Care Home: Randolph House Care Centre

Similar services:

• Snydale Care Home
• Abbey The
• Hawkhills
• Larchfield Manor
• Beeches The - North Yorkshire County Council
• Staveley Birk Leas Nursing Home
• Carentan House

What the care home does well Staff are very welcoming and friendly and were observed assisting people in the home in calm and dignified ways. They were seen to encourage people where necessary, to for example, walk with a zimmer frame correctly to ensure they do not over balance and fall but can still exercise their independence by walking around the home. The basic topics to ensure staff can do their job have been covered in training sessions. Systems are in place to ensure safety checks have been completed on staff prior to their commencement of employment and that they can safely work with people in the home. Prior to admission to the home the management team use a comprehensive tool to assess each individual to ensure the home can meet their needs. This is then used as a basis to plan a fuller programme of care. The physical needs of individuals are well recorded. There is a varied programme of activities to ensure peoples social, cultural and religious needs and expectations can be met. This includes events on a one to one basis, some group events both inside and outside the home. A varied menu is on offer to ensure people receive a balance diet. Accurate records are kept of peoples personal allowance money and this is audited to ensure it is being used for their benefit and to enhance their lives. The parent company ensures that the home is a comfortable place in which to live and suited to each person`s needs and tastes and that they can contribute to this as much as they are able. A very extensive quality assurance system is in place and covers a diverse range of subjects. The methods used include checks on records and documents kept, speaking to service users and relatives and staff and sending out surveys to people. Staff working in the home complete some of these checks but so do regional and head office staff of the parent company. What has improved since the last inspection? The variety of social activities provided in the home has increased and events take place for individuals on a one to one basis and in group events covering a diverse range of events. What the care home could do better: To ensure peoples current needs are being met the care plans on each individual must be regularly reviewed. The recording of staff must be accurate in these records to ensure people are not being placed in harmful situations. Any incident and accident which has meant the safety of an individual or the home has been compromised must be reported to us on the correct forms. Where an incident and/or accident has occurred where there has been a possible allegation of abuse this must be reported to the correct local safe guarding team as well as CQC. We can then determine whether the staff have protected people they are caring for.All staff must receive training in how to recognise an abusive situation and know how to report this to enable them to protect people. Staff must receive supervision through out the year covering the topics described in the National Minimum Standards. This will enable the management team to see whether they are capable of doing their jobs and safely look after people resident in the home. There must be sufficient staff on duty at all times to ensure peoples needs can be met. A number of recommendations of good practice have also been made to the home to ensure people can be looked after safely and that all their needs can be met by suitably trained staff. Key inspection report Care homes for older people Name: Address: Randolph House Care Centre Ferry Road West Scunthorpe North Lincolnshire DN15 8EA     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: Theresa Bryson     Date: 0 4 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Randolph House Care Centre Ferry Road West Scunthorpe North Lincolnshire DN15 8EA 01724272500 01724272505 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.fshc.co.uk Four Seasons (DFK) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) care home 70 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 70 The registered person may provide the following category of service only: Care Home with Nursing - Code N, To service users of the following gender: Either, Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places 51, Dementia - Code DE, maximum number of places 19, Physical Disability - Code PD, maximum number of places 41 Date of last inspection Brief description of the care home Randolph House is a dual registered home for residential, and nursing care for older people. The home was pleasantly decorated and furnished, and provided a homely atmosphere. The accommodation is provided over two floors, and has a unit on the Care Homes for Older People Page 4 of 28 Over 65 0 51 0 19 0 41 Brief description of the care home first floor, which provides specific care for those with Dementia. The first floor is accessible by a lift, and stairs There are good parking facilities to the front of the building, and there are enclosed gardens to the rear and sides of the home. These were well maintained. The home is close to local amenities, including a post office, and general shops. It also has close links to the M180 motorway. There is a wide range of fees within the home due to the complex cases recieved. Additional charges were made for hairdressing, chiropody and newspapers etc for which separate invoices are raised. The Service Users Guide and Statement of Purpose are given to each prospective service user and were also on display in the main entrance and available at each nurses station. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Prior to the site visit we asked the service to send us their Annual Quality Assurance Assessment (AQAA) which they did. This gave us details of the work they have achieved since the last inspection and what they hoped to do in the future, plus a lot of statistical information. We spoke to several relatives and health and social care professionals before the site visit and also looked at information we had received since the last key inspection. On the site visit day we spoke to people who live in the home, relatives and other visitors plus staff. We looked at a number of records and documents, observed staff at work and toured the home and grounds. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: To ensure peoples current needs are being met the care plans on each individual must be regularly reviewed. The recording of staff must be accurate in these records to ensure people are not being placed in harmful situations. Any incident and accident which has meant the safety of an individual or the home has been compromised must be reported to us on the correct forms. Where an incident and/or accident has occurred where there has been a possible allegation of abuse this must be reported to the correct local safe guarding team as well as CQC. We can then determine whether the staff have protected people they are caring for.All staff must receive training in how to recognise an abusive situation and know how to report this to enable them to protect people. Staff must receive supervision through out the year covering the topics described in the National Minimum Standards. This will enable the management team to see whether they are capable of doing their jobs and safely look after people resident in the home. There must be sufficient staff on duty at all times to ensure peoples needs can be met. Care Homes for Older People Page 7 of 28 A number of recommendations of good practice have also been made to the home to ensure people can be looked after safely and that all their needs can be met by suitably trained staff. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive an holistic assessment of their needs prior to admission to ensure the home can meet their needs and this is used as a basis for a fuller programme of care to be put in place. Evidence: When some one new wishes to be resident in the home the manager or her deputy will assess this person prior to admission. Some times senior management staff go in pairs for this assessment. The Company has introduced a new dependency assessment rating tool to help staff make a decision as to whether the home can meet that persons needs. The file on the last person admitted to the home was tracked and all records had been completed. A full holistic assessment had been completed which staff told us was then used as a basis for developing a fuller care plan. People spoken to in the home said they were surprised staff knew so much about them prior to admission but they had found this comforting. Care Homes for Older People Page 10 of 28 Evidence: The home does not provide intermediate care, therefore Standard 6 is not applicable to this service. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs should be regularly updated to ensure all current needs are being met and that staff understand the need for accurate recording of events. Staff must also be tested to ensure they can competently do their jobs. Evidence: During the course of the site visit we tracked four care plans of people living in the home. These were from all different units in the home, covering the nursing and residential wings and the dementia unit. The Company provides a comprehensive set of records and documents to ensure staff can record the needs of people in the home and keep them regularly evaluated. For example where a person had been admitted to the home who had a history of falls prior to admission a care plan had been developed around this specific need. This was supplemented by a manual handling assessment of that person and a long term risk assessment with future outcomes. Where necessary the services of a community falls co-ordinator were recorded in the notes, who gave advice to staff on how to manage someone who falls frequently. For some one who had been admitted as being under weight a care plan was in place to help staff address this persons dietary needs. A Care Homes for Older People Page 12 of 28 Evidence: nutritional assessment and malnutrition assessment had both been completed to see where, within a scale, they were at risk. The daily report records also detailed what meals that person had consumed in any one day or if there had been difficulties in them maintaining a healthy diet. Regular weights and body mass index records were also kept so staff could see if any progress had been made in helping this person gain weight and maintain a healthy diet to aid their well-being. Care plans covering peoples physical needs were evaluated more frequently than for those with mental health needs, so did not give a clear picture as to a persons total current needs, which could put them at risk of harm. There was a lack of consistency in some parts of the care plans seen. For example the National Minimum Standards state they should be evaluated at least once a month but this was not so for some care plans. The Company also asks the home to ensure that key workers complete a key worker diary but again there was only spasmodic recording on these sheets. In another persons care plan there were three occasions where an altercation had occurred between two people living in the home and one of the people had a care plan covering the topic of aggression. This had not been updated since June 2009, despite an exacerbation of this behaviour. Neither had any of the incidents been referred to the local safe guarding adults team or our selves. The Acting Manager was reminded of the need to ensure everyones plans of care were up to date to ensure their current needs were being met and that they were free from harm and risk and also that it is an offense not to alert CQC of events covered under the guidance for Regulation 37 notices. We randomly checked the drug administration sheets and found that accurate records appeared to be kept. A senior member of staff told us how the ordering and receiving of drugs take place and the process of disposal of controlled drugs. There appeared to be safe systems in place and the storage area was clean and tidy. During the site visit we observed part of a drug administration round and at one point the trolley was left unguarded for 15 minutes. This could have resulted in the trolley going missing, if we had not stood by it for that length of time. The competency of people administering medication should be checked to ensure, despite the training they have previously received that they are aware of what constitutes good practice. Staff were observed through out the day assisting people with a variety of tasks which they completed in a dignified and calm manner. People using the service told us they were splendidly looked after and that staff were friendly. Others told us they were extremely happy living in this home and relatives said staff are generally very good. Health professionals spoken to also told us they had raised concerns in the home about care plans not being evaluated but felt staff were open to suggestions to improve care plan recording to ensure peoples current needs could be met. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A varied programme of social, religious and cultural activities are in place to ensure peoples expectations can be met and the environment changed to suit their needs and tastes. Evidence: People living in the home told us how they occupy their days and said how individual events, personal to them, such as reading, were balanced with group events such as entertainments and music to movement groups. Some people talked about going to a local rehabilitation group in the community and others to events such as a fund raising event at the local Hospice. Others enjoyed visits by the Pat-A-Dog scheme, as one person said I have owned a dog and its the next best thing, without the expense. Some also enjoyed visits by the work experience students as they said it gives us someone new to talk to. A weekly service of holy communion was also seen to be recorded as taking place, for those Christians wishing to attend. Staff spoken to hoped that next year more outings will take place now the mini bus was working and a member of staff had passed a certificate to enable them to drive it. People told us that staff welcomed their relatives and other visitors and they were able to go out when they liked. Relatives told us they were always made most welcome and offered refreshments on a regular basis. The home has employed a full time Care Homes for Older People Page 14 of 28 Evidence: activities coordinator to facilitate activities and to help with assessing this part of a persons care needs. In the care plans seen each person had an updated social needs assessment, which is completed by the trained nursing staff and other staff put together a plan for each individuals social, cultural and religious expectations and needs. In the dementia wing of the home peoples individual rooms had been identified with special displays such as their name in a colour they could recognise or a picture of a family member. In one persons case their original name plate from their last place of work had been attached to the door, which also described their last job role, which they could still remember they held. On several peoples doors were potted histories of who they were, their families and what they had achieved in life. No permissions could be found in their notes to say families had agreed this could be displayed, as in each case, we were informed, the person could not make informed consent. There were permissions for people to have their photographs displayed in the home and/or Company newsletters. The Acting Manager volunteered to have these removed until permission could be obtained to safe guard each persons privacy and dignity. People also told us how much they enjoyed the meals provided. Saying for example I have a big appetite but am never hungry and others told us the food was good and that the chef comes around to ask us how we have liked various dishes. We observed staff at different times of the day assisting people with meals which they did calmly and encouraging those who needed it, explaining the reasons why they needed a good balanced diet. We made a brief tour of the kitchen area and observed food being prepared in a clean and safe environment. At the last Environmental Health Officers visit in July 2009 they had given the home a 3-star rating which was a good rating, showing safe practices where in place. Staff on duty were able to tell us how the 4-week cycle of menus were arrived at and how they keep safety records in the home. Menus were displayed at different points around the home so people could see what was available that day. When touring the home we also could see, in peoples individual rooms, how they had been altered to suit a persons needs and tastes. In one persons room a large digital display clock had been attached to the bed end as this person can not have free movement of their body to see a wall or table clock. People also told us how they had contributed to the redecoration of their rooms, one person saying I choice this wall paper some time ago and feel it still look fresh and clean due to the care staff take in keeping my room clean. Others told us how relatives had been allowed to contribute to the decoration in rooms by adding photographs and paintings. One person told us how this had helped them settle into the home. Care Homes for Older People Page 15 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A more robust system of training must be put in place to ensure staff can recognise an abusive situation and know when and how to refer such matters. Evidence: We looked at the complaints log within the home and saw that since the last visit there had been seven complaints made. Each appeared to have been investigated and the outcomes recorded. At the time of this site visit there was an on going safe guarding investigation being undertaken by the local safe guarding adults team of the local authority. We were also aware of three other investigations which had taken place since the last site visit by us in 2007. On checking the accident records it appears the management team have made a further four safe guarding referrals to the local team since January 2009, but failed to inform CQC. On checking the care plan documentation further possible abusive incidents had also occurred with one person living in the home in the last year, which the management team had failed to report to the local safe guarding team and CQC. This lack of consistency of recording and reporting could put people at risk of harm if the correct action is not taken. When staff were spoken to by us they had mixed views and knowledge about what, who and when referrals should be made to the safe guarding adults team and CQC to protect the vulnerable people living in the home. The training records of staff were also not up to date in this topic. This could put people at risk of harm if staff do not Care Homes for Older People Page 16 of 28 Evidence: have a clear understanding of what constitutes an abusive situation. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in comfortable surroundings suited to their needs. Evidence: During the site visit we were able to tour the whole of the building and also look at the grounds and gardens. All areas were clean and there appeared to be no trip hazards in the home. Since the last site visit various parts of the home had been decorated and some new furniture purchased. The head cook was waiting on some new dining room furniture as the present pieces were now looking very tired. A new pamper room had been developed as part of the hair dressing salon which people said they used at different times for manicures, chiropody and relaxation times. A coffee spot had also been added, where people can make their own drinks. Relatives told us they used this so staff would not be taken away from other duties. Staff were using notices on the doors when they were attending to people in their rooms. These stated care in progress and prevented people from entering if personal care tasks were being undertaken to preserve peoples dignity. All safety certificates were seen to be in place to ensure both the building and equipment in use was safe. Regular checks were recorded for such items as bed rails and wheelchairs, as well as fire and water temperature checks. Some people preferred to have their bed room or communal area doors open but where this was observed these were, in some cases, wedged open with wooden Care Homes for Older People Page 18 of 28 Evidence: wedges or pieces of furniture. This could contravene the homes fire regulation policy as no records were seen which stated this had been checked by the local fire brigade as safe practice. In the event of a fire this could put people at risk. All garden areas are accessible to wheelchair users and appeared free from hazards. There was ample care parking spaces and clear signage around the building for visitors and emergency services. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There must be sufficient staff on duty at all times to ensure the needs of people living in the home can be met. Evidence: Since the last key inspection there have been several queries raised by concerned relatives and staff about the staffing levels with in the home. On a couple of occasions we felt it was necessary for the management team to send us copies of their rotas and details of how they had arrived at their decisions. On one occasion the Company admitted there had been a breakdown in communication between staff groups in the home which left barely minimum staffing levels in all units. We were informed on this visit that the staffing levels are determined by a head office team but there were no details available of how different dependency levels with in the home are provided for. For example in the dementia wing we were informed that staffing is one person to eight people but when challenged of what would happen if a couple of people required one to one care how this could be achieved, no evidence could be produced of how staff could ensure people are safely looked after. Health and social care professionals had also raised concerns about the level of staff sickness, which sometimes they had noticed meant staff were very rushed in their work. Some people we spoke to who live in the home and some relatives also told us that at times staff seem hurried and we dont like to worry them because they tell us they are busy. Some staff also told us that at times they struggle because of staff Care Homes for Older People Page 20 of 28 Evidence: sickness levels. The Company has a system of requesting Agency staff if the lead nurse in charge of the home feels there are insufficient staff on duty, but we are aware that on at least one occasion this system has failed. There must be sufficient staff on duty at all times to meet the needs of people through out the home and a verifiable tool used to ensure staff can calculate whether enough staff are on the working duty rota. This will ensure people are not put at risk of harm from their needs not being met. We checked the staff training matrix, which showed the topics staff had covered in the last year. Most mandatory training such as manual handling and medication training had been completed, but staff still need to up date their safe guarding vulnerable adults training, as detailed under Standard 18 of this report. Some staff had completed other topics such as dementia, palliative care and wound management care and some had been booked on topics such as first aid. A large proportion of staff had achieved their NVQ in Care Awards at level 2 and some were now working towards level 3. Staff spoken to said how this had thrown a new light on how they worked and look after people and others talked about a sense of achievement for themselves. There have been several safe guarding adults investigations in the home where people living there have shown some challenging and aggressive behaviour but these topics were lacking on the list of training completed and booked. Staff would probably benefit from sessions covering these topics to help them address issues before they occur with any more people living in the home which required this type of management. We tracked six staff personal files and found that in most the relevant information was in place to ensure sufficient safety checks had been made prior to their commencement of employment. There was some inconsistency in the record keeping. In some files there were photos and some not and in some checklists of what should be in the files and when for example references had been sent for and in others there were not these records. We were informed that a new system was in place and that the administration staff were going through each staff file but had not yet completed this task. This will help them see where gaps have occurred and enable them to be rectified. Only one person required a Home Office work permit which we saw and was relevant to this place of work. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff must be supervised in their work to ensure they can safely do their jobs. Evidence: The home has been without a Registered Manager for over a year and the Acting Manager has only just put in the first part of their application to CQC. They were informed it is an offence to be in charge of a home without being registered and we were assured this application will be processed as soon as possible. The Company owning this home has an extensive quality assurance system and we were able to see details of a variety of auditing processes. Some are undertaken by the local team, some by Regional staff and some by Head Office staff. Topics were varied such as laundry processes, health and safety in the home, medication audits. The format varied from looking at records and documents to user group meetings and talking to individuals or by surveys sent to staff, service users, relatives and other visitors to the home. A Company representative had also completed five site visit reports since the beginning of the year under their obligations against Regulation 26. We looked at the policy and procedure manual, as the Annual Quality Assurance Care Homes for Older People Page 22 of 28 Evidence: Assessment (AQAA) sent to us prior to this visit stated most had not been reviewed since 2006. This is a parent Company task and we were informed is on going, with the Regional Operations Manager covering this home being on the national committee. This is a vital piece of work for the Company to undertake to enable staff to work to the latest guidance to ensure people are looked after safely. We asked to see the records for peoples personal allowance money. The parent Company has one bank account to pay money into but keeps computer records of individual accounts. These records showed the correct use of these funds to support peoples personal care and no items appeared to have been bought which would normally be covered by the Companys operational budget. The Company also completed random audits of these records to ensure staff are accurate in their recording and service users have agreed what their money is being used for. We looked at six supervision records of staff. These were not up to date and the management team are aware that these have not been completed according to our National Minimum Standards. Staff also told us that they had received very little discussion time with their supervisors. The management team have not assessed staff through out the year to see if they are doing their jobs correctly and safely which could put people at risk. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 17 There must be accurate recording in all care plan documentation. This will ensure the correct information is kept on each individual to ensure they are free from harm and risk. 04/02/2010 2 7 37 All accidents and incidents covered by this Regulation must be reported to us. This will ensure we can make a judgment as to whether the service has taken the correct action in each case. 04/02/2010 3 7 15 Peoples care plans must be regularly updated. To ensure their current needs can be met. 04/02/2010 4 18 13 All staff must be trained in methods to protect people from abuse. 04/02/2010 Care Homes for Older People Page 25 of 28 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure they are not harmed and put at risk. 5 18 13 All incidents which have 04/01/2010 resulted in a possible abuse of a person must be referred to the correct organisation. This is to ensure every vulnerable adult is protected. 6 27 18 There must be sufficient staff on duty at all times. To ensure the needs of people living in the home can be met. 7 36 18 Staff must be supervised to do their jobs. This is to ensure they are safe to work with people living in the home. 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 04/01/2010 04/02/2010 1 7 There should be a consistent use of the documentation provided to ensure staff can make accurate recording of events affecting each person they care for. Staff should be tested, after completing their safe administration of medicines training to ensure they understand what constitutes good practice and not put people at risk. Permissions should be sought before information is Page 26 of 28 2 9 3 14 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 displayed on each individual which could intrude on their privacy and dignity. 4 5 19 30 Suitable precautions must be in place to ensure the fire regulations are not compromised. Staff would benefit from training in such topics as managing aggression and challenging behaviour to ensure people living in the home are not put at risk. The Acting Manager should put in their application to register with CQC as it is an offence to work in this role without being registered. The policy and procedure manual should be reviewed more regularly to ensure staff have the latest guidance to follow to be safe practitioners. 6 31 7 37 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!