Care Home: Quenby Rest Home

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What the care home does well The service is currently offering a wide range of activities for the people using the service. There is a regular and varied activity programme. Quenby Rest Home offers a warm friendly environment where residents feel relaxed and at home. As part of the inspection process we conducted a Short Frame Observational Inspection (SOFI). The SOFI took place over an hour and a half and involved directly observing a number of identified people using the service and recording every five minutes their experiences of using the service. The persons experiences were recorded by identifying their state of being, any engagement they received or had and with what or who and the level of staff interaction. Five people were identified as part of this SOFI. The SOFI took place in an open plan living area where a number of people were sitting. The SOFI showed a high level of positive staff engagement and showed that many of the people using the service were able to enjoy engaging with one another also. Results also determined that those people who were observed for the specified period of time generally experienced a positive state of well being. Staff were directly observed to interact well with those people being observed, with dignity and respect for the individuals. The SOFI tool is able to show how people using the service experience the services provided. It is able to show how person centred a care worker may be whilst engaging with a person. On a number of occasions positive manual handling practices were observed to occur further respecting and dignifying people. The service offers a nutritional, well balanced menu, meeting the needs of the people using the service. People using the service are able to make active choices over the foods they are consuming. A sample of the food available was tasted. It was well displayed with a good consistency and taste. People were directly observed to be enjoying the food available. One person using the service stated "I like the food". The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. The staff working at the service were directly observed engaging with all people in a respectful and dignified manor. Many people commented on the staff. One person using the service stated "the staff are all so lovely, kind and caring". What has improved since the last inspection? A number of improvements have been to the service since the last inspection. This includes a revision of the assessment process. In addition to this a new television has been purchased for the middle lounge, including new chairs and accessories for the general living areas. A number of rooms have been redecorated, including some carpets and floorings replaced. What the care home could do better: A high number of requirements have been made as part of this inspection process and include the need for the service to revise the Statement of Purpose and Service User Guide as these were out of date during the inspection. In addition to this the complaint and compliments policy and procedure was out of date and all other polices and procedures required reviewing. At the time of the inspection the service did not have the local authority multi agency safeguarding policy and guidance. There is a need for the service to further explore equality and diversity issues and ensure that this is truly reflected in the care plan. Where risks are identified as part of the assessment process then suitable assessments must be completed in line with the services own policy and guidance. Temperatures must be recorded where medication is being stored to ensure that it is being stored as prescribed by the manufacture. In addition to this all controlled drugs must be managed in accordance to relevant legislation. Hand written entries should be double signed and a management systems should be introduced to ensure that all topical medications are suitably administered with accurate records being maintained. The service would benefit from a review of the activity resources available. The service requires works to be completed in relation to the environment, this includes the re decoration of a number of communal areas including walls and paint work. In addition to this the flooring in the kitchen is to be replaced. Following a visit from the fire authority the service is required to fix smoke seals and door opening devices to a number of doors. All Control of Substances Hazardous to Health (CoSHH) materials but be suitably stored, assessed and reviewed. Risk assessments must be in place for the management of fire and the stairs to the first floor. Risk assessments must be completed with suitable management and control of risks identified. Fire drills must take place and be accurately recorded. A review of the fire aids and equipment available in the event of evacuation or to a place of safety must be reviewed. Bathrooms must not be used as store rooms. The responsible individual must ensure that there is a qualified, competent manager who is registered with the Care Quality Commission. Key inspection report Care homes for older people Name: Address: Quenby Rest Home Brightlingsea Road Thorrington Colchester Essex CO7 8JH     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: Louise Bushell     Date: 1 1 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 38 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 38 Information about the care home Name of care home: Address: Quenby Rest Home Brightlingsea Road Thorrington Colchester Essex CO7 8JH 01206250370 01206250787 enquiries@quenbyresthome.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Ajvinder Sandhu and Mrs Rajwinder Sandhu Name of registered manager (if applicable) Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Persons of either sex aged 65 years and over, who require care by reason of dementia (not to exceed 11 persons) Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 26 persons) The total number of service users accommodated in the home must not not exceed 26 persons Date of last inspection Brief description of the care home Quenby is a former domestic dwelling located on the main Colchester Road to Brightlingsea. The property is among established houses of similar age and design. The Care Homes for Older People Page 4 of 38 Over 65 11 26 0 0 Brief description of the care home premises have been extended to the rear to provide the current accommodation comprising of mainly single rooms, most of which have en-suite facilities. There are four lounge/dining areas located to the front, centre and rear of the building providing varied and accessible space. The front garden is mainly laid to hard standing for vehicle parking. The rear garden is mainly laid to lawn with shrubs and trees. The ranges of fees charged by the service are between £367.00 and £495.00 per week. There are additional charges for hairdressing, chiropody and staff and some activities. The provider provided this information to the Commission in August 2006. Care Homes for Older People Page 5 of 38 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 focus of the inspections undertaken by the Care Quality Commission is based upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting a number of people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The last key inspection took place on the 10th January 2008. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Care Quality Commission. We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection. We also looked at the Annual Quality Assurance Care Homes for Older People Page 6 of 38 Assessment (AQAA) and reviewed what the service has improved in the last twelve months and its plans for the next twelve months. During the visit information was gathered directly from the staff, people who use the service and relatives and or visitors to the service. The visit took place between 9:30am and 16:30pm. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and the manager on duty. Part of the inspection process invloved a Short Frame Observation Inspection (SOFI). The SOFI is a tool we can use to observe people using the service every five minutes. The aim of the observation is to observe the experiences of the individuals. The findings from the SOFI were fed back to the manager of the service at the end of the inspection. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? A number of improvements have been to the service since the last inspection. This includes a revision of the assessment process. In addition to this a new television has been purchased for the middle lounge, including new chairs and accessories for the general living areas. A number of rooms have been redecorated, including some carpets and floorings replaced. Care Homes for Older People Page 8 of 38 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 9 of 38 order line 0870 240 7535. Care Homes for Older People Page 10 of 38 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 11 of 38 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. The people using the service can be assured that their individual needs are assessed prior to moving into the service. Evidence: The admission of new people to the service aims to involve the individual as much as possible. The AQAA tells us that a comprehensive initial assessment and needs assessment based on National Minimum Standards and Alzheimers society standards are in place for each service user. During the inspection three peoples assessments and care plans were case tracked. Case tracking is a method used to review a persons care package and reviews the person from the assessment stage to the current stage in their lives, including assessments, care planning, risk management and health issues. Where possible the people case tracked are also visited to gain their views directly. Indirect and direct observations also occurred in order to establish if the care being provided was as per the care plan. Care Homes for Older People Page 12 of 38 Evidence: All three of the assessments reviewed showed that people had received an initial assessment prior to moving into the service. For those people who are funded by social services on all occasions an assessment had been received from the local authority. The assessment process aims to involve the person as much as possible and there was evidence that the service had attempted to involve family members, friends and or representatives where possible. The assessment also explored some areas of preferences for the person, for example the religious needs of the person and some of their preferences in relation to food likes and dislikes. In addition to this there is a form called my day routine. This documents aims to explore the wants and needs of the person. One person using the service stated before I moved here, the manager visited me and went through the papers with me. She talked me through the guides, they were all very courteous and we had lots of information. The assessment process sets out each separate area of need and how the service is able to meet individual needs. Of the three people case tracked the assessments were generally well completed, however minor gaps were identified. For example there were gaps in the individuals risk assessments and the life history was rather sparse in information.The pre admission assessment does explore some areas of difference and diversity and identifies the persons preferred name, religion, age, ethnic group and wishes in the event of death or a terminal illness. The form also explores marital status but does not prompt or identify civil ceremony and partnerships. The AQAA tells us that initial assessments are more comprehensive and once a resident is admitted, we cross check if they are any different from the contents of the initial assessments as certain aspects of care needs may not be completely drawn up from initial assessment. The service has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service users guide, which provides basic information about the service and the specialist care the service offers. The guide is made available to individuals in a standard format. These documents, although available and on display within the service, were out of date. Ten people were surveyed as part of this inspection. of the questionnaires received all people stated that they received enough information and have been given written information about the terms and conditions of the service. The service does not provide intermediate care. Care Homes for Older People Page 13 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their immediate social and health care needs will be met, however additional risks may not have been fully identified. Evidence: The care plans of three people living at the service were read to determine how the service supports the needs identified in the persons initial assessments. All the plans seen were completed and followed a format that provided information about the persons abilities and how staff should support these. The care planning format followed the information obtained during the assessment process. Each area of need was identified in a separate care planning tool and covered items such as a safe environment, eating and drinking, personal hygiene, elimination, dressing, communication, mobility, sociability, oral / mouth care and foot care. Each of the care plans detail the identified need for the individual person followed by the individuals need and outcomes for delivery of the care and support. Each of the care plans seen, followed the same format. One person using the service commented Its lovely here, the staff are so kind and Care Homes for Older People Page 14 of 38 Evidence: caring. In addition to this a further person stated the staff are always really kind to us. A number of relatives were seen during the inspection process, they were seen not to be restricted by the services visiting hours and were relaxed within the service. The manager was observed to be engaging with all relatives throughout their visit, answering questions and updating them with information. It was observed that a number of relatives were reviewing the care plan of their relative with them and signing to state that they are aware of the care plan and happy with its content. One person using the service stated we are given a copy of our care plan once a month and I sign it. Its very comprehensive you know. The practices observed throughout the day, by staff were respectful and caring at all times. It was pleasing to find that the care plans, did focus on the specific needs of the person. For example the individuals hobbies and interests were recorded. As part of the inspection process we conducted a Short Frame Observational Inspection (SOFI). The SOFI took place over an hour and a half and involved directly observing a number of identified people using the service and recording every five minutes their experiences of using the service. The persons experiences were recorded by identifying their state of being, any engagement they received or had and with what or who and the level of staff interaction. Five people were identified as part of this SOFI. The SOFI took place in an open plan living area of a lounge, where a number of people were sitting. The SOFI showed a high level of positive staff engagement and showed that many of the people using the service were able to enjoy engaging with one another also. Results also determined that those people who were observed for the specified period of time generally experienced a positive state of well being. Staff were directly observed to interact well with those people being observed, with dignity and respect for the individuals. The care plans give instruction to staff in meeting peoples needs, and from observation and discussions with people living at the service and the staff group there was evidence of knowledge of the individuals and their needs. The files also contained risk assessments relating to the moving and handling needs of people living at the service. These gave an indication of the persons strengths and weaknesses that affect the outcome of their movements. A number of risk assessments had been completed as part of the initial assessment and care planning process. This included a pressure sore assessment and manual handling assessment. This occurred a number of areas for example, mobility, walking abilities, falls, fire and smoking, self harm, self neglect and abuse. It was observed however that these risk assessment had not been fully completed. This was brought to the attention of the manager on duty. Risk assessments identify and support the service in determining a proportionate response to risks presented in peoples daily living whilst recognising their rights to live their life Care Homes for Older People Page 15 of 38 Evidence: in as independent a way as possible. Without the process of risk assessment the service is unable to ensure these rights and protection of an individual are supported. The AQAA tells us that relevant organisations like local PCTs are contacted where required. Service user pressure sores and falls are managed according to the clinical trigger guidelines. Psychological health, hearing and eye tests of service user are also managed effectively. Medication administration complies with guidelines of Royal Pharmaceutical Society of Great Britain. Service users feel they are treated with respect, dignity and their right to privacy is upheld. The service maintains records that monitor peoples health and wellbeing such as regular checks on their weight and fluid intake. This provides tools that give indications of changes in the persons wellbeing which may require action by the service. The service uses a number of recognised tools to identifying deterioration in a person specific health area, which in turn alerts the service to other possible health issues associated with the deterioration. It was evident that these documents had been reviewed. Visits made by medical professionals such as GPs or District Nurses were maintained on peoples files, and included the reason and outcome of the visit. Changes made as a result of these visits to the individuals support or medication were transferred to their care plan and medication records. This helps staff understand how the persons changing medical needs are to be met. Feedback was gained from several social and health care professionals as part of the inspection process. One Community matron commented I have been been visiting the home as a community matron on a weekly basis since August 2009. Staff are always helpful, show concern for residents. Always report any concerns / issues to me regarding residents and follow through my advise / instructions I have discussed with them. One person using the service stated I feel well cared for here, they are kind and respectful, to us all. In addition to this one person who completed a survey stated the staff is very kind helpful and caring. The management of medication administration was reviewed as part of this inspection visit. This included the indirect observation of staff administering the lunchtime round, checks on documentation and discussion with the manager on duty. A number of areas were highlighted during the inspection conducted on the medication systems. The shortfalls included hand written entries being made on the Medication Administration record (MAR) by care workers, topical medications not being appropriately signed for due to the medication being stored in the persons own room and temperatures were not being recorded where medication was being stored. Care Homes for Older People Page 16 of 38 Evidence: In addition to this a discrepancy was observed in the stock level of a controlled drug. It was also observed that the service were pro active in adding a date of opening to all bottles and boxs and that the service holds a positive relationship with the pharmacy used. One person using the service commented this is my best place. Care Homes for Older People Page 17 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that there social needs and preferences are met with a variety of activities and stimulation. Evidence: Staff are aware of the need to support people to develop their skills, including social, emotional, communication, and independent living skills. People are consulted or listened to regarding the choice of daily activity, but this process could be improved. The service is not currently providing an activities co ordinator, however recruitment is under way. In addition to this there is a volunteer who provides a variety of hours on a weekly basis. it was directly observed during the inspection the volunteer worker, playing bingo, chatting and holding discussion groups with the people using the service. People using the service are given the opportunity to take part in a number of activities within the service. Where possible, staff gather information on communitybased events and try to make individual arrangements for people to attend. However due to the number of people residing at the service, the frequency of community base trips is minimal. The service does not have a standardised activity programme and tends to provide activities as per the mood and agreement with the individuals. Care Homes for Older People Page 18 of 38 Evidence: The initial assessments held on the persons care plan detailed some references to a persons life style and interest, although this is sometimes not fully completed. The plan also details a section where information is obtained regarding the persons family, working life and what the individual enjoys. There were care plans relating to the social needs of people there were not specific details of how the assessed needs and abilities of people shaped their choices and how staff should support these. People who live at the service said that they felt they were given opportunities to exercise choices during their day. One person spoke about how they enjoyed spending time in their room and actively chose not to take part in activities provided or outings. They felt that this was respected although staff never forgot to offer the opportunity to take part. One person using the service commented we like it here really, the staff are so caring they really are. Another person spoke about the choice of meals and felt confident that if they chose something else from the offered menu this would be not be a problem, they said the food is always nice. In addition to this one person stated we can more or less do what we like, they are all very good to us. The menu is planned in advance and people are asked for their choice for the following days meals. The menu includes at least two choices at each meal and provides a nutritious and balanced diet. The inspector sampled the food during the inspection and found it to be well presented and tasty. There is a menu board on display in the lounge with pictures of meals and utensils. The observation of the lunchtime meal indicated that there was generally a congenial atmosphere where people were given time to eat in a relaxed manner. The staff moved around the dining room serving the meal, encouraging people to eat and offering assistance if required. Throughout the service there are displays of art work completed by a number of individuals. This gives a homely and friendly feel to the environment. During the inspection it was observed that eight people were participating in bingo. All people engaged appeared to be enjoying the opportunity. It was observed however that the provision of resources could be improved to make the experience easier for the people using the service and the staff providing the activity. During the SOFI, there were many examples of positive engagement with people using the service and positive examples where people personal choices and Care Homes for Older People Page 19 of 38 Evidence: preferences were noted. Examples of this include the wish the take holly communion, meal choices, drink choices and participating in activities. Activity records are maintained which displays what a person has engaged in during the day. However the records are not a true reflection of all the engagement occurred. The service could record significantly more to reflect the positive outcomes for people. Care Homes for Older People Page 20 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the service can be assured that their views will be listened to and that staff understand how to protect them. Evidence: The service has an open culture that allows people to express their views and concerns in a safe and understanding environment. Individuals and others involved with the service say that they are happy with the service provided, feel safe and well supported by an organisation which has their protection and safety as a priority. One person using the service commented that I have no complaints at all. The service has a complaints procedure that is clearly written and easy to understand. The procedure is available to in the the Statement of Purpose and is on display in the foyer of the building. However the procedure is out of date and requires the revised contact details of the Care Quality Commission to be added. The AQAA tells us that the service has received two complaints in the last twelve months and it reports that one hundred percent of these have been managed within a twenty eight day period. Individuals and others involved with the service understand how to make a complaint and are clear about what will happen if a complaint is made. The service keeps a record of complaints, however the record is not detailed to provide a full history of actions taken. The AQAA tells us that our management team have shown excellent knowledge, capacity in dealing with any alleged abuse and in completing referrals Care Homes for Older People Page 21 of 38 Evidence: forms and by co-operating with other agencies and by setting an example to all staff. All stakeholders are engaged and are encouraged to complain and compliment, where relevant. Although the service has responded very well to any safeguarding issues, the service does not have an up to date policy and procedure in place. On the day of the inspection the service did not have a copy of the local authority multi agency procedure either. Staff working at the service know when incidents need external input and who to refer the incident to. The service has recently managed a safeguarding alert in line with local authority procedure. This is now closed and no further action was taken. The service is currently managing a complaint with support from the local authority. There is a clear system for staff to report concerns about colleagues and managers. Seven staff were surveyed and all confirmed that they have enough support, experience and knowledge to meet the different needs of the people using the service. All people surveyed commented that the service provides high levels of good quality care for the residents. During and throughout the inspection all staff were seen to positively interact with people with full respect and dignify for them as individuals. The home understands the procedures for safeguarding adults and will always attend meetings or provide information to external agencies when requested. There are a low number of referrals made as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. The outcomes from any referral are managed well and issues resolved to the satisfaction of all involved. Training of staff in safeguarding is regularly arranged by the service and the manager reported on the day of the inspection that a further training session on safeguarding adults is scheduled. The Commission monitors the outcomes of safeguarding referrals and considers how the findings of any investigation indicate the services compliance with the Care Homes Regulations 2001. Care Homes for Older People Page 22 of 38 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. People using the service reside in a homely environment, however additional redecoration work and essential maintenance work is required to ensure people continue to be in a safe, well maintained environment. Evidence: The service provides a basic physical environment that is appropriate to the specific needs of the people who live there. The environment provides a number of aids and equipment to meet their needs. The service is a homely and offers a relaxed feel where people are able to move freely around the building. Bedrooms that were seen, were personalised to the individuals own taste. All the services fixtures and fittings meet the needs of individuals and can be changed if their needs change. One person using the service commented I like my room. In addition to this one person commented I enjoy going to my nice room. Most bedroom doors have the name of the person on a plaque, however the service does support a number of people with Dementia. No additional memory aids were being used at the service. The lay out of the service attempts to encourage people to socialise and engage in small clusters rather than all in one area. The service has many different seating areas available with books and music available to all. The design of the building allows people to move freely throughout with a lift available to move between floors. The manager on duty reported that a number of improvements have been made including Care Homes for Older People Page 23 of 38 Evidence: new chairs in the lounges, a range of new beds, new flooring to some areas of the service and a new television. It was pleasing to see that the lounges were homely with a personal touch made. Cushions were in place with art work completed by a number of people using the service. A large fish tank provided additional visual stimulation for a number of people. Some areas of the service require redecorating. A number of carpets were seen to be tired and worn, including worn and tired paint work and walls. On the first floor the area was very un homely and dark with paint work and walls requiring attention. There is a stair gate at the bottom and the top of the stairs, however easily accessible. No additional risk assessments were in place at the time of the inspection. The manager stated that there is a plan to redecorate the entire building and replace more flooring. Following a recent Environmental health Inspection, it was determined that a new kitchen floor was required. The manager stated that this would be completed in the warmer months. A number of doors were seen to be wedged open by means not recommended by the fire authority. Remedial action was taken at the time of the inspection. The manager reported that a number of doors required new smoke door seals and door closures as recommend by the fire authority. The environment promotes the privacy, dignity and autonomy of people. This was directly observed during the inspection, where people where seen to be supported to their rooms for personal care and support tasks. Staff were also seen to knock an wait on bedroom and bathroom doors. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who use the service, one of the bathrooms up stairs was being used as a store room, housing washing powder and toilet rolls, however this was not locked. The service is clean and tidy and smelt fresh. The management has an infection control policy. The AQAA tells us that six people have completed a course in Infection Control. Gloves and aprons were being used and were visible throughout the building with easy access at all times. The AQAA tells us that service users live in a safe, well maintained environment. The building complies with the requirements of the local fire service and environmental health department. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient lavatories and washing facilities. Specialist equipments like hoists and slings are available for service users. Service users rooms suit their needs very much. Service Care Homes for Older People Page 24 of 38 Evidence: users live in safe, comfortable bedrooms with their own possessions around them. Appropriate level of heating and lighting are available. The home is clean, pleasant and hygienic. The manager on duty spoke about a training room on site, but separate from the building being developed in the near future. Care Homes for Older People Page 25 of 38 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. People using the service can be assured that they are supported by a competent, qualified, experienced work force, ensuring they are in safe hands at all times. Evidence: People are generally satisfied that the care they receive to meet their needs. One person using the service stated we get to chat with the staff and they are very nice people. The rota showed that there were adequate number of staff to meet the needs of the people using the service. In addition to this the manager on duty is supernumerary. In addition, there are catering, housekeeping and activities staff on duty in the waking day. The activity co ordinator is currently a vacant role and recruitment is in process. The manager stated that the numbers of staff required are arrived at by a calculation of individuals needs, discussions with staff about how they work with people living at the service and an allowance of time for the tasks to be undertaken. The rota was also arranged to provide increased staffing levels for the periods where people living at the home require the most support from staff such as early in the morning when people wanted to get up and late in the day when people wanted to go to bed. Care Homes for Older People Page 26 of 38 Evidence: The recruitment records of the four staff contained documents that supported the employment of people who were suitable to work with vulnerable adults. This included full application forms, references, proof of their identify and CRB checks. In each case the staff had commenced their employment with a POVA first request while the full CRB report was waited for. Staff files were well managed. Through feedback received, staff verified that they undertook a robust recruitment process and were asked to provide supporting documents before they were offered a post. One staff member commented all staff are working very well as a team and we are all very much attached to our service users. We always try to provide the best quality of care. The training programme included items such as and manual handling, food hygiene and diabetes training. The manager on duty produced a plan for 2010, however this was rather sparse and required more work. The manager spoke about further planned training including safeguarding, first aid and infection control. Those staff surveyed confirmed that they feel they have enough training in order for them to meet the needs of the people using the service. It was evidenced that a number of staff have received training in the Mental Capacity Act and Deprivation of Liberty and Safeguards. The AQAA tells us that skills for care Induction training and external training are provided. Service users needs are met by the numbers and skill mix of staff. the ratio of care staff to service users is based on Department of Health guidelines. Service users are supported and protected by the homes recruitment policy and practices. More than 50 percent trained staff are available. All staff are employed only after a enhanced CRB check. All staff are clear regarding their role and what is expected of them. People using the service report that staff working with them know what they are meant to do, and that they meet their individual needs in a way that they are satisfied with. Care Homes for Older People Page 27 of 38 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. People can not be assured that they will be protected from harm due to the shortfalls in the management of health and safety. Evidence: The service focuses on the individual, takes a basic account of equality and diversity issues, and works in partnership with families or close friends, as appropriate and professionals. Staff surveyed as part of the inspection process, commented on strong staff morale and team work. This was evident throughout the inspection. People commented that they felt supported and knew that they could speak to them at any time. This was endorsed by the people who live at the service, who said that they thought the service was well run and that they knew they could speak to the staff at any time. The manager on duty was new to role, following the departure of the previous registered manager. We received formal notification of this, including interim plans to Care Homes for Older People Page 28 of 38 Evidence: support the new manager in her role. The manager is currently not suitably qualified and remains unregistered with the Care Quality Commission. The service has a quality assurance system in operation that consists of the consultation of people who live at the home and their families through the distribution of surveys at the end of the calendar year. The manager reported that they have not completed a satisfaction survey recently. Findings from the previous survey were seen with actions plans in place. Discussions occurred with the manager on duty regarding the quality assurance system place and how they intend to report the findings back to the people that use the service and their families, friends or representatives. Additional quality assurance systems were in place in the form of audits, however they were not periodically completed. The manager spoke about completing a weekly quality assurance audit. The AQAA tells us that the health, safety and welfare of service users and staff are promoted and protected. The process of managing and running the home are open and transparent. A commitment is made to equal opportunities in the organisation. The home is run in the best interests of service users. Quality Assurance surveys are undertaken at least once a year and the results evaluated and published. Policies, procedures and practices are regularly reviewed in light of changing legislation and of good practice advice from the Department of Health, local / health authorities, and special / professional organisations. Service users are safeguarded by the accounting and financial procedures of the home. Regulation 26 reports are done every month. The service held certificates in relation to the safe operation and maintenance of equipment according their legislative responsibilities. The certificates that demonstrated this were considered at this inspection and included electrical installation, gas safety soundness test, lift maintenance, moving and handling hoists, water regulations, portable appliance testing, fire extinguishers and emergency lights and fire alarms. The service carries out monthly visual check of the fire safety systems and there was a basic fire risk assessment in place, however this did not explore the needs of the people using the service and the process that would take place if a fire occurred. The risk assessment was not comprehensive and areas of significant risk were not included in the assessment, for example the stairs. The records did not show that any fire drills had been carried out. This was discussed with the manager who confirmed that only verbal discussion occurred. It was observed that the service does not currently provide any equipment aids to support people in zone evacuation or total evacuation of the building. Care Homes for Older People Page 29 of 38 Evidence: The service has completed a number of risk assessments regarding the building. During the inspection an additional risk assessment was provided that demonstrated slightly more depth to the assessment process. The risk assessment process was led by tick boxs and did not provide information for how the risks are controlled and or minimised. There was no risk assessment in place for the stairs and associated risks. Control of Substances hazardous to Health (COSHH) data sheets were in place, however these were out of date and no additional risk assessments were in place at the time of the inspection. Policies and procedures were reviewed, as the AQAA told us that a number of them had not been reviewed for some period of time. Upon review it was evident that the polices and procedures had not been reviewed and required updating as a matter of priority. Care Homes for Older People Page 30 of 38 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 31 of 38 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 8 13 Risk assessment regarding the health care needs of a person using the service must be fully completed. To ensure that peoples health care needs are being reviewed, monitored and areas of need identified and met at all times. 25/05/2010 2 9 13 Tempertaures must be recorded where medication is being stored. To ensure that medication is being managed and stored in line with the manufactures guidelines and requirements. 30/04/2010 3 9 13 Controlled drugs must be managed in line with the Misuse of Drugs (Safe Custody) Regulations 1973. To ensure that the controlled drugs are stored and managed effectively in the 30/04/2010 Care Homes for Older People Page 32 of 38 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 best interest of the people using the service. 4 19 22 A number of carpets and 31/05/2010 flooring that is worn and not appropraite are to be replaced. To ensure that the people using the serive are able to reside in a well maintained and safe service. 5 19 13 Doors must not be held open with means other than those recommended by the fire authority. To ensure that people using the service are residing in a safe environemnt. 6 19 13 Suitable risk assessments are required to be in place for the management and control of access to the stairs. To ensure that people using the service are able to reside in a safe environemnt. 7 19 13 COSHH items must be locked away securely at all times. To ensure that people using the service are protected from risk and harm. 21/04/2010 30/04/2010 30/04/2010 Care Homes for Older People Page 33 of 38 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 8 19 23 Redecoration is required throughout the building to tired and worn paint work and walls. To ensure that people using the service are residing in a well maintained environment. 30/06/2010 9 21 23 The first floor bathroom must not be used for storage. If used for storage the bathroom must be locked if other facilities are adequate in resource and number. To ensure that people using the service have access to suitable facilities at all times. 21/04/2010 10 31 9 The manager must become suitably qualified, fit and registered with the Care Quality Commission. To ensure that the service is managed by a qualified, competent, registered person. 30/06/2010 11 33 17 Quality Assurance systems must be robust and fully completed in line with service policy and procedures 31/05/2010 Care Homes for Older People Page 34 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that people using the service are assured that they are residing in a well managed service. 12 37 17 All records must be kept up to date, including risk assessments, health and safety checks and policies and proceedures. To ensure that the service is managened and run in the best interest of the people residing there. 13 38 17 Risk assessments and revised safety data sheets must be in place for all COSHH items. To ensure that all people using the service are suitably protected. 14 38 13 Fire drills must occur and 30/04/2010 records must be maintained. To ensure people using the service are protected from harm. 15 38 13 A review of fire safety aids 31/05/2010 and equipment is required in order to meet all peoples needs who use the service. 31/05/2010 30/06/2010 Care Homes for Older People Page 35 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that in the event of a fire people can be adequately supported to a place of safety. 16 38 13 A deatiled fire risk assessment must be in place. To ensure that all people using the service are kept safe. 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 30/04/2010 1 2 3 4 5 6 7 8 9 1 3 3 9 12 18 18 18 19 The Statement of Purpose and Service users Guide should be up to date for the people who use the service. Risk assessments in place and completed as part of the assessment process should be comprehensively completed. The assessment process should further explore and record equality and diversity issues of the person. Topical medications should be signed for on the Medication Administration record. The service should consider the up grading of activity resources throughout. The service should ensure that detailed records of complaints are maintained. The service should review the complaint procedure. The service should obtain a copy of the Mulit Agency Safegurading Adults Proceedure. The service should erect memory boxs for people with Dementia. Care Homes for Older People Page 36 of 38 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 10 27 The service should access external local authority safeguarding training. Care Homes for Older People Page 37 of 38 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. 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