Care Home: Rosewyn House

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What the care home does well The registered persons provide a warm, comfortable, homely environment for people using the service. The home was clean and there were no offensive odours. Bedrooms were personalised with people`s belongings and some people had their own furniture. The grounds were tidy with well laid out flowerbeds and patio areas. Prospective residents and their family were invited to visit the home prior to any decisions being made to live there. People said their healthcare needs were met and specialist healthcare professionals visited the home when required. There were regular minibus trips arranged and entertainers visited the home. Links with family and friends were good. There was a set four week menu, with alternatives available, and people said the food was good with fresh produce included. Meals were served in an attractive spacious dining room. There were suitable policies and processes in place for complaints and adult protection. There had been no complaints to the home or the Commission. 75% of care staff were qualified to at least NVQ level 2 in care, new employees were encouraged to achieve the qualification. Staff had undertaken regular statutory training. Health and safety was promoted and relevant service and equipment checks were kept up to date. What has improved since the last inspection? More staff have achieved NVQ qualifications and new staff who already have a qualification have been employed. The head of care has surveyed residents to find out their preferred daily routines and the kind of social activities they like. She has started to include the information into the care plans. The care plans have changed to a different format and a great deal of work has taken place to try and make these more person centered, social and religious needs have been included and there are plans for those who are prescribed medicines on an as required basis. The employment of an activities co-ordinator is being considered. A new controlled drugs cupboard has been purchased that complies with current legislation. The current pharmaceutical guidelines for care homes have been obtained and are available to staff. Handwritten instructions on the medicine charts are now witnessed with two signatures recorded. Signage is displayed where oxygen cylinders are stored along with no smoking signs. What the care home could do better: The registered manager was given feedback throughout and at the end of this inspection. She is aware that regulations have been breached and agreed to address the issues. Some breaches have been discussed with the manager and reported in the body of this report others have been notified as requirements and recommendations.The care plans need to be more detailed to fully inform and direct staff on the person centered care to be provided. Risk assessments should be referred to in the care plans especially when a scoring system is used. Daily records should be more informative as to what people have done each day and provide an accurate account of events. If each person delivering the care was to write in the records it would help to ensure this is done. The management should ensure that the preferences of people using the service are always considered and that suitable activities are provided for stimulation. The management should review the staffing arrangements to evidence there are sufficient skilled staff on duty at all times to meet all of the needs of people using the service. This should include the staffing arrangements for domestic and kitchen duties and training provision as necessary. There should be a review of the use of notices detailing daily routines and other aspects of resident`s care to respect the privacy and dignity of residents and to ensure that their daily routines are flexible to suit them. There should be discussions between staff and mangement regarding the regimental practices in the home to resolve differences of opinion and improve staff morale and working relationships. For the prevention of infection in the home the providers should seriously consider the installation of a dishwasher, the provision of a washer disinfector for the cleaning of commode pots and the fitting of washable impermeable flooring in bathrooms and toilets. There should be a policy for the management of resident`s money so that staff know what is expected of them. Staff training records should be kept up to date and reflect the training that has taken place. Key inspection report Care homes for older people Name: Address: Rosewyn House Alverton Terrace Truro Cornwall TR1 1JE     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: Diana Penrose     Date: 2 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Rosewyn House Alverton Terrace Truro Cornwall TR1 1JE 01872279107 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: rosewynhouse@gmail.com Mr William Percival Dawes,Mr Gregory Brian Murrell care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Rosewyn House provides care for up to twenty elderly service users. The registered providers are Mr Dawes and Mr Murrell who are actively involved in the management of the home. Mrs Spargo is the registered manager. Rosewyn House, is situated within walking distance of the centre of Truro. Rosewyn is a large old house situated in pleasant grounds. The house has two floors with access to the first floor via either a staircase or lift. There is one double bedroom and eighteen single bedrooms. No bedrooms currently have en-suite facilities. There are suitable bathroom facilities. There is a large lounge and a large separate dining room. The home is pleasantly decorated throughout. There is also a block of supported living flats next door to the home, which are also managed by the registered persons. Some of the service users from there have their meals at the home. Although the flats are not registered for personal care, some move in to the care home as peoples needs change. Care Homes for Older People Page 4 of 32 Over 65 20 0 1 9 0 3 2 0 0 9 Brief description of the care home A copy of the full inspection report is available from the manager. The fees at the time of the inspection were 420 pounds per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. 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: Two inspectors visited Rosewyn Care Home on 21 December 2009 and spent seven and a half hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that peoples needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that peoples placements in the home result in good outcomes for them. All of the key standards were inspected. On the day of inspection 20 people were living in the home. The methods used to undertake the inspection were to meet with a number of residents, relatives, staff, manager and registered providers to gain their views on the services offered by the home. Records, policies and procedures were examined and the inspectors toured the building. CQC surveys had been returned in respect of 13 residents and 6 staff, these too have Care Homes for Older People Page 6 of 32 informed the inspection. This report summarises the findings of this inspection. 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: The registered manager was given feedback throughout and at the end of this inspection. She is aware that regulations have been breached and agreed to address the issues. Some breaches have been discussed with the manager and reported in the body of this report others have been notified as requirements and recommendations. Care Homes for Older People Page 8 of 32 The care plans need to be more detailed to fully inform and direct staff on the person centered care to be provided. Risk assessments should be referred to in the care plans especially when a scoring system is used. Daily records should be more informative as to what people have done each day and provide an accurate account of events. If each person delivering the care was to write in the records it would help to ensure this is done. The management should ensure that the preferences of people using the service are always considered and that suitable activities are provided for stimulation. The management should review the staffing arrangements to evidence there are sufficient skilled staff on duty at all times to meet all of the needs of people using the service. This should include the staffing arrangements for domestic and kitchen duties and training provision as necessary. There should be a review of the use of notices detailing daily routines and other aspects of residents care to respect the privacy and dignity of residents and to ensure that their daily routines are flexible to suit them. There should be discussions between staff and mangement regarding the regimental practices in the home to resolve differences of opinion and improve staff morale and working relationships. For the prevention of infection in the home the providers should seriously consider the installation of a dishwasher, the provision of a washer disinfector for the cleaning of commode pots and the fitting of washable impermeable flooring in bathrooms and toilets. There should be a policy for the management of residents money so that staff know what is expected of them. Staff training records should be kept up to date and reflect the training that has taken place. 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 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. The assessment process does not ensure that peoples needs can be met by the home. Evidence: We looked at the pre-admission assessment documentation for two residents one admitted in June 2009 and one admitted the day before this inspection. The information was extremely brief with no information on what the people could do or what assistance was needed. The information did not include any details about leisure activities. There was no record of who was present at the pre-admission assessments but the forms were dated and signed by the registered manager. We saw some assessment information from the department of adult social care. We noted that the newest admission did not have a care plan compiled from the pre-admission assessment information. We were told that prospective residents and their relatives could visit the home before admission is arranged to see the home, meet the staff and other residents. They could Care Homes for Older People Page 11 of 32 Evidence: stay for a meal if they wished. 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. Not every person using the service had a written care plan and the care plans were not detailed enough to fully direct staff and ensure that all health and social care needs were met. There was an appropriate system for the use of medicines that ensured that people using the service were safeguarded. Evidence: We inspected three care files. The file of the newest admission did not contain any care plan. We were told that this had not yet been completed as they had little information about the person. We discussed the importance of an initial care plan, with the manager and the head of care, to inform and direct staff on the care to be provided. We saw that the care planning documentation had improved since the last key inspection and that religious and social care plans were being compiled. We were told that the responsibility for the night care plans had been delegated to the night staff and should be completed soon. The care plans were based on the activities of daily living. At the random inspection on 29 October 2009 we saw that the system was Care Homes for Older People Page 13 of 32 Evidence: inconsistent; some people had more detailed care plans than others. Some care was detailed under the incorrect subject, for example catheter information was recorded under nutrition in one file. These issues were discussed with the head of care who has since started to make improvements. The care plans still need expanding to fully inform and direct staff on the specific care to be provided. Some residents had fluid intake and output charts with no documented reason as to why. One person had no specific care plan for pressure area care although there were turning charts and notes of visits by the community nurses in respect of this. We saw some risk assessments in the care files for example moving and handling, falls and Waterlow scoring. The scoring and its relevance was not included in the care plans. We were told that no nutritional risk assessments are undertaken. We saw the daily records which lacked detail. Most of the night entries were the same. Day entries included mainly personal care and diet. Pressure area care was not well documented and information about an air mattress and when it was installed was not found. Care planning was discussed with the Head of Care at the inspection in October when she was grasping the person centred approach and was keen to ensure that the plans were specific to the individuals. She told us she had not had time to complete all of the care plans but she was working on them. We saw records of visits by doctors and other healthcare professionals. Residents told us that a chiropodist visits and they do exercises to music with a visiting entertainer. Thirteen surveys were received from people using the service eleven said they always receive the medical support needed and two said usually. One commented that medical care is good. Equipment was seen for moving and handling purposes and pressure sore prevention. A hoist had been purchased since the last key inspection. We were told that one person had developed pressure sores and we saw records that showed that the community nurses were visiting regularly and had given instructions regarding the care. We were told that there were problems obtaining an air mattress promptly from the community nurses. We saw a medicines policy that was available to staff. We discussed the addition of oxygen therapy with the head of care. We saw a copy of the guidelines for the Care Homes for Older People Page 14 of 32 Evidence: handling of medicines in social care and that patient information leaflets were seen. A monitored dose system was in use and the receipt, administration and disposal records were seen and were satisfactory. We saw that the manager had noted several times in a book that she had observed the charts to lack signatures and she had addressed this. We were told that one person was administering his own medicines but there was no risk assessment or care plan in place for this. Consent had, however, been obtained. Staff told us they had undertaken training regarding medicines and the records confirmed this. We were told that a pharmacist visits regularly and we saw the last report . Handwritten instructions on the medicine charts were witnessed with two signatures recorded. For people prescribed to have medicines administered, when required, we found that there were care plans in place. Medicines storage was satisfactory with a controlled drugs cupboard that complies with current legislation. We saw that peoples privacy was upheld during this inspection and people using the service said their privacy was upheld at all times. We saw one room that was shared by two people, there were no screens in this room for privacy. A member of staff had commented on this in a survey undertaken by the manager. We were told that the people accommodated in the room were happy and did not require screens at this time; the manager said she would discuss the issue with them and ensure it was documented. We observed a notice in the dining room detailing the names of residents and which toilet they go to after meals. This was removed when an inspector talked to the manager about this and the invasion of residents privacy. 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. Some activities and entertainment are provided but it is not evident that they meet the needs and interests of people using the service. Links with family and friends are encouraged, good food is provided and people have some choice as to how they live their lives. Evidence: We were told that care staff provide activities as part of their daily work, a game of bingo took place during this inspection. People using the service told us about outings that take place every two weeks and we saw a notice displayed about these. There was also a notice about music for health sessions each month and people told us they enjoy these. Staff told us that activities are limited and more could be done to keep residents occupied. We observed that the television was on all day in the lounge; the manager told us that this is the residents choice. Survey comments included More activities, Provide someone to do activities with residents every day, not just once a week, Celebration of special occasions is kept to the bare minimum, Could maybe vary or increase daytime activities sometimes (but no criticism) and Activities such as wordsearch etc could be given to residents. A member of staff told us she had been to a pantomime with some residents recently. Care Homes for Older People Page 16 of 32 Evidence: We were told that carol singing had been organized and that a jewellery party and a clothes party had taken place. We saw individual activity records for each resident they included when people had decided not to join in. There was little information on the level of participation, enjoyment, emotional responses or what people gained from the activity, if anything. The head of care said a scrap book was going to be compiled to further evidence what takes place. We were told that the night staff get all of the residents up in the mornings and serve them breakfast in their rooms. We saw lists on the staff notice board of the daily routines for staff to follow; these included the times for putting some residents to bed, for administering medicines, for personal hygiene, for toileting and for some domestic tasks. They did not reflect the views of people using the service. The manager told us these were only guidelines but staff said they have to keep to the routines. They told us the home is run in a very regimental way that is not person centered and they are unable to use their professional judgement. They said the routines are task orientated and they have no time to spend talking with residents. Residents told us the staff are kept busy and they only have time to chat if they are doing something for them. At the random inspection in October all of the residents were having to sit in the dining room and wait until the medicines were given out before they had their lunchtime and evening meals. We were told that this practice had now stopped and the memo regarding this was no longer on the notice board. We saw that the bedrooms were homely and personalised with peoples belongings and some had their own furniture. The manager told us that people could have a lock fitted to their bedroom door if they asked. People told us that their family and friends visit and the visitors book showed that people visit regularly. We were told that a cook is employed and works from 08.00 to 14.00 each day. On the day of this inspection a carer was doing the cooking, she said she covers for the cook on her days off and annual leave. She said the care staff start the breakfasts at 07.00 and they prepare and serve the teatime meal at 17.30. A four-week menu was seen and was displayed in the dining room. The menu was varied and showed that nutritious meals were on offer. Food records were seen that showed that people do have alternatives to the set menu. We were told that a choice of a hot or cold meal is offered at tea time. Fresh fruit and vegetables were seen and we were told that cakes were homemade. The dining room tables were set with linen table cloths and napkins. Residents said they eat in their rooms sometimes but at lunchtime they usually go to the dining room. They said the meals were good and comments included The food is smashing, Care Homes for Older People Page 17 of 32 Evidence: Food is excellent, We have a glass of sherry and Good homemade food. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are suitable policies and processes in place for complaints and adult protection, to ensure that people using the service are safeguarded. Staff say they have received training in this area but the records need improving to reflect this. Evidence: The complaints policy was seen, the Care Quality Commission contact details need to be updated. The Commission had not received any complaints about this service since the last inspection and the manager told us they had not received any complaints. We saw the adult protection policy and a copy of the local authority procedures was seen in the home. The head of care told us that she provides in house training on abuse annually, using a training DVD. She told us that all new staff attend this training as part of their induction. She said that she had attended training provided externally and that some other staff had also done this. The training matrix showed that all staff had attended No Secrets training but only five of the fourteen staff had attended during 2009, most staff had attended in 2007, the managers record had no date recorded. We were told that the list was not up to date. Staff we spoke to said they had received abuse training this year. All staff and the registered manager attended training on the Mental Capacity Act and Deprivation of Liberties in October 2009. There had been one safeguarding referral to the Department of Adult Social Care in July 2009. This was in respect of the care of a resident who was very poorly and Care Homes for Older People Page 19 of 32 Evidence: developed pressure sores before being moved to a nursing home. A random inspection was undertaken on 29 October 2009 when we reviewed the progress made with care planning and pressure sore prevention. This showed that care plans were being reviewed and there was an improvement. The head of care was trying to source training in respect of pressure area care and training has not yet taken place. Concerns were raised to inspectors at the random inspection in October, on surveys and during this inspection from staff regarding regimented and institutional practices in the home. We discussed this with the registered providers and the registered manager during this inspection and it has been dealt with in the management section of this report. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Rosewyn House provides a pleasant, homely, clean and well-maintained environment for people to live and feel at home in. Evidence: We toured the building and people told us that the home was a homely, comfortable place to live in with no unpleasant odours. The home was warm, one resident told us the heating is only turned on in the afternoons another said it does get cold sometimes. All areas of the home appeared well decorated and well maintained. Some of the carpets were frayed and worn but we were told that new carpets were in the garage ready for fitting in the staff room, and corridors downstairs. The grounds were tidy with flowerbeds and patio areas. The lounge was divided into three areas, which enabled people to move away from the television if they wished but it could still be heard. In the kitchen there was a cracked and a missing tile behind the AGA, we were told these had been put forward for repair. The bathrooms and toilets were carpeted with carpet fitted around the bath panelling as well. The providers told us this was Flotex washable carpet and had previously been told this was acceptable. We recommend that impermeable flooring that is washable Care Homes for Older People Page 21 of 32 Evidence: be installed for infection control purposes. We advised the providers to seek advice from the Health Protection Agency. There was a soft cover on the bath seat upstairs and we saw a rota for the washing of this. Hand washing facilities for staff were appropriate in some areas but not at each hand wash basin, some areas had only cotton hand towels. Protective aprons and gloves were seen in use by staff. Laundry facilities appeared suitable, we were told that only personal clothing is laundered in the home, the bed linen and towels go out to contractors. Some cleaning products were observed in the laundry and we discussed this with the manager and head of care who agreed to ensure they were locked away in future. It is still recommended that a washer disinfector be provided for disinfecting commode pots and urinals for better infection control. Staff told us they have attended infection control training and the training records confirmed this although a few members of staff were due for an update. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is not clear that staffing levels are suitable to meet the needs of people using the service. Care staff hold NVQ qualifications but little other training, apart from statutory training, is provided to keep their knowledge and skills up to date. Recruitment procedures are appropriate and ensure that people using the service are protected and safe. Evidence: We were told there were staff vacancies for a deputy head of care and a part time cleaner. We saw the rota which showed that there are usually three care staff on duty in the mornings, two in the afternoons and evenings and two overnight, one of whom sleeps in for part of the shift. Cooks are employed to produce the lunchtime meals and cleaning staff are also employed. The care staff told us they are responsible for the breakfast and tea time meals and for dealing with the laundry and some cleaning tasks. The manager told us she had met the requirement of reviewing staffing in the home however this could not be evidenced so the requirement timescale has been extended. Staff and residents told us that staffing levels do not allow time for activities or for spending time with residents. Staff felt that two in the afternoons was not enough and that rigid routines meant there were always tasks to do. Surveys from residents told us that staff are usually available when they need them and that they usually or Care Homes for Older People Page 23 of 32 Evidence: always listen and act on what they say, however one said they never listen. Comments included Staffing depends on the time of day and staff pressure and More help by staff if unable to walk. Staff surveys told us that sometimes there are enough staff, one person said usually and one said never. Comments included More staff, Quite often we are under staffed, Care staff have to rush to get their jobs done, these are besides the hands on care, washing dishes and numerous other jobs and Staff turnover is high, this leads to low morale in staff. Residents told us the staff are hard working and kind and caring. We observed this to be so and staff interacted well with people using the service during this inspection. The manager told us she is always in the home, often from 09.00 - Midnight, and she lives very close by. The rota we saw did not reflect the hours she had spent working in the home and this was discussed with her. 75 of care staff were qualified to NVQ level 2 in care, three staff had achieved level 3 and a further three were working towards level 3. We examined the staff file of the newest employee and at the random inspection in October we examined the file of another new employee. The files contained the records required by legislation apart from photographs of the employees. Interview records were seen and the manager explained the new system she has put in place for the supervision of new employees prior to the full CRB check being obtained which was satisfactory. A new carer was being supervised by the head of care during this inspection. We saw induction check lists in staff files and we were shown the induction packs in use which appeared to be in line with the skills for care standards. A training matrix was displayed in the staff room, it showed the records mainly for statutory training. Training in other areas relating to the client group, such as the diseases of old age would improve the knowledge and skills of the staff. We were told that there was a mixture of in house and external training and that the matrix requires updating. Staff told us they have a lot of training which they enjoy. 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 manager has run this home for many years but has not undertaken regular training and updating so her knowledge and skills may not be up to date for meeting the needs of this client group or for directing staff. The management culture is regimental and task orientated, it does not appear to allow flexibility of care or to enable staff and residents to be involved in the running of the home. Systems are in place to ensure the home is safe and there is some monitoring to improve the service for residents and staff. Evidence: We were told that the registered manager lives in a property in the grounds of the home and that the registered providers visit the home most days during the working week. The registered manager has no formal qualifications but has told us she is looking into accessing the Leadership and Management for Care Services Award. She told us she had attended infection control, moving and handling, Mental Capacity Act and Deprivation of Liberties training since the last inspection. Staff told us they receive some support from the manager but most of the support comes from the head Care Homes for Older People Page 25 of 32 Evidence: of care. Staff told us they felt undervalued and unable to use their professional judgment. Staff told us that the management culture is to tell them what to do rather than to include them in the running of the home. There were differing opinions between staff and the manager on the regimental practices used in the home and staff said they could not approach the manager or the registered providers for fear of losing their jobs; this needs to be resolved. There was a suitable quality assurance policy seen at the last inspection. We were told that the annual survey of residents and relatives had recently taken place and was positive. The manager told us she would compile a report and forward it to the Commission. The head of care told us she had surveyed the residents since the last inspection to obtain information on their preferred daily routines and activities. She said she had been updating the care plans accordingly. We were told that no audits take place but that accident reports are looked into. Staff told us that staff meetings were irregular but minutes were kept. Staff told us they find it difficult to air their views as they feel that the management do not listen to them. They said that no resident or relatives meetings take place. The manager told us that she sees the residents every day and they can air their views to her. The registered providers said they had only just received the AQAA so it was not due to be returned yet. The manager told us there was no policy for the management of residents money and the importance of having one was discussed with her. We were told that money was only held for one person, suitable records were seen and the balance was checked and correct. Money was mainly used for hairdressing and the hairdresser signed the record sheet when she was paid. we saw that money was stored safely in a locked facility and we were told that the manager and head of care held the keys. The manager said she was available out of hours. The head of care told us about the system for the supervision of staff which had been implemented since the last inspection and we saw some of the records, we discussed the development of these with her. The registered providers told us that health and safety continued to be taken very seriously and all relevant maintenance and servicing checks were up to date. New fire door closers had been fitted. Statutory training records for staff were seen and showed that training was not up to date for all staff. We were told the records had not been updated to show recent training. The head of care told us she would update the records and ensure that training is kept up to date. We ran water from hot taps around the home and it was not too hot. We were told Care Homes for Older People Page 26 of 32 Evidence: that the hot water is regulated to prevent the risk of scalds. We saw that some of the downstairs windows were not fitted with restrictors we discussed the need to risk assess these to reduce the risk of intruders. We saw that signage was in place where oxygen was stored and there were no smoking signs. There needs to be a sign to indicate no naked flames as well, we discussed signage with the manager. The registered providers told us they were considering the installation of a dishwasher as this was highly recommended by the Environmental Health Officer in January 2009; this would help with infection control 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 3 14 The needs of prospective residents must be fully assessed prior to their admission to the home. To ensure that the home can fully meet all of their iindividual needs. 22/02/2010 2 7 15 All of the people using the 26/04/2010 service must have a detailed care plan. To inform and direct staff on the care to be provided. 3 27 18 A review of the management, staffing levels and deployment of all staff must be conducted with appropriate action taken for any shortfalls or issues arising. To ensure that the care home is able to promote and make proper provision for the health and welfare of people using the service. To 22/02/2010 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action include their care, and where appropriate, treatment, education and supervision. 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 10 The management should ensure that notices displayed in the home respect the privacy and dignity of people using the service. All staff should undertake annual training in respect of safeguarding adults and this should be recorded in the records. Impermeable, washable flooring should be fitted in all bathrooms and toilets to help with the control of infection. A washer disinfector should be installed for the disinfecting of commode pots and urinals to reduce the risk of cross infection Staff should undertake training other than that required by legislation to improve their knowledge and skills and improve the care they provide to the elderly people using the service The registered manager should undertake the Leadership and Management for Care Services Award to ensure she is keeping herself up to date on management issues. The registered providers should review the way in which the home is run, with the manager and staff to ensure an open and transparant culture that enables staff and residents to be involved. A dishwasher should be installed to ensure that dishes are washed appropriately and at temperatures that reduce the risk of infection. The training records should be kept up to date to evidence that all staff have received the training required by the law Page 30 of 32 2 18 3 4 26 26 5 30 6 31 7 32 8 38 9 38 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations at the correct intervals. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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