Care Home: Regent House Nursing Home

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What the care home does well Regent House provides nursing care for up to 32 older people in a homely environment. Prospective residents receive enough information about the home prior to deciding whether they wish to live there, and the manager or her deputy undertake a comprehensive assessment on prospective residents to ensure that they can meet their needs. Staff receive sufficient ongoing training to enable them to have the knowledge to meet resident`s needs and registered nurses undertake training to ensure that their existing skills are updated. Other health care professionals such as General Practitioners, specialist nurses and speech and language therapists visit the home as required. Residents can have visitors at any time and resident`s next of kin are kept informed of any concerns about the residents by the staff. Some leisure activities are provided by the home and some of the residents are escorted to the shops or on outings to the seafront, other activities are provided in house. Various activities take place in the gardens in the summer including fetes, parties and barbeques. Comments received from surveys and from conversation with residents and staff included: " They care for me well". " The registered nurses are very good and know how to look after me and have the care I need". " There is a family atmosphere in the home". The home has taken advice from other health care professionals towards improving the quality of the life of the residents in the home and is continuing to work towards this. What has improved since the last inspection? Several improvements have taken place in the home since the last inspection, improvements to the environment are now taking place including repainting of the front of the house, some redecoration of resident`s rooms and the purchase of new furniture for communal areas. Pendant call bells are now available for resident`s use which enables them to call for assistance when out of their rooms. Care plans have improved and now include all information necessary to ensure that the resident`s care needs are being met. The manager and staff are now working on these to ensure that they are sufficiently personalised to individual residents and take into account their preferences both in care and in daily living. The standard of medication administration is more robust and medications are regularly audited to ensure the safety of residents. Ongoing recruitment of all grades of staff is taking place to ensure that residents are looked after by staff that they know and are familiar with. Comments from surveys and converstations with residents and staff included: " We have more time now to talk with residents". " During the years I have worked here I have seen a lot of improvement in the past year". "The new sofas in the lounge are lovely, they have bought us a computer and I hope they will give us lessons on it so we can email our family, there are new staff coming in and that helps". All requirements made at the last inspection have been complied with. What the care home could do better: Whilst there are sufficient staff to meet the needs of the residents, concerns were raised with the manager regarding the deployment of staff, the use of agency staff who were not familiar with the home, and the reported and witnessed attitude of some care staff. A requirement has been made regarding this. Concerns were also raised about the presentation of meals and staff attention to ensuring that meal times were a relaxed social occasion. Concerns were also raised by residents about the quality and quantity of the food provided. A requirement has been made relating to these issues. There is scope to increase the leisure activities provided to ensure that they reflect resident`s interests and the perception by staff of this being a meaningful part of holistic care and a requirement has been made. The provider and the manager are expected to ensure that improvements made during the past year are sustained, and that further improvements take place across all sectors identified in this inspection report to enable residents to enjoy a good quality of life in a pleasant environment. Key inspection report Care homes for older people Name: Address: Regent House Nursing Home 107 - 109 The Drive Hove East Sussex BN3 6GE     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: Elizabeth Dudley     Date: 1 4 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Regent House Nursing Home 107 - 109 The Drive Hove East Sussex BN3 6GE 01273-220888 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): matron@impex.co.uk Shafa Medical Services Limited (Head Office) Name of registered manager (if applicable) Ms Ann Marie Lee Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Regent House Nursing Home provides nursing care and accommodation for up to thirty-two older people. The home is owned by Shafa Medical Services Limited, and is situated in a residential area of Hove, East Sussex. Regent House is within walking distance of local bus routes, with both Hove and Brighton town centres a short drive away. A small number of parking spaces are available at the front of the home for Care Homes for Older People Page 4 of 31 Over 65 32 0 2 5 0 9 2 0 0 9 Brief description of the care home visitors. The home is a detached residence converted from two houses. Accommodation is provided over three floors, with a basement housing the laundry and kitchens. The home provides a passenger lift that enables residents to access all parts of the building. Regent House has thirty single rooms, all with en-suite facilities. Two of these rooms are registered as shared accommodation if required. There is a large garden at the rear of the property that is accessible to residents, including those in wheelchairs or with mobility problems. There is a large, attractive sitting room, and two dining rooms. There is a further seating area in the hall of the second house. Current fees for the home range between £545 and £750 per week. These do not include extra services such as chiropody or hairdressing and details of charges for these are available from the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This Key Unannounced Inspection took place on the 14th April 2010 commencing at 10:00 and finishing at 16:00 and was facilitated by the registered manager. The Annual Quality Assurance Assessment (AQAA), a document required by regulation, which informs us of what has occurred in the home since the last inspection, any shortfalls in the home and plans for the next twelve months, was received when we asked for it. This document was comprehensive and accurately described the current status of the home. Prior to the inspection the Care Quality Commission sent out ten surveys to residents and ten to staff, of these five were returned by residents and five by staff. During the day of the inspection all residents were seen and eight residents, seven members of staff, and three visitors to the home were involved in the inspection Care Homes for Older People Page 6 of 31 process and gave their views on life in the home. Methodology used to inform the judgements made in this report included examination of documents consisting of care plans, medication records, health and safety documents and personnel and training files. Observation of staff working with residents, administration of medication and provision of meals took place, and all areas of the home including residents personal accommodation were visited. The last key inspection took place on the 25th September 2009 Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Several improvements have taken place in the home since the last inspection, improvements to the environment are now taking place including repainting of the front of the house, some redecoration of residents rooms and the purchase of new furniture for communal areas. Pendant call bells are now available for residents use which enables them to call for assistance when out of their rooms. Care plans have improved and now include all information necessary to ensure that the residents care needs are being met. The manager and staff are now working on these to ensure that they are sufficiently personalised to individual residents and take into account their preferences both in care and in daily living. Care Homes for Older People Page 8 of 31 The standard of medication administration is more robust and medications are regularly audited to ensure the safety of residents. Ongoing recruitment of all grades of staff is taking place to ensure that residents are looked after by staff that they know and are familiar with. Comments from surveys and converstations with residents and staff included: We have more time now to talk with residents. During the years I have worked here I have seen a lot of improvement in the past year. The new sofas in the lounge are lovely, they have bought us a computer and I hope they will give us lessons on it so we can email our family, there are new staff coming in and that helps. All requirements made at the last inspection have been complied with. 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 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents receive sufficient information to enable them to make an informed choice over whether the home can meet their needs. People are only admitted to the home following a thorough assessment which ensures the home is aware of, and can fully meet, their needs. Evidence: The home provides a Statement of Purpose and Service User Guide. Both documents have been reviewed recently and each resident has a copy of the Service User Guide. It was noted that whilst a copy of this document was present in every residents room, some of these were kept in a position that made them inaccessible to residents. The manager said that this would be addressed. Discussions were held with two recently admitted residents, or their relatives, regarding the admission process, they said that they had received sufficient Care Homes for Older People Page 11 of 31 Evidence: information prior to admission and that the manager had visited the individual and undertaken a full preadmission assessment to ensure that the home could meet their needs. Three preadmission assessments were looked at and showed that all areas of the care required were documented, this information then formed the basis of the individuals care plan. Prospective residents are informed in writing over whether the home can meet their needs and they can be admitted to the home. Residents and their representatives are invited to view the home prior to making the decision over whether they wish to move there. Every resident, irrespective of their funding arrangements, receives a copy of the homes terms and conditions of residence. The home admits people for permanent and respite care but not for intermediate or transitional care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Discussion with residents and care plans showed that residents health and psychological needs were being met. The standard of medication administration, recording and storage, safeguards the residents. Residents are able to make their own decisions regarding their wishes for end of life care and these are recorded in the care plans. Evidence: Care plans belonging to four residents were examined to determine whether the home was addressing the care needs of the individuals. The home is working towards ensuring that the care plans take into account the individual wishes of the residents in how they would like their care given and address their personal choices in activities of daily living. Care plans were robust, had utilised the information from the preadmission Care Homes for Older People Page 13 of 31 Evidence: assessment and included current and ongoing health, psychological and social needs. They had been reviewed on a regular basis and, in general, daily records showed the care that had been given at any specific time. Staff had not always ensured that care plans had been formed or reviewed in consultation with the resident or their representative. Discussions were held with the manager regarding any extra information that required including in the care plans to ensure staff were fully informed and that residents received the care required. Risk assessments for bed rails and other equipment used were in place. Nursing charts in residents rooms were up to date, however fluid intake and output charts were not being totalled in a twenty four hour period and the results added to care plans for the registered nurses to review. This negates the purpose of commencing a fluid chart. Electric mattresses used for the relief of pressure are checked on a daily basis to ensure the correct pressure is maintained, records of this were in the relevant residents rooms and were up to date. There was evidence that other health care professionals, such as General Practitioners, speech and language therapists and the tissue viability specialist nurse visit the home.The manager said that a dentist could be accessed if required. The general opinion from residents, visitors and surveys received was that the home met their needs and the standard of care was usually good. Residents said that their privacy was maintained and that care was given in a private manner and their dignity maintained. Comments received included: The staff are mostly good and caring, I think that the home looks after me very well. I am pleased with the care that I am given, they do everything to ensure that I am comfortable. The registered nurses work really hard to make sure that my care is top notch. Care Homes for Older People Page 14 of 31 Evidence: Some residents were concerned about the attitude of some of the care staff, insomuch that specific care staff sometimes showed annoyance about being asked to do things and were abrupt with them. This occurred on all shifts over the twenty four hours but the residents were emphatic that it was a small proportion of staff that this related to and did not include the registered nurses. This was also seen to a lesser degree during the day, and was fully discussed with the manager who has said that this will be addressed. Examination of medication records showed that all medications were signed for following administration and the management and recording of controlled drugs met the regulations. Residents who wish to self medicate can do so, following a risk assessment, with those who are able to do so having a lockable drawer in their rooms. The standard of medication administration safeguards the residents. The majority of residents have care plans recording their wishes for care when they reach the end of their lives, these include their preferred place for care and any interventions or treatment they wish to take place. Staff in the home have not yet received training on the Liverpool Care Pathway or Gold Standards Framework (nursing tools for ensuring that residents receive a nationally recognised standard of care and pain control at the end of their lives) but some staff have attended courses relating to end of life care at the local hospice and through distance and e-learning. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is scope to increase the range and frequency of activities to ensure that all residents have the opportunity to take part in stimulating activities. Residents generally did not make positive comments about the food, and observations showed that meal times did not provide a relaxed social occasion conducive to stimulating the appetite. Evidence: The home employs a part time activities coordinator who provides leisure activities including quizzes, board games, some outings, art and crafts and one to one sessions. The home has some outside entertainers such as musical entertainers visiting. Social care plans have been commenced and in some instances residents have been encouraged to pursue activities they enjoyed previously; i.e. one resident is encouraged to do ink drawings which he previously enjoyed. The home has provided a computer and wi fi internet for residents, and although at present few are able to use this, is hoping to commence some computer training for other residents. Residents have also been provided with a games/ exercise console and pendant call bells for when they use the garden or walk around the home. Care Homes for Older People Page 16 of 31 Evidence: Some residents are able to go out for walks with the activities co-ordinator or staff, but due to staffing limitations this is only available to one or two residents. On the day of this visit to the home, the activities organiser was on annual leave and therefore staff were providing activities with one member of staff having being designated to do this, there were no activities provided this day although a music video had been scheduled. Due to a technical fault this could not be shown but staff had not arranged anything else in lieu of this. There was little interaction taking place between residents and staff at this time of day and one comment received in a survey said Staff try to make time for us, but are too busy. Although there is still some scope to ensure that all residents receive adequate stimulation and leisure interests, there has been improvement over the past twelve months in the provision of activities, and the home is starting to embrace the notion of person centred care and that productive leisure is an important part of holistic care. Most residents spoken with said they had a choice over the activities of daily living such as rising, retiring and bathing. However it was noted that the night care plans, whilst including the individuals preferred time of rising , did not indicate preferred time of retiring. Two residents said that they fitted in with the staff, the staff come in and help us into bed when they (the staff) want. It was noted in the previous section of this report that residents were not necessarily comfortable with asking some staff to provide care or facilities outside of the homes routines and therefore this may indicate that some staff do not fully embrace the residents right to conduct their lives as they please. Residents can have visitors when they wish to do so, two visitors spoken with said they could come in when they wished and were happy with the care given. Ministers of religion visit the home. The overall opinion of residents spoken with was that the quality of the meals was variable and the supper meal was generally too little and not too good; and that meal times were a rushed occasion. These comments were supported by responses to surveys which stated that : Care Homes for Older People Page 17 of 31 Evidence: The home does well at caring but needs improvement in the food. Sometimes likes the food. The impression gained when observing lunch being served was of a chaotic and disorganised event rather than a relaxed social occasion for residents. Tables in both dining rooms were carelessly laid up, in the small dining room fish knives had been provided for residents whereas sausages were being served. Although residents in the main dining room who required assistance were being assisted in an empathetic manner, those in the small dining room had meals put in front of them with no one enquiring whether they could manage to cut the food. Whilst care staff were seen taking meals to residents rooms on trays, these were not attractively laid out or left with the resident. Knives and forks were put directly onto the residents chair side tables and there was no evidence of the table being cleaned first. Residents in their rooms also said that there was a long wait in between courses. Residents pointed out that they only received one sausage at lunch, whilst some said that this was sufficient for their needs, others said that they would have liked more. However it was noted on examining records of residents weight, that the majority of residents had gained weight since being in the home, and care plans showed that appropriate actions were being taken to address weight loss in the very small minority of residents who had lost weight. The menu provided appeared well balanced and varied although the supply of fresh fruit available appeared limited to fresh fruit salad once or twice a week, and a banana at breakfast if the residents wish for this. A visitor spoke of residents being offered tinned pineapple when fresh fruit was available. Breakfast is served until 0930 and residents can have a cooked breakfast if they wish. Residents can take their meals either in their rooms or in the dining room, whilst staff said they ask the residents where they would like to have the meals, one resident said that : I would prefer to have my meals in my room but the staff dont ask and cant be bothered. Care Homes for Older People Page 18 of 31 Evidence: Some residents said that the amount of food given at supper time was insufficient for their needs and three residents said that they were not offered a night time hot drink during the evening, therefore the last hot drink they had was at supper time. The cook does not have a kitchen assistant to help with cleaning and care staff have to lay up the trays for meals and the tables, this task takes them away from caring or providing leisure activities to residents and may possibly increase the feeling of pressure at meal times. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel comfortable with taking complaints or minor concerns to senior members of staff. Staff were aware of their responsibilities in the safeguarding of those in their care. Evidence: The complaints policy is displayed in the entrance hall and is also included in the Service User Guide, the majority of residents spoken to were aware that the complaints policy was in the guide but said that primarily they would speak with a senior member of staff if they had a complaint. Some people who had asked the manager to address minor concerns said that generally these had been resolved, however it was ascertained by the residents concerned that they had not spoken to the manager regarding various matters identified in previous parts of this report. The home has received minor concerns since the last inspection; but no complaints or adult safeguarding issues. The training matrix showed that all staff have undertaken some adult safeguarding training, with senior staff attending training with the local authority. Three of the staff spoken with were aware of the procedure to follow if they became Care Homes for Older People Page 20 of 31 Evidence: aware of an adult safeguarding issue. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the provider and manager have made many improvements to the environment, this needs to be sustained to ensure that residents live in a pleasant and well maintained home. Evidence: There have been several improvements to the environment since the last inspection. These include a new furniture in the large dining room and two new sofas in the lounge, some residents rooms have new carpets and furniture and external improvements including repainting of the exterior of the home and removal of rubbish from both the back and front of the home. Maintenance to various areas such as kitchenettes has now been addressed. Following the mattress audit undertaken by the Tissue Viability Specialist nurse mattresses are being replaced as required. Some residents rooms still require refurbishment, many of them do not have a bedside table or cupboard or lockable drawers. There are still many improvements required such as redecoration, to ensure that the home becomes a pleasant environment for residents, and the provider and manager Care Homes for Older People Page 22 of 31 Evidence: should ensure that the current plan of improvement is sustained. Window restrictors were in place throughout the home and hot water temperatures to resident outlets are monitored and records showed that these were within recommended parameters. The home has purchased pendant call bells to ensure the safety of the residents when they are not in their rooms. There are policies and procedures on infection control, all members of staff were seen wearing protective gloves and aprons as appropriate and the home has an infection control champion (a specific member of staff who liaises with the Health Protection Agency and ensures the home is following the correct procedures to minimise infection). The home has sufficient equipment to ensure that residents are able to maximise their independence and to ensure the safety of staff when nursing the residents. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst numbers of staff on duty over a twenty four hour period are sufficient to meet the needs of the residents currently in the home, inadequate deployment and supervision of staff are resulting in some residents needs not always being met. Robust recruitment procedures ensure that residents are safeguarded. Evidence: The home is in the process of recruiting more care staff and whilst the duty rota and discussion with staff showed there were sufficient staff on duty to meet the needs of the residents in the home, residents said that staff were not always available, and were not always happy to meet their needs. Mealtimes, as previously stated, were rushed. Whilst agency staff are used to make up staff numbers, the home is not always using staff that are familiar with the home therefore putting extra strain upon permanent staff. Deployment of staff as opposed to numbers of staff may be the issue. As stated, the attitude of some staff and perception of residents needs requires addressing. One example of this is one resident had some marmalade given to her but is unable to open it and in spite of frequent asking, no staff have helped with this or provided her with a spoon or knife to use. A resident was not helped with removing her coat when coming in to the home after an outing, although she was in a Care Homes for Older People Page 24 of 31 Evidence: wheelchair. Staff follow an induction course which meets the National Minimum Standards on commencement of employment and six (40 ) of the fifteen care staff now have their National Vocational Qualification in Care at level 2 or above. Staff are now attending training with outside bodies to supplement the e- training and distance learning courses available in the home, and training records show that staff are receiving mandatory health and safety training. It was recommended to the manager that staff attend Dementia training at a higher level than currently due to the amount of residents in the home who have mental health conditions of the older person secondary to their physical nursing needs. Registered nurses undertaken suitable training to update or enhance their skills. Four personnel files belonging to new members of staff were examined and these were shown to include all the documentation required by regulation. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems in place have led to improvements in the environment, the records kept in the home and practices within the home, and ensure that residents are safeguarded. Evidence: The manager has been in post for almost two years and is registered with the Care Quality Commission. She is a registered nurse and has commenced a Leadership and Management course. Both the manager and the deputy manager are now in process of consolidating their roles and many improvements in the home noted since the last inspection. Both the manager and senior staff have undertaken the Mental Capacity Act and Deprivation of Liberty Safeguarding training with the Local Authority. This training is being cascaded to other members of staff who are also undertaking e- learning on these subjects. Care Homes for Older People Page 26 of 31 Evidence: The AQAA ( Annual Quality Assurance Assessment) was received when we asked for it and accurately showed what was happening in the home, improvements made, shortfalls to be addressed and plans for the coming year. The home has an ongoing quality monitoring programme which involves the use of questionnaires by residents, visitors and health and social care professionals; and the manager is in the process of collating these and taking any actions required. The manager told us that residents and relatives meetings are held six monthly and that staff meetings are held at regular intervals. The majority of staff have received formal supervision on a two monthly basis. Regulation 26 visits ( monthly visits to the home by the provider required by regulation) have taken place most months. The home keeps small amounts of money for safekeeping for some residents. This has been examined and records seen on each previous inspection and found to be accurate with up to date records, therefore this was not examined on this occasion and the manager gave assurances that a recent audit had taken place. Records used in the home were up to date and policies and procedures have been recently reviewed. Evidence was seen that utilities and equipment has been regularly serviced and that a fire risk assessment was in place. All doors to residents accommodation have automatic door closures which are triggered in the event of fire and staff have regular fire training and other mandatory health and safety training. A member of staff was seen pushing a resident in a wheelchair without using foot rests. This could cause serious injury to the resident. Senior staff said that foot rests are available for all wheelchairs in the home and that these have been checked. The manager is addressing this. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 10 5 That the manager ensures, by training or other methods, that care staff interactions with service users are undertaken in a wholly professional, polite and caring manner. To enable service users to feel comfortable in making their needs known 02/06/2010 2 12 16 That the home continues to improve the opportunities for service users to participate in meaningful leisure activities and that adequate amounts of staff are available to facilitate this. To provide sufficient stimulation for service users and ensure that they receive the benefits of holistic care. 01/06/2010 3 15 16 That the manager ensures that meals are well presented and are provided 01/06/2010 Care Homes for Older People Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action in an unhurried and relaxed manner and that there is regular consultation with service users about the quality and variety of meals provided. To ensure that service users receive maximum enjoyment of mealtimes. 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 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. 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