ongoing assessments. We would recommend that the new care planning format is introduced as discussed. We would recommend that any risks are assessed and monitored through the care plan and clear guidelines for care interventions are made. 2 7 3 8 We would recommend that visiting professionals such as district nurses have their feedback and progress reports recorded in the care notes. Page 26 of 28 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 4 9 We recommend that clear instructions for any PRN [give when necessary medications] are entered on the medication record in the form of a care plan which can then be continually monitored and evaluated. We looked at one person who is prescribed a cream to be applied daily. some times this cream is applied by care staff who do not record this fact. We discussed ways to record this and recommend that this is carried out so that an accurate record of who and at what time the cream is applied. 5 14 We would recommend that the homes pets are highlighted in the information guide [SUG] so that people are aware before being admitted to the home. Any in house training needs to reference the local policies and the wider picture in terms of how abuse is reported and investigations are carried out. We would recommend that the local safeguarding contact number is included in the homes polices for staff to be made more aware. 6 18 7 29 We strongly recomend that any gaps in employment should be recorded at interview. All references should be dated and clear in that the person supplying the reference needs to identify in what capacity they knew the member of staff. We strongly recomend that the manager get a reference from a care setting if the person has previous worked in such. This helps give a full picture of the persons fitness to work with vulnerable people. Care Homes for Older People Page 27 of 28 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. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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