Care Home: Robert Bean Lodge

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What the care home does well Both the manager of Robert Bean Lodge and the manager of Napier Unit were open, honest and receptive to advice given and demonstrated a commitment to put right any matters needed addressing to improve the service further. Staff in both units spoke enthusiastically about their roles and enjoy working at the home. Residents like living at the home and feel comfortable and safe. There is an extensive range of activities which should meet the diverse preferences and abilities of all the residents currently living at the home. Compliments about the service included; "Very good company. I like the activities here particularly the ones where to we talk in groups. I feel safe here whereas I didn`t at home. Staff are all very nice and helpful. They are all considerate and explain everything to me". "We are kept informed of all the changes going on. It`s very good here. The home is always clean and there are no smells. My visitors feel it is a very well run home". "They respect my wishes. Lots of changes going on but we are kept informed about them. Go out occasionally for trips in the mini bus and we get a choice of where to go". "It is very good here in all things. It is not dictatorial here. Very, very good staff. Company is good here and there are lots of things to occupy us. They never restrict your visitors". "There is everything we could wish for here, although I would rather be at home. Girls wait on your every wish". "We`ve been extremely impressed with the home and staff from the word go". "I`m happy here. The girls are kind to me". "We are well looked after here. Nothing to be unhappy about. We are lucky to have this place". "I`ve only had good feedback from service users and relatives. The service treats service users as individuals. It provides a friendly atmosphere. Has skilled caring staff and tries to treat each person as an individual". "I feel the service provides a high standard of care and it is a pleasure to discuss care needs of service users with staff who are so committed to the residents` well being". "I`ve been coming for many years and am always happy with the place and people". "My son is helped in every way. Staff are very helpful. My son enjoys his respite stay and always comes home happy". "The service absolutely responds to different needs of individual clients and how these factors interact with their health needs. They are caring and professional staff. They work very closely with all professionals concerned". What has improved since the last inspection? A new manager has been appointed and is in the process of being registered with us. Carpets have been replaced in the lounge dining rooms. The gardens are now maintained to a good standard and residents enjoy using the facilities. The maintenance of care records for residents living on Robert Bean has improved and provides a better picture of residents` daily experiences. The Kingfisher unit has been refurbished and upgraded to provide younger people who use the Napier Unit respite service with much improved accommodation. This includes increased day space and better bathing and showering facilities. Application is now being made to us for the unit to be separately registered. The unit will also have its own registered manager. The provider is committed to ensuring its workforce is appropriately trained. This hasresulted in almost all staff now being trained to NVQ 2 or equivalent in care. In preparation of the main purpose of Robert Bean Lodge being changed, all staff have or are about to receive dementia care training. The provider also encourages and supports staff in continuing with their further education in order to obtain qualifications relevant to their position in the home. For quality assurance purposes, regular and recorded visits are now carried out by the provider`s representative. What the care home could do better: It was difficult to obtain a coherent picture of residents` current condition, due to the maintenance of care records for Robert Bean residents. Care staff on Robert Bean Lodge must continue with the improvements seen in the care plans with particular regard to person centred care. For residents` protection, carers must make sure they administer medicines in line with current good practice. This includes observing residents taking their medicines. Although most comments about meals were positive, one interviewee added "Meals are reasonable but the variety is not as good as it used to be. We seem to get a lot of sausages now". No requirements have been made, but a number of good practice recommendations have been made throughout the body of the report. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Robert Bean Lodge Pattens Lane Rochester Kent ME1 2QT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elizabeth Baker     Date: 2 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 30 Information about the care home Name of care home: Address: Robert Bean Lodge Pattens Lane Rochester Kent ME1 2QT 01634831122 01634831113 ann.togwell@medway.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Medway Council Name of registered manager (if applicable) Mrs Ann Elizabeth Togwell Type of registration: Number of places registered: 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 to be accommodated is 44 The maximum number of services users to be accommodated is 44 The registered person may provide the following category of service only -(PC) to service users of the following gender: Either: Whose primary need on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Robert Bean Lodge is a purpose built home which includes a community day centre. All the accommodation is on the ground floor in single rooms. Medway Council owns and runs the establishment which is registered for 44 older people. The home is on a bus route. Parking is available. The building includes a separate unit for younger people, currently known as the Napier Unit. The unit has been totally refurbished and will be registered with us as a separate unit with eight beds. The current weekly fee for Care Homes for Older People Page 4 of 30 care home 44 Over 65 44 0 Brief description of the care home residents using Robert Bean Lodge is £413 per week. Additional fees are payable for hairdressing, toiletries, newspapers and chiropody. The current range of Robert Bean Lodge activities include music, shopping, discussions, arts and crafts, bingo, gardening and trips out. Fees for Napier Unit residents are dependent on the level of benefit being paid and their assessed individual needs. Currently they range from £9 to £20 per night. Additional charges are payable for social activities and admission charges. Current activities include shopping, visiting pubs and libraries, cooking and excursions to the coast and London. Napier Unit residents also continue with their structured activities at their respective day centres. A Church of England service takes place at the home monthly. The inspection report is available in the reception area. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Link inspector Elizabeth Baker carried out the key unannounced visit to the service on 28 April 2009. The visit lasted over eight hours. As well as briefly touring the home, the visit consisted of talking with some residents and staff. Five residents, three carers and two visitors were interviewed. Separate verbal feedback of the visit was provided to the manager of Robert Bean Lodge and unit manager of Napier Unit during and at the end of the visit. At the time of compiling the report, in support of the visit, we the Commission received survey forms about the whole service from 11 residents, three care managers, three health professional and 11 members of staff. At our request the home was required to complete and return an Annual Quality Assurance Assessment (AQAA). The detailed Care Homes for Older People Page 6 of 30 assessment gave us the information we asked for. Some of the information gathered from these sources has been incorporated into the report. Since the last visit one safeguarding adult referral has been made and investigated. There have been no referrals to the Protection of Vulnerable Adults list. We have not received any complaints about the service. The last visit to the home was carried out on 8 May 2008. What the care home does well: What has improved since the last inspection? A new manager has been appointed and is in the process of being registered with us. Carpets have been replaced in the lounge dining rooms. The gardens are now maintained to a good standard and residents enjoy using the facilities. The maintenance of care records for residents living on Robert Bean has improved and provides a better picture of residents daily experiences. The Kingfisher unit has been refurbished and upgraded to provide younger people who use the Napier Unit respite service with much improved accommodation. This includes increased day space and better bathing and showering facilities. Application is now being made to us for the unit to be separately registered. The unit will also have its own registered manager. The provider is committed to ensuring its workforce is appropriately trained. This has Care Homes for Older People Page 8 of 30 resulted in almost all staff now being trained to NVQ 2 or equivalent in care. In preparation of the main purpose of Robert Bean Lodge being changed, all staff have or are about to receive dementia care training. The provider also encourages and supports staff in continuing with their further education in order to obtain qualifications relevant to their position in the home. For quality assurance purposes, regular and recorded visits are now carried out by the providers representative. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out 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. Information about the home is good and provides prospective residents and their advocates with the information they need to make a decision about moving into the home or not. Evidence: Robert Bean Lodge and Napier Unit each have their own statement of purpose, which incorporates the service user guide. The documents are available in different formats in accordance with good practice. The documents provide respective residents and or their advocates with information about the services provided at the home. Prospective residents to both units are referred to the home by care management. Not all prospective residents to Robert Bean Lodge are able to visit the home prior to admission. If this is the case their relatives or advocates do so on their behalf. Care Homes for Older People Page 11 of 30 Evidence: Prospective residents to the Napier Unit are invited, with their relatives or advocate to the unit for an initial meeting. Following this meeting introductory visits are set up so the prospective resident can meet current residents and staff. This provides the unit with time to establish whether it can properly support the prospective resident and indeed their advocates with the respite packages it provides. Information gathered by care managers and the home during the pre admission assessment process is used to inform the corresponding care plans each resident is provided with. Since the last visit there have been changes to the environment. This has resulted in Napier Unit being totally refurbished specifically for the purpose of accommodating younger people using the respite service. The provider is currently making application to us for this unit to be separately registered. Robert Bean Lodge is in the process of changing its main purpose to become a care home for older people with dementia. Existing residents and their advocates have been kept informed of all the changes. The home is not registered for intermediate care. Standard 6 is not applicable. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and social needs of residents are met with evidence of good multi disciplinary working taking place on a regular basis. Personal care is offered in a way to protect residents privacy and dignity and promote independence. Evidence: For case tracking purpose the care records of four residents were inspected. Three related to residents on Robert Bean Lodge and the other to the one resident currently staying at the Napier Unit. Since the last visit care records for residents on Robert Bean Lodge have been changed and provide a better picture of residents assessed needs and support. The records contained pre admission and admission details, care plans and some assessments, including dependency and moving and handling. The records evidenced input from GPs, hospitals, chiropodists and opticians. As the home does not provide nursing care, where there is a nursing need district nurses provide this. Records included where this is the case, although the records did not actually record what the Care Homes for Older People Page 13 of 30 Evidence: actual problem was. Reviews of care plans are recorded on a separate monthly review sheet. However where the review sheet identified a change in the residents plan, the actual plan itself is not updated with the new information, which could cause a problem when the monthly review sheet is superseded. Some residents experience pain and take medication for this. However it has not been the homes practice to provide a pain care plan or pain assessment, where there is an assessed need. Having this would help staff monitor the effectiveness of the pain treatments. The residents care record on the Napier unit provided a clearer picture of the residents assessed needs and how the care was being delivered and is more person centred. The care plan is also supported by a range of risk assessments. All residents spoken with indicated they do not self medicate or indeed wish to. Medication administration is therefore carried out by care staff. During an interview with a resident on Robert Bean Lodge it transpired the resident sometimes has pain and is given pain relief for this condition. The resident relayed an incident whereby they were given night time pain relief in a pot to be taken later if required. This is not safe practice. Medication administration record (MAR) charts are used to record medicines prescribed and administered. These had mainly been completed as is required. However, one chart for a resident on Robert Bean Lodge contained handwritten transcription entries. The entries had not been signed or countersigned. For auditing purposes, it is good practice to do so. The home has a drug room within a medication room. The drug room allows for medicines to be safely and securely kept. Since the last visit a new drug refrigerator has been purchased and records are kept of the daily temperatures, as is required. However it has not been the homes practice to monitor and record the temperature of the actual drug room. Medicines need to be stored in accordance with manufacturers instructions with regard to temperatures to ensure efficacy of medicines is not compromised. Daily records of residents conditions are maintained on both units. These generally provided a picture of the residents quality of day and experiences. Records had been signed, dated and timed. A review of the daily contact sheet for the resident on Napier unit identified that abbreviations are used, without the aid of a glossary. This could present a problem if an investigation needed to be carried out. Following a recommendation made by the providers representative, separate timed night records are now maintained. This is good practice. Residents seen throughout Care Homes for Older People Page 14 of 30 Evidence: the visit were appropriately dressed for the time of day and season, with particular attention to detail where this is important to them. Residents spoke highly of the hair dressing arrangements at the home and said how much they enjoy going there. Another resident said they have their own hairdresser come in as they prefer this. All residents spoken with said staff support them with their personal hygiene needs in a way which respects their privacy and dignity. All the records contained details of residents religion. However there are no specific care plans for death and dying. To ensure residents cultural and spiritual wishes and preferences are met, this information should be sought and recorded. Whilst acknowledging it is a sensitive subject, it is an important aspect of care and needs to be addressed. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities in the home are excellent with a range that meets the diverse needs of its residents. Meals are nutritious and offer variety and choice. Evidence: Residents spoken with on Robert Bean Lodge said they choose when to get up and go to bed and particularly enjoy their early morning cup of tea in bed. They choose how to spend their time. Some like to stay in their rooms while others enjoy the communal activities which take place at the home. At this visit some residents were seen in a small group quiz activity whilst others where watching the television or reading. One resident said how much they enjoy sitting out the gardens and helping with the planting and hanging baskets. Another resident described how much they had enjoyed their day in Rochester and another said they had recently been on a shopping trip to Chatham for some new clothes. The home currently employs one activity coordinator. Another activity coordinator is to be employed. Current activities include gardening, painting, model making, cooking, film shows, discussions, bingo, reminiscence, board games and exercise to music. Day trips are arranged to shopping centres and other places of interest. And residents said how much they do like going out on trips. Care Homes for Older People Page 16 of 30 Evidence: For the Napier unit, respite residents usually spend their time at the day centres they attend when living in the community. The activities would include swimming, shopping, cooking and relaxing. The unit endeavours to take the residents out on as many external trips as is feasible. Planned trips include London Zoo, Ramsgate, Hastings, National History Museum, Wildwood and the Circus. The refurbished Napier unit now has its own kitchen area which should enable residents to assist with their meal preparation if they wish to. The unit now has a large wide flat screen TV with both satellite and Freeview facilities enabling the units residents to access an increased selection of sports and other programmes younger residents may prefer. The units new garden area is almost complete and will offer secure and private facilities. Church of England services regularly take place at the home. Indeed a resident said how much they had enjoyed the Easter service. Pastoral and spiritual support is accessed for residents of other religions and beliefs when this is required. All the units in the home offer a combined lounge dining area. This has greatly enhanced the facilities for Napier unit residents. Visitors were seen coming and going throughout the visit. Residents and visitors confirmed visiting is unrestricted, they are made welcome and refreshments are provided. Although residents have a choice of where to eat their meals, they mainly do so in the dining areas of each unit. Meals were not sampled on this visit but the lunchtime meal seen was presented and smelt appetising. Fresh fruit is available for residents to enjoy. Care records seen evidenced residents are regularly weighed. Chair scales are used for this purpose. Since the last visit the chair scales are now calibrated as the manufacture requires. This is good practice. Where there is an assessed need, input is provided by the Speech and Language Therapist. Survey respondents indicated they either always or usually like their meals. A survey respondent added they would like new choices. Care Homes for Older People Page 17 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. Residents and or their advocates can feel confident their concerns are taken seriously and acted upon. Evidence: For the publics ease of access, the homes complaints procedure is displayed near to the main entrance. The procedure which includes our contact details is currently being updated. The procedure is available in other formats and versions if required. This is good practice. Residents spoken with knew what to do if they had a concern or were unhappy about their care. All survey respondents indicated they knew how to make a complaint and who to speak to if they were not happy. Arrangements are available for residents to vote in elections if they wish to. This would include postal votes or indeed taking residents to the polling station if they preferred. A resident confirmed she had voted during her stay at the home. The returned AQAA records that the home has received one complaint. We have not received any complaints about the home. The AQAA also records that there has been one safeguarding referral and investigation made. Care Homes for Older People Page 18 of 30 Evidence: The home maintains records of formal complaints. Niggles and adverse comments are not routinely recorded. For monitoring trends and practices for quality assurance purposes, it is good practice to do so. Care Homes for Older People Page 19 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 environmental changes have provided all the residents with a good, warm, safe and homely place to live in. Evidence: Areas of the home, including the Napier unit, were warm, tidy, fresh and clean. Residents spoken with confirmed this is always the case. And all the returned surveys from residents indicated the home is always fresh and clean. An environmental health inspection of the main kitchen was carried out in February 2009. No requirements were made. The kitchen was not re-inspected on our visit. Since the last visit one of the units has been refurbished in preparation of the proposed registration of a separate home for younger people. This will be used for respite accommodation for up to 8 people. The refurbished unit now provides good communal accommodation, a new shower room, refurbished bathroom, utility room and its own secluded private garden. Communal carpets in the lounge dining rooms of Robert Bean Lodge have been replaced and there are plans for corridor carpets to be replaced. Care Homes for Older People Page 20 of 30 Evidence: Following the homes electrical circuit survey carried out last September emergency lighting has been renewed throughout the home. Indeed to ensure the home is maintained to a good fire safety standard, the manager has requested a fire safety officer undertake a visit of the premises, to provide professional advice. It is expected this will happen shortly. For safety purposes, a new security system has been installed. This is in preparation of the home changing its purpose to accommodate future residents with dementia. Rooms used by residents are nicely decorated, furnished and maintained in good order. Although compact, bedrooms have been individualised with personal affects, making the rooms homely and inviting. Each unit has a sluice room for the safe storage and disposal of clinical waste. As is good practice the doors are kept looked when not in use. However a visit to one of the sluices identified that the room was also being used to store inappropriate items. This resulted in ready access to the sluice sink being precluded and a clinical waste bin having to be stored in the corridor. This is not good practice and presents potential hazards to both residents and staff. The door to the medical room was noted to be left wide open throughout this visit. The room is used to store the homes chair scales, treatment chair and other nursing sundries. Some sharps boxes were also seen in this room, one of which was still in use. The practice of leaving the door open presents potential hazards to residents as well as people and children visiting the home. Protective clothing was seen throughout the home strategically placed for staff use. Residents said the laundry service is good, although one mentioned ironing can be lacking on occasions. The home has a range of moving and handling equipment for the safe transferring of residents and staff. Corridors are wide and fitted with handrails enabling residents to move safely and independently around the home. Since the last visit the number of adjustable beds has increased. Although the intention is that all residents are eventually provided with this type of bed, residents still retain the choice of keeping their normal bed if they so wish. Rooms used by residents are fitted with a call alarm system and residents said staff are pretty quick in responding to them. Care Homes for Older People Page 21 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by a trained and enthusiastic workforce. Evidence: As well as care staff, staff are employed for cooking, cleaning, laundry, activities, administration and maintenance. Staff rotas are maintained and evidence the home is staffed 24 hours a day. Staff were seen carrying out their duties in unhurried and attentive manner. Conversations as well as good banter was heard between residents and staff. Residents spoken with indicated staff respond to their call alarm requests quite quickly. All the returned surveys from residents indicated staff are always available when needed. 98 of Robert Bean Lodge and 100 of Napier unit staff are now qualified to NVQ level 2 care or above. This is an excellent achievement. New staff are required to complete an initial induction programme during which they work supernumerary at the home. A corporate induction day is also undertaken at some point. Staff are then required to complete the homes in depth induction programme, which now follows the Skills for Care common inductions model. Staff said they had received induction training. The majority of returned staff surveys their induction mostly covered everything they needed to know to do the job. And staff Care Homes for Older People Page 23 of 30 Evidence: confirmed that their job descriptions actually reflect what their jobs entail. Since the last visit staff have received mandatory training for topics such as moving and handling, fire safety, first aid, food hygiene and infection control. Other subjects covered include diabetes, safeguarding, Mental Capacity Act, child protection, medicine administration and dementia care. Disappointingly, despite the managers best efforts, training for Parkinsons disease is still awaited. It is the providers responsibility to ensure staff are appropriately trained to care for the assessed needs of current and future residents. Following the introduction of the Deprivation of Liberties guidelines, the home manager has attended awareness training and will undertake an depth course in July 2009. This will then be cascaded to all staff. This training is important as it could have implications on the homes current and future residents. Since the last visit, staff have undergone a training needs analysis by the providers learning and development team. A member of staff interviewed said the training needs identified during the process are now being arranged. Two staff files were inspected. Files contained evidence that references had been sought and Criminal Record Bureau (CRB) checks undertaken. For residents safety, staff are required to update their CRB checks every three years. New applicants are required to complete an application form. The form requires details of former employments. However the form does not state that full employment histories need to be recorded. One of the forms inspected did not have a full history and there was no explanation for an employment gap. For residents safety, our regulations require such details are obtained and recorded. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All the residents benefit from living in a well run home. Evidence: Since the last visit there has been a change of registered manager. Although the manager had been in an acting capacity for over a year, she was actually appointed to the position of permanent manager in July 2008. The manager is experienced in working with older people with personal care needs. Prior to this appointment she was the registered manager of a former care home, also owned and operated by the provider. The manager is in the process of being registered with us. In preparation of the imminent change to the homes main purpose, the manager is working towards the Diploma of Higher Education in Dementia Studies. This should be completed in June 2009. The Napier unit is managed by an experienced manager who also has held management positions with other services owned and managed by the provider. Care Homes for Older People Page 25 of 30 Evidence: Applications for the Napier unit and manager to be registered separately with us are currently being completed. Staff in both units spoke openly about the managers. Comments about the management team included Our manager back us up and encourage us and Our manager is always available and very approachable. A survey respondent added Our manager is very supportive at all times. Robert Bean Lodge has its own quality assurance programme which includes satisfaction surveys and meetings. Surveys have recently been undertaken to obtain the view of residents and their advocates. The results have now been analysed and are available on request. For views and opinions of the Napier Unit respite service, relatives are contacted after each stay. The providers representative visits the home regularly and provides a written report of the findings. Conversations with residents confirmed their opinions are sought and acted upon. The home does not act as appointee for any resident and does not manage the personal allowance of residents either. However where the home does keep cash amounts on behalf of some residents, these are kept individually and safe. There is a limit to the amount of monies the home will hold in such circumstances. This has been agreed with us. Records are kept for transactions made on behalf of residents and are subject to the providers auditing arrangements. Staff interviewed said they receive regular supervision from their managers and are given records of the sessions. The AQAA records that the homes policies and procedures were reviewed in March 2009. This is important as up to date information should be readily available to all staff for them to comply with current regulation and good practice. The AQAA also records that the homes equipment is serviced or tested as the manufacturer or other regulatory body recommend. Care records inspected contained various risk assessments, including moving and handling and smoking. However it was difficult to locate specific ones quickly for the Robert Bean Lodge residents as the current method of maintaining some of the records prevents ease of access. Care Homes for Older People Page 26 of 30 Care Homes for Older People Page 27 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 28 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 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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. 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