Care Home: Romford Care Centre

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What the care home does well The home was clean and free from offensive odours and staff were observed to be implementing good infection control methods. Residents told us that they were happy at the home and that the staff were very kind and caring. They told us that they enjoyed the meals. Medication administration is generally good and in accordance with the home`s policy and procedures. The staff group work as a team and have provided a good standard of care in spite of the difficulties caused by the many management changes since registration. Staff training is being given a high priority within this new service and staff have undertaken training in safeguarding of vulnerable adults. What has improved since the last inspection? This was the first key inspection of this new service. What the care home could do better: It is essential that the organisation makes every endeavour to employ a permanent manager to ensure that the care home is managed in a consistent manner to the benefit of residents and staff. Work must continue to ensure that all care plans are in place, person centred and up to date. The requirements of the Mental Capacity Act 2005 must be implemented as appropriate and necessary. This was discussed with the acting manager during the inspection. PRN protocols to be in place for this type of medication, and the control drugs cupboards to be resited in accordance with the new legislation around the Misuse of Drugs. Key inspection report Care homes for older people Name: Address: Romford Care Centre 107 Neave Crescent Harold Hill Romford Essex RM3 8HW     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: Sandra Parnell-Hopkinson     Date: 0 9 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Romford Care Centre 107 Neave Crescent Harold Hill Romford Essex RM3 8HW Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Wendy Pike Type of registration: Number of places registered: care home 114 Ranc Care Homes Ltd Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following categories of service: Care Home with Nursing - Code N To service users of the following gender: Both Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP Dementia - Code DE Physical Disability - Code PD Mental Disorder, excluding learning disability or dementia - Code MD Learning Disability - Code LD The maximum number of service users who can be accommodated is: 114 Date of last inspection Care Homes for Older People Page 4 of 30 Over 65 0 0 0 114 0 114 114 114 0 114 Brief description of the care home Romford Care Centre is a care home with nursing which provides care to frail elderly people, people living dementia and those with a physical disability. All bedrooms are single with en suite facilities and there are communal lounges and dining rooms. Accommodation is provided within 5 units and is on three levels. The home has a cinema and a hairdressing salon, a rear garden and car parking to the front of the home. The home is located in Harold Hill, Romford within the London Borough of Havering and is near to main roads and public transport. A copy of the statement of purpose, service user guide and other information can be obtained on request from the home, as can fee levels. 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: This was the first unannounced key inspection for this newly registered service. We arrived at the home at 09:00 hours and were met by the acting manager who was available throughout the inspection process and received feed back following the completion of the inspection. Evidence has been taken from talking to residents, visitors, staff, case tracking, medication administration records and other records and documentation relating to the operation of a care home. Due to a systems error within the Commission an annual quality assurance assessment form was not requested from the provider. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 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 8 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 wish to use the service and their representatives have the information needed to choose a home that will meet the needs of the prospective resident. Evidence: The service provides a statement of purpose which clearly sets out the objectives and philosophy of the home and this is supported by a service users guide. People are given a copy of the complaints procedure and people spoken to told us that they knew how to complain and who to. However, as many of the residents are living with dementia, it is recommended that more work be undertaken to provide information in simpler formats for the benefit of those residents. Admissions are not made to the home until a full needs assessment has been undertaken, and this assessment should include details of a capacity test which may have been done under the Mental Capacity Act 2005 where the individual lacks capacity to make informed decisions. The pre-admission assessment is undertaken by Care Homes for Older People Page 9 of 30 Evidence: staff who are qualified to do this, and involves the individual, their family and/or representative where appropriate. Where the assessment has been undertaken through care management arrangements, the service insists on receiving a summary of the assessment and a copy of the initial care plan. Again it is important that the home ensures that a capacity test under the Mental Capacity Act 2005 has been undertaken by the placing authority, where a person does not have capacity to make an informed decision, especially around moving to long term care. Comprehensive details of the capacity assessment must be detailed and the areas covered as decisions are time and decision specific. Details must also be obtained around Lasting Power of Attorney; if this has been granted and who holds this authority. Prospective residents and their families are given the opportunity to spend time in the home, and a relative told us that when she visited the home prior to her husbands admission the staff were very informative and kind and I had the opportunity to speak to some residents and other visitors who were very happy with the service, so I decided this was the right home for my husband. New residents are given a statement of terms and conditions or a contract which sets out what is included in the fee, the role and responsibility of the provider and the rights and obligations of the individual. The acting manager and staff actively promotes the opportunity for discussions and clarification as observed on the day of the inspection. Care Homes for Older People Page 10 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 personal care that people receive is based on their individual needs and the principles of respect, dignity and privacy are put into practice. Evidence: We case tracked a selection of residents on each of the four units which are currently occupied. Care plans on Amys were found to be comprehensive with the development of preferred place of care/end of life care plans still progressing. Care plans on the other three units, Raphaels, Manor and Rom Valley were patchy with regard to the comprehensiveness of these documents. Care plans need to be developed around preferred place of care/end of life as this is an important area of care for people living in long term care homes. However, where care plans were in place these were generally person centred. Monthly reviews were being undertaken, and more frequently if the need was identified. Where residents were diabetic care plans were in place and evidence that blood sugars were being monitored on an agreed basis with the GP or district nurse (in the residential part of the home, it is the responsibility of the local district nursing service to deliver health care). Food and fluid charts were being completed where necessary. There were some short falls around referrals to the Care Homes for Older People Page 11 of 30 Evidence: continence care service, and also in the catheter care. All of these issues were discussed with the acting manager, unit managers and senior care staff during the inspection and we are confident that work is currently being undertaken to address any shortfalls. Some of this has been due to inconsistent management since the home was registered early this year, and also to some changes in the services being provided on the units. However, in discussions with some of the staff they demonstrated a good knowledge of the needs of the residents that they were caring for. On all units there were generally comprehensive hand over notes from one shift to another, and daily recordings were informative of the persons wellbeing but these notes should be more reflective of the outcomes identified in the individual care plans. This information will be useful in the reviewing process of the care plans. Residents are able to choose when to get up and go to bed, and when we arrived at the home at 09:00 hours some residents were still in bed, and some just getting up and other were up, washed and dressed. We observed that personal support was responsive to the varied and individual needs and that the delivery of personal care is individual and flexible, consistent, reliable and person centred. Some residents are choosing to sit in recliner chairs due to health reasons, but it is important that staff ensure that residents can either operate the chair controls themselves, or that staff frequently make sure that they are able to change positions or chairs. In this way the chairs will not be viewed as a restraint and a possible deprivation of liberty. Where a resident may be under 1:1 care, again it is essential that strategies are in place to make sure that the 1:1 care is meaningful and beneficial to the individual. Again it is important to ensure that 1:1 care is not seen as a restraint and a deprivation of liberty. This was discussed with the acting manager during the inspection. All residents have a GP and have access to a dentist, optician, chiropodist and other health and social care professionals as necessary. Residents are weighed monthly and referrals are made to the local speech and language therapist or dietetic service as necessary. Nutritional assessments are undertaken on admission and ongoing monitoring of nutrition is undertaken where indicated. Skin integrity and tissue viability is given a high priority within the service, and currently there are no residents who have developed pressure ulcers in the home, but there are several who developed these wounds whilst in hospital. Risk assessments are in place where necessary, and these are regularly reviewed and amended when necessary. Where necessary, residents have access to aids and equipment that they need and these are well maintained. However, we found that some residents are unable to use Care Homes for Older People Page 12 of 30 Evidence: the emergency call system and the use of telecare aids such as alarm mats and cushion alarms was discussed with the acting manager. Such aids could be beneficial for these residents when in their rooms and needing assistance from care staff, and we have been assured that this area will be reviewed so that staff can be alerted when a resident requires help but is unable to use the homes emergency alarm system. Generally the home has an efficient medication policy supported by procedures and practice guidance which staff understand and follow. Internal audits are undertaken of medication administration, and daily audits of controlled drugs are undertaken at each shift handover. Protocols need to be developed for PRN (as required) medication, including oxygen, and should cover signs and symptoms of pain exhibited by people who are not able to verbally communicate their needs. PRN medication should also be given at times suited to the individual. This was discussed with staff and the acting manager, and information on medication can be obtained from the Commissions website around areas such as covert medication, secondary dispensing and PRN medication. Due to a change in legislation the service must review the storage of controlled drugs and guidance can be obtained from the local pharmacist or from the Commissions website. With regard to the Mental Capacity Act 2005, it is necessary for the service to be clear as to who, if anyone, holds Lasting Power of Attorney for a resident, and the specific areas covered such as finance and/or health and or social care. If someone holds Power of Attorney this is no longer valid but if Enduring Power of Attorney was held this is still valid but only related to a persons financial arrangements. It is also essential that where a resident may lack capacity, that a capacity assessment is undertaken as required by the Mental Capacity Act 2005, remembering that the assessment is time and decision specific and must be continually reviewed. This is particularly relevant to several residents where safeguarding issues have been identified. Also it is important that important aspects include consultation with health, social care and family members as well as with the resident. Residents can choose the home as their preferred place of care, and nursing and care staff work to a very high standard to ensure that individuals receive the care they need. When residents die family and friends can help with the arrangements if this is what the resident had agreed to. Support is given to family and friends and the homes other residents during the bereavement process. Where necessary guidance and support is sought from other professionals to ensure that the care given meets the needs of the person who is dying. Care Homes for Older People Page 13 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 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 this service are encouraged to make choices about their life style, and supported to maintain their life skills. Evidence: The home was registered with the Commission in April of this year, and was officially opened by the Mayor of Havering, and residents and families were invited to celebrate this day with entertainment by a jazz band, good food and a glass of bubbly. Residents and visitors told us that the home was a happy place in spite of the problems around the consistency of the management. One resident told us that the girls are really kind and caring. We observed staff interacting well with residents and some staff were engaged in group activities with some of the residents. The home currently employs an activities co-ordinator and there is a budget for another coordinator who will be employed once the new manager is in post. Activities include a weekly cinema session in the homes cinema situated on the ground floor, bingo, quizzes, games and crafts, trips to restaurants and a local theatre, trips to shops and external entertainers visiting the home including Pets as Therapy. On Wednesdays the homes mobile shop visits all of the units with a selection of toiletries, confectionery and drinks. Festivals are celebrated and for birthdays the chef makes the cake. Care Homes for Older People Page 14 of 30 Evidence: Recently the home had a visit from a pearly king and queen and residents ate pie and mash. Residents told us that they really enjoyed this. Religious services are held at the home, and room visits can be arranged for those residents who wish this. Plans are well underway for the Christmas celebrations. All residents are encouraged to have a taxi card, and plans are underway for residents to become members of dial-aride. The home produces a newsletter on a quarterly basis which is available to all residents and visitors. Programmes of daily and weekly activities are advertised on the various notice boards around the home. The service is a member of NAPPA (an organisation giving advice and training on the provision of activities for people in care homes), and the activities co-ordinator recently attended training on activities for mixed ability. As far as is possible residents are encouraged to maintain their skills, including social, emotional, communication and independent living skills. The service recognises the importance of residents maintaining personal and family relationships. During our visit we spoke to several family members visiting relatives, and they told us that we are always made welcome and can visit at any time. Residents are encouraged to personalise their bedrooms and during our visit we saw evidence of this where residents had chosen to have some of their own furniture, pictures, photographs of family and friends, television and ornaments. We observed lunch being served on several units and generally assistance was being given in accordance with the needs of the residents. The food was well presented and residents told us that they enjoyed the meals. However, it is important that where a resident has a pureed diet, that this meal is presented in a manner which is attractive and appealing in terms of texture, flavour and appearance in order to maintain appetite and nutrition. Drinks and snacks are available throughout the day and a light bite is available in the evenings. Care staff must be reminded of this when giving assistance to residents. Generally tables were appropriately laid with tablecloths, napkins and cutlery. However, an exception were the units caring for people living with dementia as there were no tablecloths. Staff felt, without evidence, that residents would pull the tablecloths off. This was discussed with staff and the acting manager as it was important to ensure that the dignity of equality of these residents was maintained at all times. Although residents told us that the food was very nice and some told us that they were given choices as detailed on the menus which we viewed during the visit, we are not convinced that all residents, especially those living with dementia, are given a choice. It seems that generally it is the care staff who do the choosing. The home Care Homes for Older People Page 15 of 30 Evidence: does have a book of pictorial menus, and it is important that staff spend time with residents living with dementia to ensure that they are enabled to make positive choices for themselves. We did discuss this with the acting manager, some staff and the chef. The chef ensures that he visits the units to discuss the menus with residents, and was also aware of many of their likes and dislikes. The chef was aware of the need to provide finger foods for some residents, fresh fruit and vegetables, build up foods which contained full fat milk, cream and butter for those residents whose dietary needs indicated this need. Equality and diversity issues are seen as a priority within the service and the staff work hard to ensure that these issues are identified and met within the service for all of the residents. Care Homes for Older People Page 16 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 living at the home are able to express their concerns and have access to an effective complaints procedure and can feel that they are protected from abuse and have their rights protected. Evidence: The complaints procedure is supplied to everyone living at the home and is available to visitors. Some residents and visitors told us that they knew how to complain, and when they did they felt that they were generally listened to. One lady told us there have been changes with the manager, but the new lady is very nice and seems to really listen to us. We looked at the complaints log and saw that complaints are recorded and the outcomes are used to improve service delivery. Complaints are dealt with in accordance with the homes policy and procedures with written responses where necessary. One complaint, which is currently still being progressed, requires a multiagency assessment before a response can be given as this involves the administration of medication. This was discussed during the inspection and are confident that this is being appropriately progressed by the acting manager. We spoke to staff around their knowledge of safeguarding and those spoken to demonstrated a sound understanding of this important area. Staff told us that they would not hesitate to report any abuse to the manager, or to the Commission or local Care Homes for Older People Page 17 of 30 Evidence: authority. Staff confirmed that they have undertaken training on safeguarding issues, and were aware of the organisations policy and procedures and also of the whistleblowing procedure. There are currently 2 safeguarding referrals which have been made by the service, and these are being investigated by the London Borough of Havering, which is the authority responsible for undertaking such investigations in the location in which the care home is situated. Staff told us that they have had training in dealing with physical and verbal aggression, and also demonstrated an understanding of restraint and that alternatives to its use would always be looked for. Equipment that may be used to restrain individuals such as bed rails, keypads, recliner chairs and wheelchair belts are only used when necessary and within a risk assessment framework. Currently two residents have chosen to sit in a recliner chair for health reasons, and the acting manager is aware of the need to ensure that these people are able to either operate the chair controls themselves, or that staff are very aware of the need to ensure that these residents are not left sitting in the chairs for long periods, without their agreement. Care Homes for Older People Page 18 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 residents to live in a safe, wellmaintained and comfortable environment. Evidence: The environment is well maintained and specialist aids and equipment are provided to meet the needs of the residents. On arrival at the home we undertook a tour of the building, together with the acting manager, and found it to be clean and free from offensive odours. All bedrooms are single with en suite facilities, and residents have personalised their own rooms in accordance with their choice. All bedrooms have television and telephone points, and many residents have purchased their own televisions. The communal areas are also well furnished, clean and comfortable and there are quiet areas which can be used by residents who wish to meet relatives and/or friends in private. The home has its own cinema and also a hairdressing salon. Bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who use the service, and all toilets were equipped with toilet rolls and hand washing/drying facilities. Care Homes for Older People Page 19 of 30 Evidence: All parts of the home were well lit and warm. The management has a good infection control policy and staff were observed to be following good infection control procedures. Hand gels were available throughout the home. Where necessary the service seeks advice from external specialists. We visited the kitchen area and found this to be clean and well maintained. This was supported by the local environmental health office who had recently visited the home and the only requirement was the need to install a fly screen by the rear door. This is currently in hand by the organisation. The laundry area was also clean. The garden area was well maintained and there is also car parking facilities to the front of the home. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are trained and generally skilled and in sufficient numbers to support the people who use the service. Evidence: We spoke to some residents and visitors who told us that they have confidence in the staff who care for them, and also that most of the staff were very kind and caring. In discussions with staff we were told that they enjoy working at the home and generally all work as a team. This was observed by us to be the case, in spite of the many changes in the management of the home since its registration and opening. On the day of the inspection there were sufficient staff on duty to meet the needs of the residents. There is some use of agency staff, but generally vacant shifts are being covered by permanent staff doing overtime. The service is currently in the process of recruiting more staff and interviews were being undertaken on the day of the inspection. Staff told us that training is always available, and this was confirmed when viewing the training records. Recent training has included induction training, manual handling, infection control, food hygiene, first aid, dementia awareness plus yesterday, to-day and tomorrow, safeguarding of vulnerable adults, health and safety, fire awareness, medication administration and care planning. Care Homes for Older People Page 21 of 30 Evidence: Some staff have NVQ level 2 and the organisation is working to ensure that all staff will eventually achieve NVQ level 2. This will take some time as this is a new service. Staff were also able to demonstrate an awareness and understanding of equality and diversity issues and of meeting the diverse needs of the residents, as well as those of the staff team who are from various ethnic minorities. We looked at several staff files and found that the recruitment procedures were robust with the necessary application forms, references, interview, documentation scrutiny and POVA first/criminal records bureau disclosures being completed or obtained prior to employment. Staff told us, and records confirmed that regular supervision is being undertaken and this includes 1:1, team meetings and direct observations of care practices. Some staff told us that they found supervision helpful and helped them to focus on improving outcomes for residents. Notes and action points are taken of staff meetings and progress is regularly reviewed. In discussions with staff we were told that the recent changes in the management and styles of management caused difficulties, but that generally staff morale has remained high because of the need to provide good services to the residents. There have also been changes in the administrative and reception staff. The staff team are to be commended for ensuring that through all of the recent difficulties, the residents at this home have continued to receive a good standard of care. Care Homes for Older People Page 22 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. The current management and administration of the home is based on openness and respect, but it is essential that a permanent manager be recruited who is qualified and competent to ensure consistency for this service. Evidence: Since registration and the opening of the home there have been several changes in the management. This has obviously resulted in some difficulties at the home and in the consistency of following policies and procedures. Currently the home is without a permanent manager and the organisations Quality Manager is acting as the manager at Romford Care Centre. This person is qualified and has the necessary experience to run the home. We have been informed that a new manager has been recruited and following that persons acceptance of the post, and the take up of references and other checks such as the criminal records bureau disclosure, this person will be in post before Christmas. We were told by both residents, visitors and staff that the acting manager has really Care Homes for Older People Page 23 of 30 Evidence: taken on board the problems and is working to resolve many of these. On the day of the inspection we were able to have a full and frank discussion with the acting manager who was very aware of the improvements which were required at this home. As previously stated the staff team are working together and the priority is the continued good care of the residents. However, all recognise that there are still some shortfalls and are looking forward to the employment of a permanent manager. The acting manager is ensuring that staff training is prioritised and that supervision of the staff team is being undertaken. She is very aware of equality and diversity issues and works in partnership with families, residents, staff and other professionals. Staff have undertaken training in safeguarding and the acting manager works with the responsible authority to ensure that the outcomes of any safeguarding referrals are put into practice. The organisations policies and procedures are now being followed by staff, and a fire risk assessment is currently being undertaken by the acting manager. We did not look at the maintenance records as these were viewed prior to registration being granted. Recruitment procedures were found to be robust although there had been some discrepancies which had been uncovered by the acting manager and the necessary action was taken to address these. There have also been changes in the administrative staff, and the current administrator has worked hard with the acting manager to ensure that the systems in place are followed and robust, and this also related to the safekeeping of residents finances which were found to be in good order. Notifications as required under Regulation 37 of the Care Homes Regulations 2001 continue to be sent to the Commission, and visits as required under Regulation 26 of the Care Homes Regulations 2001 are also undertaken. Currently there have not been any referrals under the Deprivations of Liberty Safeguards (DOLS). Whilst we wish to acknowledge the good care and work which is being undertaken at this home, and the current commitment of the organisation, the acting manager and the staff team to ensure that good care continues, we are concerned at the continuing lack of a permanent manager since registration. It is essential for the residents and staff that a permanent manager, who has the commitment to stay at the home, is recruited and given the support necessary. Care Homes for Older People Page 24 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 25 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 1 3 14 The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so the needs of the service user have been assessed by a suitably trained person, the registered person has obtained a copy of the assessment and there has been appropriate consultation regarding the assessment with the service user or a representative of the service user. The assessment must include details of a capacity assessments where it is deemed that the person does not have capacity to make an informed decision, having regard to the fact that decisions are time and decision specific, as required 30/11/2009 Care Homes for Older People Page 26 of 30 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 under the Mental Capacity Act 2005. This is to ensure that the Act is complied with and the interests and rights of the individual are maintained. Details of Lasting Power of Attorney must also be included, where this has been obtained. 2 7 15 The registered person shall, 30/11/2009 after consultation with the service user, or a representative of his, prepare a written plan as to how the service users needs in respect of his health and welfare are to be met, and such plans reviewed on a regular basis. This will ensure that the needs of the individuals are identified and kept under review to the benefit of the individual. These needs should also include capacity assessments as required under the Mental Capacity Act 2005, with documentation around the important areas of finances, medication, relationships etc. 3 9 13 The registered person shall make arrangements for the safe administration of 30/11/2009 Care Homes for Older People Page 27 of 30 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 medication and the safekeeping of controlled drugs. PRN protocols (as required medication) must be in place and include signs/symptoms of pain for residents who cannot verbally communicate. Also where PRN medication is being given on a regular basis this should be reviewed by the GP as it may be required on a regular basis. The requirements of the cupboard for storage of controlled drugs has changed, and the current storage facilities do not meet the new legislative requirements. 4 15 16 The registered persons shall provide, in adequate, quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such time as may reasonably be required by service users. All residents should be enabled to make a positive choice as to meals, and pureed foods should be presented in a manner 30/11/2009 Care Homes for Older People Page 28 of 30 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 which is attractive and appealing in terms of texture, flavour, and appearance, in order to maintain appetite and nutrition. 5 31 8 The registered provider shall 29/01/2010 appoint an individual to manage the home, and shall forthwith give notice to the Commission of the name of the person so appointed and the date on which the appointment is to take effect. It is essential for the continued good care and consistency for residents and staff that a permanent manager be appointed as soon as is possible. 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 1 The registered persons should endeavour to provide information in more simpler formats for the benefit of residents who are living with dementia, memory loss or cognitive impairment. 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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