Care Home: Queens Care Centre

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What the care home does well The staff and the people that use the service appear to have very good relationships with each other and the atmosphere between them is relaxed. This helps the people that use the service to feel very settled and this means that they can rely on the staff for any support that they may need. People that live at the home are provided with meals that they can choose and like, however they are encouraged to follow a healthy diet including lots of fresh fruit and vegetables to try and maintain their health. People living in the home told the Commission that the care they were receiving was good. Relatives and people that live at the home said that staff were always respectful toward them. What has improved since the last inspection? The recruitment procedures for the staff have improved. This means that people that use the service are kept safe from any form of abuse. The care staff now all receive the right training to make sure that they understand the needs of the people that they are caring for and makes sure that the care if provided in a safe manner. Staff confidence has grown in relation to how they are managed and are supported in their roles. This means that they will be more positive in the approach to their roles and responsibilities. The management of the home are working well with the local authority to improve the quality of care that is being provided by the home. The new assessment and care planning documentation will also help to support more appropriate individual care being provided to the people that live at the home. What the care home could do better: The home needs to improve its infection control policies and procedures. This will help to promote the health and safety of the people that live and work at the home. Staff need to be provided with regular supervision to make sure that they have the right knowledge and skills to safely care for the people that use the service. The assessments and care plans for people that use the service need to be looked at on a more regular basis to show that they are still appropriate to meet the needs of the individual concerned and to make sure that they are being cared for safely and properly in the home. The service needs to respond to peoples needs more appropriately and minimise any health risks due to any delay in referring to appropriate health care support.The home needs to respond more appropriately and effectively to any concerns raised or accusations made in relation to safe guarding adults. Key inspection report Care homes for older people Name: Address: Queens Care Centre Millard Lane Maltby Rotherham South Yorkshire S66 7NA     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: Stephen Robertshaw     Date: 2 2 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Queens Care Centre Millard Lane Maltby Rotherham South Yorkshire S66 7NA 01709818181 01709769756 queenscarecentre@msn.com www.queenscarecentre.co.uk Z.A.K. HealthCare Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 70 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of users who can be accommodated is 70 The service may admit up to 4 persons between the age of 55 to 65 years whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Queens Care Centre is situated in Maltby within a short walking distance of all local amenities. The home is attached to a Health Centre from which the Registered Person operates his GP practice. The home accommodates older people that require 24-hour personal care. It is a purpose built home with accommodation situated on two floors; the first floor is accessible by a lift and staircases. All bedrooms are single occupancy Care Homes for Older People Page 4 of 31 Over 65 70 70 0 0 0 6 0 1 2 0 0 9 Brief description of the care home with the exception of four double rooms, which at present have single occupancy and will remain so whilst occupied by the existing service users. There is an intention that in the future these rooms may be used for wheelchair users that need additional space (as opposed to double occupancy). There are two lounge areas, both of which accommodate dining areas and a kitchenette. The home has a non-smoking policy for both staff and residents. There is a pleasant, sheltered garden/patio area in front of the building. The home is owned and operated by Z.A.K. Healthcare. At the time of the site visit the current fees for the service were between £366-£411 per week. Further information is available in the homes service user guide that is available both in written and CD-rom formats; these can be obtained from the management at Queens Care Centre. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of this service included analysis of the information received by the Commission since the last key inspection of the service.This was an unannounced key inspection The site visit to the home took place on the 22nd March 2010. The Commission was in the home for approximately six and a half hours and was made to feel very welcome by all of the people that use the service, visitors and staff working in the home. Three surveys were returned from people that use the service before this report was completed and elements of them have been included in the text of the report. The Commission also spoke with seven people that live at the home and four family/ friends that were visiting the home on the day of the inspection. The deputy manager and the proprietor of the home were given verbal feedback during Care Homes for Older People Page 6 of 31 and at the end of the site visit. The Commission checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection. The progress made has been reported on under the relevant standard in this report. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The home needs to improve its infection control policies and procedures. This will help to promote the health and safety of the people that live and work at the home. Staff need to be provided with regular supervision to make sure that they have the right knowledge and skills to safely care for the people that use the service. The assessments and care plans for people that use the service need to be looked at on a more regular basis to show that they are still appropriate to meet the needs of the individual concerned and to make sure that they are being cared for safely and properly in the home. The service needs to respond to peoples needs more appropriately and minimise any health risks due to any delay in referring to appropriate health care support. Care Homes for Older People Page 8 of 31 The home needs to respond more appropriately and effectively to any concerns raised or accusations made in relation to safe guarding adults. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service needs to improve the quality of the pre-admission assessments to make sure that the home can meet the needs of the people that are admitted there. Evidence: The Commission looked at the care files for five of the people that live at the service. There had only been one new admission to the home since the last inspection of the service and that was to a person that was private funded. All of their care files included assessments of care needs that had been identified before they had been admitted to the home and that identified that the home could support all their needs. The pre-admission assessments were a combination of the homes pre-admission assessment and care management assessments of need.The homes pre-admission assessment documents were quite limited in the information that they collected. Much Care Homes for Older People Page 11 of 31 Evidence: of the information was recognised by tick boxes and did not give any clear indication of what actual difficulties people had and how people wanted to be supported with their needs. The registered manager of the service was not available on the day of the site visit, however the deputy manager said that the service were in the process of developing a more person centred approach to the assessment of peoples individual needs. She stated that this would make sure that nobody would be admitted to the home with needs that the home could not safely support. People spoken to by the Commission said that they had been given the opportunity to visit the home before they decided to move there on a more permanent basis. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This means that the home needs to implement new care plan information that relates more clearly to the needs of the individuals that use the service. Evidence: The Commission observed the care files for five of the people that use the service and case tracked their care at the home. This means that we looked at all of the information that had been recorded in the home in relation to the care and support that they received. All of their individual care files included care plans to identify how their needs should be met at the home to make sure that they remained appropriate to the needs of the individuals concerned. These need to be evaluated on a more regular basis due to the changing needs of most of the people living in the home and the need to implement new care plans to suit their needs. This included water low assessments that recognised high risk patients and the assessments were not reviewed or evaluated over a five month period. This would make it difficult to monitor any changes in peoples skin integrity. One persons pressure area care plan had not been updated since December 2009. Care Homes for Older People Page 13 of 31 Evidence: A moving and handling assessment of need and care plan stated that a person was weight bearing, wheelchair variable with no explanation of what this meant. Another persons care file had behaviour management concerns identified in their assessment of need, however there was no care plan in position to support these needs for the individual involved. There was a record of any behavioural problems that occurred but as stated there was no plan to support these needs. The care plan section of the care files include a definition of competency form. These provide very little detail and only refer to a grid A-E. The form does not allow additions of of how peoples capacity needs may affect them and the support that they need. The people that use the service have their health care needs met through various health care professionals that are based in the community including GPs, hospital consultants, dentists, chiropodists and district nurses. However the recent safe guarding investigations at the home identified that peoples health care needs had been responded to slowly and earlier interventions should have been sought minimising the risk of further health problems to people that use the service. The deputy manager of the home stated that the service had received a great deal of support form the local authority and following this the service was going to introduce person centred care planning for all of the people that use the service. She stated that this should make sure that all of the above problems are resolved. The new documents were shown to the Commission and they looked as if they would be more appropriate to the care needs of the people that use the service, however they needed to be defined more to relate to the actual service. All of the staff in the home that administer medication had received accredited medication training. This helps to make sure that the health, welfare and safety is maintained for the people that use the service. The medication fridge was also checked. The senior members of the care staff and the deputy manager of the service stated that at the beginning of April 2010 the home was changing to a new provider for their prescribed medication. One person said This should provide better delivery and better administration of medication. As part of the inspection process it was identified that the provider for the service was acting to prescribe medication to some of the people that live at the home. This is against good working practises. The registered person must make sure that everyone that uses the service are registered with a GP that is independent of the home. Care Homes for Older People Page 14 of 31 Evidence: Direct observations supported the evidence that the service users privacy, dignity and respect are upheld at all times at the home. People that use the service stated to the inspector that its good here and another person said that the staff are friendly and happy. This helps to support the evidence that peoples dignity and respect is upheld at the home. Before the inspection took place the Commission received three questionnaires back from people that use the service. These were all positive in relation to the care and support that they receive at the home. One person commented that the home provides a clean environment and kindness to residents. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is working hard to improve the quality of peoples daily lives and has introduced new activities for them to become involved in. Evidence: The routines in the home were observed to be very flexible. People that sue the service are provided with the choice of what time to get up from and retire to bed. This was confirmed through direct observation undertaken by the inspector and discussions with people that use the service, visitors and care staff. One person said I get up when i want to, I always get up early. The Commission also spoke with three visitors to the service and they all confirmed that they are made to feel welcome any time that they visit the home. One person stated the staff are friendly and the environment is very good. The people that use the service and visitors confirmed that the home has a variety of communal areas that can be used for visits and that the peoples individual rooms can also be used if they prefer this for privacy. A mealtime at the home was observed by the Commission. The food that was provided was well presented and was very tasty. The people that use the service told the Care Homes for Older People Page 16 of 31 Evidence: inspector that the meals were always very good. One person said good dinners here. Two questionnaires returned to the Commission before the site visit confirmed the evidence that meals that people that use the service experience a good quality of food provided at the home. One questionnaire stated good food daily and another commented good meals under the section of the question what the home does well. Staff were observed offering support to individual service users to enable them to eat their meals. This was seen to be done whilst at the same time upholding the dignity and respect of the service users involved. There were no special diets required by the service users in relation to cultural or religious needs, however some service users required low fat, low sugar or semi-soft meals. The Commission also looked around the homes kitchen. This was found to be very clean and was well organised. There were plenty of stores and these were all within the specified safety dates. All of the appropriate recordings were maintained in the kitchen for the temperature of meat when received, the temperature probes of all hot meals and regular temperature monitoring of the kitchens fridges and freezers. The people that use the service were generally very happy with their lifestyles at the home, however the activities in the home were very limited and one person said theres nothing to do. One of the questionnaires returned to the Commission by a person that uses the service commented under the section what could the home do better maybe more stimulation for residents who are able to do so. It is important that people have the opportunity to participate in stimulating activities of their choice, taste and personal preference. This will help to improve their quality of life while they are resident at the home. However approximately two weeks before the site visit the management of the service had employed a new activity coordinator. A new programme of activities was displayed on the walls in the home and activities were observed to be offered during the afternoon at the home. This included singing familiar songs and some hand crafts and bingo. The deputy manager of the home said that it was a priority for the service to provide interesting stimulation for the people that live at the home. This also needs to be developed for the people that use the service and have memory related problems. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has worked closely with the local authority to improve the protection of the people that use the service. Evidence: Since the last inspection of the service there had been seven cases referred to the local safeguarding adults team. These were all very similar and related to poor standards of care, or institutional care. At the time of the site visit none of these investigations had been resolved. The local authority had placed a temporary embargo on admissions to the home limiting it to 26 beds.However the local authority had put together an action plan for the service that would help them to move forward in a positive manner.Discussions with the local authority and observations made during the time of the site visit supported the evidence that the home had implemented all of the changes that the local authority had requested. This included the managements plan to introduce new paperwork to create person centred assessment and care at the home. This cannot be tested fully until the home begins to admit new people to the service. The local authority had also supported the home through providing safeguarding training for all of the homes staff and have also offered to support the home with the mandatory training of the care staff group. The deputy manager of the home stated that this could be established on a rolling programme. Care Homes for Older People Page 18 of 31 Evidence: People spoken to by the Commission were all very positive in relation to the standards of care that they receive at the home. Visitors to the service were also very positive in relation to the standards of care that they observed being offered at the home. The Commission observed the complaints records for the home. Since the last inspection there had been no formal complaints made in relation to the services provided at the home. People spoken to by the Commission were aware of the complaints procedure but stated that they had not had any cause to use the procedure. The complaints procedure was also available in the public areas of the home so that visitors to the home could also access it. The home also needs to review its employment policies and procedures to safeguard the people that use the service. This includes receiving a full Criminal Records Bureau safety check before they are employed to work at the home. This will be referred to under the recruitment section of this report. At the time of the site visit for the service the local authority were still heavily involved in supported the home and the people that work there. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is safe and suitable to the needs of the people that use the service. However there are some areas that could be improved in relation to infection control. Evidence: The Commission made a tour of the premises as part of the site visit and found the home to be very clean and tidy. People that use the service and visitors on the day of the site visit all commented on how clean and tidy the home was. One person in their questionnaire stated the rooms are always warm and cosy. the new rooms are very nice and comfortable. Another person commented that the home provides clean bed and linens. There are a variety of communal areas that people can choose to use to see their family, friends and to interact with the other service users. The communal areas and the individual bedrooms were clean and had been pleasantly furnished and decorated. People that resided at the home on a permanent basis had bedrooms that were personalised to their own tastes and preferences. The bedrooms had privacy locks and lockable facilities to keep their belongings safe. Hot water outlets accessible to people that use the service are monitored to ensure safety and prevent scalding. The temperatures of the water are regularly checked to Care Homes for Older People Page 20 of 31 Evidence: make sure that they are safe for people to use. However these temperatures need to be maintained close to 43 degrees Celsius. The records observed by the Commission ranged from 10-54 degrees at the hot water outlets. Records seen in the home included a legionella safety check and the certificate was available to the inspection. The kitchen was kept very clean and tidy and was well organised. The kitchen facilities at the home had recently been awarded a 4* star rating from the local authority environmental health services. There are sufficient toilets and bathrooms in the home for the use people that live at the service. However at the time of the inspection most of the bathrooms and toilets had blocks of soap left in them and included linen hand towels. This could cause infection control difficulties in the home. The staff training records identified that the care staff do undertake infection control training and the management and staff spoken to by the Commission were all aware of the policies and procedures for infection control in the home. Major building work had been completed since the last inspection of the service. The temperature in the communal areas of the home continue to be quite high. Staff were observed using protective aprons and gloves. The homes laundry was sited away from food preparation areas and the washing and drying machines were to industrial standards. The washing machines have automatic feeds on them. This means that there is less risk of workers coming in to contact with caustic substances. The environment of the home was generally very good, however the green hall carpet on the second floor and the green stair carpet needed some attention to make sure that they did not present any trip hazards. A radiator at the bottom of the stairs was also hanging off its brackets. The management of the service should also limit access to the homes stores cupboards to minimise the risk of cross infection. the sluice room door should also have a bolt fitted to it to make sure that only people that need to access this area can walk in. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This means that the staff are beginning to receive the training that will make sure that they have the necessary skills and knowledge to safely care for the people that use the service. Evidence: There are sufficient staff on duty at all times in the home to meet the services commitments to the people that live at the home. There are no staff that are under twenty one working at the home. The home have made a strong commitment to make sure that 50 of the care staff to have achieved NVQ 2 in care or equivalent. Six members of staff have completed NVQ 3 in care and 4 others have completed NVQ2 in care. The deputy manager stated that some of the remaining staff are registered on the award and are working towards it. She could not say how many as she had only recently taken up her position at the home and this had not been determined. The staff group working in the home is very consistent and most of the staff had worked in the home for a considerable length of time. They also confirmed to the Commission that they receive in excess of three paid training days per year. The staff training records and interviews with the staff group supported that they had all Care Homes for Older People Page 22 of 31 Evidence: recently been involved in mandatory training and safeguarding training that had been provided through the local authority. One member of staff commented this is the best home that I have ever worked in. One of the questionnaires returned to the Commission by a person that uses the service commented staff will do anything that I ask of them. The recruitment procedures for the home need to be improved to make sure that the health, safety and protection of the service is upheld at all times. This includes that staff must not be employed to work at the home until after they have received a full CRB check. One staff file seen by the Commission did not include a completed CRB before the member of staff commenced working at the home. This was also identified in the safeguarding section of this report. If staff do not have a new CRB before they commence working at the home, then this could put the people that use the service at risk of abuse. The deputy manager stated to the Commission that the training department of the local authority were instigating a rolling programme of training for residential care staff to make sure that all of their training is maintained and kept up to date. Direct observations supported the evidence that the care staff have the necessary knowledge and skills to understand and care for the needs of the people that live at the home. A visitor to the home commented to the inspector there are always plenty of staff around, they are very friendly and helpful.The surveys returned to the Commission were also very positive in relation to the professional abilities of the staff. The only thing that was identified to improve the staff more staff available. Staff interviewed by the Commission said that they enjoyed working at the home and got a lot of job satisfaction from their work. The staff are currently involved in a great deal of training, however it will take time to determine if the training that they have received has been put in to practice. As many of the safe guarding issues that have been raised in the home have related to the quality of the care provided, the staff skills and knowledge will need to be monitored to make sure that they have all of the knowledge and skills to safely care for the people that live at the home. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management structure in the home is being developed to make sure that it can support the needs of the people that use the service and the needs of the people that work there. Staff need to be provided with regular supervision to ensure that they can safely carry out their roles. Evidence: At the time of the site visit the manager of the service was not available. The deputy manager of the home was available. She had only been employed by the home for approximately two weeks. The deputy manager of the home had completed NVQ 2,3 and 4 in health and social care. There are clear lines of accountability and responsibility in the home. The current management approach to the home provides an open, positive and inclusive atmosphere. Staff stated that this had improved over recent times. Care Homes for Older People Page 24 of 31 Evidence: The home does not have an adequate quality assurance and monitoring system in position. It is important that the service seeks the views of other people about the services that they provide. Questionnaires should be sent out to people that use the service, their families and outside professionals that are involved in the care of people living at the home. The returned questionnaires should then be analysed and an action plan should be created showing how the home will maintain or improve the services being delivered through the home. The service users in general are responsible to look after their own finances whilst they are in the home and have a safe lockable area in their bedrooms to keep their belongings. The inspector randomly checked the personal accounts for three of the people that use the service and all of their records were up to date and had been accurately recorded. The care staff files observed by the inspector showed that they had not received the recommended minimum for formal supervision. The management of the home must provide regular formal supervision for all of the staff to make sure that they have all of the knowledge and skills to safely carry out their roles at the home The deputy manager of the home was aware that this standard needed to be improved and said that this would be one of her priorities. The records for the maintenance and servicing of all of the equipment in the home were up to date and had been accurately recorded. The service had a copy of the homes fire, gas and electrical systems safety certificates. The proprietor of the service was approachable and stated that it was his intention to raise the standards of care at the home. Staff, visitors and people that live at the home all commented that the proprietor was approachable and was accessible if they wanted to speak to him. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must make sure that peoples individual care plans clearly identify how they should be supported with their needs at the home. This will help to support the health and safety of the people that use the service. 28/04/2010 2 18 13 The registered person must make sure that peoples health and social care needs are continually assessed to make sure that any changes are appropriately supported at the home. This will help to maintain peoples personal health and minimise any risk of abuse. 28/04/2010 3 26 16 The registered person must make sure that bathrooms and toilets are free form the possibility of spreading infection through sharing towels and blocks of soap. 15/04/2010 Care Homes for Older People Page 27 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will help to support the health and safety of the people that use and work at the service. 4 29 33 The registered person must make sure that before any staff are employed to work at the home they have received all of the appropriate safety vetting including a full enhanced CRB. This will help to support the health safety and welfare of the people that use the service. 5 33 24 The registered person must make sure that the home has an effective quality assurance and monitoring system in position. This will make sure that the home is taking in to account the thoughts of other people in relation to the services that the home offers. 6 36 18 The registered person must make sure that all of the care staff working in the home receive a minimum of six formal recorded supervision periods per year (pro rota) 23/08/2010 31/05/2010 27/04/2010 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will help to make sure that the staff group have all of the skills and knowledge that they require to safely care for the people that use the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The registered person should make sure that the homes pre-admission assessment documents provide sufficient detail to ensure that peoples individual needs cam be met at the home. this will make sure that people are cared for in a safe way that is acceptable to them. The registered person should make sure that all care plans and risk assessments are regularly reviewed and evaluated to make sure that they are still appropriate to support the needs of the individuals that use the service. This will help to support the health, safety and welfare of the people that use the service. The registered person must not be responsible for the prescription of medication to anyone that uses the service. This will help to make sure that medication is only prescribed by an independent doctor and will support the health and safety of the people that use the service. The registered person should make sure that the development of stimulating activities in the home is acceptable to all of the people that use the service. This will help to improve the quality of life for the people that use the service. 2 7 3 9 4 12 5 25 The registered person should make sure that at all of the hot water outlets the temperature is close to 43 degrees Celsius. Page 29 of 31 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 This will protect people from scalds and also make sure that there are no infections in the water system 6 26 The registered person should limit access to the storage areas in the home. This will help to prevent cross infection at the service. The registered person should continue with the homes commitment to NVQ training and make sure that a minimum of 50 of the care staff have achieved NVQ2. This will help to make sure that the staff group have all of the necessary skills and knowledge to safely care for the people that use the service 7 30 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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