Care Home: Ridgwell House

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What the care home does well Residents are happy living at Ridgewell House and speak positively about the staff team and services offered. Comments include `the staff are friendly and helpful` and `I am quite happy here and feel settled`. Ridgewell provides a homely environment that is popular with people and residents say that they have choice in their day to day lives. The residents also speak highly of the food provided. Despite not being in day to day control of the home the provides committed to providing a good service and is steadily investing in the home. What has improved since the last inspection? There have been some improvements since we last visited but we are concerned that these have been limited and that the team at the home have not met many of the regularity requirements set at the last inspection. Progress is hampered by the current management arrangements at the home. Improvements were noted in the management of complaints, medication management, signage and odour control. What the care home could do better: The team at the home have a lot of work to do in order to improve standards and this was discussed with the provider. Many of the regulatory requirements set at the last inspection have been repeated and should these not now be addressed by the management of the home, the commission would consider taking enforcement action. In order to improve outcomes for residents work is needed in the following areas; residents` care planning and management, medication, social care/activities, adult protection, staffing training, day to day management of the home and quality assurance. Key inspection report Care homes for older people Name: Address: Ridgwell House 95 Dulwich Road Holland on Sea Essex CO15 5LZ     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: Diane Roberts     Date: 1 1 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Ridgwell House 95 Dulwich Road Holland on Sea Essex CO15 5LZ 01255815633 F/P01255815633 dunaibrahim@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Prestige International (EC) Ltd care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The total number of service users accommodated in the home must not exceed 16 persons Date of last inspection Brief description of the care home Ridgwell House is an established care home for older people in the village of Holland on Sea, near the town of Clacton on Sea. The home has been open since 1985, and was registered to the present owners Prestige International (EC) Ltd in July 2004. The accommodation offers care for 16 residents on the ground and first floor. At the time of the inspection a double bedroom was used to accommodate a single person and therefore all accommodation is in single rooms for 15 residents. There is a stair lift to the first floor. The majority of the accommodation is on the ground floor, with 4 residents on the first floor. There are 3 bathrooms and 1 shower room, all with toilets. In addition, there are 3 separate toilets around the home. Catering and laundering facilities are found in the centre of the home. Communal areas consist of a front and rear lounge and a large dining room. The rear lounge overlooks the rear garden, which Care Homes for Older People Page 4 of 31 1 4 0 4 2 0 0 9 16 0 Over 65 0 16 Brief description of the care home is laid to lawn with flowers, shrubs, fruit trees and vegetable beds. In the garden there is a summerhouse, a green house and shed. Seating is provided during the summer in the garden. The front garden has a semi-circular driveway offering some off-road parking. Flowerbeds, plant pots, flowering shrubs and trees bring colour and interest to this area. The range of fees charged by the service are between £480.00 and £540.00 per week. Respite rates are up to £495.00 per week. There are additional charges for hairdressing, chiropody and staff escort fees. 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: 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: We visited the home for a day and a half and met with the day to day manager (referred to as the manager in this report) and the provider/registered manager, who currently lives abroad but visits the home approximately every six weeks. Prior to this we reviewed all the information that we already had on the home and this included the managers Annual Quality Assurance Assessment. The manager was asked to complete this and this tells us how well they think are doing, what they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. On the day of the inspection we spoke to 3 residents and 2 staff at the home and prior to that we sent out surveys to relatives and staff asking for feedback on the home. The response was quite good and these comments are referred to in the report. Whilst at the home we also reviewed records and undertook a tour of the home. Care Homes for Older People Page 6 of 31 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 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 8 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. Residents can be assured that their needs would be assessed prior to admission and that they would generally have all the information that they needed. Evidence: The manager said that they have a service users guide that has been updated since the last inspection. She was unable to locate it on the day of the inspection. The managers AQAA said we have reviewed our service user guide and made it more user friendly by increasing the number of picture references and making the font bigger and language simpler. The manager needs to make sure that this document is easily available around the home. The manager undertakes any pre-admission assessments. A recent assessment was reviewed and a comprehensive tool is used that subsequently informs the care planning system. The assessment was seen to be quite detailed and identified risks and the levels of support needed but some sections had not been completed fully, for Care Homes for Older People Page 9 of 31 Evidence: example those relating to orientation and comprehension. Overall the information was sufficient enough to allow the team at the home decide whether they could meet the residents needs. The assessments only contained very limited person centred information and this should be developed in order to aid a smooth transition into residential care for for residents, giving staff the information needed to make people feel at home. Under what we could do better in the managers AQAA she said we will continue to improve upon the amount and type of information we gather, in particular we will aim to expand our knowledge and record more information about the persons life history. Residents we spoke to said I am very happy here, I have settled in well and the staff helped me settle in and unpack all my things which helped. One person who feedback to the home on their visit said I was satisfied with the information and the tour of the home and I had the opportunity to ask questions. Residents and relatives who commented on our surveys said that they all felt that they had enough information about the home prior to admission. Care Homes for Older People Page 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be fully assured that all their care needs would be appropriately met, giving them variable outcomes. Evidence: The manager has a care planning system in place. This can differ between residents with often no consistent use of recording tools. Since the last inspection the care planning and management at the home has not progressed and similar shortfalls remain. This was discussed with the manager and the provider. Residents have a choices record in place regarding their daily routine and these contained some good pieces of person centred information, giving staff a good idea of individual preferences. In some cases, sections had not been completed, for example, any hobbies was often left blank. Daily records evidenced that these preferences were generally being met, for example, with bedtime drink, timings etc. Some, but not all residents also had a good routine of the day information sheet in place that detailed what residents liked to do and some of these had been reviewed and were up to date. These are a useful tool in helping to provide a person centred approach to care. Care Homes for Older People Page 11 of 31 Evidence: Whilst the assessment information was in place and quite informative, in the case of one resident, who had been in the home some weeks, we noted that no care plans had been put in place and the manager identified that she should have done these. The resident had several medical conditions that should have had a management plan in place, for example, arthritis, vertigo and mental health needs relating to recent experiences. The assessment documentation also highlighted the need for other care plans to be written, for example, if the score is 2 or more a plan should be written. This was not followed. For those residents who did have care plans in place these gave basic guidance for staff on the level of support and care needed. The care plans lacked any person centred information. Social care plans were limited and these are discussed in Section 3 of this report. The care plans showed evidence of reviews but these were often inconsistent, with some being up to date and others having not been reviewed since November 2009. Care plans were noticeable absent for issues such as on going health needs, i.e diabetes, arthritis, mental health etc. Despite having residents in the home living with dementia, the care plans did not identify how their dementia affected their day to day lives and what support staff could give to help them maintain independence, retain skills and promote their self worth. The assessment information would help with this as it covered comprehension and orientation etc. but these were not always completed. Some, but not all residents had a chart in place that assessed their wellbeing and ill being, but these were not consistently completed which, therefore does not give a full assessment of the situation for the resident. For example, one had been completed in November 2009 and not since. The manager in her AQAA said we use the information we gather at assessment to draw up detailed care plans. Based upon the evidence, we would not concur with this statement. The manager also said we have a person centred approach to our care plans that include the skills and abilities people have and how we can help maintain them Based upon the evidence we would not fully concur with this statement. Staff spoken to knew the residents in some aspects but not others. For example they knew about relative involvement and the level of support needed, but they were not all aware of any medical conditions that the resident may be living with and that may be pertinent to their care management. Care staff complete daily notes and these evidence that residents have eaten well, had choice with regard to food and how they spent their time but did not give an indication of the residents mood or wellbeing or Care Homes for Older People Page 12 of 31 Evidence: link into the care plans in place for that resident. Relatives who completed our surveys on behalf of residents, primarily said that residents got the care and support that they needed and that staff were either always or usually available to them and that staff always or usually listened to them and acted upon what they said. Relatives who commented said if my relative refuses care, the staff are very good, different staff try or they chat to them and try again later, I cannot fault the care, if my relative has been in hospital the staff have been to visit, which helps me a lot. All of the relatives who commented in our surveys said that their relatives always also got the medical attention that they needed. We spoke to the district nurses who said that the home was not a concern to them and the staff were quite prompt with raising any concerns or issues with them. They said that the care team were good at dealing with end of life care and monitoring pain relief. However the district nurses do have concerns regarding the nutritional management of residents including whether they are being weighed and if the agreed risk assessment tool is being used. Some risk assessments were in place, for falls, and the quality was variable with some completed properly identifying the risk and the action to be taken and some identifying the risk and no actions listed. There was evidence of inconsistent reviewing with some assessments being up to date and others not. In some cases, where risks should have been linked to a care plan to guide staff, this was not in place, for example, loosing balance. One resident did not have a manual handling assessment, despite the records saying that they needed one completing. Residents do not have risk assessments in place with regard to the prevention of pressure sores. However staff generally manage this well and care for residents in bed who have not developed sores. Residents were also seen to have the correct equipment in place. Staff however need to seek guidance to ensure that they are using specialist cushions etc. correctly as this has been an issue at the home. The records say that nutritional assessments are mandatory but we did not see any completed and the residents files we checked showed that they had not been weighed regularly or at all. Some new sit on scales have been purchased that have been in the home some weeks, but staff have yet to weigh the residents. It was positive to see that food diaries had been kept for 14 days after new residents were admitted which can help with ongoing assessment. The MUST nutritional risk assessments that the district nursing team would like completed were not evident on the care files. One resident who had been refusing food had also not been weighed and no nutritional risk assessment had been completed. A social work review was requested but referral to a dietitian or the doctor was not evident. Care Homes for Older People Page 13 of 31 Evidence: Records do show that residents are seeing their doctors and the district nurses appropriately and have access to the chiropodist and and dentist etc. Relatives who commented said They always call you if something has happened or if my relative is unwell, I feel the staff are good with my relatives health and always contact the doctor if there is any concern and my relative is treated with respect. We reviewed the medication administration system at the home. This had improved since out last visit but we still noted some shortfalls that need addressing. Medication is checked in at the time of the monthly delivery but when items are delivered during the month, these are added to the administration sheet without being checked in. All items should be checked in and signed for appropriately. When administering as and when medication, staff must use the coding system if the item is omitted or refused etc. so that when a medication is reviewed a full evaluation can be seen of the use of the item. Staff are not using codes consistently. Where items are prescribed regularly, any omitted items, where the O code is used must be accounted for on the reverse of the administration sheet. Other than these issues the signing is acceptable and signed charts match the blister packs in use. Medication profiles are not in use and it may be of value to develop these so that staff become more aware of the medical conditions that residents are living with. We also noted that staff are not dating items such as eye drops, which should only be open for 28 days and then discarded. Old drops, from the prescription label, were left in the trolley creating a risk of out of date medication being given. This must be addressed. Since the last inspection the manager has introduced a weekly audit, which is good, however on the most recent audit the manager has ticked that all items opened were dated when that was not the case. For any audit to be valuable, it must be completed objectively and accurately. We noted at this visit that, although not holding any controlled drugs, the home does not have the correct facilities to do so should the need arise. The proprietor dealt with this on the day of the inspection, ordering a cabinet straight away. Care Homes for Older People Page 14 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. Outcomes for residents are good in relation to meals and generally exercising choice but continuing shortfalls in the social activities programme means that their needs may not be met in full. Evidence: From discussion with residents and the staff, the routines of the day are primarily resident led, but from talking to staff, within that routine,the staff are also task led and for example, say if we have time we do chat to residents and do things like giving them grapes in pots. The team have not planned to deploy staff to, for example, to spend time with residents, focusing on other tasks that need doing first. Staff spoken to did not identify time during the day when they would provide any social stimulation for residents. Residents were seen to be exercising their choice regarding whether they got up or not and their choice was respected by staff. Staff confirmed that there are residents often still in bed when they came in for an early shift at 8 a.m. Interaction with residents from staff during the day was observed to be limited. Staff put music on and several times during the day residents were sitting on their own with no social stimulation, at times were something constructive could be done. The manager in her AQAA said we have daily activities between 3.30 and 4.30 and Care Homes for Older People Page 15 of 31 Evidence: sometimes group activities but mostly one to one as our residents needs have changed. We saw limited evidence of this and this also contradicts what the manager said to us on the day regarding one to one activities. We reviewed recent social activity records and these showed that meaningful activities are very limited and primarily consisted of chatting to staff, asleep, stayed in room, watched TV and weeding the garden. The manager said that group activities are very different and that they are just starting to look at one to one activities. We could found evidence of group activities that included, snakes and ladders, colouring pictures, reminiscence discussion, gentle exercises and dominoes. It was positive to see that occasionally residents have taken part in daily living activities such as folding washing and making their own bed. As identified at the last inspection, the team need to have a more regular and person centred approach to the provision of social care ensuring both group and individual needs are met. Residents who commented said I could do with some company, a visitor would be good to chat to, Relatives who commented said they do do some activities, the other day they did some drawing and a singer has come to the home, the Christmas party was really quite good and the residents got involved. Relatives who commented in our surveys gave variable response with regard to the provision of activities with some saying that there were always activities that their relatives could take part in and others saying that there were usually some or never any. Comments included my relative could do with some-one to chat to, x gets lonely. Whilst social care plans were in place for some residents, these contained limited information and often no preferences from the resident themselves on the type of activities that they would enjoy. The care plans primarily outlined the fact that staff were to encourage residents to attend activities and to ask residents to come out of their rooms. The was no real assessment of need that would guide care staff as to what activity to do that would help promote independence, the retention of skills and self worth, along with providing a level of entertainment. Some, but not all residents, have a family history in place which would be of value to staff in compiling these care plans. Residents who choose to stay in their own rooms were seen to have drinks of juice available to them during the day other than at drink rounds/mealtimes. Staff were heard to discuss lunch with residents and offer them choices. The tables are laid nicely for lunch and the manager reports that the staff have just started to sit and eat with residents during lunch. This would help residents to maintain independence with using condiments and helping themselves to drinks and gravy. This has not been considered by the team and at the current time residents do Care Homes for Older People Page 16 of 31 Evidence: not have access to condiments etc. as staff are worried they may use them incorrectly. The food prepared looked appitising and residents were seen to be enjoying their meal, choosing between salmon and curry. Where residents choose alternatives, these are also made and residents spoken to confirmed this. Some residents records showed a good note of residents food preferences. Residents who commented said the food is nice, they make me what I want to eat, I choose where I want to eat my meals, the chef knows what we like and what we dont like. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their concerns would be listened to but they cannot be assured that they would always be fully protected with regard to adult safe guarding matters. Evidence: The manager has a complaints procedure in place. This requires updating with regard to contact addresses. Since we last inspected the logging of complaints has improved. Only two complaints were recorded, one relating to staff approach and this is an adult safeguarding matter and the other related to gardening. The latter complaint was dealt with appropriately. All of the relatives who completed our surveys on behalf of residents said that they knew how to raise a complaint with the team at the home. Records show that the team have received some compliments and comments included that my relative was well looked after and thank you for the care, attention and affection shown to my relative. Prior to the inspection the manager had the need to refer the above adult protection matter. The manager did not report this correctly and investigated the matter herself, despite having the local up to date guidance in the home and having had up to date training. Following discussion the manager reported it to the responsible authority and the matter is now being dealt with appropriately. The correct procedures must be followed in relation to any adult protection matter. Care Homes for Older People Page 18 of 31 Evidence: Staff spoken to show a an understanding of adult protection matters and the need to report and record issues. Training records show that out of 25 staff listed 17 have up to date adult protection training. The manager in her AQAA said that all staff attend annual SOVA training and any allegations or incidents of abuse will be dealt with promptly and the correct procedures followed. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean and generally well maintained home. Evidence: Overall the home was clean and no odours were noted. The provider has been decorating and refurbishing some rooms and updating the look of the bedrooms. Lockable bedside cabinets are also now in place. New bedroom furniture is also on order for some bedrooms. Residents have personalised their rooms and where possible have brought in small items of furniture. Since we last visited the signage around the home has improved a little with pictures put on bathroom doors but not on residents own bedroom doors to promote their independence. This shows a limited appreciation of the needs of people living with dementia. Since our last inspection the provider has plans in place to refurbish one of the main bathrooms making it into a wet room and work is to start in the near future. People who visited the home in 2009, from the providers own feedback said smart and appealing house and garden, fresh and clean, another said first impression, a bit disappointing, not odour free. All of the relatives who commented on our surveys said that the home was always fresh and clean. Other comments included they have done a lot of improvements to the home but the front drive needs improving. Care Homes for Older People Page 20 of 31 Evidence: Records in relation to fire safety were checked and found to be in good order, including a fire safety risk assessment. Fire drills could be undertaken more often, with the last one being October 2009. Care Homes for Older People Page 21 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. Residents benefit from a stable workforce but shortfalls in training and the application of their training means that they may not always meet residents needs in full. Evidence: The current staffing levels at the home are 1 senior and 2 care staff in the morning and afternoon/evening reducing to 1 senior and 1 carer after 8 p.m in the evening. At night there is 1 senior and one carer, one of which is an asleep duty. From the rota, these levels are maintained. At the current time there are 12 residents. Staff who commented said that there are times when the staff is insufficient for the dependency of the residents and the night shift was highlighted. The management team need to keep the staffing levels under review based upon the needs/dependency of the residents. No agency staff are used and the manager in her AQAA said we maintain a stable and loyal workforce. Residents who commented said the staff are nice, they chat to you, The staff answer the buzzer quickly if you call them, the staff are fine, very friendly and helpful staff, more staff needed at busy times and staff have a friendly and helpful attitude. Relatives who commented said the staff are brilliant with my relative, the staff are always pleasant and ready to help when a problems arise and more time could be spent with residents at mealtimes to ensure that they eat well. Care Homes for Older People Page 22 of 31 Evidence: Out of the 18 care staff on the rota, the provider confirmed that 10 have achieved and NVQ level 2 and above. We reviewed two staff files to check the robustness of the recruitment procedures in the home. These have improved since we last visited the home and overall all the required checks and documentation were in place. We would suggest that the provider review the application form so that this allows applicants to list their full employment history with dates so that any gaps in employment are evident and can be explored. We would also recommend that interview records are maintained to evidence any discussion. One person had no evidence to show that they had completed an induction to the home. From the training records it shows that whilst training is ongoing there are some gaps that need addressing. Compliance is reasonable with regard to adult protection, safe moving and handling, fire safety, but there still staff, approximately 25-30 that do not have training in place. The manager states in her AQAA that all the staff have had training in infection control but this is not backed up by the information submitted on the training record. It is positive to see that some staff have been attending training on equality and diversity, nutrition, epilepsy awareness, deprivation of liberties, risk assessments and palliative care. Along with NVQ training the management team now need to work with staff to put the training into practice with regard to the care management and planning for residents. It is disappointing to note that despite the registration of the home, the level of staff with training in dementia is low and again those senior people who have attended training are not evidencing that they are putting their training into practice. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inconsistent management of the home continues to limit its progress and this means that outcomes for residents could be better in some areas. Evidence: Despite assurances at the last inspection, the day to day manager has not applied for registration. On discussion with her and the provider, the plan is to advertise for a registered manager even though the provider/manager is coming back to the country permanently in July 2010. It will help the home to have a committed manager in post day to day, who can help move the home forward. The provider has a range of quality assurance forms in place, which cover residents and visitors etc. to the home. From a review of the forms, there is no consistent approach to completing these and therefore no analysis of the results of subsequent action plan. We only found two completed forms dated August and December 2009. This is insufficient to gauger a full feedback on the home and needs a full review to put a proper system in place. Care Homes for Older People Page 24 of 31 Evidence: Comments we saw included the residents appear well cared for, staff caring and kind, polite and freindly and warm and friendlyfriendly welcome, residents are probably well cared for. Residents we spoke to who commented said I am very happy here, I am quite happy, Comfortable and the home feels like my home. Relatives who commented said I like the atmosphere in the home, its friendly and relaxed. We saw that in the laundry room, whilst the chemical cupboard had a lock on, this didnt work and it could be easily opened and contained bleach based liquids which are a potential risk to some residents.We reviewed the accident book and found that staff fill this is in properly. Residents who were shown to have regular falls have had body charts completed showing any injuries and one had a pressure sensor mat put by the bed to show staff if they moved, but they had not be referred to the falls prevention team for review. This should always be considered. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 Residents must have up to date care plans in place that ideally are person centred and contain sufficent detail to guide staff. So that residents recieve the care they need in a way that they would wish. 30/06/2009 2 8 12 Residents must have up to date risk assessments in place, as required, that contain sufficient detail to guide staff. So that any risks to residents are appropriately managed and kept under review. 30/06/2009 3 8 12 Residents weight monitoring and subsequent assessment and managemnet must be consistant and effective. So that residents recieve the care that they need in reltion to thier weight. 14/06/2009 4 12 16 The social activities programme must be developed so that it is resident led and meets their group and individual needs. So that all residents have sufficient social stimulation that meets their differing 30/06/2009 Care Homes for Older People Page 26 of 31 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 needs. Care Homes for Older People Page 27 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 9 13 Staff must follow the correct 14/05/2010 procedures when checking in a signing for medication. So that residents can be assured that their medication is properly managed. 2 18 13 The correct procedures must 14/06/2010 be followed in the case of any adult abuse concern and all staff should be trained in this subject. To help ensure that residents are protected from abuse and can be reassured that any matters would be dealt with properly. 3 30 18 The staff at the home must be appropriately trained to undertake their responsibilities and roles that they have in the home. 30/06/2010 Care Homes for Older People Page 28 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 So that residents needs can be met by a competent staff team. 4 31 8 The home needs to have a 30/06/2010 permanent manager in place who is committed to moving the home forward. So that the home is run in the best interests of the residents. 5 33 24 A consistent approach needs 31/05/2010 to be taken with regard to quality assurance, based upon feedback from residents. So that the home is run in the best interests of the residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 5 1 9 19 19 27 Make sure that the service user guide is easily available in the home for residents etc. Medication profiles should be put in place. Continue to develop appropriate signage around the home in order to promote residents independence. Carry out more regular fire drills with staff. Keep the staffing levels under review and base this on residents dependency, ideally using a recognised tool to underpin the decision. Care Homes for Older People Page 29 of 31 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 6 7 29 38 Update the staff application form so that a full employment history can be given. Ensure that potentially hazardous chemicals are safely locked away. 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. 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