Care Home: Rose Lodge Care Home

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What the care home does well The home ensures that comprehensive pre- admission assessments are carried out on all new and potential people with only those who needs can be met, being admitted to the home. The health needs of the people who use the service are well met with evidence of good multi disciplinary working taking place. Staff provide personal support to the people accommodated in such a way that promotes and protects their privacy and dignity. Mealtimes are unhurried and provide staff and people who use the service with an opportunity to socialise. All meals are home cooked. The location and layout of the home are suitable for its stated purpose. The home has a welcoming and homely feel and is free from odours. There is a robust complaints procedure in place and the homes processes and staff training should protect individuals in the event of an allegation of abuse. The home has a staff team that have the necessary skills and experience to the meet the needs of the current people accommodated. Staff training is on going and is appropriate to the level of needs of the people who use the service. What has improved since the last inspection? A written guide has been produced (referred to in the Regulations as `the service user`s guide`) which will include all the information required by law as listed in Regulation 5 of The Care Homes Regulations 2001. To ensure people have the right information about the service. A system has been put into in place to ensure that after consultation with the person or a representative of theirs, revise the plan of care and notify the person of any such revision. The provision of activities has been reviewed to provide more appropriate activities for people who use the service. Policies and procedures are now available which, include the reporting process for any safeguarding referrals. Staffing numbers have been increased in order to ensure that sufficient staff are on duty to meet the health and welfare needs of people living at the care home. There is a system in place to ensure that records are up to date and contain accurate and sufficient detail in relation to peoples finances which, are held by the service. What the care home could do better: Urgent action was required in order to ensure: That all handwritten entries onto Medication Administration (MAR) sheets are signed by two care staff, dated and explained, in order to provide a clear audit trail of when medications have been prescribed and by whom. That medication fridge temperatures are recorded on a daily basis, in order to ensure the efficacy of the product stored within the medication fridge. That all first floor windows must be restricted. Where restrictors are deemed as inappropriate, this must be suitably risk assessed, in order to ensure that the health, safety and welfare of people who use the service, will be further safeguarded. That all radiators should be appropriately covered, in that this will further safeguard people from the risks associated to hot surface temperatures. Requirements were made in order to ensure: That the Controlled Drug storage is reviewed and an appropriate storage device is installed, in order to ensure that Controlled Drugs are stored safely, effectively and in accordance with The Misuse of Drugs Regulations 2001 (as Amended). That the homes activities program is expanded further and in accordance with the wishes of the people using the service, in order to ensure that the people using the service will benefit from a full and stimulating activities program. That during the introduction of Person Centred Plans, people who use the service are consulted with regards to accessing the community and a program should be implemented to take into account their wishes. That a record is maintained of visits made to the service by the Registered Provider, in the context of the service and its provisions, in order to ensure that there is a clear audit of how issues are discussed amongst Management and what actions are planned or have been taken to address any issues that arise. That a formal process for staff supervision is implemented, in that this will allow staff to feel that they are listened to and that part of the operation of the home, is as a result of their valued opinion. Recommendations for good practise were also made: That the agreed amendments to the Statement of Purpose are made, in order to ensure that people are fully informed of how to contact the Care Quality Commission. That in the scheduled six months timescale, the Appointed Manager implements Person Centred Plans. That daily record entries are written in conjunction with the care plan. That consideration is given to the comments made relating to people using the service, having access to a Roman Catholic Priest.That the complaints policy is amended to include that referrals may need to be made to the Safeguarding Team at the Local Authority, under safeguarding procedures. That consideration is given to the comments made relating to the garden being lit at night time and the comments made relating to the curved garden path needing a steadying rail constructed. Key inspection report Care homes for older people Name: Address: Rose Lodge Care Home 88-90 Musters Road West Bridgford Nottingham NG2 7PS     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: Rebecca Shewan     Date: 0 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 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 32 Information about the care home Name of care home: Address: Rose Lodge Care Home 88-90 Musters Road West Bridgford Nottingham NG2 7PS 01159455575 F/P01159455575 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Old Brompton Court Limited, c/o Mr David Wheatcroft (Shrubs) Limited care home 17 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: 1 resident shall be aged 55 or over Date of last inspection Brief description of the care home Rose Lodge Care Home is located close to West Bridgford town centre and the main local amenities. The home is registered to provide care care for up to seventeen older people. Communal space includes two lounges and two dining areas. There is a stair lift to the first floor and the home is well maintained throughout in terms of decoration and furnishings. There is an enclosed garden to the rear of the property with seating and shade for communal use. At the time of the inspection the Appointed Mmanager confirmed that weekly fees range from £366 (GBP) - £475 (GBP), additional charges are made for hairdressing ( Care Homes for Older People Page 4 of 32 Over 65 17 0 1 6 0 3 2 0 0 9 Brief description of the care home £8 GBP to £25 GBP) and chiropody (£7 GBP per session). Information about these costs, as well as the day-to-day operation of the home, including a copy of the last inspection report is available in the homes Statement of Purpose. Potential new people who may wish to use the service, find out about the home by contacting the home directly, word of mouth, CQC website and reports and through placing authorities and Healthcare Professionals. Care Homes for Older People Page 5 of 32 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 unannounced inspection took place during the morning and afternoon of the 1st December 2009. Incident reports and the homes previous inspection report, were read before the inspection. The inspection of the home took seven and a half hours and was conducted by Rebecca Shewan (Regulatory Inspector - CQC), Ros Johnson (Assessor - CQC) and Geoff Lilley (Expert By Experience - Age Concern and Help the Aged). A tour of the home was undertaken and the Appointed Manager, three staff, one relative and ten people who use the service were spoken with. The main method of inspection we use is called case tracking, which involves us choosing three people who live at the service and looking at the quality of the care they receive by speaking to Care Homes for Older People Page 6 of 32 them, observation, reading their records and asking staff about their needs. Records such as care plans, staff files and medication records were also viewed. Fourteen people were accommodated at the home at the time of the inspection. The Care Quality Commission (CQC) referred to as we throughout this report, also conducted surveys of staff and people who use the service. One survey was returned. The responses received were generally positive in many of the aspects of care and provisions provided. The views and experiences of people who use services are central to helping us make a judgement about the quality of a service. An Expert by Experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Urgent action was required in order to ensure: Care Homes for Older People Page 8 of 32 That all handwritten entries onto Medication Administration (MAR) sheets are signed by two care staff, dated and explained, in order to provide a clear audit trail of when medications have been prescribed and by whom. That medication fridge temperatures are recorded on a daily basis, in order to ensure the efficacy of the product stored within the medication fridge. That all first floor windows must be restricted. Where restrictors are deemed as inappropriate, this must be suitably risk assessed, in order to ensure that the health, safety and welfare of people who use the service, will be further safeguarded. That all radiators should be appropriately covered, in that this will further safeguard people from the risks associated to hot surface temperatures. Requirements were made in order to ensure: That the Controlled Drug storage is reviewed and an appropriate storage device is installed, in order to ensure that Controlled Drugs are stored safely, effectively and in accordance with The Misuse of Drugs Regulations 2001 (as Amended). That the homes activities program is expanded further and in accordance with the wishes of the people using the service, in order to ensure that the people using the service will benefit from a full and stimulating activities program. That during the introduction of Person Centred Plans, people who use the service are consulted with regards to accessing the community and a program should be implemented to take into account their wishes. That a record is maintained of visits made to the service by the Registered Provider, in the context of the service and its provisions, in order to ensure that there is a clear audit of how issues are discussed amongst Management and what actions are planned or have been taken to address any issues that arise. That a formal process for staff supervision is implemented, in that this will allow staff to feel that they are listened to and that part of the operation of the home, is as a result of their valued opinion. Recommendations for good practise were also made: That the agreed amendments to the Statement of Purpose are made, in order to ensure that people are fully informed of how to contact the Care Quality Commission. That in the scheduled six months timescale, the Appointed Manager implements Person Centred Plans. That daily record entries are written in conjunction with the care plan. That consideration is given to the comments made relating to people using the service, having access to a Roman Catholic Priest. Care Homes for Older People Page 9 of 32 That the complaints policy is amended to include that referrals may need to be made to the Safeguarding Team at the Local Authority, under safeguarding procedures. That consideration is given to the comments made relating to the garden being lit at night time and the comments made relating to the curved garden path needing a steadying rail constructed. 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 10 of 32 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 11 of 32 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. The home has processes in place for assessing potential new people, with services being offered to only those individuals whose needs can be met. Evidence: We observed that a written guide, known as the Statement of Purpose, has been produced in order to ensure that potential new people have the right information about the service. We observed that this document includes all the items required under the associated Regulation, though some minor amendments are required in that the CQC is referred by its predecessor name of CSCI and the contact details for CQC were incorrect. The required amendments were discussed with the Appointed Manager. From the files that we sampled and from discussions with the Appointed Manager, we observed that pre- admission assessments are conducted by the Appointed Manager. Records inspected showed that pre- admission assessments are carried out on all new Care Homes for Older People Page 12 of 32 Evidence: and potential people. Documentation relating to the most recent admissions to home were viewed and found to have been completed fully and conducted with the involvement of the individual and/or their representatives (where applicable). The Appointed Manager confirmed that copies of care management assessments from the placing authority are obtained, where these exist and she addresses any issues, which are highlighted within this assessment. From the records viewed for recent admissions we observed that people planning to come into the home, receive written confirmation that having regard to their assessment, the care home is suitable for the purpose of meeting their needs. Intermediate care is not provided by this service. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service are offered a good provision of health care and personal support by the home. All care is administered in way that protects the individuals privacy and dignity. Medication procedures require improvements in order to ensure that medications are stored and administered safely. Evidence: We sampled care plans (including risk assessments) and we evidenced that they covered all aspects of the individuals needs. We observed that monthly reviews had not been conducted on all elements of the care plans sampled or on a consistent monthly basis. We also evidenced that individuals and/or their representatives involvement in the care plan generation and review process had been documented. Discussions were held with the Appointed Manager regarding the current care plan system and it was reported that it has been acknowledged that care plans are basic Care Homes for Older People Page 14 of 32 Evidence: and require improving. The Appointed Manager confirmed that she has attended training in Person Centred Planning and has set a target date of six months to have all care plans formatted in this manner and drawn up with the involvement of the individual or their representative. We observed that daily records are maintained and are not reflective of the care plan. Entries made included: Fine. Ate and drank well. No probs at all, ok, no problems, No problems at all, seems well and Has been fine. Ate and drank well. Records viewed and discussions with the Appointed Manager provided evidence that the service has good access to Healthcare providers. Records viewed confirmed that the people who use the service are registered with a GP of their choosing and have access to a Dentist, Optician, Audiology, Occupational Therapy, Physiotherapy and Specialist Nurses. The Expert By Experience reported that All residents said they felt assured that the staff would respond to them if they were ever ill and a GP called or an appointment made to visit the surgery, depending on their mobility and state of health. From records viewed we evidenced that the service has good procedures in place for the monitoring and recording of all drugs administered and those entering and leaving the home. The stores for medication were viewed and we found them to be clean and orderly manner. Medication Administration Record (MAR) sheets were viewed and we evidenced that these did not always provide a clear audit trail for all medications prescribed. We observed that there were a number of handwritten entries made onto charts that are undated, unsigned and unexplained. Therefore an Immediate Requirement was made. We audited the controlled drugs (CD) and found them to be incorrect. We observed that there was one tablet more than had been recorded in the CD register. Audits of the medication were undertaken but no cause for the extra tablet could be found. The Appointed Manager confirmed that this would be discussed with the Pharmacist, in order to determine how this incident should be managed. We observed that all controlled drugs are stored in a cash box which is screwed to a shelf in a locked cupboard. Confirmation of the appropriateness of such storage was sought after the field visit and the Appointed Manager was informed that the current storage device does not comply with CD Regulations and must be changed. Care Homes for Older People Page 15 of 32 Evidence: We observed that daily medication fridge temperatures are not maintained consistently. Therefore an Immediate Requirement was made. Staff were observed providing personal support to individuals in such a way that promoted and protected their privacy and dignity. We observed that individuals bedroom doors were knocked before staff entered them and that people were called by their preferred choice of address. The Expert By Experience reported that Many of the residents could self manage, some needed a little assistance (like hair-washing) and others required all their personal care needs done for them. All comments were positive. and that All residents were cleanly dressed and all said they had regular change of clothing. One resident said, You only have to put it out one day and its ready the next. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are not able to enjoy a full and stimulating programme of activities to choose from. A wide variety of meals and specialist diets are provided for the people who use the service, with individuals choice and wishes being respected in relation to food. Evidence: Although there is a published list of activities in place, we observed that it is basic and does not offer a full and stimulating programme. Discussions with the Appointed Manager highlighted that activities are an area where improvements are being made. The Expert By Experience reported that: Activities. This is an area that is sadly lacking in the home. There is no dedicated activities co-ordinator, not even as part of one persons job. Indoor activities are very ad hoc and it would seem only done when the staff have a spare moment which, would be infrequent because the staff were all busy during the time of my visit. Outings. Again, this is an area that needs particular attention to. Those residents who Care Homes for Older People Page 17 of 32 Evidence: were mobile were able to come and go as they pleased. Whilst taking people out with mobility problems is labour intensive, some effort should be put into enabling this to happen consistently in the near and distant future. Religious/Cultural practises and provision. There is regular contact with the local Church of England church; in fact, a visit was due that week by the local church choir. However Roman Catholics said they would have appreciated a visit by a priest. The Cook confirmed that the homes menus are devised on a four weekly basis. Menus and records viewed confirmed that all medical and therapeutic dietary needs were catered for. We observed that all meals are home cooked with an alternative available for each mealtime. The Cook confirmed that meals can be taken in their bedroom or in the communal dining room. Both the lunch time and teatime meal served during the inspection were ample in quantity and attractively presented. The lunchtime meal was observed and was unhurried, with those requiring assistance with feeding being treated patiently and encouragingly. We noted that drinks and snacks are available at all times. The Expert By Experience reported that All residents comments were positive as far as quality and quantity of food and drinks were concerned. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from a robust and efficient complaints procedure, whilst the homes procedures, processes and staff training should protect individuals in the event of an allegation of abuse. Evidence: We observed that the home has an established complaints procedure in place. Discussions were held with the Appointed Manager, in relation to how the policy should be amended to include that given the nature of a complaint, referrals made need to made under safeguarding procedures. Records viewed confirmed that the home has received one complaint since the Appointed Manager commenced her role in July 2009. Records viewed provided evidence that the Appointed Manager and staff took appropriate action to address the issue raised. From the staff files viewed we observed that Criminal Records Bureau (CRB), Vetting and Barring Scheme checks and Protection of Vulnerable Adult (POVA) checks had been carried out on all new and existing staff. Staff have attended training in the Safeguarding of Vulnerable Adults within the last twelve months. This was evident from the staff files that were viewed. The Appointed Manager is qualified to Train the Trainer level in Safeguarding Vulnerable Adults. Care Homes for Older People Page 19 of 32 Evidence: Discussions with the Appointed Manager highlighted that there have been no Safeguarding Alerts raised by the home in the last twelve months. We observed that policies and procedures relating to Safeguarding are being updated to reflect current practice and that they are readily accessible staff. Care Homes for Older People Page 20 of 32 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 home provides accommodation for people that is fresh, clean and well maintained, whilst infection control procedures are adhered to at all times. Urgent improvements are required to ensure that the environment is maintained, in a manner, that protects and promotes the health and safety of the people who use the service and staff. Evidence: We observed that the size, location and layout of the home are suitable for its stated purpose. We observed that the home is well maintained and all areas of the home, including the garden, are accessible to people who use the service. The Appointed Manager reported that the home has an ongoing plan of refurbishment in place. Staff and people who use the service reported that they would like the garden to be lit at night. They reported that this would not only make the garden accessible at night but would make them feel safe, knowing that the garden could not be accessed by intruders. The Expert By Experience commented in their report that The garden and patio area was neatly laid-out. The notion of the fencing being at hand-height for residents who are unsteady on their feet (was liked). It was felt, however that the curved path also Care Homes for Older People Page 21 of 32 Evidence: needs a steadying rail constructed. From a tour of the premises we also observed that radiators were uncovered and had hot surface temperatures, therefore an Immediate Requirement was was made. We observed that there were two windows on the first floor that were unrestricted. Whilst these windows opened from a mid way point, we observed that furniture in people rooms had been placed, so that they provided a clear step up to the height of the window. Therefore an Immediate Requirement was made. We also observed that some bedrooms were cold in temperature. The Appointed Manager reported that that the Cleaner opens windows in bedrooms whilst they are being cleaned, so that the room gets aired. The Expert by Experience commented in their report that The residents bedrooms were extremely cold and two residents told me so. The Appointed Manager was informed of this and immediate action was taken to resolve the issue. We observed from staff records that staff are trained in infection control procedures. We observed that there is a daily cleaning schedule in place and that the home was fresh and clean, whilst no malodours were noted. Care Homes for Older People Page 22 of 32 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. The home has a staff team that have the necessary skills and experience to the meet the needs of the people accommodated. Staff training is being updated, in both mandatory subjects and in accordance with the needs of the individuals accommodated. Evidence: From records viewed we observed that a competent staff team meets the needs of the individuals accommodated. We observed that there is a staff rota in place, which details staff hours of working and staff job designations. Records viewed confirmed that the home has a permanent staff team of the Appointed Manager, four Senior Care Assistants, nine Carer Assistants, two Cooks and a Housekeeper. We observed from discussions with the Appointed Manager and from staff files viewed that nine care staff are National Vocational Qualification (NVQ), level 2 or 3, trained in care. Staff recruitment files were viewed and we evidenced that these files contain all of the items required under the Care Homes Regulations 2001. We observed that Criminal Care Homes for Older People Page 23 of 32 Evidence: Record Bureau (CRB) checks have been carried out on all staff. We observed that the home has an Equal Opportunities policy in place and is an equal opportunities employer. Training records were observed and we evidenced that staff receive effective induction training. All staff providing care have received up to date training in mandatory courses including moving and handling, fire safety, first aid, safeguarding adults and infection control. Discussions with the Appointed Manager confirmed that staff training has improved and that dates for further mandatory training are being established. Care Homes for Older People Page 24 of 32 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. People who use the service benefit from a home that is well managed and administrated. Quality Assurance procedures conducted by the provider do not always ensure that issues arising in the home are formally documented. Staff do not benefit from a formal process of supervision. The health, safety and welfare of staff and the people who use the service are protected most of the time. Evidence: The Appointed Manager has been in post since July 2009. She is a qualified Registered General Nurse, Train the Trainer qualified in the Mental Capacity Act, Deprivation of Liberties and Safeguarding Vulnerable Adults, is an NVQ Assessor and holds a Moving and Handling Training certification. Care Homes for Older People Page 25 of 32 Evidence: The Expert By Experience reported that The new manager is on track to improve the quality of care provision and standards. People spoken with said that the Appointed Manager is friendly and approachable. We observed that Regulation 26 visits are not conducted by the Registered Provider, as he is in the home almost everyday of the week. Though it is acknowledged that these visits are often to visit a relative, they do involve discussions with the Appointed Manager and staff. We observed that there is currently no formal way of recording how feedback and discussions between the Registered Provider and Appointed Manager occur and how often. The Appointed Manager reported that staff meetings and meetings involving the people who use the service will be held monthly. Minutes of meetings held for staff and people who use the service have taken place since the Appointed Manager came into post and minutes of these meetings were viewed. The Expert By Experience reported that One resident said, The new manager brought us all together and told us to treat the house as though it were your own home. I appreciated that. The Appointed Manager reported that the home does not take any responsibility for any of the finances of the people accommodated. The Appointed Manager confirmed that all individuals accommodated have family, friends or representatives who protect their financial affairs. Personal Allowance accounts held for individuals, were found to be maintained in a secure manner, in individual wallets and with clear accounts maintained. From staff files viewed we observed that there is currently no formal staff supervision being conducted. The Expert By Experience reported that staff had commented that There is no individual, regular, scheduled staff supervision. We observed that a system of regular checks on fire systems and equipment is in place. We observed that there is a fire risk assessment in place, which is current. The Appointed Manager confirmed that during a recent fire audit, it was noted that fire doors are wedged open. The Appointed Manager reported that this is an ongoing concern being monitored. We observed that fires doors remained wedged open during the field visit. The Appointed Manager was informed of this and all fire doors were unwedged prior to the conclusion of our visit. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 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 1 9 13 That all handwritten entries 01/12/2009 onto Medication Administration (MAR) sheets are signed by two care staff, dated and explained. In that this will provide a clear audit trail of when medications have been prescribed and by whom. 2 9 13 That medication fridge temperatures are recorded on a daily basis. In that this will ensure the efficacy of the product stored within the medication fridge. 01/12/2009 3 25 13 That all first floor windows must be restricted. Where restricters are deemed as inappropriate, this must be suitably risk assessed. In that this will ensure that the health, safety and welfare of people who use the service, will be further safeguarded. 03/12/2009 4 25 13 That all radiators should be appropriately covered. In that this will further safeguard people from the risks associated to hot surface temperatures. 04/12/2009 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 That the Controlled Drug 17/12/2009 storage is reviewed and an appropriate storage device is installed. In that this will ensure that Controlled Drugs are stored safely, effectively and in accordance with The Misuse of Drugs Regulations 2001 (as Amended). That the homes activities 01/02/2010 program is expanded further and in accordance with the wishes of the people using the service. In that this will ensure that the people using the service will benefit from a full and stimulating activities program. 2 12 16 3 13 16 That during the introduction of Person Centred Plans, people who use the service are consulted with regards to accessing the community and a program should be implemented to take into account their wishes. In that this will ensure that the people using the service will benefit from accessing the local community. 01/02/2010 Care Homes for Older People Page 29 of 32 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 4 33 26 That a record is maintained of visits made to the service by the Registered Provider, in the context of the service and its provisions. In that this will provide a clear audit of how issues are discussed amongst Management and what actions are planned or have been taken to address any issues that arise. 01/01/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 That the agreed amendments to the Statement of Purpose are made, in order to ensure that people are fully informed of how to contact the Care Quality Commission. That in the scheduled six months timescale, the Appointed Manager implements Person Centred Plans. That daily record entries are written in conjunction with the care plan. That consideration is given to the comments made relating to people using the service, having access to a Roman Catholic Priest. That the complaints policy is amended to include that referrals may need to be made to the Safeguarding Team at the Local Authority, under safeguarding procedures. That consideration is given to the comments made relating to the garden being lit at night time. That consideration is given to the comments made relating to the curved garden path needing a steadying rail constructed. Page 30 of 32 2 3 4 7 7 13 5 16 6 7 19 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 31 of 32 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. 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