Care Home: Regency Care Centre

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What the care home does well Management make sure that they assess the needs of people before they are admitted to the home. This is to make sure that staff only care for those people whose needs they feel they can meet. Residents feel that they are well looked after by the staff. Residents and relatives made the following comments: "It`s a good place to be". "I feel safe". "No complaints". Activities are considered to be a very important part of the residents` day. The meals provided are varied, nutritious and the residents have a good choice of menu. The residents live in a safe and pleasant environment. Management make sure that they check people out thoroughly before offering them a job. This is to prevent the residents being cared for by unsuitable people. Management make sure that the staff are properly trained so that they have the knowledge and skills they need to protect and meet the needs of the residents. Management continually check out the quality of care and the services provided for the residents. What has improved since the last inspection? The activities have become more person centered with special emphasis on the needs of people with dementia. Some improvements to the environment have been made. What the care home could do better: To make sure that the needs of the residents are always met and the dignity of the residents is always preserved, management need to keep the staffing levels under review. Key inspection report Care homes for older people Name: Address: Regency Care Centre 140 Lilyhill Street Whitefield Manchester M45 7SG     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: Grace Tarney     Date: 0 9 0 7 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 27 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 27 Information about the care home Name of care home: Address: Regency Care Centre 140 Lilyhill Street Whitefield Manchester M45 7SG 01617961811 01617961819 regency@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashbourne Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 63 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 home is registered for a maximum of 63 service users, to include up to 53 OP, up to 10 (DE)(E), up to 6 PD aged 60 years and over for post cardiac care. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home The Regency Care Centre is a purpose built home with accommodation on the ground and first floors. The home is situated in Whitefield close to a main bus route and not too far from the motorway network. There is level access to the front of the home to allow access for wheelchair users and people who have problems climbing steps. There Care Homes for Older People Page 4 of 27 Over 65 10 53 0 0 0 6 Brief description of the care home is plenty of parking to the front of the home and it is surrounded by very large, pleasant gardens. The bedrooms on the ground floor are for the residents who need personal care. This unit is called Springwood. The nursing residents bedrooms are on the first floor and this unit is called Philips. The first floor is reached either by stairs or a passenger lift. The 10 bed Dementia unit is a separately contained unit with its own lounge and dining areas and is situated on the first floor. This unit is called Heaton. There are several lounges and a dining room on the ground floor. All the bedrooms are single and have an en-suite facility of a toilet, some also having a bath or shower. The toilets and bathrooms have aids to assist any resident with a disability or mobility problem. The weekly fees within the home ranged from 385.00 pounds per week to 770.00 pounds per week. The fee charged depends on the care needed and the bedroom provided. Additional charges are made for private chiropody, hairdressing and newspapers. This information was received on the 9th July 2009. A copy of the last inspection report is kept in the reception area. Care Homes for Older People Page 5 of 27 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 staff at the home were not told that this inspection was to take place although many weeks before the inspection questionnaires (comment cards) were sent out to some of the residents and to the staff. The questionnaires asked what people thought about the care and quality of the service provided. We have not yet received comment cards back from the residents. We received 4 back from staff. What they felt about the care and services provided is written in different sections throughout this report. Also before the inspection we (The Care Quality Commission) asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they did at present, what they felt they did well and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we do. We spent 8 hours at the home and during this time we examined care and medicine records to make sure that the health and care needs of the residents were being met. Care Homes for Older People Page 6 of 27 In addition we looked at what activities were available for the residents and whether they were given choices about how they spent their day. We looked at what the residents were having for their meals, to make sure that there was a choice of meals and that they were varied and wholesome. We also looked around the building at some of the bedrooms, bathrooms, toilets and sitting areas to check if they were clean, warm and well decorated. We checked how many staff were provided on each shift to make sure that the residents needs were being met. We then looked to see if management recruited and trained the staff properly and safely. This is so the staff can do their jobs properly and the residents are protected from being cared for by unsuitable people. We also looked at how management check that the care and services they provide is what the residents and their relatives want, or expect. How the residents spending money is managed was also checked. In order to get further information about the home we spent time talking to 3 residents, 3 visitors, the activities person and 4 members of the care staff. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? 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 8 of 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are properly assessed before they are admitted to the home and this gives an assurance to everybody that a person is only admitted if the staff feel they can meet their needs. Evidence: The home admits people for short and long term care. The people who are admitted for short-term care are usually people who have undergone heart surgery who, whilst being medically fit for discharge from hospital, need some nursing support and reassurance. Before anybody is admitted from hospital following heart surgery they have an assessment undertaken by the hospital staff. If the staff at the home feel that they can meet this persons need then they are admitted to the home. An assessment looks at what help and support a person may need to help them make the most of their daily life. Before any resident was admitted to the home for long term care we saw that an assessment of their needs was undertaken, either by the manager or a senior member of staff from the home. We looked at 1 assessment that the staff from Care Homes for Older People Page 10 of 27 Evidence: the home had undertaken. It was detailed and showed clearly what the person could do for themself and what she needed help with. Based on this information it was decided that the staff at the home could meet their needs and therefore their admission to the home was possible. The AQAA document sent to us confirmed that an assessment was undertaken prior to admission. Standard 6 does not apply. The home does not provide Intermediate care. Care Homes for Older People Page 11 of 27 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. Overall the care plans reflect the needs of the residents and care practices ensure the residents needs are met in a safe and caring way. Evidence: Individual care plans were in place for each resident. A care plan details the individual care and support needs that a resident may have and also shows how those needs are to be met by the staff. We looked at 4 care plans, 3 on Philips Unit and 1 on Heaton Unit. The care plans gave instruction and guidance on how most of the care needs of the residents were to be met. They also provided information about the residents daily routine, their past life and their interests. The care plans were checked regularly by the staff so that any change in the residentss condition could be identified and action taken to put things right if necessary. We did see however that 1 of the care plans had nothing written in it about whether the resident was able to look after her own medicines. In view of the fact that this resident was only at the home for a short while to recuperate from heart surgery it would be good practice to ask if she wanted to get used to handling her own medicines. A care plan that we looked at on Heaton Unit did not have enough information in it to show how the condition of a pressure Care Homes for Older People Page 12 of 27 Evidence: sore was progressing. This resident was being seen by the district nurses with regards to the pressure sore but staff on the unit were not recording regularly in the notes about any progress. It was difficult to identify from the notes if there was 1 or 2 pressure sores and what the condition of any pressure sore was. We visited this resident in her bedroom. She was being cared for properly and looked very comfortable. A pressure relieving mattress was in use. The care notes however did not detail that this resident was being cared for on a pressure relieving mattress. We saw that this resident also had a problem with her hand. The care staff told us what the problem was and what they were doing but there was no record of the problem and how it was being cared for, in the care file. It is important to write down exactly how a resident is being cared for so that there is a clear record of care for everybody involved. In all the care plans that we checked we saw that the staff looked at whether or not there was any risk in relation to the residents developing pressure sores. They also looked at whether there was any risk of the resident falling and also if a resident was at risk due to problems with their food and drink intake. Staff also looked at how any resident was to be assisted with moving around and by how many members of staff and what equipment if any, was to be used to assist in safe moving and handling. We saw that residents were weighed regularly and their weight was recorded in their care notes. Equipment necessary for the prevention and treatment of pressure sores was available and in use. We saw that staff wrote in the care notes when the residents had received visits from health care professionals such as dentist, opticians, district nurses and chiropodists. We spoke to 3 residents on Philips Unit. They made the following comments: No complaints. They look after us very well. Its great here. We also spoke to 2 visitors on Heaton Unit. They said: He is well looked after, always clean and well dressed We looked at how the medicines are managed on the Springwood Unit. Care staff who have received medicine training have responsibility for managing the medicines. We looked at how medicines, including controlled drugs,were ordered, stored and recorded. The medicines are kept in a locked room in locked medicine trolleys that are secured to the wall when not in use. Only staff who have responsibility for the medicines have the keys. Identification photographs of each resident are kept with the medication administration sheets. Controlled drugs were being stored safely and recorded accurately. The following things however needed putting right: Handwritten instructions,written by the staff, were not being signed by the person who wrote the prescription. Handwritten instructions need to be signed, checked and countersigned. This reduces the risk of medication errors and therefore protects the residents from harm. A medicine prescription had been changed on the instruction of the residents GP. Staff had crossed out the dose and written in the new dose. It was not very clear on the prescription sheet. To avoid any confusion, when a prescription has been Care Homes for Older People Page 13 of 27 Evidence: changed, in the absence of a new prescription sheet from the pharmacy, staff should rewrite it and not alter what was previously written. Throughout the day we saw that the staff spoke to the residents in a respectful way. They were discreet and understanding when providing assistance to the residents. The residents looked clean, comfortable, well groomed and suitably dressed. We saw that staff knocked on bedroom, bathroom and toilet doors before entering. On Heaton Unit however, we were told that the day staff get some residents dressed in their nightclothes before 8pm so that the 1 night carer does not have to get them ready for bed by herself. We feel that this is an unacceptable practice and does not preserve the dignity of the residents. In the AQAA document sent to us we have been told about the Homes commitment to the Dignity in Care Challenge. We believe that the dignity of the residents on Heaton Unit is being challenged if they have to sit in night clothes in the lounge areas before they are ready to go to bed. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are supported and encouraged by staff to make choices about what they do so that they can find enjoyment and satisfaction in their daily life. Evidence: The residents routines of daily living, such as when they go to bed and when they get up, plus their social interests are recorded in their care plans. The home employs an activities person who works 30 hours a week, mainly Monday to Friday. We spent time talking to the activities person who told us what activities are available and what is planned for the near future. She showed us the activities folders that are in place on each unit. What each person does is written down in the folder. We were told that the choice is varied and includes baking, making sweets, arts and crafts, board games, croquet, hand massage and whatever the residents request to do. What is going on is displayed on the notice board in the reception area. Whilst we were at the home the residents were sat in the lounge watching a Magic Show. They seemed to be enjoying themselves. In the staff surveys returned to us, some staff told us that they felt more trips out for the residents would be nice. The hairdresser was at the home whilst we were there. The AQAA document sent to us stated that the majority of the residents were of the Christian Faith. There was 1 resident of the Muslim Faith and 3 residents of the Jewish Faith. Staff told us that the Roman Catholic residents, if they Care Homes for Older People Page 15 of 27 Evidence: wish, are visited by members of their church and are able to receive Holy Communion. We were told that other clergy visit regularly. We were also told that religious and cultural diets are provided for the Muslim and Jewish residents. We saw that the residents are encouraged to bring personal possessions into the home. The bedrooms that we looked at were highly personalised with the residents pictures, photographs and ornaments. The home has an open visiting policy. There are no unreasonable restrictions on the time people visit. We saw relatives coming and going throughout the day and they seemed to know the staff well. The 3 relatives that we spoke to told us that they are always made to feel welcome. We saw what the residents were having for their lunch whilst we were on Heaton Unit. Most of the residents were seated in the small dining room. The tables were nicely set. The main meal is served at lunchtime, a lighter meal in the evening and savoury snacks and milky drinks are served for supper. The meal served looked appetising and nutritious and there was plenty of it. Inspection of the menus showed that there is always a choice of main meal and dessert. Hot and cold drinks are served throughout the day. The residents that we spoke to told us: The food is very good. Yes, it is good food. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to ensure that people know how to complain. Staff have a good knowledge and understanding of what abuse is and know what to do if it happens. This helps reduce the possible risk of harm to the residents. Evidence: A notice is displayed in the reception area explaining to people how and to whom they can complain, and how their complaint will be dealt with. It is easy to understand and tells people that complaints will be looked into and a full written response will be given within 14 working days. We saw that a record is kept of any complaint made and includes details of the investigation and any action that the management may have taken to put things right. One complaint has recently been made to us since the last inspection of July 2007. The manager at the home is presently dealing with this. We spoke to some of the staff and asked them to tell us what they would do if they felt that a resident had been mistreated in any way. They were very aware of what to do and how to report it. They told us that they had been trained so that they could, as far as possible, protect the residents from harm. We saw evidence of this training in their individual training files. Care Homes for Older People Page 17 of 27 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 residents live in suitably adapted, clean and comfortable surroundings. Evidence: The home is purpose built and the accommodation is provided on 2 floors that can be reached either by a lift or stairs. It is situated in very pleasant, well stocked gardens that have seating areas for residents and visitors. The home is divided into 3 units. On the ground floor is Springwood Unit and on the 1st floor there is Philips Unit and Heaton Unit. There is a very welcoming reception area that leads onto the main lounge, a smaller lounge and the dining room. Residents can access the gardens from the lounges. During this visit we looked mainly at the environment on Heaton Unit. The unit was clean, bright and tidy. There is a lounge that leads onto a secure safe roof top terrace and a small dining room that has a small sitting area. The corridors were bright and well decorated. There is 1 bathroom on the unit. This bathroom did not have a handwash sink. Staff told us that this had been removed when a sluice room had been built next to the bathroom. We discussed the need for a sink with the manager who agreed to speak to senior management about it. To reduce the spread of infection staff need to be able to wash their hands after delivering personal care in the bathroom and toilet. We also saw that there was an unguarded radiator in this bathroom. We were told that this radiator is very rarely turned on. Regardless of this the radiator needs to be guarded. This is to reduce the risk of the residents being harmed by a hot radiator. Staff also told us that the unit would benefit from having a Care Homes for Older People Page 18 of 27 Evidence: shower installed. We saw that 1 of the toilets was without a lock on the door. To protect the privacy and dignity of the residents a safety lock needs to be fitted to the toilet door. We spoke to the manager about this and she agreed to have a new safety lock fitted. At the time of writing this report we were told that it is not yet in place. We looked at the small kitchen on the unit and saw that it was in need of redecoration. The work tops, floor and walls were stained. The manager told us that she was aware that the kitchen was in need of refurbishment. The bedrooms on the unit were clean and suitably decorated and furnished. Whist we were on the Philips Unit we saw that the proposed creation of a small lounge area was not yet complete. On our last visit 2 years ago we were told that it was the intention of management to create a small sitting area for the residents on this unit so that they could choose to stay on the unit and not have to go downstairs. Whilst some structural work had been undertaken the area was being used to store various things. It was not a suitable area for residents to sit down and relax in. The AQAA document stated that this was part of their plans for improvement in the next 12 months. Apart from the bathroom on the Heaton Unit the radiators throughout the home were suitably covered. We were told that thermostatic control valves were fitted to baths and showers. This reduces the risk of residents being harmed by protecting them from accidental scalding. The home was clean and there were no unpleasant smells. Apart from the bathroom on Heaton Unit, disposable hand washing equipment (liquid soap and paper towels) was in place in bathrooms, toilets and bedrooms. Disposable gloves and aprons were provided for the staff to wear. Providing this equipment helps to reduce the spread of infection and therefore helps to protect the residents health and wellbeing. Care Homes for Older People Page 19 of 27 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. The residents are cared for by staff that are well trained and safely recruited. The minimal staffing levels on Heaton Unit and at times on Philips Unit, could affect the ability of staff to meet the residents care needs fully. Evidence: A check of the duty rotas, discussions with staff and observation of the dependency of the residents, showed that on 2 of the units the staffing levels were minimal. Philips Unit:- Staff told us that almost 50 of the residents on this unit were cared for in bed and over 50 required the use of the hoist for them to be mobilised. We looked around part of the unit and saw that there were several residents with high dependency needs. On the day of the inspection visit there were 23 residents in, a new resident was being admitted that morning and another admission was expected. We were also aware that the unit regularly admitted residents following cardiac surgery. This increased the staff work load. The staff rotas showed that the unit operated on 1 qualified nurse and 3 care assistants between the hours of 8am to 8pm and 1 qualified nurse plus 1 care assistant during the night hours of 8pm to 8am. The staff that we spoke to told us that at times they felt there was not enough staff on duty to meet the needs of the residents. Heaton Unit:- For the 9 residents in the unit there were 2 care staff on duty between 8am and 8pm and 1 care staff for the night between 8pm and 8am. Only 1 resident was being cared for in bed. We were told that staff do not leave the unit for their unpaid meal breaks as it would leave only 1 staff Care Homes for Older People Page 20 of 27 Evidence: member on duty to care for and supervise the residents. As previously stated in Standard 10 of this report, we were also told that the day staff do get some residents dressed in their nightclothes before 8pm so that the 1 night carer does not have to get them ready for bed by herself. We feel that this is an unacceptable practice and does not preserve the dignity of the residents. Also when the night carer does get some residents ready for bed it leaves other residents unsupervised in the lounge or around the unit. These issues have been identified on the last 2 inspections and each time management have agreed to an indepth assessment of the residents needs and care practices. We discussed the concerns with the present manager who agreed to look at the staffing and care practices. Information from the 4 staff surveys sent to us showed that 3 staff members felt there was not always enough staff on duty. Comments were: Sometimes they could do with more staff to take the pressure off. Staff become tired and run down due to always trying to maintain a high level of service. I feel there is not enough staff to cater to all the residents needs. The information form the AQAA document sent to us and the information that we looked at in the training files showed that 50 of the staff had obtained their NVQ level 2 or above in Care. We were told that some staff have not yet finished the training and that some are waiting to start. We looked at how management recruit their staff. The personnel files of 2 staff members were looked at. All were in order and these staff had been properly and safely employed. this helps protect residents from being cared for by unsuitable people. The information in the AQQA form showed that management provide a staff induction programme for all newly employed staff. This is to make sure that they understand what is expected of them before they start caring for people. We also saw that lots of training has been provided for the staff to make sure that they know how to do their jobs properly and safely. Staff told us that they felt the training was good. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and safe. Evidence: The Manager is a Registered General Nurse who has extensive experience in caring for elderly people. She also has a management qualification. She has worked for the company for several years but only recently taken on the position of manager at the Regency Care Centre. She keeps herself regularly updated with training, both in management and care issues. The staff that we spoke to told us: She is approachable and we think, fair. She knows what is going on. The Manager has to do regular checks on lots of things in the home to make sure that the staff get things right for the residents. Some of the things that she has to do are to check the records about care, medicines and any accidents that have happened. Management also send out comment cards to residents and relatives asking what they think of the quality of the care and the facilities that are provided. In addition,regular relative and resident meetings are held. These meetings enable the residents and their Care Homes for Older People Page 22 of 27 Evidence: relatives to have a say on how they think things are being run and what they would like to see changed. The system in place for the management of residents money was safe. We were told that they mainly handle money brought in for residents expenses. We saw that receipts were given for any money received and receipts were kept for any money that was spent on behalf of the residents. Individual computer records are made of all transactions and balances. We saw that regular weekly checking and testing of the fire detection system, fire exits and emergency lights was undertaken and documented. Information from the AQAA document showed us that the equipment and services within the home were serviced on a regular basis. Care Homes for Older People Page 23 of 27 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 27 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 25 13 The radiator in the bathroom 28/09/2009 on Heaton Unit must be guarded or a low surface temperature radiator fitted. To reduce the risk of the residents being harmed by a hot radiator. 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 7 When a care issue has been identified, a care plan should be in place. It is important to write down exactly how a resident is being cared for so that there is a clear record of care for everybody involved. Staff should ensure that the progress, or otherwise, of any pressure sore wound is recorded. This will help any decision making in respect of whether further intervention from other professionals is needed. Consideration needs to be given to asking residents, especially those recovering form cardiac surgery, if they wish to be responsible for taking their own medicines. Staff should rewrite a prescription and not alter what was previously written. This could lead to confusion and result Page 25 of 27 2 7 3 9 4 9 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 in the resident receiving the wrong dose of medication. 5 9 Handwritten instructions need to be signed, checked and countersigned. This reduces the risk of medication errors and therefore protects the resident from harm Management need to look at the care practices on Heaton Unit to ensure that the dignity of the residents is always preserved. The kitchen on Heaton Unit needs to be refurbished. To protect the privacy and dignity of the residents, a safety lock needs to be fitted to the toilet door on the Heaton Unit. For the benefit of both residents and staff, consideration should be given to providing a shower unit on Heaton Unit. A sink should be provided in the bathroom on Heaton Unit. This should help to reduce the spread of infection as staff need to be able to wash their hands after delivering personal care in the bathroom and toilet. The staffing levels need to be kept under review so that the needs of the residents are met and their dignity is preserved. 6 10 7 8 19 21 9 10 21 21 11 27 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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