Care Home: Regents House Rest Home

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What the care home does well . What has improved since the last inspection? Since the previous inspection the home had made progress in addressing requirements relating to pre-admission assessments, care planning, risk assessments, responding to people`s healthcare needs, cleanliness, quality assurance and health and safety. Some progress had been made in activities, maintenance and the Manager`s training. While these improvements are acknowledged, the home needs to demonstrate ongoing and sustained improvment that becomes embedded in practice. What the care home could do better: The home needs to monitor buildings and maintenance issues more thoroughly and to further improve the activities available to people. The Manager needs to complete her training. The odour in the building needs to be addressed. This was required at the previous inspection and people continue to live in a home with an unpleasant odour. The home needs to continue to monitor the staffing levels so that the needs of the people in the home are addressed fully. The Manager needs to ensure that staff support and supervision occurs on a regular basis. Key inspection report Care homes for older people Name: Address: Regents House Rest Home 206 Regents Park Road Southampton Hampshire SO15 8NY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Nick Morrison     Date: 2 9 0 1 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 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 28 Information about the care home Name of care home: Address: Regents House Rest Home 206 Regents Park Road Southampton Hampshire SO15 8NY 02380322101 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): sandra.regent@hotmail.co.uk Mrs Jean Newson,Mr Ian Newson Name of registered manager (if applicable) Mrs Sandra Pearl Anaszko Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 17. The registered person may provide the following category/ies of service only: Care home only - (PC) 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) Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Physical disability (PD). Date of last inspection 0 0 0 0 Over 65 0 0 0 0 Care Homes for Older People Page 4 of 28 Brief description of the care home Regents House is a large period property that has been adapted to provide residential care for up to 17 older people. The accommodation is both single or shared bedrooms available on the ground and first floors with a passenger lift to the first floor. None of the bedrooms have en-suite facilities but do have a wash hand basin. There is a lounge, dining room and garden with patio area for residents to use. The building is accessible. The home is close to local shops and amenities. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 29 January 2010 from 12:30pm until 5:30pm. During this time we looked around the premises, looked at the files of six service users and spoke with three people who live in the home. We observed the support they were receiving. We also met the Manager, spoke with one member of staff and observed interaction between staff and service users. All records and relevant documentation referred to in the report was seen on the day of the inspection visit. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: 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 7 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from having their needs assessed prior to moving into the home. Evidence: We looked at the files of six people who live in the home, including one person who had recently moved in. The files showed that assessments were undertaken prior to people moving in so that the home could determine whether or not they could meet the persons needs. These assessments were undertaken with input from the service user where possible and from their relatives and relevant other professionals. The assessments were comprehensive and covered all aspects of potential needs the person may have. There had been a requirement from the previous Key Inspection on 12 August 2009 that the home must identify the social and the nutritional needs of people in the preadmission assessment in order to ensure that the needs of people using the service are identified and addressed. In looking at the file of the person who had recently moved into the home we found Care Homes for Older People Page 9 of 28 Evidence: that attention had been paid to both their nutritional and social needs and this information had then been used in the care planning process. This requirement has been met. Care Homes for Older People Page 10 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from having clear care plans and risk assessments in place and are protected by the homes medication policy and practices. There is no evidence yet of these improvements being sustained. Service users privacy and dignity is not fully protected and needs are not fully met. Evidence: We looked at the files of six people who live in the home. We also looked at medication records, observed staff administering medication, spoke with four people who live in the home, spoke with the Manager and observed how staff supported people throughout the day. There had been a requirement from the previous Key Inspection on 12 August 2009 that care plans must be kept up-to-date and must reflect peoples current needs in order to ensure that the current needs of people living in the home can be addressed. From looking at the care plans we saw they are now being regularly reviewed and records are kept to demonstrate this. There had also been a requirement from the previous Key Inspection on 12 August 2009 that risk assessments must be kept up to date and must reflect peoples current Care Homes for Older People Page 11 of 28 Evidence: needs in order that people living in the home are safeguarded from potential harm. Evidence from care plans showed that the risk assessments were being kept under regular review and were reviewed at the same time as care plans. Care plans and risk assessments were written clearly and explained to staff what they needed to do in order to meet peoples needs. Staff spoken with on the day of the inspection visit told us they understood peoples care plans and had clear up-to-date information on how to support them. We had made requirements relating to care plans at the previous four Key Inspections and requirements relating to risk assessments at the previous five Key Inspections. While there is evidence that the home has met these requirements on this occasion, we will need to see sustained improvement in these areas over future inspections in order to demonstrate that any improvements have been embedded in practice. There had been a requirement from the previous Key Inspection on 12 August 2009 that the healthcare needs of people living in the home must be monitored and responded to appropriately in order to ensure that people remain healthy. At the previous inspection there were people living in the home who required a lot of support with their healthcare needs, particularly their food and fluid intake. The home had not been adequately addressing those needs. By the time of this current inspection people with those particular needs were no longer living in the home. Despite this there had been improvements in the home in relation to addressing the nutritional needs of people living in the home. There was improved identification of nutritional needs in the initial assessment process and staff training in basic nutrition. In the day of this inspection we observed that drinks were available to people throughout the day. Tea and coffee was taken around to people at specific times and jugs of squash were available in the lounge throughout the day. There was also evidence from one service users file that the home had had concerns about the persons diet and had sought the assistance of professionals in dealing with this. There had been a requirement from the previous Key Inspection on 12 August 2009 that facilities must be provided so that people living in the home are able to maintain and protect their own privacy. This requirement related to the lack of a functioning lock on one of the bathroom doors. We noted from the inspection that there was now a lock on the door. We also noted that another toilet door in the building did not have a lock on it. While the home had responded to the original requirement regarding the lock, they had failed to ensure that the reason for the requirement had been addressed. It is a significant breach of peoples privacy and dignity if they are not able to lock the door of the toilet while they are using it. A further potential breach of Care Homes for Older People Page 12 of 28 Evidence: dignity occurred when one person living in the home had to wait ten to fifteen minutes for a member of staff to help them to use a commode. As well as being a breach of dignity this also means the person was not having their needs met and may have been very uncomfortable having to wait this long to use the commode. The reason for the wait was due to the availability of staff and this is dealt with further in the staffing section of this report. This example gave us concerns that, due to staffing availability, peoples needs were not being met. The requirement concerning ensuring peoples privacy and dignity had not been met. The service users we spoke with during this inspection told us they felt their privacy and dignity was respected by staff working in the home and this was also evident from our observation of staff on the day of the inspection. We observed that staff were discreet with people about providing personal care and also respected privacy by knocking on service users doors and waiting for a reply before entering. The medication records we saw on the day of the inspection were clear, accurate and up to date. The records included what medication had come into the home, what and been administered and what had been returned to the pharmacy. The medication file contained information for staff on the mediation used in the home and the homes medication policy. On the day of the inspection we observed a member of staff while they were administering the medication. They followed the process well and checked each item of medication against the records before administering it. They recorded the medication as having been administered only after they had observed the person take it. They also checked with each person whether or not they wanted their medication at that time before giving it to them. The member of staff concentrated on the task of administering medication but also took time to talk to service users while they were doing it. Staff involved in administering medication had received training and all medication in the home was stored securely. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from being offered a variety of nutritious meals and are able to exercise choice. Activities in the home do not take place as planned. Evidence: We looked at the files of six people who live in the home and spoke with three people who live in the home. We looked at menus, spoke with the Manager and observed how staff supported people throughout the day. There had been a requirement from the previous Key Inspection on 12 August 2009 that a programme of activities must be put in place to ensure that the social and stimulation needs of people living in the home are met. The home had made some progress with this. An activities file was in place which listed some possible activities staff could arrange for people living in the home. It stated that activities would take place between 2.00pm and 3.00pm each day. However, no planned activities took place on the day of the inspection visit. In the lounge there were newspapers and some books and games available for service users to use if they wanted to. We did not observe anyone making use of the games or books on the day of the inspection, but we did see one person reading a newspaper. Records of which activities people had Care Homes for Older People Page 14 of 28 Evidence: taken part in were kept in their individual files. These showed that people had watched films and television and had spent time chatting with members of staff. Other activities people had taken part in included singing and going to the shops. Through consultation with service users the home had identified that some people were interested in learning computer skills and the home had said it would look into organising this with an outside agency. Some people living in the home were supported to make use of the local church three times a year and there were occasional visits from external entertainers. The homes assessment process had improved and included asking people about their leisure interests. Although there is now some planned activity in place in the home it is only for one hour a day, even when it occurs. Peoples need for stimulating activity extends beyond this and the home needs to seek to increase the range and amount of activities on offer. We had made requirements relating to activities at the previous three inspections. There was evidence of some progress at this inspection but the home must continue to expand the ways in which people at the home have adequate stimulation and must ensure that activities take place as planned. The homes visitors policy states that people are able to visit friends and relatives who live in the home at any time that is convenient to them both. The three service users we spoke with during the inspection told us they were able to choose how they spent their time at the home. Our observations throughout the day of the inspection showed that staff in the home were skilled in being able to offer choices to people, give them time to choose and respect their decisions about what they wanted to do. Menus in the home showed that a wide range of food was on offer to people and that different alternatives were always available. People we spoke with told us they thought the food in the home was of good quality and served in adequate portions. From observation on the day of the inspection we saw that people were able to choose which room they sat in to eat their meals. Service users were told what was on the menu for the day and we saw staff going around asking people if they wanted what was on the menu or wanted an alternative. Alternatives were given to people who requested them. A record of the food people had was kept in the homes diary. Staff served the meals to people living in the home and we observed staff asking people if they wanted any support eating their meals. Drinks were available throughout the mealtime and afterwards staff took cakes and Care Homes for Older People Page 15 of 28 Evidence: fresh fruit to people. These were left in the lounge so that people could help themselves. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from a clear complaints procedure and are protected by the homes safeguarding procedures. Evidence: We looked at the homes complaints procedure, spoke with the Manager, looked at staff training records and referred to information given to us by other professionals. The home has a complaints procedure in place. Information on how to complain was given to service users and their families when they moved into the home and a copy of the complaints procedure is available in the building. Three service users we spoke with told us they were aware of how to make a complaint, but each said they had never had the need to. The home has a process in place for recording and responding to any complaints. In discussion with the Manager on the day of the inspection visit we found that she was able to demonstrate an understanding of the local safeguarding reporting procedures and how to use them. Staff had received training in protecting vulnerable adults. We asked one member of staff about their understanding of protection and safeguarding and they were able to explain the process to follow and the kinds of situations that might cause them to do so. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The issue of the odour in the home has not been fully addressed and the privacy and dignity of people living in the home is compromised by the fact that there is no lock on one of the toilets. Evidence: We walked around the building and spoke with the Manager. We also referred to previous reports and our own observations on the day of the inspection. There had been a requirement from the previous Key Inspection on 12 August 2009 that the unpleasant odour in the home must be addressed in order to ensure that people living in the home have a pleasant environment in which to live. On the day of the inspection we noted there was still an odour in the home which appeared to be caused by a mixture of the fact that there is a caged bird in the dining room and that the home has a smoking room that is well used by people living in the home. We were able to detect the smell of smoke in the hallway as well as in the lounge. None of the people living in the home who we spoke with expressed any concern about the odour in the building, yet it is still very obvious on entering the home. An extractor fan has been placed in the smoking room and was functioning at the time of the inspection, but the amount of smoking in the home means that it is likely to continue to have an odour. The home has not assessed each person living in the home as to whether or not they are troubled by the odour in the home or whether or not their health is Care Homes for Older People Page 18 of 28 Evidence: affected by the smoke in the home. This needs to be done in order to identify whether or not their needs are met by living in the home. There had been a requirement from the previous Key Inspection on 12 August 2009 that the home must be kept clean and free from the risk of infection in order to ensure that people living in the home have a pleasant environment in which to live and are free from the risk of infection. On the day of the inspection visit the home appeared clean throughout. Staff training records showed that staff had received training in infection control. Throughout the building there were paper towels and anti-bacterial soap in order to contribute to good infection control. No further cleaning or infection control issues were highlighted on the day of the inspection. There had been a requirement from the previous Key Inspection on 12 August 2009 that facilities must be provided so that people living in the home are able to maintain and protect their own privacy. This requirement related to the lack of a functioning lock on one of the bathroom doors. We noted from the inspection that there was now a lock on the door. We also noted that another toilet door in the building did not have a lock on it. While the home had responded to the original requirement regarding the lock, they had failed to ensure that the reason for the requirement had been addressed. This is also referred to in the Health and Personal Care section of this report. There had been a requirement from the previous Key Inspection on 12 August 2009 that maintenance issues must be identified and responded to in a timely manner in order to ensure that people living in the home are safe and have a pleasant environment in which to live. On the day of the inspection visit we saw the maintenance plan that the home had in place and noted the improvements that had been made to the building. However, the fact that the Manager was unaware that there was not a lock on one of the toilets demonstrates that the process of identifying maintenance issues is not thorough. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from being supported by trained staff and are protected by the homes recruitment policy and practices. Staffing numbers in the home need to be assessed and monitored in order to ensure that peoples needs are fully met. Evidence: We looked at the files of four members of staff, the homes training plan and records, spoke with the Manager, staff and people living in the home. There had been a requirement from the previous Key Inspection on 12 August 2009 that the Registered Person must ensure that no-one works in the home without satisfactory pre-employment checks being in place in order to ensure the safety of people living in the home. We looked at the recruitment files of three members of staff, including one person who had been appointed since the previous inspection. The records in the files demonstrated that the home is ensuring that all necessary preemployment checks are undertaken prior to staff beginning to work in the home. There had been a requirement from the previous Key Inspection on 12 August 2009 that Staffing in the home must be reviewed in order to ensure that at all times there are sufficient staff to meet the needs of people living in the home. We looked at the homes staff rota and spoke with the Manager. Since the previous inspection the home Care Homes for Older People Page 20 of 28 Evidence: had told us they had reviewed their staffing and were satisfied that the amount of staff they had was sufficient to meet the needs of the people who live there. The home has two care staff working on each shift and the Manager works five days a week during the daytime. At the previous inspection the home had a number of people living there who had a high level of need and this was not the case this time. However, we did observe that one person living in the home at this inspection had to wait ten to fifteen minutes for a member of staff to help him to use a commode as one of the two care staff was administering medication and the other was busy in the kitchen. The rota in the home is worked out so that one member of staff is mainly responsible for providing care and the other is mainly responsible for cooking and cleaning. The reason for this person waiting so long to use the commode may have been either that there were insufficient staff or that the Manager was not able to prioritise work for staff so that the persons needs were met. We have made a requirement that the Manager carry out a formal and recorded assessment of staffing levels and staff deployment in the home to determine whether the current staffing levels and methods of deployment meet the needs of people living there. There had been a requirement from the previous Key Inspection on 12 August 2009 that the training provided must reflect current good practice and must inform care practices in the home in order to ensure that people living in the home receive the support they need and remain safe. Training records showed that there had been an improvement in the amount of training since the previous inspection. The training plan showed that the home is planning training for staff based on their needs and the needs of the people living in the home. Staff told us they received regular training and that they thought it was relevant to their role. From observation on the day of the inspection we saw that staff interacted very well with people living in the home, showing sensitivity and concern for their welfare. The member of staff providing care and administering medication on the day of the inspection demonstrated that she was skilled in undertaking her role and supported people in a professional and friendly manner. The service users we spoke with on the day of the inspection told us they thought staff were skilled and supported them well. They also told us they got on well with the staff and felt comfortable whenever they needed to ask for any support. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from being consulted about the running of the home and from the homes management of health and safety issues. The Manager has not completed her training and staff in the home do not have regular support. The home did not send us their Annual Quality Assurance Assessment when we asked for it. The home is not managed and monitored effectively. Evidence: We looked at the management processes in the home and spoke with the Manager. We also looked at health and safety records, quality assurance records and staff support and supervision records. There had been a requirement from the previous Key Inspection on 12 August 2009 that the Manager must have the skills and training to manage the service effectively in order to ensure that the home is managed so as to meet the needs of the people living there. At this inspection the Manager was able to show us evidence that she has Care Homes for Older People Page 22 of 28 Evidence: begun to undertake management training. We had made this requirement at the previous four inspections and will continue to monitor until the training is completed. The home had failed to provide us with the Annual Quality Assurance Assessment (AQAA) after we wrote to them on 24 November 2009 asking for it to be returned to us by 22 December 2009. There is a legal requirement for registered services to provide an AQAA which the home failed to meet. There had been a requirement from the previous Key Inspection on 12 August 2009 that there must be an effective system of quality assurance that focuses on the views of people living in the home and measures how well the service is meeting their needs and that monitors compliance with the homes legal and statutory requirements. The home has made progress on this. Survey questionnaires had gone out to people living in the home and some had been returned by the time of the inspection. In addition to this the home had also used residents meetings to consult with people about the running of the home. They have developed an improvement plan for the service which reflects the feedback they have had from people living in the home. Clear records were kept of both the consultations and the plans for the service. The AQAA is fundamental to the quality assurance processes in the home and to ensuring that peoples needs are met. The fact that the home had failed to provide us with this at the time we asked for it means that they are not meeting the standards for quality assurance. We had made requirements relating to quality assurance at the previous five Key Inspections. While there is evidence that the home has made progress with this at the time of this inspection, we will need to see sustained improvement in this area over future inspections in order to demonstrate that any improvements have been embedded in practice. The Manager informed us that the home does not look after any service users money. We looked at the support and supervision records of three people who work in the home. These showed that support and supervision sessions had been erratic. One person who had been working in the home for four months had only had one formal support and supervision session in that time. In discussion the Manager acknowledged that support and supervision had not been occurring as often as it should have and said that she would now be aiming for it to occur at least every two months for each member of staff. Health and safety issues in the home were being monitored. The home has an environmental risk assessment in place which is monitored and updated by the Manager. Staff had received training in health and safety issues and one member of Care Homes for Older People Page 23 of 28 Evidence: staff we spoke with was clear about their responsibilities to maintain a safe working environment. The requirements we have needed to make throughout this inspection report reflect on the way the service is managed. The home has begun to make progress with activities and with quality assurance, but there is still further work to do in each of these areas in order ensure the needs of the people living in the home are met. The home failed to send us their Annual Quality Assurance Assessment when we asked for it and staff in the home are not receiving regular support and supervision. There is a system in place for identifying maintenance issues but it is not implemented thoroughly enough to have identified the fact that one of the bathrooms has no lock on it. The home informed us they believe there are sufficient staffing levels but there is no evidence of how this was assessed and we still had concerns that staffing levels may not be adequate to meet the needs of people living in the home. If the service was being managed and monitored adequately then they would have identified and rectified these issues themselves rather than have to have them highlighted through the inspection process. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 10 12 Facilities in the home must enable service users to maintain their own privacy and dignity So that peoples privacy and dignity is maintained 01/04/2010 2 12 16 Activities must take place as 01/04/2010 planned. So that the leisure and stimulation needs of people living in the home are addressed 3 19 16 The Manager must assess if people living in the home find the odour unpleasant to live with. So that people have a pleasant environment to live in. 01/04/2010 4 19 12 Maintenance issues in the home must be thoroughly monitored and addressed 01/04/2010 Care Homes for Older People Page 26 of 28 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that the building is fit to ensure peoples privacy and dignity is maintained. 5 27 18 The home must make a formal and recorded assessment of the staffing levels in the home and keep staffing levels under review. To ensure that there are adequate numbers of staff a all times to meet the needs of the people who live there. 6 31 9 The Manager must complete 31/12/2010 her current training and keep her training up-to-date So that the home may be managed in an effective way 7 36 18 Staff in the home must receive regular support and supervision To ensure that they have the assistance they need in meeting the needs of the people who live in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 01/04/2010 01/04/2010 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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