Care Home: Redlands House

Similar services:

• Claremont House
• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home
• Henrietta House

What the care home does well People were given useful information about the home and were encouraged to view the facilities. This helped them to decide whether Redlands House was the right place for them. Before anyone moved in, the manager visited them to assess what care they needed and to make sure that their needs could be properly met at the home. The residents and family members we spoke to were satisfied with the care and support provided at the home. They told us staff were kind and caring and that they were looked after if they were not well. Family members told us that the staff always let them know if their relative was unwell and they were referred to the right professionals. One told us, "I feel that they genuinely care about her." People also told us that staff were polite and respected their privacy and dignity. One resident said, "They treat everyone properly and with kindness, they look after everyone the same." A relative, who visited regularly, said "Staff are very kind, they allow people their dignity." Most of the residents we spoke to said they were happy with their daily lives and routines at Redlands House. There were some group activities and staff spent one to one time with residents. Several residents said there was sufficient going on to satisfy them. Residents said they enjoyed the meals and were given a choice. One person told us, "The food is so good I`m putting on weight." We noted that the lunchtime meal was served in an attractive way. There was a clear complaints procedure that explained who residents could speak to if they were unhappy. The records showed that complaints were taken seriously and investigated. Staff had training and written guidance to help to ensure they had the skills to recognise and respond to any reports of abuse. Most people told us there were enough staff on duty to meet the needs of the residents and they did not have to wait long for staff attention. The manager made sure that new staff had thorough background checks to ensure they were fit to work in a care setting. Staff had training to help protect the health and safety of residents and themselves. Over half the staff had a nationally recognised qualification in health and social care, called an NVQ. What has improved since the last inspection? Care plans had improved. They were more detailed and gave staff clearer directions about the support needed and the residents` preferences. This helped to ensure that residents received consistent and appropriate support in the way they wanted. There had also been improvements in assessments and plans for risks associated with pressure sores, falls and the use of bed rails. The care records were kept under review and changed when necessary, which helped to ensure that staff had up to date, written directions to refer to. The home owners had drawn up a plan for redecoration and renewal, which was being carried out in accordance with their timescales. Since our last inspection a number of areas of the home had been redecorated. Some had new flooring and some new furniture. The residents we spoke to said the home was comfortable. They were happy with their bedrooms, which they were able to personalise with pictures and ornaments. A relative described Redlands House as, "A homely home." Since our last inspection the manager had registered with The Care Quality Commission. In addition to being a legal requirement, her registration also demonstrated her commitment to the service. What the care home could do better: Despite the improvements in the care records, there was room for further improvement. For example, important information identified in assessments was not always transferred to the care plan. The care plans were not always read by staff, which could result in staff missing out on information about new residents, or those with changing needs. The assessment tools for identifying risks associated with moving and handling and poor nutrition should be reviewed to make sure that staff have clear information about risks to residents` health and safety. We made a recommendation to improve the security of the medication storage room and to monitor the temperature to make sure it remained at the recommended level. The systems for monitoring the quality of the service must be improved. There should be a formal process which includes evaluation and audit of all aspects of the service and a plan for future developments. Residents and relatives should continue to have opportunities to be involved in the process. This helps to ensure that they have a say in how the service progresses. To minimise the risk of errors and to provide safeguards for residents and staff, records of money handed over by residents, for safekeeping, should be audited on a regular basis. In order to protect residents` health and safety all potentially hazardous substances, such as caustic denture cleaner, must be stored safely. There must be risk assessments to support residents who wish to keep denture cleaner in their room. Key inspection report Care homes for older people Name: Address: Redlands House 134 Reepham Road Hellesdon Norwich Norfolk NR6 5PB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Craig     Date: 1 0 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 32 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 32 Information about the care home Name of care home: Address: Redlands House 134 Reepham Road Hellesdon Norwich Norfolk NR6 5PB 01603427337 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Redlands@fireflyuk.net Mrs Frances Smart,Rhoderick James Robert Smart Name of registered manager (if applicable) Mrs Nadine Perrin Type of registration: Number of places registered: care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Thirty-three (33) Older People, not falling within any other category may be accommodated. Date of last inspection Brief description of the care home Redlands House is a care home providing personal care and accommodation for 33 older people. Mr Rhoderick Smart and Mrs Frances Smart are the owners. The home is located on a busy road in Hellesdon on the outskirts of Norwich and is close to all local amenities. Redlands House is a large detached house that has been extended over recent years. There is accommodation on the ground and first floor, providing a mix of double and single bedrooms. Some of the rooms have en-suite facilities and there are a number of other toilet facilities throughout the home. There are three bathrooms and Care Homes for Older People Page 4 of 32 Over 65 33 0 0 2 0 4 2 0 0 9 Brief description of the care home one shower room. Residents have a choice of lounge and dining areas. The grounds and garden area are well maintained and provide attractive outside facilities for service users in the summer months. Information about the home is available to people enquiring about admission and the latest inspection report is displayed in the home. Information about the range of fees and extra charges is available from the manager. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection on this service was completed on 2nd April 2009. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 10th March 2010 by one regulatory inspector. We met with a number of people who use the service and where possible asked about their views of Redlands House. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. The registered manager was on leave at the time of our visit and the inspection was conducted with the help of the senior carer, who was in charge of the home, and the Care Homes for Older People Page 6 of 32 proprietors. We talked to a number of visitors and members of the staff team. We looked around the home and viewed documents and records. As part of the key inspection, surveys were sent out to a random selection of people living and working at Redlands House. We received five surveys from residents, all of whom had been assisted by relatives to complete their questionnaires. Their views have been taken into account when writing this report. The report also includes information from the annual quality assurance assessment (AQAA), which is a selfassessment report that the manager has to fill in and send to the Commission every year. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? Care plans had improved. They were more detailed and gave staff clearer directions about the support needed and the residents preferences. This helped to ensure that residents received consistent and appropriate support in the way they wanted. There had also been improvements in assessments and plans for risks associated with pressure sores, falls and the use of bed rails. The care records were kept under review and changed when necessary, which helped to ensure that staff had up to date, written directions to refer to. The home owners had drawn up a plan for redecoration and renewal, which was being carried out in accordance with their timescales. Since our last inspection a number of areas of the home had been redecorated. Some had new flooring and some new furniture. The residents we spoke to said the home was comfortable. They were happy with their bedrooms, which they were able to personalise with pictures and ornaments. Care Homes for Older People Page 8 of 32 A relative described Redlands House as, A homely home. Since our last inspection the manager had registered with The Care Quality Commission. In addition to being a legal requirement, her registration also demonstrated her commitment to the service. 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 order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 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 admission process helped to ensure that the home was suitable to meet the needs of the people who moved in. Evidence: People thinking about moving into the home were provided with an information pack, which included the updated Service Users Guide. There was also a copy of the guide in every bedroom for people to refer to. The latest inspection report was on display and accessible to anyone visiting. The service had also put together a reference folder covering topics likely to be of interest to people moving into residential care, and their families. People were encouraged to visit the home before they moved in, which helped them to decide whether it was the right place for them. Detailed assessments were completed before anyone was admitted. The assessments of people who had recently come into the home were informative and provided staff with a clear picture of their needs and abilities with regard to daily living tasks. Where Care Homes for Older People Page 11 of 32 Evidence: possible peoples preferences and wishes were also recorded. People who were referred by social services also had supporting information from relevant health and social care professionals on their files. This information helped the manager to decide whether the persons needs could be met at the home and reduced the risk of failed placements. The annual quality assurance assessment (AQQA) told us there had been no placement breakdowns in the past year. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care records provided staff with most of the information they needed to meet the needs of people using the service. Evidence: Residents who were newly admitted to the home had initial care plans in place to direct staff how to meet their personal and health care needs, as identified on their pre-admission assessments. Those who had been in the home for some time had been reassessed to ensure that staff had up to date information on which to base their care plans. The assessments we saw provided meaningful information, which helped to build a clear picture of the persons needs, abilities and preferences for support. Care plans were person centred and included directions to assist residents to maintain their independence and receive support in the way they preferred. However, we noted that some essential information gathered on one persons assessment had not been transferred to their care plan. This could result in the care being missed. There were no records to show that the care plan audits we saw at the last inspection had been continued, which could result in shortfalls such as this not being identified. Care Homes for Older People Page 13 of 32 Evidence: The care plan documents included a section to record the residents view of the plan. For example, one resident had written that they were happy with the care plan to support them to maintain their personal hygiene as it kept his independence. Residents were also asked for their opinion when evaluating the care plans, which were done every month. Plans were generally amended as and when the residents needs changed. We saw some good examples of plans to monitor residents ongoing physical and mental health care needs. They told staff what signs to look for that could be an indication of a relapse or need for medical intervention. Clear guidance was in place to assist staff to support a resident with complex behaviour. Some staff told us they read the care plans. One person said they used them to check on information, especially if they had been on days off. However, this did not apply to all staff. Other staff we spoke to said they did not always get the opportunity to read plans and were not completely clear about the healthcare needs of some newer residents. We discussed this with the proprietor who took steps to ensure that all staff read the care files of new residents. The care files we looked at included health care risk assessments and there were corresponding strategies to reduce risks. For example, the plans for people who were at high risk of developing pressure sores included information about equipment and positional changes. Following a requirement at the last inspection, the risk assessments for the use of bed rails were more robust, which helped to protect residents health and safety. We discussed with the proprietor that the nutritional risk assessment tool used at Redlands House may not always provide an accurate judgement of risk. For example, the risk assessments for two of the people we case tracked indicated that they were at low risk, despite them having lost weight and having reduced appetites. Staff had already drawn up good care plans to try to help them to improve their diet. Everyone had a moving and handling plan that indicated the number of staff and what equipment they needed to assist them. However, there were no moving and handling risk assessments to help to identify particular risk factors that should be taken into account when drawing up the plan. We observed staff using appropriate handling equipment. There were records to show that staff called in healthcare professionals as necessary and we saw evidence that their advice was added to care plans, which helped to ensure it became part of the day to day care. Staff work closely with the GP and Care Homes for Older People Page 14 of 32 Evidence: district nurses with regard to anyone needing palliative care. A relative told us that staff had talked to them about the Liverpool Care Pathway when their relative needed end of life care. Residents and relatives we spoke to were satisfied with the level of care and support they received. A resident said, They treat everyone properly and with kindness, they look after everyone the same. Another said, I have never been poorly but they are very kind with others and let them stay in bed. Relatives comments included, I am very comfortable with the way they look after her, and Mum was very poorly at first and there has been noticeable progress, all credit to the staff. We were also told that staff were polite and respectful to residents and visitors. One person told us, They allow people their dignity, and another said, They are always polite, they never ignore you. We looked at the systems for storing, recording and administering medication. One resident administered some of their own medication. They had been assessed as being capable and safe to do so but there was no evidence that staff had carried out relevant checks to ensure they remained so. This had been identified during our last inspection but there were no changes. All staff with responsibility for managing medication had been trained. Medicines for oral use were stored in a central location and a second lock had been put on the door to increase security. However, the keys to the medicine trolley and the controlled drugs cabinet were stored in the medicine room, which meant anyone who gained entry had access to all medicines. The last recorded temperature of the room was 30 degrees centigrade, which was higher than the recommended storage temperature for most medicines. The room thermometer had broken, which meant that staff were not monitoring this. The proprietor purchased a new thermometer before the end of our visit and talked about a vent being put into the door to help to maintain a suitable temperature. Prescribed creams were stored in locked cupboards in residents rooms. There were complete records of medicines received, disposed of and of any stocks of medicines carried over from the previous month. These records contributed to the audit trail and helped to ensure that prescribed medication was always available. There were no gaps on medication administration record (MAR) charts and appropriate codes were used whenever medication was omitted. We checked a small sample of medicines and found that the amount of stock accurately matched the records, which indicated that residents received their medication as it was prescribed. The senior carer with responsibility for medication carried out regular stock checks of medicines. Care Homes for Older People Page 15 of 32 Evidence: However, there were no records of full audits to check that all medication procedures were being followed. There were handwritten entries on some of the MAR charts. Following a recommendation at the last inspection these had been signed by two staff, which helped to reduce the risk of transcribing errors. All the records we saw accurately matched the directions on the medication labels. Controlled drugs were stored, administered and recorded in accordance with the policy. Care Homes for Older People Page 16 of 32 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. Daily routines, activities and meals suited the majority of people living at the home. Evidence: The care records we looked at included information about the residents past social history and interests. Each resident should have had an individual social and activity file, which included an assessment and plan of what activities they wished to do and how staff could support them. The new activity co-ordinator was working to bring these up to date. Because of the lack of records, it was difficult to be able to evidence whether all residents were regularly offered, or engaged in suitable recreational activities. The activity co-ordinator told us she was still learning about residents interests but tried to organise group activities she knew people would like, for example, there had been flower arranging and cooking groups. She was booked on a training course relating to activities. Several residents we spoke with said there was usually something going on. One resident told us, I like that they take us out as a surprise. Another said, Theres something almost every day, I enjoy the musicians. However, two people who returned surveys indicated that the service only provided suitable activities sometimes. One commented, I think there is a shortage of stimulation for many people in the home. These surveys may have been sent out before the new activity person started but we have recommended that the manager Care Homes for Older People Page 17 of 32 Evidence: continues to seek the opinions of individual residents. Information about residents preferred daily routines was also recorded on their plans. People who were independent or only needed minimal help were able to choose when they got up and went to bed. One said, They just remind me when breakfast is served. However, we were told that there was an expectation by some staff that day staff would help night staff by putting residents who needed hoisting to bed before they came on duty. Staff told us that if residents objected then it would not be done. However, this practice meant that not all residents had complete freedom of choice. We discussed this with the proprietor who said she would look into the issue. Several residents told us they were happy living at Redlands House. One said, Its the next best thing to your own home. Another commented, Im very happy here, they are all so friendly. A number of other residents and relatives commented on the friendly atmosphere in the home. One said, It has a nice, family atmosphere, and another attributed their relatives improvement to the, Sheer friendliness of the staff. Only one resident told us that one member of staff was not as friendly as the rest. We discussed this with the proprietor who said she took this very seriously and would look into it. A number of residents, staff and visitors also told us that they felt there had been recent improvements in the home. One family member said that their relative had wanted to come to Redlands House but initially it was not very good. They told us there had been, massive improvements. Another said, I would say there have been noticeable improvements in the home over the last year. There was open visiting, which helped residents to be able to stay in touch with their friends and family. We observed visitors being greeted warmly and being offered refreshments. One visitor told us, You can come when you like and you are always greeted by a friendly face. Several residents went out with relatives and so maintained links with the local community. The activity co-ordinator said she felt it was important to give everyone opportunities to go out and was trying to increase the number of outings. The AQAA acknowledged that one of the things the service could do better was to increase the use of the mini bus. The AQAA stated All meals provided are of a high nutritional value, using local produce. All meals are home cooked. Almost everyone we spoke to said they liked the meals. One person said, The food here is really nice, another said, Its so good I am putting on weight. Residents had a choice at each mealtime. On the day of our visit the meals looked appetising. The dining tables were set with full place settings, Care Homes for Older People Page 18 of 32 Evidence: candles and flowers. At lunchtime the vegetables were served in tureens on the tables, which helped to give people choice about portion size. One resident said, Its a good idea, it means you can help yourself. Lunch was a social, unhurried meal. Staff provided assistance in a sensitive manner. Care Homes for Older People Page 19 of 32 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. Complaints were dealt with appropriately and procedures and training were in place to help to ensure that people were safeguarded from abuse. Evidence: Everyone who moved into the home was given a copy of the complaints procedure. It was available in various languages and a large print version was on display in the entrance hall. The procedure indicated that the service had a positive attitude to complaints and explained to people how any complaints would be dealt with. Residents and relatives we spoke to said they had no complaints but would feel able to speak to the manager or owner if they did. They were all confident that any concerns would be dealt with. Staff had a procedure to follow with regard to receiving complaints. The home had received two complaints since the last inspection. One had been found to be a misunderstanding and a letter of apology had been sent to the relative concerned. The other was about the care of a resident and was addressed with staff involved through the supervision process. The proprietor told us that they were considering introducing a gripe book which would enable peoples minor concerns and grumbles to be recorded. Staff received training in safeguarding vulnerable adults and they also had written Care Homes for Older People Page 20 of 32 Evidence: information to refer to. This included the local authority procedure. Staff we spoke to were aware of their responsibility to report any allegation or suspicion of abuse or harm. Staff were also aware to report any unexplained marks or bruising to senior staff in order that they could be properly investigated. The manager had made one safeguarding referral since our last inspection. There was no evidence that any of the staff at the home had acted inappropriately. Senior staff had received training about the mental capacity act and associated legislation. The plan was to cascade this to other staff to ensure that they understood and upheld the rights of people living in the home. The proprietor told us that there was a plan to talk with residents and their families about advance directives. This would help to ensure that the residents wishes would be carried out in the event that they lacked capacity to make decisions about their future care and treatment. Care Homes for Older People Page 21 of 32 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. The home was clean and comfortable but the lack of window restrictors in some areas could compromise residents safety. Evidence: Overall the home was well maintained and there were systems in place for reporting and dealing with minor faults. Safety measures such as radiator guards were in place and most windows had restricted openings. However, those without restrictors could present a security risk, especially those on the ground floor. Most of the areas we highlighted in our last report as needing attention had been improved. For example, there was new flooring in some downstairs rooms and the laundry had been repainted to ensure that the walls and floor were easily cleanable. A number of bedrooms had been redecorated and re-carpeted and new furniture was on order. Work was due to start on replacing some permanently misted windows. The proprietors had drawn up a plan for renewal and redecoration which was being completed within the timescales they had set. A member of staff told us that the owners were working hard to improve the standard of the environment. As we recommended at the last inspection, moving and handling equipment was no longer being stored in the lounge, which helped to make the area more homely and comfortable. The changes to the lounges and dining areas were still working well and Care Homes for Older People Page 22 of 32 Evidence: a family member commented that they liked what they had done with the small dining rooms. Other people described the home as comfortable and homely. All the residents we spoke to said they liked their bedrooms. Those we saw had been personalised with ornaments and pictures to help make the space more familiar and homely. A family member said, Its nice that she has all her pictures up because she had a lot up in her own house. We noted that some of the ground floor rooms that looked out onto the car park did not have privacy curtains or blinds that would allow residents, who spent time in bed during the day, to have privacy without taking away their external view. At the time of our visit the home was clean and free from unpleasant odours. Residents told us that the home was kept clean and the beds were changed regularly. The laundry was adequately equipped for the size of the home. One resident told us the laundry was very good and said, They look after your clothing very well, it often comes back the same day. Staff had written guidance in prevention and control of infection. The training was overdue but booked in the next few weeks. There were ample supplies of gloves and aprons, which staff used to help control the spread of infection. There had been one outbreak in the past year. Notifications sent to us by the manager showed that the appropriate procedures were put into place and the outbreak was quickly contained. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were recruited safely and had appropriate training to meet the needs of the people using the service. Evidence: We heard mixed opinions about whether there were always sufficient staff on duty at all times. Staff we spoke to said they thought the staffing levels were sufficient, although one said that sometimes they had more staff at times when they werent needed as much, such as the afternoon, and they were occasionally a bit short at peak times in the morning. Most residents and visitors said there were always enough staff. One told us, If I need staff I just pull the cord and theyre here immediately. Another said, People dont have to wait too long for attention. A few people thought there were not always enough staff on duty. One visitor told us that if their relative needed help from staff they sometimes had to go and find someone. They told us they did not feel it compromised the care, just that they needed to wait. On the day of our visit we noted that staff were in and out of lounge areas and anyone who requested help was attended to almost straight away. We looked at the recruitment files of two newly appointed staff. Both had an application form which provided an employment history. However, one did not provide the reasons for leaving a number of previous care jobs. Neither person had started work until they had an ISA first check, which showed that they were not listed as Care Homes for Older People Page 24 of 32 Evidence: being unfit to work with vulnerable adults. The staff signed a statement that they took responsibility for ensuring they worked under supervision until they had a full CRB disclosure to show they did not have a criminal record that could preclude them from working in a care setting. They both had two written references before starting work. There was a good induction programme for new staff, which followed the Skills for Care Common Induction Standards. The training was carried out through a mix of self study and one to one sessions with senior staff. The trainee was expected to complete a workbook to evidence that they had understood the training. The proprietor told us that any new staff who already had a National Vocational Qualification (NVQ) would undertake a shortened version of the training but would still have to demonstrate their competence before being signed off. Staff who had been promoted to senior carers completed a six week induction programme to help to provide them with the skills to be able to lead a shift. The central training record showed that there were a few gaps in the mandatory training, such as health and safety and infection control but we saw evidence that courses had been booked and staff would be attending. We were told that training in other topics relevant to the needs of the residents would be identified during staff supervision and appraisal. At the time of our visit over half of the care staff held an NVQ at level 2 or above in health and social care. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service benefited from a stable management team but shortfalls in the quality monitoring system could result in areas of practice in need of improvement not being identified. Evidence: Since our last inspection the manager had successfully registered with The Care Quality Commission. In addition to being a legal requirement, her application also confirmed her commitment to the home. The manager is supported in her role by the proprietors, who visit the home on a regular basis, and by senior care staff. Although the management team had implemented the requirements and recommendations we made after our last inspection, their systems for monitoring the quality of the service were not thorough enough to ensure that areas that needed improvement were identified. There was no formal plan for future developments. These shortfalls could result in the improvements noted previously in this report not being sustained, or built upon. Minutes of residents and relatives meetings showed Care Homes for Older People Page 26 of 32 Evidence: that they were encouraged to air their opinions and make suggestions but there was no plan to show how these would be taken forward. We discussed that records of care plan and medication audits should be kept, which would enable the management team to identify whether there were any problem areas or trends. There was no evidence of audits of other policies, procedures or practices. The incomplete quality monitoring process was reflected in the AQAA which was, in parts, very brief with a lack of clear plans as to how the service was to develop over the next year. Several residents had small amounts of money held for safekeeping. There were individual account sheets which indicated when money was deposited or withdrawn. These transactions were signed and witnessed by staff and sometimes by residents if the money was being withdrawn. Receipts were obtained for any money paid out by staff on behalf of residents, for example, for hairdressing or chiropody. We looked at the records and money held for four residents. Three were correct but there were errors in calculations for one of the residents, which meant the money did not match the records. The records had not been audited previously, which meant the error had not been identified. Immediate steps were taken to put the account right and the proprietor drew up an audit schedule for residents finances before the end of our visit. Information received from the proprietors showed that all staff had received fire safety training. There were copies of the fire procedure on display all around the home. The AQAA told us that the fire safety and other installations and equipment were tested and serviced as recommended. The proprietors had set up annual contracts with various companies to ensure that the servicing was not overlooked. The AQAA indicated that the service had written assessments for hazardous substances. However, we noted that at least one resident had caustic denture cleaner in their room. There was no assessment to show that any potential risks to the resident had been looked at and, if necessary, controlled. Care Homes for Older People Page 27 of 32 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 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The manager must ensure that information recorded in care plans about residents care needs and support is communicated to staff. To ensure that planned care is carried out. 30/04/2010 2 9 13 Risk assessments for people who self administer any of their medication must be evaluated. To ensure that the resident is administering their medication safely. 31/03/2010 3 19 13 There must be risk 30/04/2010 assessments relating to the lack of window restrictors in some parts of the home and the open storage of caustic denture cleaner in residents rooms. This is to protect residents safety. Care Homes for Older People Page 29 of 32 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 4 33 24 The systems for monitoring the quality of the service should ensure that areas of practice that need improvement are identified and action is taken to carry out the improvements. This is to ensure that the service has a robust system of self monitoring. 31/05/2010 5 35 17 The system for recording 31/03/2010 money that residents have handed over for safekeeping must be reviewed. The records must be checked regularly to ensure that any miscalculations are identified and rectified. To protect residents and staff. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 8 8 The tool used to assess nutritional risk should be reviewed to ensure that it is fit for purpose. Each resident should have a moving and handling assessment to ensure that all potential hazards are identified and relevant strategies put into place. Keys to medicine cupboards should be retained by staff to ensure that access is strictly controlled. The Temperature of storage areas for medicines should be 3 9 Care Homes for Older People Page 30 of 32 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 monitored and maintained at the levels recommended on the medicine information leaflets. 4 12 Individual social and recreational plans should be brought up to date and residents opinions and wishes with regard to activities should be monitored. There should be privacy blinds or curtains at the windows of the rooms overlooked by the car park and buildings opposite the house. The window coverings should continue to allow residents to be able to see outside. 5 19 Care Homes for Older People Page 31 of 32 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 32 of 32 - 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!