Care Home: Rosegarth

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What the care home does well People are assessed before they move into the home and following this a letter of confirmation is sent to the prospective service user to confirm that their needs are known and can be met by the staff in the home.This allows people clarity and further information when deciding which home they may move into. People are supported through good systems of care planning that are regularly reviewed and up to date.This helps to make sure that staff are aware of peoples latest needs and how these are to be met. People`s daily life and social needs are assessed and good systems are in place to offer people the opportunities that help to ensure that these needs are met. There are good systems in place for the handling of complaints and people are aware of how to use these systems, feeling confident that their complaints will be listened to. People live in a well maintained home that is clean, warm and comfortable. They are able to personalise their own rooms and specialist equipment is provided as necessary to enable people to live their daily lives. People are supported by staff who are recruited through a good system to ensure that they are suitable to work with vulnerable people. Staff have received a variety of training that included the individual needs of the people who live in the home. This is monitored by the manager of the home to ensure that staff have understood what they have been taught. People live in a home that is well managed by a manager that works to keep the home and her knowledge up to date. People are consulted on any changes on the home; participating in the development of the service. Peoples health and safety needs are protected through risk assessment and good maintenance systems in the home. What has improved since the last inspection? Specific activities are now provided for people who suffer with dementia, improving their lives and helping to prevent boredom. Complaints are now analysed, so that should the complaint constitute an allegation of abuse it is referred appropriately. Multi - agency policies and procedures are now followed should an allegation of abuse or poor practice occur. Staff have now received training in specific needs of people who live in the home, for example, dementia. This helps to ensure that the right level of care is offered to the people who have specific needs.People now receive written confirmation prior to moving into the home that their needs can be met, additionally mobility and psychological needs are clearly assessed and recorded in peoples care plans to ensure that these needs are identified and met. Medication practices have improved so that when necessary two signatures are obtained and records are up to date, with clear instructions on how, `as directed`, medicines are to be administered. Activities in the home have improved and increased to offer greater choice, with records being kept to ensure that assessment and audits can be undertaken. Choices with people`s daily menus have also improved following consultation with both the people who live in the home and a dietician. Practices have improved so that people are clearer about who to speak to should they wish to raise a concern and they know how to make a formal complaint. What the care home could do better: Risk assessments could be undertaken for people who choose to smoke. This would help to identify any risk in the home including the risk of fire. Supermarket points cards should not be used by staff members when they undertake shopping with or on behalf of the people who live in the home. If necessary the individual service user should receive their own points card. Key inspection report Care homes for older people Name: Address: Rosegarth Rosegarth 30 - 32 Belgrave Drive Bridlington East Yorkshire YO15 3JR     The quality rating for this care home is:   two star good 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: Sarah Rodmell     Date: 3 0 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Rosegarth Rosegarth 30 - 32 Belgrave Drive Bridlington East Yorkshire YO15 3JR 01262677972 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hexon Limited Name of registered manager (if applicable) Miss Kirsty Louise Sutton Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Rosegarth is situated close to the seafront in Bridlington and is registered to provide care and support to twenty-six older people, some of whom may have dementia care needs. The home comprises of four traditional houses that have been joined internally. It is close to shops and local facilities. The accommodation has a mixture of single and shared bedrooms, many of which have en-suite facilities. Communal areas consists of two lounges, a dining room and a small sitting room leading onto a small garden area. People wishing to smoke use the area just outside this sitting room. Care Homes for Older People Page 4 of 28 Over 65 26 26 0 0 0 7 0 8 2 0 0 9 Brief description of the care home There is a further garden leading from one of the other lounges. Street parking is available at the front and rear of the home. The homes Statement of Purpose and Service User Guide is available in the entrance hall of the home and in bedrooms. The current fees for living in the home range from £369.25 to £420 per week, with additional fees for sole use of a double room. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that the people that use this service experience good quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key unannounced inspection on 7th August 2009, including information gathered during a site visit to the home. The unannounced visit was undertaken by two inspectors and lasted 6 hours. On the day of the visit the inspectors spoke with people who live in the home, staff and the manager. Inspection of the premises and close examination of a range of documentation, including three care plans was also undertaken. The home sent us their Annual Quality Assurance Assessment (AQAA) on time. This is a self assessment, that details what the home is doing well and what they could Care Homes for Older People Page 6 of 28 improve upon. It also gives us some statistical information. We looked at this information and have referred to it in the report. As the end of the visit feedback was given to the manager of our findings, including any requirements and recommendations that may be in the key inspection report. We have reviewed our practice when making requirements to improve national consistency. Some of the requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement actions will be taken. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? Specific activities are now provided for people who suffer with dementia, improving their lives and helping to prevent boredom. Complaints are now analysed, so that should the complaint constitute an allegation of abuse it is referred appropriately. Multi - agency policies and procedures are now followed should an allegation of abuse or poor practice occur. Staff have now received training in specific needs of people who live in the home, for example, dementia. This helps to ensure that the right level of care is offered to the people who have specific needs. Care Homes for Older People Page 8 of 28 People now receive written confirmation prior to moving into the home that their needs can be met, additionally mobility and psychological needs are clearly assessed and recorded in peoples care plans to ensure that these needs are identified and met. Medication practices have improved so that when necessary two signatures are obtained and records are up to date, with clear instructions on how, as directed, medicines are to be administered. Activities in the home have improved and increased to offer greater choice, with records being kept to ensure that assessment and audits can be undertaken. Choices with peoples daily menus have also improved following consultation with both the people who live in the home and a dietician. Practices have improved so that people are clearer about who to speak to should they wish to raise a concern and they know how to make a formal complaint. 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 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 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. We looked at standard 3. People are assessed prior to moving into the home to ensure that the staff in the home are aware of and can meet their needs. Evidence: We looked at three care files for people who live in the home. Each of these files included an initial assessment of the persons needs, a further assessment completed by the manager and copies of the Local Authority assessments and care plans. One person had recently moved into the home and it was clear that the manager had visited them at their previous address prior to them moving into the home. The assessments covered a variety of areas that included the physical and mental health of the person, including their mobility needs. The manager had used this information in a 15 point care plan to detail what the persons needs were and how Care Homes for Older People Page 11 of 28 Evidence: these needs were to be met. Following the assessment of the individual the manager had written to them to confirm that the home is able to meet their needs. From the surveys we received all of the responses confirmed that people felt they had received enough information to help them decide if this home was the right place for them before they moved in. The information recorded in the AQAA included in the section how we have improved, Have included a more in depth assessment form including mobility and psychological needs. We now write to people to inform them we can meet their needs and are looking forward to them residing with us.All senior staff have been trained and effectively undertake admission assessments in the managers absence. The manager confirmed to us that the home does not offer intermediate care; consequently standard 6 does not apply. Care Homes for Older People Page 12 of 28 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. We looked at standards 7,8,9 & 10. People are supported through a care planning process to have their health, personal care and nutritional needs met. Peoples medication needs are met, with up to date systems and policies. Evidence: We looked at the individual files for three of the people who live in the home. Each persons file included a variety of information that had been gathered by the manager. This included a, getting to know you, form that described the persons past and some of their individual choices. The information included the homes own assessment and that from the Local Authority, this was used to compile a plan of care that covered a large amount of areas. The care plan describes to staff what the area of need is, for example, personal care and how the person is to be supported to have these needs met. It included Care Homes for Older People Page 13 of 28 Evidence: personal choices from the individual, for example, not to be bathed by young people of the opposite sex. Whenever possible the manager has ensured that the individual service user has been involved in their care plan and has signed to confirm this. Although these were large files they were well organised and it was easy to find information. We saw that the care plans were monitored regularly and checked for changes in the persons needs. They were updated when any changes occurred with the person and how their care was to be provided. Additionally, there are regular care reviews held with the Local Authority. These allow for a formal review of the care and support provided by the home. Relatives may also participate in these reviews and an overall picture is gained on how well peoples needs are being met and if any changes to this are required. There is a system of key working in place that helps to ensure consistency in the meeting of peoples needs. When we spoke to the staff they had a good understanding of their roles with this. We saw that staff kept records of the persons care during the day and night. Daily diary notes included what the person had eaten and drunk, what their mood was like and some of their activities and choices. Additionally, peoples key workers keep separate records of the persons week and what time they have spent with the individual. We looked at the health care records in each persons file. Each of the care plans contained sections that related to different areas of a persons health, for example, they included; breathing, fluid and diet (including nutritional screening), mobility and mental health. Specific care plans are developed for areas of need, for example, mental health. Peoples weights are monitored to ensure that changes are easily identified and that advice and support are sought. Risk assessments are also completed when necessary for peoples health needs, for example, the risk of falls, and when a need is identified, specialist advice, for example from the falls team, is sought. There were records kept of any visits or contacts with professionals and these included the GP, district nurses and community nurses. Letters were held on file that showed that people could access other health professional and we saw records for one person being supported with health screening. When we spoke to the people who live in the home they told us that they were happy with the support they received in the Care Homes for Older People Page 14 of 28 Evidence: maintaining of their health. Responses in surveys recorded that people felt that they always get the medical care that they need. We saw that there are risk assessments held in each persons file. For example, there is a risk assessment for the risk of scalding, a risk assessment for moving and handling and a risk assessment for tissue viability and the risk of pressure sores. We looked at the medication records and system in the home and found these to be very good. There were clear records kept of the receipt, administration and disposal of medicines in the home. This included clear records for when someone declined their medication. There is a policy in the home for referring back to a persons GP or specialist should a person refuse their medication for 2 consecutive days and this helps to ensure that peoples health needs do not deteriorate due to their choices over their medication. The manager organised a visit from the local Primary Care Trust pharmacist and has acted upon the advice given, improving the systems in the home. There are medication policies in place in the home and the manager told us how they have utilised the latest guidance, including that from the Royal Pharmaceutical Society to ensure that best practice is followed. This included risk assessments for medication that people wished to administer themselves. Staff have been trained in the administration of medication and the manager told us how she is improving the medication systems at night, ensuring that there are now more night staff trained in medication administration. This is good practice and would help should someone require any prescribed medication during the night, for example, pain relief . The information recorded in the AQAA included, The medication processes and working practices have been improved and now adhere to all policies and procedures, CQC guidance and legislation. We saw that the interactions between the people who live in the home and the staff team was polite and positive. There are notes in peoples files to ensure that peoples choices and dignity are respected when personal care is provided. All of the surveys we received from people who live in the home recorded that people felt positively that the staff listened to them and acted upon what they said. One comment included, Get me things when I ask for them. The staff are always happy. We saw that peoples individual appearances reflected their own personalities as did their individual rooms, which they had personalised to their own tastes. Care Homes for Older People Page 15 of 28 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. We looked at standards 12,13,14 & 15. Peoples leisure needs are identified and activities are provided within the home. This includes activities designed for people with specific health needs. Evidence: The manager told us and we saw on the duty rota that there is now an activities person employed for two hours everyday to support the people who live in the home with their choice of activities. We saw the activities records file and this included details of the types of different activities that may be undertaken. There were good and clear records kept of all the activities provided and how people responded to these including their level of participation. These could be developed further into individual records, providing an easy audit trail when re-assessing people or monitoring that their needs are met. The recorded activities included; motivation games, using a bean bag, chair exercises, reminiscing, knitting, poems and going out for walks and to visit cafes in the local community. Clear records were kept of the activities offered for people with dementia needs and how well these worked and how people participated in these. When we spoke to the people who live in the home they told us they were happy with the activities provided. From the surveys we received, all were positive in Care Homes for Older People Page 16 of 28 Evidence: their responses to, Does the home arrange activities that you can take part in if you want?, with only one person replying, dont know. Information recorded in the AQAA included, Have implemented a more comprehensive person centred activities scheme, which provides activities to promote individual choices and interests. When we spoke to the manager she reflected a good knowledge of the needs of the people who live in the home and their religious and cultural needs, including how these are met. People continue to be supported with any religious needs. We saw in peoples records that their family and friends can visit the home and chat with them, and we saw visitors throughout the day. People told us about their family coming in to see them and we saw how one person is supported to undertake trips to the family home. All of the surveys we received from people who live in the home recorded that people felt positively that the staff listened to them and acted upon what they said. When we spoke to people they told us that they are well looked after, that the staff are marvellous and that they can go to bed when they like. Peoples records included details of their choices, for example what time they like to get out of bed in a morning. Staff told us how they respected peoples wishes regarding this and that it was an individual choice when to get up. We looked at the menus on offer to people and these provide a variety of choice for people. We saw in the records of the service user meetings that people had been consulted about the menus and how there are winter and summer menus. The manager told us how she has developed the menus further with consultation from a dietician. On the day of the visit, minor work was expected to be undertaken in the kitchen so fish and chips were purchased locally. Information in surveys recorded that overall people were happy with the food provided in the home. When we spoke to people about the food they told us that it was alright, that they liked the food and that they had 2 choices for their lunch. The manager recorded in the AQAA, A new 4 weekly summer and winter menu has been designed and implemented in collaboration with the dietician and clients. Care Homes for Older People Page 17 of 28 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. We looked at standards 16 & 18. People are supported through good systems and practices to be able to raise any concerns and to be protected from harm. Evidence: There are systems in place in the home for the receipt and handling of any complaints. We looked at the records for these and saw that they were organised into individual years. One complaint had been received by the home and this had been dealt with; including clear records of the outcome. The complaints procedure was on display in the entrance hall of the home, for any visitors, and each person had a copy of the complaints procedure on display in their room. When we spoke to staff they knew how to handle a complaint and who they would speak to to deal with this. Responses in surveys from the people who live in the home included that everyone knew who to speak to if they were not happy and how to make a formal complaint. Staff responses in surveys recorded that staff felt they knew what to do if someone had concerns about the home. The information recorded in the AQAA included, All clients have a copy of the complaints procedure including CQCs contact details on the back. There were polices in place for the handling of any allegations of harm in the home, Care Homes for Older People Page 18 of 28 Evidence: these included a copy of the Local Authority policy on the Protection of Vulnerable Adults. We saw that staff had undertaken training on this subject and when we spoke to them they had a good level of understanding of the issues of abuse and the actions they would take should an allegation occur. The information recorded in the AQAA included, All staff receive safeguarding training. All safeguarding issues are referred without delay. Care Homes for Older People Page 19 of 28 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. We looked at standards 19 & 26. People live in a clean, warm and comfortable home. Evidence: The home is comprised of four properties joined together. We completed a tour of the premises with the manager of the home. We found that the home was clean, warm and comfortable throughout, with no unpleasant odours. Previously, some of the carpets had been seen to be slightly worn, but these have all been replaced with new carpets. There was a comfortable dining room, tables were nicely set with tablecloths and flowers, with napkins and condiments being available. There are two lounges for people to relax in, and an additional sitting room. People wishing to smoke have a covered area at the side of the home. The manager told us that there are plans to extend this area of the home, with a patio area also being made so that people who use wheelchairs will have easier access to the garden. We saw that peoples bedrooms were very comfortable and that people are able to personalise them to reflect their own individuality and taste. There is a combination of single and double rooms, with the double rooms having screening in place to protect peoples privacy. All of the bedroom doors are lockable with people being able to keep a key to their own room. If people require specialist equipment, for example, bed Care Homes for Older People Page 20 of 28 Evidence: rails, regular checks are undertaken by the staff. Records are kept of these checks to ensure that this equipment continues to be suitable for the individual and does not pose a risk to peoples health and safety. There are a variety of bathrooms throughout the home, again offering people choices and easy access to respect peoples dignity. There is also a separate laundry area that is well equipped to ensure that peoples clothes are washed and dried as required. People told us that they are happy with their rooms. One person told us that they like to tidy their room themselves and that the staff vacuum the room as this is the one task that they cannot do. All of the responses in the surveys recorded that people felt that the home was fresh and clean. The manager recorded in the AQAA, We assist clients to personalise their bedrooms, ensure rooms are kept clean and tidy and odour free as much as possible. Undertake a monthly deep clean on a rota of all the bedrooms, maintain a high level of cleanliness, undertake weekly headboard and pressure equipment check to ensure safety. We saw the records for the fire systems in the home. In house checks are completed weekly to ensure that the fire alarm and fire doors are in good working order. Annual maintenance checks are undertaken of the fire systems and staff have completed training on fire safety. There is a fire risk assessment that has recently been updated. Care Homes for Older People Page 21 of 28 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. We looked at standards 27, 28, 29 & 30. People are supported by a staff team that is well recruited and trained to meet peoples needs. Evidence: The duty rotas recorded that there are 3 staff throughout a day shift and 2 staff on a waking night shift. There is an activities person employed 2 hours a day for 5 days per week, a domestic person working from 8 am until 2 pm everyday and a cook also being employed. We looked at the dependency levels for the people who live in the home, which the manager confirmed to us. The amount of care hours provided was 420 hrs per week with an additional 10 hours from an activities person. We calculated that the home needed to provided 475.25 care hours per week based upon the dependency levels of the 25 people who live in the home. Although we found that peoples needs are being met and people were happy with the care provided, the staffing levels in the home must be kept under constant review to ensure that all of peoples needs and choices are met. We looked at the records for three of the people who work in the home. Each of these people had completed an application form prior to working in the home. The manager has kept records of each persons interview and any issues discussed at this point. The Care Homes for Older People Page 22 of 28 Evidence: manager ensures that two written references are undertaken on people to help to confirm that they are suitable to work in the role that they have applied for. It is recommended that the manager commences a system of verification of references when received, to confirm that the details are correct. All of the three staff had undertaken a Criminal records Bureau check that included a check of the Protection of Vulnerable Adults (POVA) list. This check helps to ensure that people do not hold a criminal conviction that might prevent them from working with vulnerable people. The manager has developed a system for assessing any convictions that appear on these checks, including an assessment of the conviction and if this constitutes a risk to the people in the home. This includes record keeping. Peoples files included a copy of their induction and training records. Surveys received from staff all confirmed that they felt that their induction covered everything they needed to know to do the job when they started. People have undertaken training on a variety of subjects that included; Food Safety,First Aid, Infection control, Moving and Handling and Fire Safety. Additionally people have undertaken training on specific conditions including, mental health and dementia awareness. Staff have also participated in role play training were they learn about experiences, for example, what life is like when you have suffered a stroke, and limited mobility. This training was assessed as part of peoples supervision sessions, and the manager discussed this session with the staff member to gain feedback. All of the feedback was positive and had helped the staff to understand better the lives of the people who live in the home. Responses in staff surveys included that all felt that their training helped them to meet the individual needs of people. The manager recorded in the AQAA that 11 members of staff had achieved a National Vocational Qualification (NVQ) level 2 or above, which is over the recommended 50 of the care staff team. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 31,33,35 & 38. People live in a home that is well managed and where their choices are considered and their needs are protected by good health and safety systems. Evidence: The manager of the home has over 17 years experience of care and has managed this service for over two years. She has kept her knowledge up to date by attending different courses. Regulation 26 visits have been undertaken by the senior management of the service and the manager told us that this was unannounced. We looked at the records of the last visit and saw that it had covered a variety of areas, including examination of the records kept in the home. We looked at the quality assurance system in the home. This includes questionnaires Care Homes for Older People Page 24 of 28 Evidence: for the people who live in the home and for the staff in the home. The manager completes a summary from the responses in the surveys and told us that she uses this information to maintain standards and develop the service further. We saw that there are regular staff and service user meetings. In the service user meetings people are consulted on any proposed changes, for example, the daily menus. We saw that the relationships between the manager, staff and the people who live in the home were positive and respectful. We looked at the systems for handling peoples money. Records are kept of monies received and spent by people and these appeared correct. We saw that on one occasion a supermarket points card had been used with a purchase for someone who lives in the home. We discussed this with the manager who is to address this with the member of staff. We looked at the staff supervision records for three members of staff. All of these had received three supervisions in 2009, which means that they are working to meet the recommended minimum of 6 supervisions per year. The supervision records reflected that these were sessions to discuss training and development issues. It is recommended that the manager develop these further to assess individual support and practice also. We saw that maintenance checks are undertaken for the Gas, Electric and Water systems in the home and that these were up to date. This helps to ensure that these systems do not pose a risk to the people who live in the home. There has been a new nurse call system installed in the home and this assists people to call for assistance from the staff team. There are weekly audits of equipment in the home, for example, pressure mattress audits. The manager has used the guidance from the Health and Safety Executive regarding the risk of scalding and each person living in the home has an individual assessment for this risk. Records are kept of any accidents or incidents in the home and when necessary the manager has notified the Care Quality Commission of these incidents. Care Homes for Older People Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 Risk assessments for the risk of smoking cigarettes should be undertaken. This will help to identify any potential risks and the actions to be taken to reduce these risks. Staffing hours should be reviewed regularly, considering the dependency levels of the service users and amended as necessary to ensure that peoples needs continue to be met. References should be verified to confirm the authenticity of the details. Staff should not obtain credit points on supermarket cards, from the shopping that they have undertaken for or with a person who lives in the home. 2 27 3 4 29 35 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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