Care Home: Riverside Residential Home

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What the care home does well The manager had the qualifications required of the person in day to day control of the delivery of care and their approach to the management of the home was based on openness and respect. There was an experienced and stable staff team to support people. People and their representatives spoke very highly of the staff team. They commented, "nice staff", "was a lack of organisation in relation to basics but due to new manager and unit manager this is now coming together", "I have also found the manager (and previous manager) to be receptive to feedback/complaints and remedial action is usually taken/followed through", "good to see a unit manager in the EMI section of the home. Both manager and the unit manager react quickly and efficiently to situations. Friendly, approachable staff", "I believe there is a genuine desire to care for residents amongst staff. There are a number of staff who are highly professional and who execute their duties diligently and with compassion", "Julie`s approachable and pleasant", "more on the up than down", "went down pan like a bomb after EMI unit opened. Now, it`s a devil I know", "sorted out a lot of my problems" and "Julie and staff amazing. I`ve got a lot of support, I`m absolutely overwhelmed. They`re very professional. I could approach Julie if a problem" and "Kath - lovely like a Florence Nightingale. Never raises her voice. She`s lovely. Needs gold award". On the whole, the health and personal care that people received reflected what assistance they needed and they were treated with respect, dignity and privacy. People were treated as individuals. They were assisted to make choices and decisions in their daily life. Social activities met some peoples` expectations and they were able to keep in touch with family, friends and representatives. People had meals that were of a good quality. People were able to express their concerns and had access to a complaints procedure. The living environment was clean, with living areas well maintained and a comfortable environment for people to live and enjoy. People said, "it`s great. ... likes it. It`s like a hotel", "room`s lovely" and "it`s warm enough". What has improved since the last inspection? Visits to the service carried out on behalf of the owner to determine the quality of care provided in their opinion. These were now being more effective in identifying issues within the service and ensuring that appropriate action is taken, for example, reporting incidents to the appropriate authorities, so that agencies can work together, in order that people are kept safe. What the care home could do better: The manager should submit an application to the Commission for them to assess her fitness to be registered. Ensure the admission assessment covers in detail information about people`s mental awareness and their dependency, so they are not placed at risk of not having their needs met or their wishes and choices adhered to.Staff could engage people better in meaningful activities of daily living and social activities for longer periods to improve their quality of life. Having a staff member trained in dementia care mapping should aid this process. Also, the provision of transport would enable a more spontaneous approach to activities at a time when people want and the weather is appropriate. The complaints record should detail how a complaint has been investigated, the outcome and if any action has been taken as a result of the complaint. This would demonstrate the service do act properly about complaints that people make and the action they take to prevent a reoccurrence of the same complaint. Comments made by a some representatives and three concerns about staffing levels, since the opening of the dementia unit identify there may be insufficient numbers of staff on duty at all times to meet the needs of people. This needs further review. The recruitment of staff needs to be more robust to ensure it is sufficient to protect people using the service. So that staff are sufficiently trained for the role that they perform, induction training should include induction training to Skills for Care specifications within the first six weeks of appointment and first aid training. The quality assurance procedures should be implemented as soon as possible to engage people and other stakeholders in providing their views of the quality of the service provided. This would enable a formalised plan of annual improvement to be formed, that can be measured. Key inspection report Care homes for older people Name: Address: Riverside Residential Home Camborne Way Monk Bretton Barnsley South Yorkshire S71 2NR     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: Jayne White     Date: 1 5 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Riverside Residential Home Camborne Way Monk Bretton Barnsley South Yorkshire S71 2NR 01226296416 F/P01226296416 riverside@parklanehealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Park Lane Healthcare (Riverside) Limited care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Riverside is a care home providing personal care and accommodation for 50 older people. The accommodation is separated into two units. One of the units is for 33 people who need assistance with personal care. The other is for 17 people who also need assistance with their personal care needs, but who have dementia. The home is situated at the head of a cul-de-sac on Camborne Way, Monk Bretton, on the edge of an estate of modern houses and bungalows. Shops and other amenities, including a main bus route are close to the home. Accommodation is on one level and all bedrooms are for single occupancy. The home stands in its own grounds and has lawned areas. There is a car park to the front. Care Homes for Older People Page 4 of 31 Over 65 0 33 17 0 Brief description of the care home Information about the home, including the service user guide is available in the entrance hall. This includes the most current Care Quality Commission (CQC) report about the service. The manager said the fees ranged from £356.77 to £386.20, dependant on peoples needs and their medical diagnosis. Additional charges were made for newspapers/magazines, hairdressing, dry cleaning, telephone calls and chiropody. 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: This was a key inspection. We visited without giving the service any notice from 09:00 until 18:00. Ms Julie Cross, manager was present during the visit. The manager completed an Annual Quality Assurance Assessment before the site visit. This gives the service the opportunity to tell the CQC how well they think they are meeting the needs of people using the service and what they are working on to improve. Various aspects of the service were then checked during the site visit including inspection of parts of the environment, records relating to the running of the home, observing care practices and inspecting a sample of policies and procedures. Surveys regarding the quality of the care and support provided were sent to: Five people who used the service. One was returned (20 ). Five to representatives (this Care Homes for Older People Page 6 of 31 could be either a relative or a friend). Two were returned (40 ). Five to staff. One was returned (20 ). Six to health care professionals. None were returned (0 ). We have used this information to inform our judgements about the service. The majority of people living at the home were seen throughout the visit and several were spoken with about the care they received, as were some of their representatives. The care provided for three people was checked against their records to determine if their individual needs identified in their plan of care were being met. We also spoke with staff and the manager about their knowledge, skills and experiences of working at the home. We checked all the key standards. The manager was provided with initial feedback from the inspection during and at the end of the visit. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The manager should submit an application to the Commission for them to assess her fitness to be registered. Ensure the admission assessment covers in detail information about peoples mental awareness and their dependency, so they are not placed at risk of not having their needs met or their wishes and choices adhered to. Care Homes for Older People Page 8 of 31 Staff could engage people better in meaningful activities of daily living and social activities for longer periods to improve their quality of life. Having a staff member trained in dementia care mapping should aid this process. Also, the provision of transport would enable a more spontaneous approach to activities at a time when people want and the weather is appropriate. The complaints record should detail how a complaint has been investigated, the outcome and if any action has been taken as a result of the complaint. This would demonstrate the service do act properly about complaints that people make and the action they take to prevent a reoccurrence of the same complaint. Comments made by a some representatives and three concerns about staffing levels, since the opening of the dementia unit identify there may be insufficient numbers of staff on duty at all times to meet the needs of people. This needs further review. The recruitment of staff needs to be more robust to ensure it is sufficient to protect people using the service. So that staff are sufficiently trained for the role that they perform, induction training should include induction training to Skills for Care specifications within the first six weeks of appointment and first aid training. The quality assurance procedures should be implemented as soon as possible to engage people and other stakeholders in providing their views of the quality of the service provided. This would enable a formalised plan of annual improvement to be formed, that can be measured. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A written assessment of peoples needs had taken place before they moved into the home, but this needed more information, so that the person is not placed at risk of not having their needs met or not having their wishes adhered to. Evidence: The persons survey that was returned stated they received enough information to help them decide if the home was the right place for them before they moved in. Generally, when we spoke to people they said their family had taken the responsibility for making the decision about the choice of home. They reflected what the manager had told us in their AQAA. The manager in the AQAA told us a senior member of staff carried out a full preadmission assessment before people moved into the home. This was to ensure all prospective peoples needs can be met and questions or concerns they have can be Care Homes for Older People Page 11 of 31 Evidence: answered before they move into the home. She told us people and their families were invited to visit to see if it was the right place for them to live. We looked at three files to confirm what the manager and people had told us. It told us a pre-admission assessment was carried out before they were admitted to the home. However, the assessment did not include in detail all assessment information such as the persons mental state and cognition and their dependency. This was important missing information because the people did not have full mental awareness because of their dementia, which meant they may be unable to tell staff of their preferred wishes and choice. This affects how dependent they are for staff and this is needed to determine the number of staff to provide care to those people, in order to meet their needs. A summary assessment had not been received from the placing authority, to confirm to the service information about the person they might need to know when conducting their own assessment. A plan of care had been put together from the information in the homes assessment. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. On the whole, the health and personal care that people received reflected what assistance they needed. Overall, people were treated with respect, dignity and privacy. Evidence: The person returning their survey told us they always received the care and support they needed. They stated they usually received the medical care they needed. This was reflected when we spoke to people about the care they were given. Both the relatives surveys that were returned told us they usually got enough information about the care service to help them make decisions, the service usually met the needs of their representative and they were usually kept up to date with important issues affecting their relative. One stated they felt the service usually gave the care to their representative that they expected, one that they sometimes did. They commented, they adapt to changes, in most cases, when changes in clients abilities change as something the service did well. For what they need to do better they commented, basic needs - toileting of every resident more regularly - some are Care Homes for Older People Page 13 of 31 Evidence: made incontinent of urine when they have no need to be, ordering of basics i.e. pads - seem to run out of them and keep residents cleaner - spillages from lunch/dinner needs to be cleaned from residents clothing immediately rather than being allowed to remain on their clothes. Also, to be more proactive in toileting residents. When we spoke to representatives they were highly satisfied with the care provided. One said, Mum looks clean. They really look after her. The staff survey that was returned told us they were usually given up to date information about the needs of the people they cared for. They stated the way information was shared about people they cared for with other carers and the manager usually works well. They commented, the home provides a good 24 - 7 care package for the elderly person. I feel that staff work very hard to cater for their needs. When we spoke to staff about peoples needs they were knowledgable about how they would do this and how people preferred this to be given. The manager in the AQAA told us a comprehensive plan of care was compiled after a pre-admission assessent had been carried out by a senior member of staff and that these were regularly reviewed. She stated risk assessments were completed so that everyone involved in the persons care was aware of any risks. This, she stated, ensured no unecessary restrictions were placed on people. She stated nutritional screening was carried out on everyone admitted to service and eighteen staff had received training in malnutrition care and assistance with eating via their NVQ level 2 in Care. She told us further training for staff in person centred care plans and documentation was something they could do better and this was planned and booked. She stated improvements had included implementing new care plans and the purchase of a stand aid and hoist. We looked at three care plans to verify information that everyone had told us. On the whole, the plans contained good information that was sufficient to inform staff of the action they needed to take to meet peoples needs. The daily report identified that staff acted on this information. In the main, risk assessments were in place to identify any risks that might be presented by people, for example, mobility, nutrition, pressure areas and falls. The assessment identified the action required by staff to reduce the potential risks to people, which promoted and maintained their independence. Records of healthcare visits that were undertaken were maintained and demonstrated people did receive visits from healthcare professionals. Care Homes for Older People Page 14 of 31 Evidence: When we observed staff working there was clear and respectful communication between people and staff and staff treated people in a kind manner. On the whole, people were well dressed and their hair and nails were clean. This indicated respect and dignity by staff when caring for people. Senior care staff administered medication. Medicines were securely stored and the service had storage for controlled drugs that met the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973. There was also suitable storage for medication that required refrigeration. This meant medication was stored at the correct temperature. We looked at the recording and administration of medication on a sample basis. On the whole, medication received was clearly recorded on the persons medication administration record and medication administered signed for. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main, people were assisted to make choices and decisions about their daily life, but social activities could be improved. Evidence: The persons survey that was returned stated the home always arranged activities they could take part in if they wanted. One of the representatives survey that was returned stated the service responded to the different needs of individuals, one didnt answer. One stated the service usually supported people to live the life they chose, one didnt answer. In what the service did well they commented, in the past couple of months positive steps have been taken to make visitors feel more welcome (e.g. offering tea/coffee and invitations to have meals along with loved ones) and feedback is periodically sought on visitors perceptions. When we spoke to representatives they said, shes (their relative) improved here and is more settled, they cant do enough for families. I love to come, Im elated. Ive nothing but praise and they do a marvellous job. They were unable to provide information about the activities they saw that took place, but a couple did say they Care Homes for Older People Page 16 of 31 Evidence: had seen staff dancing with people. The manager told us in the AQAA improvements had included a new activity coordinator, that families and friends are now actively encouraged by staff to participate and feel free to give us their input. This confirms what representatives were telling us. The AQAA also told us activities were chosen by the residents and advertised on the notice board and that anyone requiring help will be assisted by staff to join in. Their own quality assurance processes of listening to people has identified the need for their own transport to enable more spontaneous outings, more often. Our observations during the visit and discussions with people identified people could spend their day as they wished following their preferred routines. However, we didnt see staff spending quality time with people engaging them in meaningful activities. In the afternoon, in particular, on the dementia unit the TV was on, but it was staff that were watching it, whilst they were watching the people (see staffing). The survey returned by the person living at the home stated they always liked their meals at the home. Generally, this was supported by people when we spoke with them and their representatives, although some comments need addressing. They said, (improve) variation of tea time meals - always soup and sandwiches and food not 100 , but cant grumble. I can have what I want thanks to John in kitchen. The dining rooms were welcoming, being bright and clean. Where people needed assistance with eating staff helped the person at their pace, making them feel comfortable and unhurried. 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. People were able to express their concerns and had access to a complaints procedure, but there was not always a record of the outcomes of those complaints. Policies and procedures were in place to keep people safe, but this hadnt always protected people. Evidence: The survey returned by the person living at the home stated there was someone they could speak to if they werent happy and they knew how to make a formal complaint. When we spoke to people they also knew who they would talk to if they were unhappy about any aspect of their care and they said they had no complaints. One said, I was living with harrassment, but now theyre ok with me. This indicated there was now an open culture that allowed people to express their views and concerns in a safe and understanding environment. Both of the surveys returned by representatives of people told us they knew how to make a complaint if they needed to and that the service usually responded appropriately if they had raised any concerns. The staff survey that was returned told us they knew what to do if people or their representatives raised any concerns. This was confirmed when we spoke with them. People and their representatives could access the complaints procedure because it was displayed in the foyer and clearly described the procedure for people should they have Care Homes for Older People Page 18 of 31 Evidence: any concerns. It was clearly written, easy to understand and explained what the procedure was and how long the process would take. A record was maintained of complaints that had been made. The AQAA told us four complaints had been made in the last twelve months and that these had been resolved in 28 days. It stated none were upheld. We looked at the complaints record to confirm the information in the AQAA. This told us there had been seven complaints. There was not always full details of the complaint, the investigative action and the outcome of the complaint. The AQAA told us there had been three adult safeguarding referrals, with one adult safeguarding investigation, resulting in no referrals of staff to the protection of vulnerable adults register. Our information told us there had been eight referrals to safeguarding. Approximately twelve months ago, referrals of harm were not being made by the service to the appropriate authorities. This came to light by a representative making a safeguarding alert to the Commission. The information was relayed to the safeguarding authority. Investigations took place. These highlighted a number of concerns, because it was found there were incidents at the home that were not being acted on, reported to the appropriate authorities or dealt with properly. During this time the service worked well with other regulatory bodies to address the issues and voluntary agreed not to admit people until the issues of concern had been addressed satisfactorily. Incidents were now being reported to the appropriate authorities, investigated appropriately and action taken where this was needed. A member of staff had been referred to the protection of vulnerable adults register as a result of those investigations. The current manager demonstrated good knowledge in the procedures to be used if allegations of abuse were made, as did staff that worked at the home. This should now ensure people are kept safe, because action was being taken when incidents happened or allegations made. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment was clean, well maintained and a comfortable environment for people to live and enjoy. Evidence: When we spoke to people they said they were satisfied with their living environment. They said their bedrooms were comfortable and some people had personalised these with pieces of their own furniture and possessions. Their comments included, its great. ... likes it. Its like a hotel, rooms lovely, its warm enough, hairdryer only works on cold, but theyve titivated hairdressers room up for my visit. The survey that was returned stated the home was always fresh and clean. Representatives commented in their surveys, cleaners are very good - rooms are always presentable, pleasant surroundings, but make outdoor space more comfortable. The manager had acknowledged this in her AQAA stating landscaping the land to the side of home to create a better first impression and give more outside space for people would be something they could do better. The AQAA told us the Oakwell suite (dementia unit) opened in September 2008. All bedrooms were single occupancy and lounges had been refurbished. It told us carpets and floors were cleaned on a regular basis and changed if necessary, when there were health and safety issues. It stated the home was heated at a constant temperature to Care Homes for Older People Page 20 of 31 Evidence: keep it warm and comfortable for people. There was a pleasant ambience in the communal areas of the home. However, the main lounge in the residential part of the building had no outside windows. This meant there was no natural ventilation and people using that room spent most of their day with no exposure to outside scenes and daylight, which can be depressing. This should be noted and addressed, so that people do look out into the outside world. 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. There was an experienced and stable staff team to support people, but they were not consistently in sufficient numbers to meet the needs of people. The recruitment and training of staff needs to be more robust to ensure it is sufficient to protect people using the service. Evidence: When we spoke with people they were complimentary about the staff that worked at the home. Their comments included, nice staff and Kath - lovely like a Florence Nightingale. Never raises her voice. Shes lovely. Needs gold award. However, this suggests that because Kath doesnt raise her voice, others may and needs monitoring. The persons survey that was returned stated the staff were always available when they needed them and that the staff always listened and acted on what they said. However, when we spoke to people and their representatives they didnt all feel there was always sufficient staff on duty. One person said there were three consecutive weekends when only two members of staff were on the residential unit. They stated it should be three. About what the service could do better representatives commented in their surveys, lack of staff - lack of EMI (this is an old term for people who had dementia) training, Care Homes for Older People Page 22 of 31 Evidence: need to ensure adequate staffing levels are maintained (e.g. on 4 different days around August Bank Holiday only 2 staff were on duty on the EMI and on one afternoon at the end of July only 4 staff were on duty for both residential and EMI units, therefore, below recommended staffing levels) and staff to be located in the lounge rather than constantly at their workstation. This would enable them to be more proactive in preventing accidents/falls rather than reacting after a situation occurs. There had been three concerns raised about staffing levels. Two had been raised anonymously with the Commission and one directly to the service. One that had been raised with the Commission was relayed to the home and safeguarding as part of the ongoing safeguarding investigation. The one to the home did not identify what the outcome was, so it cannot be determined whether in the services judgement, there was enough staff on duty. Staff felt there were usually enough staff to meet the needs of people using the service. They identified there were three staff were on each unit during the day and afternoon shift and two staff at night. The manager told us in their AQAA that staffing levels were adequate and often above the required ratio. The owner at previous safeguarding meetings had told us this was worked out using the residential staffing forum and it wouldnt be below three on each unit. When we looked at the staff rotas they showed there had been three staff on duty on each unit, but this should be reviewed given the comments made by people. The manager in the AQAA told us the home had a robust recruitment policy and new staff underwent induction training in accordance with Skills for Care, which met standards. Eighteen staff had completed this. Shed identified in what they could do better was to have a few members of staff that provide an as and when required service to cover for staff sickness to reduce the need for staff to work extra hours. She stated improvements had been the review of the training programme, that was updated and monitored on a monthly basis. Sickness and absence monitoring was also taking place. She told us seventeen staff hold NVQ level 2 in Care or above (approx 61 ). One of the representatives survey stated care staff usually had the right skills and experience to look after people properly, one that they sometimes did. The staff survey stated their employer carried out checks such as a CRB and Care Homes for Older People Page 23 of 31 Evidence: references before they started work. They stated their induction mostly covered everything they needed to know to do the job when they started and that they were given training relevant to their role that helped them understand and meet the needs of people and kept them up to date with new ways of working. They stated their training gave them enough knowledge in health care and medication, They stated that they usually felt they had enough support, experience and knowledge to meet the different needs of people living at the home. About what the home could do better they stated more training set up and the actual owners to appreciate the staff more and how hard the staff work. One staff member said when they were recruited it was the most thorough interview theyd ever had. Staff told us after their recruitment they carried out an induction. Their descriptions of their induction did not identify it was the Skills for Care induction and there was no evidence it was this on their files. When we spoke to staff it told us they had a range of training including NVQs, which had included behaviour that challenges and dementia. Although staff had received some dementia training, no-one had done dementia care mapping, an observation tool that puts into practice the theorectical perspective of a person centred approach to care. The data can then be used to determine if person centred care is being applied in practice. Having this training would enable better person centred outcomes for people (see daily life). We looked at two staff files to confirm what the manager and staff had told us about their recruitment and training. The recruitment wasnt as robust as identified. There wasnt always copies of certificates that confirmed the training people had said theyd undertaken prior to their appointment. On one file, only one reference had been received. There was no commencement date recorded, to verify the CRB had been received before they had commenced work. One of the CRBs provided further information about the person and there was no written risk assessment to identify the risk this might pose with their employment. Two of the files identified gaps in the staffs work history with no written explanation for those gaps. We observed how staff worked during the visit. This told us there were good relationships between staff and people and they responded in a timely way when people needed assistance. Staff were clear of their roles and what was expected of them. Care Homes for Older People Page 24 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. The management and administration of the home had not consistently been in the best interests of people due to the health, safety and welfare of people and staff not always being met. Evidence: People were pleased with the service they received and spoke highly of the manager and staff, as did their representatives. Representatives in their surveys commented in what they did well, was a lack of organisation in relation to basics but due to new manager and unit manager this is now coming together, I have also found the manager (and previous manager) to be receptive to feedback/complaints and remedial action is usually taken/followed through, good to see a unit manager in the EMI section of the home. Both manager and the unit manager react quickly and efficiently to situations. Friendly, approachable staff and I believe there is a genuine desire to care for residents amongst staff. There are a number of staff who are highly professional and who execute their duties diligently and with compassion. When we spoke to people and their representatives they said, Julies approachable and Care Homes for Older People Page 25 of 31 Evidence: pleasant, more on the up than down, went down pan like a bomb after EMI unit opened. Now, its a devil I know, sorted out a lot of my problems and Julie and staff amazing. Ive got a lot of support, Im absolutely overwhelmed. Theyre very professional. I could approach Julie if a problem. The member of staff in their survey commented, we have a good manager in the home who is working hard to make things improve and I have worked alongside the manager for a while now and I feel that she is steadily improving the homes care for the elderly who in turn the staff are, listening and improving on matters that count. When we spoke to staff they said, all changes have been for the better and staff know where they stand with Julie. The manager commenced duty at the home in June 2009 and has twenty years experience within the caring profession. She was intending to submit an application to register as manager with the Commission after Christmas. She stated she holds the Certificate in Social Services and has nearly completed her Registered Managers Award. She had a good knowledge of the needs of people. Her direction and leadership promoted a relaxed and friendly atmosphere. All sections of the AQAA were completed and the information was sufficient in describing how the service were meeting the outcome areas in the National Minimum Standards. The manager had identified improvements they were going to make in the next twelve months to improve the service for people. When we spoke with the manager she told us a policy for quality assurance was in place, but hadnt yet been implemented. However, she said regular audits of various aspects of running the home were carried out, for example, medication and care plans. Visits to the service were being carried out on behalf of the owner, to determine the quality of care provided in their opinion. These hadnt always been effective, for example, incidents not being reported to the appropriate authorities. The manager in the AQAA told us everyone was encouraged to manage their financial affairs, but if monies were held on behalf of people they are kept individually, all transactions were receipted and the record witnessed and signed for by two members of staff. Monies were kept in a safe in a locked room. This was confirmed when we checked the record of financial transactions for one person, which told us their financial interests were safeguarded. The AQAA stated maintenance of equipment was in place and up to date for portable electrical equipment, hoists, fire detection and alarms, fire fighting equipment, Care Homes for Older People Page 26 of 31 Evidence: emergency lighting, emergency call equipment, the heating system, premises electrical circuits and gas appliances. It also stated a contract for soiled waste disposal was in place. However, we did note the portable appliance test for the refrigerator in the lounge for people with dementia was due October 2009, so the manager was asked to check this. When we looked round the building fire exits had been kept clear, which should make it easy for people and staff to leave the building in the event of a fire. When we spoke to one member of staff they said, when I started there was no equipment. I felt it was an issue with owners, because the previous manager had said we needed it, but Julie wont stand for not having the right equipment. When we spoke to staff it told us they had received training in moving and handling, emergency aid, fire and food hygiene, but this wasnt always verified by certification on their files (see staffing). Where it was, some needed updating. A plan was in place for this. The risk assessment for dealing with accidents and health emergencies told us staff should have first aid training. The manager confirmed this. When we looked at their training records it was emergency aid training, which wasnt to the same standard. This ambiguity needs addressing as two safeguarding referrals had previously raised concerns about the training and policy development with staff regarding when to obtain medical assessment, communicate with the Commission, communicate with relatives and when to take a client to accident and emergency. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 18 Staff must receive first aid training. So that staff have the training they need to perform their duties as identified in the procedure for dealing with accidents and health emergencies. 25/04/2010 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 3 The admission assessment should cover in detail all the assessment information identified in 3.3 of the National Minimum Standards. This would mean the person is not placed at risk of not having their needs met or their wishes and choices adhered to. Transport should be provided so that a more spontaneous approach can be adopted to providing activities when people want and the weather permits. Staff should engage people in meaningful activities, to improve their quality of day to day life. The complaints record should detail clearly how a complaint 2 12 3 4 12 16 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 has been investigated, the outcome and if any action has been taken as a result of the complaint. This demonstrates the service do act properly about complaints that people make. 5 27 Staffing levels on each unit should be reviewed, to make sure there are sufficient staff on duty to meet the needs of people. Where a CRB contains further information about a potential member of staff, a written risk assessment should be carried out to identify the risks that might be posed in employing the person and a judgement of whether or not they are safe to work with vulnerable people. To demonstrate a robust recruitment all staff files should contain the date they commenced work, documentary evidence of any relevant qualifications or training, two written references and a full employment history with a satisfactory written explanation of any gaps in employment. Staff induction should include training to Skills for Care specifications within six weeks of appointment, to demonstrate they have received training appropriate to the work they perform. A member of staff should be trained in dementia care mapping, to enable them to use the data to improve the daily lives of people through a more person centred approach to care. The manager should submit an application to the Commission for them to assess her fitness to be registered. The quality assurance procedures should be implemented as soon as possible to engage people and other stakeholders in providing their views of the quality of the service provided and implementing an annual plan of improvement that can be measured. 6 29 7 29 8 30 9 30 10 11 31 33 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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