Care Home: Rosehurst

What the care home does well People living in the home comment: `The care they give the residents is wonderful`. `The staff don`t rush people into things they don`t understand`. `Staff are always here when we need them this is the best answer I can give you`. `The home is always spotless, we can make a noise, shout and have fun`. A staff member comments: `We communicate well with the people and staff`. `The home is managed well and we are good at caring, cooking and cleaning`. Feedback from a relative indicates that the staff team work well together. The staff on duty at the time of the visit were kind and considerate to the people and very enthusiastic about working at Rosehurst. What has improved since the last inspection? Some improvements have been made in the care plan and risk assessments, however further work is required to make sure people have all of their care needs met. Since the last inspection some rooms have been completely refurbished and new carpet has been laid upstairs. There is a new wet room and non slip flooring in the dining room. A flat screen television has been purchased for the main lounge, a kitchen window has been replaced and a new sink installed. What the care home could do better: A staff member comments: `Buy new furniture`. `There is not always enough staff on duty`. Feedback from a relative indicates that at times there is not enough staff on duty. There are shortfalls in information provided in the Statement of Purpose. Care plans and risk assessments require improvement. Daily life and social activities would be enhanced for the people if a planned individual activity programme was in place. Staffing levels require to be reviewed to make sure there is enough staff on duty to meet the full health and social care needs of the people. Staff would benefit from regular supervision and an in depth dementia training course to have the skills and knowledge to do their jobs well. The outcome of the quality assurance programme does not inform the people who live in the home, their relatives or representatives, what needs to be improved or how they influence the day to day running of the home. Key inspection report Care homes for older people Name: Address: Rosehurst 162 Church Path Deal Kent CT14 9TJ     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: Penny McMullan     Date: 1 5 0 9 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: Rosehurst 162 Church Path Deal Kent CT14 9TJ 01304372312 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Rosehurst Care Ltd care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 22. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Date of last inspection Brief description of the care home Rosehurst is a registered residential care home for up to 22 older people. The registration of this home permits that people may live here if they have been diagnosed with dementia. The building is a detached property with a patio garden to the side and a large garden at the rear. Both gardens are secluded and surrounded by a high brick wall. Car parking is available at the rear of the property accessed via Middle Deal Road and there is also limited street parking. The home is located within a busy residential area of Deal and is within a few minutes walk of the local hospital. The home is within walking distance of several local shops and public transport, but is some distance from Deal town centre. Accommodation comprises of sixteen single rooms and three double rooms, situated over two floors. Double rooms are mainly Care Homes for Older People Page 4 of 32 1 6 1 2 2 0 0 8 22 Over 65 0 Brief description of the care home used for people who have additional care needs, such as needing hoist equipment. The first floor is accessed via a stair lift. Each bedroom has a private wash-hand basin and call bell. There are no en-suite facilities provided in the bedrooms, although there are adequate communal bathrooms and toilets. On the ground floor there is a large lounge and two smaller lounges, one of which opens up onto the patio area. The dining area opens directly onto the kitchen, so the cook is directly involved with residents during meal times. The current fees for the service at the time of the visit are £320.63 to £386.81 per week. There are additional charges for chiropody, toiletries and hairdressing. Information on the homes services and the CQC reports for prospective service users/relatives will be referred to in the Service User Guide. The email address for the home is rosehurstcare@yahoo.co.uk 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 key inspection was carried out over a period of time and concluded with a visit to the home on 16th September 2009 between 09.15am and 5.30pm. The last key unannounced inspection was carried out on the 16th December 2008 when the service was rated as a one star adequate service. Postal surveys were forwarded to the home to distribute to the people who use the service, staff and health care professionals. We sent ten surveys to the people who use the service, ten to the staff and five to health care professionals. One survey was received from the people who use the service, two from staff and none from social care professionals. As there was minimal response to the surveys we spoke to the Care Managers and health care professionals to gain their views on the service being provided. Feedback from all of the surveys and any comments provided have been included in this report. Care Homes for Older People Page 6 of 32 General observations were made during the day of how people are supported. We conducted a Short Observational Framework for Inspection (SOFI) for one and a half hours during the visit. This was to look at the daily life and social activities experienced by the residents. We observed how staff supported residents during social activities and when offering care. The care of three people was also tracked to help gain evidence as to what it is like to live in the home. We looked at parts of the home, care plans, risk assessments, training records, staff files and complaint records. We observed the meal time and the medication round. Eight residents and four members of staff were involved in the inspection. The manager assisted throughout the inspection. The Annual Quality Assurance Assessment (AQAA) that was sent to us by the service requires further detail. It did not give us a clear indication of how the home has achieved improvements in the service. Substantial improvements are therefore required when submitting the next AQQA. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The agency returned the Annual Quality Assurance Assessment (AQAA) within the required timescale. Although the home remains an adequate service, it is acknowledged that improvements have been made. An improvement plan will be requested with this report. The Registered Provider is also required to confirm to the Commission in writing by 31st December 2009 a reflective account of further improvements in the home, what has changed and what, if any, further action needs to be taken. 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: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 32 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 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further information is required for people to be able to make an informed choice to move into the home. Care needs assessments are in place to make sure the home can meet individual needs. Evidence: The Statement of Purpose was reviewed on 27th August 2009. There are shortfalls in the information provided as it does not reflect what the home actually provide by way of activities and opporotunites to express faith. Further detail is therefore required with regard to the arrangements for service users to engage in social activities and leisure interests, the consultation with service users about the operation of the care home, the arrangements for the people to attend religions services of their choice and dealing with reviews of the service user plan. A requirement will be made in this report with a timescale to address these issues. Care Homes for Older People Page 11 of 32 Evidence: The manager carries out a care needs assessment before the person moves into the home. Three assessments were examined and they contained sufficient information. Relatives or representatives are encouraged to take part in this assessment to make sure that the home has the information they need to meet the persons needs. The home also takes into account the care plan or joint assessment from the placing authority. This information is then used to form part of the care plan. Since the previous inspection the manager has introduced a new assessment form to improve the system and make sure all care needs are identified and met. The home does not provide intermediate care, therefore standard six does not apply to this service. Care Homes for Older People Page 12 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. The completion of the new care plans will ensure that residents can be confident their health and care needs will be met. Further improvements are required in the moving and handling risk assessments to ensure that staff and residents are safe. The management of the medication makes sure that people will are protected and will receive their medication safely. The home promotes privacy and dignity, however improvements are required when addressing individuals. Evidence: At the previous inspection the manager was implementing a new format of care plan to make sure that all care needs are identified and met. Nine of the plans have been completed, however at the time of this visit twenty one residents now live in the home. This leaves twelve plans to be updated. During the last nine months the Care Homes for Older People Page 13 of 32 Evidence: manager and deputy have been completing this task. The Deputy Manager is part of the care staff providing direct care to the people. This restricts her time to complete her managerial duties. There are occasions where the manager also helps the carers to provide direct care. This does not release them to complete the care plans for all of the people living in the home. The care plans are not consistent and show that some documentation has been reviewed recently while other parts of the plan, such as dependency levels and risk assessments, have not been reviewed since last year. Improvements are therefore required to make sure the new care plan format in introduced for all of the people living in the home and the reviewing and updating of the documentation is clear. There was a requirement made at the previous inspection to improve the risk assessments for moving and handling and clearly record these guidelines for staff to follow when moving the people. Although the assessments have improved with additional details on equipment to be used, there is still further work to be carried out to make sure people are moved safely. For example, although one assessment clearly states two carers, and the equipment required, there is no detail of how to move the person in a safe way. There are currently five people who require assistance from two carers. These people have not received an assessment by a person who is trained to carry out moving and handling risk assessments. The manager told us that this would be done as soon as possible as they have access to a trained assessor. The home has a hoist but this is not currently in use and requires to be serviced. A requirement will be made in this report with a timescale to address these issues. Health care needs are monitored through the care plan with records of GP and hospital visits. Each plan has a record of any accidents, and deprivation of liberty checklist for the managing authority. Nutritional needs are well documented together with physical health evaluation details such as mobility and skin integrity. Feedback from a care manager indicates that the health care needs of one person was not updated in the care plan. Dependency levels are assessed and recorded in the plan, one was dated July 08, but there was no evidence that this has been reviewed. It was noted that, if required pain charts are implemented. The manager has introduced a form for relatives and representatives to support the person to be included in the care planning process. Regular checks have been put into place for one person to make sure that he is safe, whilst at the same time promoting his independence. Care Homes for Older People Page 14 of 32 Evidence: The home now has a separate room for the medication, which has a small refrigerator and hand washing facilities. The records and storage of the medication are in good order. In some cases the hand written entries on the medication record sheets have not been countersigned to ensure that the information is correct. The manager carries out an audit of the medication on a monthly basis and all staff administering the medication have received appropriate training. As part of the SOFI assessment carers were seen interacting with the people in a kind and considerate manner. However, the staff tend to greet the people by using the words darling, sweetheart and mate. This did not seem to be intended in a derogatory manner however this does not uphold the principles of respect and dignity for the people living in the home. Staff were observed knocking on the peoples doors and pausing before entering the bedrooms. Care Homes for Older People Page 15 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. Improvements are required to make sure that there are planned, meaningful activities to enhance the daily lives of the people who live in the home. The meals in the home provide the people with a varied and nutritious diet. Evidence: We conducted a Short Observational Framework for Inspection (SOFI) for 1 hour 30 minutes during the visit. This was to look at the daily life and social activities experienced by the people living in the home. We were looking for the quality of staff interaction with the people and how often they had meaningful contact with staff. We observed three people in the lounge. One continually walked around the home while the two others stayed in the lounge during the observation time. There was minimal communication between the people being observed and the rest of the people in the lounge. The television was on with only one person showing an occasional interest in watching the programme. Other people were dozing off with no interest of what else was going on around them. After thirty minutes some members of staff came in the lounge and talked to the people. We found that when staff were in the lounge they were friendly and attentive and on the whole interactions between the Care Homes for Older People Page 16 of 32 Evidence: staff and residents are caring and positive. The people seemed calmer and more relaxed when they were being reassured and spoken to by staff. Once staff had left the lounge there was no further interaction between the residents. The home has outside entertainers who visit the home on a regular basis. Armchair aerobics exercises are carried out every week and an organist, guitarist and singer visit monthly. These events are displayed at the front of the home to encourage relatives to attend. There is no formal plan of activities to socially stimulate all of the people living in the home. We observed one carer supporting one person to read a book, however there was no planned activity for everyone to join in. Each person was approached at coffee time and offered fruit or a biscuit. They smiled and responded to the staff who supported them to make their choice of drink and snack. It is clear that the people who live in the home are not being provided with activities that meet their personal and individual social care needs. There is minimal information on life history in the care plan; however, no further effort is made to provide social stimulation to each person. During the afternoon a painting session was held but this was only for a few people and those who were not able to participate were not provided with any other activity. There is no dedicated activities co-ordinator and therefore the care staff have to build any activity around the personal needs of the people and their daily tasks. This does not give the people an opportunity to take part in a variety of activities. This was recommended in the previous inspection report and although some improvements have been made there are still no planned and meaningful activities for the people who live in the home. A requirement will be made in this report with a timescale to address these issues. Staff told us that one person goes to bed each evening then decides to get up and come down to the lounge and goes to bed later. It is evident that the home promotes the peoples choice and supports them to make decisions about their daily lives. However this may be compromised due to the lack of staff on duty after 5pm. The staff were observed, asking the people where they would like to sit, and what they would like to drink. People were also observed choosing where to eat, either in the lounge, dining room or their individual bedrooms. People are able to see their relatives as and when they wish, in the privacy of their own room or in the lounge. The manager told us that the people have the opportunity to receive regular communion each month when the church representative visits the home. Visitors are made welcome and staff make sure they are offered refreshments Care Homes for Older People Page 17 of 32 Evidence: and made to feel welcome in the home. The home employs a Chef and a cook who cover the kitchen over a seven day period. There is a four weekly menu and an alternative choice of meal is always on offer. Special diets are catered for and likes and dislikes are recorded in the kitchen. The meal served at the site visit looked appetising and staff supported the people to eat their dinner in a sensitive way. A carer was observed supporting and encouraging a person to eat their dinner whilst telling her exactly what she was eating. During the afternoon, cake and snacks were offered freely to the people and when anyone asked for tea or a drink, it was made as soon as possible. Staff told us that the kitchen is open twenty four hours and food is always available at any time of the day. A record is kept of food eaten by the residents to identify if they are any dietary problems so that appropriate action can be taken if required. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people can be sure that any concerns or complaints would be taken seriously and responded to. People are protected from abuse. Evidence: The home has a complaints procedure, which was not clearly displayed in the entrance hall. The procedure is not written in a format to make it more accessible for the client group of the home. It is recommended that the service review the format of the complaints procedure to make sure that people in the home are given the help and support to voice any complaints or concerns. Staff told us that they would have no difficulty in complaining or raising a safeguarding issue if they had any concerns, no matter how minor. There have been no complaints since the last inspection. Staff demonstrated their understanding of safeguarding procedures and are aware of whistle blowing. Staff have received training in the protection of vulnerable adults and there has been no safeguarding issues since the previous inspection. The homes recruitment procedure includes undertaking formal checks on potential staff to make sure they are suitable to work with vulnerable adults. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The ongoing refurbishment and redecoration of the home will make sure that the people live in a pleasant environment. There are plans in place to make sure that the laundry facilities are improved. Evidence: Since the previous inspection four bedrooms have been refurbished with new furniture and completely redecorated. The flooring in the dinning room has been replaced with none slip flooring . New flooring has been laid on the landing on first floor and a new wet room has been installed. A flat screen TV has also been purchased for the main lounge. The manager told us that there are plans to continue to improve the home, including the purchase of new furniture, however there is no formal plan in place. A part time maintenance person carries out the routine maintenance in the home. A programme of routine maintenance and renewal of fabric and decoration of the premises should be implemented with records kept. The manager is aware of what is required and the service is continuing to make improvements. At the time of the site visit the back garden was receiving some attention, and there was a pile of rubbish to be taken away. The manager told us that there are plans to Care Homes for Older People Page 20 of 32 Evidence: have raised beds and more flowers to encourage the people who live there to use the garden. She told us that some areas of the home have not been refurbished due to the ongoing repairs to the premises. Quotes to replace the laundry roof are being considered and new flooring and redecoration of the kitchen has taken place. The kitchen window has also been replaced and a new sink installed. The home is also in the process of receiving quotes to install plastic fire resistant panels for the kitchen wall. On arrival in the home it was noted that the downstairs area had not been vacuumed. The manager told us that the home requires an additional domestic and they were in the process of recruiting. Whilst residents were having lunch, she hovered the carpets. We can not be sure that the home is providing the required equipment and aids to meet the needs of the people. This is because there were five people who required assistance from two carers and they had not been assessed by a moving and handling assessor. This means that the correct equipment may not be in place. The home does have a hoist but it requires to be serviced to make sure it is safe to use. The manager told us that this was not being used at this time. The manager told us that she will take immediate action and that the people would be assessed as soon as possible and if required additional equipment would be made available. There are procedures in place to control the spread of infection and facilities available in all the appropriate areas for hand washing together with antibacterial hand wash dispensers. The manager told us that that the environment is checked both internally and externally each month to make sure the home is safe. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service can not be sure that their care needs will be fully met at all times. People are receiving care from trained staff and they are protected by the recruitment policies and procedures of the home. Evidence: The staff rota shows that there are four care staff and the manager on duty during the day to meet the full care needs of twenty one people currently living in the home. There are five people living in the home who require more than one carer and one person has a fifteen minute safety check in place. There is no dedicated laundry person therefore carers are also responsible for the laundry. After 5pm there are only three members of care staff on duty and two waking night staff. The manager told us that there had been a review of staffing levels since the previous inspection and this was the new working pattern. There is supporting evidence to suggest that the current staffing levels will not ensure that the peoples health and social care needs are being met. When three staff are on duty, there will be times when only two staff will be available to support the people. The senior will be completing the medication round, or assisting health care Care Homes for Older People Page 22 of 32 Evidence: professionals, which leave two care staff to meet the needs of the people. Currently there are five people who may call for assistance from two members of staff at any time, which may result in no staff to look after the rest of the residents. Staff told us that the people are only able to have bath when four members of staff are on duty, and no baths are provided after 5pm or at weekends. This does not give the people choice of when to receive their personal care and relax in the bath if required. It is therefore evident that when there are only three members of staff on duty people do not have their choice or care needs fully met. With five people requiring support from two carers, the staffing levels of two waking night staff may not be sufficient to fully meet the needs of the people during the night. A review of the assessed needs of the people during the night should be carried out to evidence that their care needs can be fully met by the two members of staff. After the site visit the manager told us that the Registered Provider has agreed to increase staffing levels with effect from 5th October,2009. Four carers will be on duty from 8am to 8pm, including weekends. We are confident that this will happen, therefore a requirement will not be given at this time. However, a requirement will be made for the service to keep an active documented review on the care support needs of the people when staffing levels are at a minimum during the night. During the SOFI observation we had to intervene between two residents who were trying to move through the doorway at the same time. Each person had a zimmer and was reluctant to give way to one another. We had to stop the SOFI process to address the situation as no staff were available in the lounge at that time. People are protected by the recruitment procedures. Three staff files were looked at. These evidenced that all appropriate documentation and checks are in place to ensure people are protected. The home is on target to achieve a level of fifty percent of staff providing care to have NVQ 2 or above. The new care staff have signed to commence the award. The Manager also told us that she has implemented new systems of working, for example, allocation of staff to individual people and the key worker system. There is an ongoing training programme in place and the staff have received this training, together with dementia training. Some of the new staff have only received a half day dementia awareness training course. The majority of people living in home require dementia care and all staff should be provided with in-depth dementia training Care Homes for Older People Page 23 of 32 Evidence: to make sure they have the skills to do their jobs well. A requirement to address this issue will be made in this report. New members of staff told us that a good induction was in place. They said they felt supported by the staff and shadowed senior carers. Copies of individual training certificates are on file. The manager and deputy manger have received Mental Capacity Training and The Deprivation of Liberty Training . The manger told us that all staff would be receiving this training. There is no evidence that the staff have received equality and diversity training. It is therefore recommended that all staff attend Equality and Diversity training to make sure they have the skills to do their job well. 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. The manger is aware of what is required to improve the service and achieve effective management of the home. Improvements are required in the quality assurance programme to make sure the people have their views taken into account and the home is run in their best interests. Staff are not receiving regular supervision to make sure they are supported to do their job well. Peoples finances are protected and the health and safety of the people living in the home and staff is promoted and protected. Evidence: The manager of the home has been in post since November 2008. She holds NVQ 3 in Adult Care Services and Level 2 Dementia Care. She is currently completing combined HSC, NVQ 4 Leadership and Management for Care Services. We were told at the last Care Homes for Older People Page 25 of 32 Evidence: inspection that an application would be sent to the Commission for consideration to become the Registered Manager. Although she confirmed that this is the case no application has been received at this time. The manager and deputy are working hard to improve the service, however progress is slow. Due to the staffing levels, the manager continues to assist the carers to provide direct care and the deputy is part of the working staff rota. The deputy manager should be allocated time to complete her managerial duties to support the manager to achieve the required improvements in a timely manner. For example since the last inspection nine months ago only nine out of twenty one care plans have not been updated to the new format and staff supervision is not up to date. The staff team is not fully experienced as eight new staff have been recruited since the previous inspection. Four of these did not have previous care experience. Whilst this is not an issue, as full training will be provided, additional pressure is on the management and senior staff to complete induction training and monitor the competencies of the new staff. We received an AQAA from the home when we asked for it. However the information was not sufficient throughout the document to assist us with parts of the inspection process. For example further detail is required to evidence how they promote equality and diverstiy in the home, what if any changes have been made or how they will promote this in the future. The manager had not taken into account the shortfalls identified at the last inspection and did not tell us in the AQAA how these had been addressed. The registered provider or his representative visits the home monthly at regular intervals to make sure the service is meeting the required standards. Although issues are identified, for example roof in laundry room needs to be looked at there is no record of what action will be taken. In addition a comment about staff being rushed due to sickness does not indicate what if any action was taken to alleviate the situation. The manager sent out a questionnaire to all of the people living in the home and the people were supported by relatives or friends to complete the information. There was no evidence that the results of the survey have been analysed and what if any improvements or changes were identified. The people who use the service, their relatives or representatives are not being told about the outcomes of the quality assurance review and how the home plans to develop and improve. Care Homes for Older People Page 26 of 32 Evidence: Questionnaires also need to be circulated to relatives/advocates and visiting professionals to make sure that the home takes into account the views of all interested parties. This will ensure that the aims and objectives written in the statement of purpose are being met. A requirement will be made in this report with a timescale to address these issues. The manager told us that supervision was not up to date. One member of staff told us that she had received one supervision since last year. Supervision records are in place, however due to pressure of work and providing direct care, the timescales to provide regular supervision are not being achieved. It is recommended that a supervision progamme in put into place to plan and provide supervision to all staff. The manager also said that staff meetings and residents meetings had been held and the minutes were with head office for typing. There was no evidence to confirm this at the time of the site visit. The minutes of the meeting should be distributed to the people who use the service and staff to make sure they are aware of the outcome of the meetings and what if any action has been taken. The home has financial systems in place to support the people with their finances. The manager checks these records regularly and receipts of all transactions are kept on file. The AQAA told us that the relevant safety checks are being carried out, however, the portable hoist servicing was not up to date. The service continues to provide the staff with mandatory and induction training. Information in the AQAA told us that all the relevant checks and inspection of equipment have been undertaken. The fire book was in good order with appropriate drills and tests in place. The current fire risk assessment has not been approved by the local Fire and Rescue Service. The water temperatures are checked and the manager carries out a monthly environmental risk assessment to make sure that any issues are identified and actioned. The accident book was spot checked through to a persons care plan. Information was recorded and appropriate action taken. Care Homes for Older People Page 27 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 28 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 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 1 4 There are shortfalls in the information provided in the Statement of Purpose. This is with regard to to the arrangements for service users to engage in social activities and leisure interests, the consultation with service users about the operation of the care home, the arrangements for the people to attend religions services of their choice and dealing with reviews of the service user plan. To make sure that people have clear information about the home and the service they provide. 31/10/2009 2 7 13 Moving and handling risk assessments must be carried out by trained competent assessors and include clear written guidelines of how to move people safely. 31/10/2009 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 To make sure residents and staff are safe. 3 7 15 To implement the new 31/12/2009 format of care plans for all of the people living in the home. The plan to be reviewed, updated in a consistent manner. To make sure that the peoples needs are clearly and consistently recorded to evidence that full health and social care needs are being met. To provide planned activities 31/10/2009 to all of the people living in the home which are meaningful and provide social stimulation. To give the people living in the home the opportunity to enhance their daily lives. 5 22 23 To provide suitable equipment to meet the assessed needs of the people living in the home To make sure the people have suitable aids and equipment to support them with their mobility. 6 27 24 The Registered Provider needs to keep an active documented review on the 31/12/2009 31/10/2009 4 12 16 Care Homes for Older People Page 30 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 care support needs of the people when staffing levels are at a minimum during the night. A reflective account is required to be forwarded to the Commission by 31st December demonstrating that this has been carried out. To make sure that the staffling levels are kept uder review to meet the full care needs of the people living in the home. 7 30 18 To provide all staff with in depth dementia training. To make sure staff have the skills and knowledge to do their jobs well. 8 33 24 To implement a full quality assurance programme. To make sure that the people and other interested parties have their views taken into account on the day to day running of the home. 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 31/12/2009 31/10/2009 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. 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