Care Home: Riverview Residential Home

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What the care home does well The home provides a comfortable and homely place to live where people feel part of an extended family. Care Plans are person centred and focus on meeting the specific individual needs of each person. Individual diverse needs are met well. These are reflected in the care plans and the environment is adapted to meet these needs. The home promotes individuality, autonomy and independence. What has improved since the last inspection? The Annual Quality Assurance Assessment (AQAA) completed by the provider told us about the following improvements: "All staff have more training and knowledge to achieve better results. Also getting different formats of documents supplied for service users. Updated individual care plans and risk assessments. More training for staff. Continue to offer a range of activites. Families are involved in helping with fundraising. Our policies and procedures have been updated. Health and Safety audit tool Health and safety checks around the home are up to date with relevant certificates. Kitchen has been up dated and new units have been fitted New cooker also has recently been fitted All staff have NVQ level 2 and some have level 3 Dementia traning update on training Also have sleeping staff. Induction pack in process We have implemented a supervision process Having a manager on board has brought new levels of experience to our home." What the care home could do better: Prospective people wishing to use the service should be admitted only on the basis of a full assessment, undertaken by the provider or care manager. This is to ensure that the home can fully meet the persons needs. Care plan assessments and individual risk assessments should be kept up to date, appropriately documented and recorded. Appropriate interventions should be carried out for people identified at risk, either of malnutrition or of falling. Outcomes of assessments should be appropriately documented and kept up to date, and staff kept informed. Nutritional screening for individuals should be undertaken on admission, and subsequently on a periodic basis, a record maintained of nutrition, including weight gain or loss, and the appropriate action taken. Activities undertaken should be recorded, and people should be given opportunities for stimulation through leisure and recreational activities in and outside of the home which suits their needs, preferences and capacities. Consideration should be given to people with dementia, visual, hearing or physical disabilities. People should be more involved in their local community, in accordance with their preferences. People should receive a wholesome, appealing and balanced diet that reflects the changes in season, and peoples choices and preferences. Suggestions about the menu, made by people at their meetings, should be implemented. The people using the service would benefit from new garden furnishings, this would also encourage people to use the garden. Additional staff should be on duty at peak times of the day, to enable activities to take place. Recruitment of more staff for night duties would enable the provider to fulfil her commitment to the management input of the home. The acting care manager should submit an application to the Care Quality Commission to be Registered as Manager for the home, in order to comply with regulations and to ensure continuity of management. Staff supervision should be formally established for all care staff. Key inspection report Care homes for older people Name: Address: Riverview Residential Home 1 Hayfield Cottages Tittensor Road Tittensor Stoke-on-Trent Staffordshire ST12 9HG     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: Pam Grace     Date: 0 7 0 5 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 30 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 30 Information about the care home Name of care home: Address: Riverview Residential Home 1 Hayfield Cottages Tittensor Road Tittensor Stoke-on-Trent Staffordshire ST12 9HG 01782374451 01782374451 bellasingh@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Rishpal Singh Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 8. The registered person may provide the following categories of service only: Care home only - Code PC To service users of the following gender: either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Date of last inspection Brief description of the care home Riverview is a residential home located in Stoke On Trent, Staffordshire, providing a service for eight older people. The two-storey property is located in a rural area with picturesque views, eight single occupancy bedrooms are provided on the ground and first floor level, six of which are equipped with en suite facility. One bathroom having an assisted bath is located on the first floor, a separate toilet facility is also provided Care Homes for Older People Page 4 of 30 Over 65 8 0 Brief description of the care home on the ground floor. The home also consists of a lounge dining area located on the ground floor, equipped with essential furnishings and fitments to provide a comfortable area for relaxation and to interact with people living in the home. A kitchen and a separate laundry are in place. There is a stair lift to assist individuals who have limited mobility. The fees for this service are not included in this description. The reader may wish to obtain more up to date information directly from the care service. Care Homes for Older People Page 5 of 30 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: The overall quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection was carried out over one day, by one inspector. The inspection had been planned using information gathered from the Care Quality Commission (CQC) database, the Annual Quality Assurance Assessment (AQAA) document that had been completed by the provider, comments and surveys received from people who use the service and their relatives. The key National Minimum Standards for Older People were identified for this inspection and the methods in which the information was gained for this report included case tracking, general observations, document reading, speaking with staff, people who use the service and their visiting relatives. Observation of the environment was also undertaken. Care Homes for Older People Page 6 of 30 The Statement of Purpose and Service User Guide had been reviewed and were available for us to view. The previous inspection report is available to read in the main entrance hallway of the home. At the end of our inspection, feedback was given to the provider and the acting care manager, outlining the overall findings of the inspection, and giving information about the requirements and recommendations that we would make. People spoken with were very positive about the care they were receiving. Our observations showed that these people were well cared for, and were happy in their surroundings. There had been one anonymous complaint received by the Care Quality Commission which had not been upheld, and no Safeguarding referrals made to or by the home, since the previous inspection. Surveys returned to the Care Quality Commission (CQC) totalled eight Have Your Say documents from people using the service, and six surveys received from staff. The feedback and comments we received from people about the service were generally positive, and many are included in this report. There were no requirements, and twelve recommendations made as a result of this unannounced inspection. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Prospective people wishing to use the service should be admitted only on the basis of a full assessment, undertaken by the provider or care manager. This is to ensure that the home can fully meet the persons needs. Care plan assessments and individual risk assessments should be kept up to date, appropriately documented and recorded. Appropriate interventions should be carried out for people identified at risk, either of malnutrition or of falling. Outcomes of assessments should be appropriately documented and kept up to date, and staff kept informed. Nutritional screening for individuals should be undertaken on admission, and Care Homes for Older People Page 8 of 30 subsequently on a periodic basis, a record maintained of nutrition, including weight gain or loss, and the appropriate action taken. Activities undertaken should be recorded, and people should be given opportunities for stimulation through leisure and recreational activities in and outside of the home which suits their needs, preferences and capacities. Consideration should be given to people with dementia, visual, hearing or physical disabilities. People should be more involved in their local community, in accordance with their preferences. People should receive a wholesome, appealing and balanced diet that reflects the changes in season, and peoples choices and preferences. Suggestions about the menu, made by people at their meetings, should be implemented. The people using the service would benefit from new garden furnishings, this would also encourage people to use the garden. Additional staff should be on duty at peak times of the day, to enable activities to take place. Recruitment of more staff for night duties would enable the provider to fulfil her commitment to the management input of the home. The acting care manager should submit an application to the Care Quality Commission to be Registered as Manager for the home, in order to comply with regulations and to ensure continuity of management. Staff supervision should be formally established for all care staff. 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. Evidence: The Annual Quality Assurance Assessment (AQAA), which was completed by the provider, told us: Each service user has to have a pre admission assessment. The home gives notice of any change of fees. Service users are given a copy of our brochure, service user guide and statement of purpose, which contains a copy of our complaints produre. A written contract will be supplied to service users once being accepted for placement stating their rights and responsibilities. We were given copies of the Statement of Purpose and Service User Guide to look at. Care Homes for Older People Page 11 of 30 Evidence: We saw that these documents had been reviewed. The previous inspection report was readily available in the entrance hallway, for people to look at. People spoken with, and feedback from surveys undertaken confirmed that they had received appropriate information prior to admission, which had included the Statement of Purpose. People also confirmed that they had been provided with a contract and or terms and conditions. The provider confirmed that contracts had all been reviewed. We looked at four care plans. These showed that three people using the service had undergone an appropriate assessment of needs prior to admission to the home. However, one person on respite short stay had been admitted as an emergency, and had not been visited or undergone a pre admission assessment via the acting care manager or provider. This was highlighted and discussed at the time of our visit. A social work assessment was evident for this individual, this had been used to inform the care plan for the service. Intermediate care is not provided in this home. Care Homes for Older People Page 12 of 30 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. The health and personal care that people receive should be based on their individual needs. Individual assessments including risk assessments must be kept up to date, and must accurately reflect peoples needs. Care plan documentation must be kept up to date, and be uniformly and consistently presented. Evidence: The Annual Quality Assurance Assessment (AQAA), which was completed by the provider, told us: The home has a policy for receipt, storage and handling, administration and disposal of medication. That the manager makes sure they carry out. Service users can register with a GP of their choice. Staff are trained in giving choice to our service users. Each of our service users are supported to make their own decisions and care plans are implemented to support this. And with agreement from the service users, we work alongside their families too. We support service users to manage their own healthcare and where this is not possilbe we aim to identify any health problems so Care Homes for Older People Page 13 of 30 Evidence: that they can be dealt with promptly. Service users privacy and dignity is respected by all staff members and this is always maintained. We examined four care plans, one of these was in relation to a person on respite short stay. We also spoke with staff and people who use the service. Staff spoken with could tell us exactly how each of these people were to be cared for, however, what staff told us did not always reflect what was written in individual care plans. Documents contained within care plans were uniformly presented, but some had not been fully completed, dated or signed, for example the missing person profiles were incomplete, life histories were very brief with sparse information, nutritional assessments had not been fully completed and were not up to date, individual weights were not consistently recorded, activities undertaken were not recorded, dependency charts were unsigned by staff and not dated, some of the risk assessments were also out of date. Some documents needed archiving, old records were mixed in with new, which made reading through the documentation difficult and lengthy. One person at risk of falls was identified as needing a zimmer frame, he was then later identified as not needing a zimmer frame, although there was no recorded evidence or guidance to support this either way. There was no documented procedure or guidance in place for staff in regard to the ongoing nutrition of a person who needed encouragement to eat and drink, and had been prescribed Ensure supplements, and needed to have nourishing pureed meals. All of the above were highighted and discussed with the provider and with the acting care manager. The provider confirmed that staff were well aware of the need to encourage individuals who are losing weight to eat, and to give Ensure supplements when prescribed and needed. She also confirmed that the tissue viability specialist nurse would be consulted where necessary in relation to a person requiring more complex treatment. District nurse records were evident in relation to wound care and treatment given to people using that service. Those records were kept separately in individuals bedrooms. A spot check of the homes medication systems evidenced satisfactory and safe practice of medication administration, storage and disposal. The medication administration system included daily checks and monthly audits by the provider, and six monthly audits by the pharmacist. This ensures the health, welfare and safety of the people using the service, and that staff are competent. The policy and procedure for medication was recently reviewed, and staff spoken with confirmed that they had received appropriate medication training. Care Homes for Older People Page 14 of 30 Evidence: Surveys we received confirmed that people received the care, support and medical care they need. Comments from surveys we received included the following: They look after us well, meet all our needs too. Respect our privacy at all times. Happy where I live. They care for us well, take care at all times, keeps us happy. Maybe need some different activities from time to time. They meet my needs, being blind they help me in many ways. They see to all my requirements each day. Very happy with the service here. Cant do any better than they already are. The home looks after us well, and is very welcoming and friendly. They look after us well, see to all of my needs, take care of me, support me in any way that I need. The home provides excellent staff and cares for the residents well. The home is situated in a beautiful area and beautiful scenery. The home could have better activities, need to sometimes change the routine, but the residents enjoy the routine so far. Staff surveys and staff spoken with confirmed that they are given up to date information in order to meet the needs of people using the service. Care Homes for Older People Page 15 of 30 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. People who use the service should be enabled to make choices about their life style and should be supported to develop their life skills. Social, educational, cultural and recreational activities must meet individuals expectations. Evidence: The Annual Quality Assurance Assessment (AQAA) which was completed by the provider, told us: We encourage our residents to do daily activities and get them involved in cooking, gardening, washing up. We have open visiting arrangements for the famillies. Special diets for the diabetics and vegetarians are catered for. The home offers 3 meals a day including drinks and snacks throughout the day. We have regular residents meetings. Residents can handle their own financial affairs for as long as they are able to. We found that opportunities for activities are very limited, and there are no organised trips out, or programmed activities. Staff told us that they sometimes play dominoes, cards, and jigsaws with individuals who want this, but that people usually watch television during the day and sit in the lounge area. Care Homes for Older People Page 16 of 30 Evidence: Surveys received contained the following comments,They could make the garden and outside space more attractive and usable. They could take the resident out and engage in community activities. They could provide more in house activities and mental stimulation. They could provide a more nourishing and well balanced diet, no way do they get the recommended daily allowance (RDA) of fruit and veg. We highlighted and discussed this with the provider and acting care manager during our visit. We recommended that they utilise the outside space, and provide more furnishings for the garden, to encourage people to use it. Suggestions discussed were cream teas in the garden, and running an activity outdoors. People spoken with confirmed that they were able to have their say, as there are regular meetings for people using the service. We saw evidence of this through the records of those meetings. We saw that daily records do not state what activities are undertaken by individuals each day. We found that care staff had the responsibility for providing people with activities each day. There were two care staff on duty most days of the week. Staff confirmed that they provided activities when time allows. For example playing cards, jigsaws, crossword puzzles, quizzes, bingo. There is no daily newspaper delivered. There is no visiting library service. However, one person had previously told us that he does receive talking books each week. We saw that although the lounge is small, armchairs had been rearranged and there was more room for people to sit, there had previously been too many armchairs in this small area. People using the service eat in the lounge diner, either on small tables, or seated at the table. This gives a more homely feel at mealtimes. People told us that they dont go out much. They said they needed transport, to take them on trips out. They also said that they dont know what is happening locally, for example at the local church, community centre or the shops. Four weekly rotational and seasonal menus were in place. We looked at the kitchen, which was very clean and tidy. We noted that a new cooker was in place. Records seen confirmed that all hot and cold food temperatures are taken daily and recorded. There was also an up to date cleaning schedule in place. We were told that people had been consulted in relation to their menu, and that this Care Homes for Older People Page 17 of 30 Evidence: had been raised at the recent meeting held for people using the service. We also saw the minutes of that meeting evidencing this. We were told that meals are sometimes substituted for something else, and are not what is written on the menu. We looked at the quality of the meals provided, as there had been some negative comments made previously about this. We found that in general food was of a reasonable quality, we discussed the need to ensure that people received nutritious and appetising food, which is well balanced and contains enough fresh fruit and vegetables. We saw that there was fresh fruit available, and that fresh vegetables are frozen by staff, and used accordingly. Staff told us that people are offered biscuits with their mid morning tea, and cake in the afternoon. We suggested some more variety in the menu. We were told that lunch and evening meal had been swapped over at the request of people using the service, and that this change was working well. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. People are protected from abuse, and have their rights protected. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the provider, told us: All residents are informed or the concerns and complaints procedure and would be fully supported by staff in making their complaints. The home keeps a copy of all complaints and received and the action which will be taken. Procedures are inplace to respond to evidence or suspicion of neglect. Residents and friends can be provided with the advocacy service information. As part of this inspection, we undertook an early morning visit to the home in response to an anonymous complaint. This established that there was a staff member sleeping in and a waking staff member on duty overnight. We spoke with staff on duty and examined the staff rota which also confirmed this. The provider confirmed that people who use the service and or their representatives are provided with a copy of the homes complaints procedure during the admission process. Care Homes for Older People Page 19 of 30 Evidence: Surveys received confirmed that staff know what to do if someone has concerns, and that people using the service knew how to make a formal complaint, and who to speak to informally if they were not happy. They said that their grumbles are listened to and acted upon by staff. Staff spoken with confirmed that the home has an open door policy in regard to complaints. There had been one anonymous complaint since the last inspection which was not upheld, and no Protection of Vulnerable Adults (POVA)/Safeguarding referrals had been made to Social Services. We spoke with staff, and requested a copy of the homes up to date training matrix. Staff told us they had received training with regard to adult abuse, its identification and types of exploitation. There is a safe and secure system in place in regard to monies held by the home, on behalf of the people using the service. Care Homes for Older People Page 20 of 30 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 physical design and layout of the home enables people who use the service to safely live in a homely and comfortable environment, which encourages independence. The garden area needs furniture that is comfortable, appealing and encourages people to sit out. Evidence: The Annual Quality Assurance Assessment (AQAA), completed by the provider, confirmed that all health and safety checks on equipment and fire systems had been undertaken, and told us: We ensure that the environment is well maintained and offers residents a homely place to live. Communal space is available within the home for all residents to access. The home has outdoor space which is accessible to all residents including those with mobility problems. Toilet and bath facilities to meet their needs. Each room is centrally heated with controls in each room. The AQAA also told us about the improvements that had been made since the previous inspection, these were as follows: Health and Safety audit tool Health and Safety checks around the home are up to date with relevent certificates. Kitchen has been updated and new units have been Care Homes for Older People Page 21 of 30 Evidence: fitted. New cooker also has recently been fitted. People spoken with during the inspection visit expressed their satisfaction with the general environment, their room, and the equipment provided within the home. People spoken with said, its always kept clean and tidy, and the staff work very hard to keep it all clean. Surveys received told us that the home is always kept fresh and clean. During observation of the environment we saw that the home provides a clean, well maintained environment throughout. The lounge area was still in need of redecoration. However, this was already known to the provider and we were told this was in hand. We also observed that people do not use the rear garden area, and tend to sit at the front of the building within the car parking area. We discussed the need for more activities in the garden, and to have more appealing garden furniture outside, which would encourage people to use the garden. Individual accommodation is personalised to suit the people using the service. One person had previously told us that he had his furniture arranged in such a way that he knew where everything was. The lounge dining area had improved, with the removal of some armchairs, and the purchase of a narrow dining table, this had given people more space, and had encouraged more people to eat at the table. The communal areas are comfortable and homely. Bathrooms and toilets are conveniently sited around the home. We saw that equipment and adaptations were provided as necessary to maximise independence. For example, wheelchairs, raised toilet seat, handrails, and assisted baths. Kitchen and laundry areas were clean and tidy, with appropriate measures in place to prevent cross infection. Care Homes for Older People Page 22 of 30 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 should be enough staff in the home to safely support the needs of the people using the service, and to provide quality activities according to individual preferences, capacities and needs. Evidence: The Annual Quality Assurance Assessment (AQAA), completed by the provider, told us: The home ensures that all staff operate in a manner which promotes liberty, we enable users to feel safe and secure whilst promoting independence As an organisation we recruit in a fair and open way ensuring we safely employ people. We undertake a robust recruitment process and carry out various checks on possible employees, e.g. POVE, CRB references. All workers recive a job description and handbook All staff recive induction training and regular updates. All staff have an appropriate experience and qualifications, and have completed their NVQ level 2 in care and 1 has completed her NVQ level 3. All staff have been trained in Dementia level 2 and have completed the course. The home displays a rota that shows what staff are on duty at what times. We looked at 3 staff recruitment records. These showed that appropriate safety Care Homes for Older People Page 23 of 30 Evidence: checks had been undertaken for individuals prior to their recruitment, including, Criminal Records Bureau, Protection of Vulnerable Adults, 2 References, and Identification. Staff, people spoken with during the inspection visit, and surveys received from people who use the service, confirmed that staffing levels had been maintained. We were told that staff are responsible for laundry, cooking and cleaning in the home, this is as well as caring for the people using the service, and for providing activities. However, we saw that activities only run if staff have time, which is not very often. The staff rota evidenced that the acting care manager works 18 hours weekly over three days, and that the provider works 4 waking nights per week, as well as 2 or 3 day shifts per week. We strongly recommend that more night staff are urgently recruited to ensure that the provider is enabled to safely fulfil her commitment to the management of the home. We were told that the staff training matrix needed to be updated to include planned training. We asked the provider to forward a copy of the updated matrix to the Care Quality Commission as soon as possible. Staff spoken with told us that they had received update and refresher training according to their role and responsibilities. We were also told by a recently recruited member of staff that they had received a formal induction, which was signed off by a senior member of staff, however, they were unable to produce the documentation to evidence this. Surveys received told us that staff are available when people using the service need them, and that staff listen to them and act on what they say. Staff told us there are enough staff to meet the individual needs of the people using the service, and that they have enough support, experience and knowledge to meet those needs. Comments received from staff included the following, gives us plenty of training and flexible hours, we need more room, and more training. We listen to residents in regard to getting up and going to bed when they want to and asking what they prefer to eat. Everyone gets enough attention. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and staff need consistent leadership and management, and a manager who is registered with the Care Quality Commission. Evidence: The Annual Quality Assurance Assessment (AQAA), which was completed by the provider, was returned to the Care Quality Commission Inspection on time, and was adequately completed, told us: All staff have induction training and then yearly appraisals to identify their learning needs. Staff undertake supervision at lease 6 times a year. We have a new manager, who has an up to date knowledge of her job role. The home has a clear management structure appropriate for its size. We provide a safe place for residents to keep valubles or money and an record of this is maintained. Residents are able to access their records if they wish to. Care Homes for Older People Page 25 of 30 Evidence: We were told that an application in respect of registration of the acting care manager for this home is in progress, and that this will be addressed without further delay. The provider and acting care manager are qualified and have the necessary experience to run the home. They are aware of and work to the basic processes set out in our regulations, and are aware of the need to keep up to date with practice and continuously develop their management skills. There is currently just enough management input into the service, to support the staff team, and to ensure the health, safety and welfare of the people using the service. However, we strongly recommend that the provider employs one additional day staff at peak times, to enable activities to take place. An additional night staff is also needed to fulfil the commitment of the providers management time. The provider trains and develops staff that are generally competent and knowledgeable to care for the people using the service. The home focuses on the individual, takes account of equality and diversity issues, and generally works in partnership with families or close friends and professionals, as appropriate. We were told by the provider that she had already started to develop a Quality Assurance system, starting with questionnaires for people who live there. This had then been further developed to include all stakeholders. We saw surveys that had been returned by relatives and people using the service. The outcomes of surveys sent to other professionals and stakeholders were awaited at the time of our visit. It is intended that they will then be collated, feedback to staff, relatives and the people using the service, along with any actions to be taken by the service. Formal staff supervision had not been established at the home, this was confirmed by the acting care manager, who told us that she was intending to develop this as a priority, and in order to help ensure that staff are supported, safe and competent. Peoples finances showed no anomalies, at the previous inspection, and were not examined during this visit. Figures previously seen tallied with amounts held, and receipts were kept for all purchases made on peoples behalf. Care Homes for Older People Page 26 of 30 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 27 of 30 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 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 Prospective people wishing to use the service should be admitted only on the basis of a full assessment, undertaken by the provider or care manager. This is to ensure that the home can fully meet the persons needs. Care plan assessments and individual risk assessments should be kept up to date, appropriately documented and recorded. Nutritional screening for individuals should be undertaken on admission, and subsequently on a periodic basis, a record maintained of nutrition, including weight gain or loss, and the appropriate action taken. Appropriate interventions should be carried out for people identified at risk, either of malnutrition or of falling. Outcomes of assessments should be appropriately documented and kept up to date, and staff kept informed. Activities undertaken should be recorded, and people should be given opportunities for stimulation through leisure and recreational activities in and outside of the home which suits their needs, preferences and capacities. Consideration should be given to people with dementia, Page 28 of 30 2 7 3 8 4 8 5 12 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations visual, hearing or physical disabilities. 6 7 13 15 People should be more involved in their local community, in accordance with their preferences. People should receive a wholesome, appealing and balanced diet that reflects the changes in season, and peoples choices and preferences. Suggestions about the menu, made by people at their meetings, should be implemented. The people using the service would benefit from new garden furnishings, this would also encourage people to use the garden. Additional staff should be on duty at peak times of the day, to enable activities to take place. Recruitment of more staff for night duties would enable the provider to fulfil her commitment to the management input of the home. The acting care manager should submit an application to the Care Quality Commission for Registered Manager for the home, in order to comply with regulations and to ensure continuity of management. Staff supervision should be formally established for all care staff. 8 19 9 10 27 27 11 31 12 36 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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