Care Home: Saffron House

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What the care home does well All the people who use the service that were able to communicate, except one person, their relatives and the Community Nurse told us that staff were friendly and attentive and welcomed visitors. The assessment system is generally good which helps ensure that peoples needs are met. People told us that medical services were called in if they needed medical attention. People are supplied with medication the way they want to take it. Complaints are taken seriously and investigated properly. People are involved in the running of the home and this extends to their relatives who can attend meetings if they choose. People said that there were a number of activities on offer to help provide stimulation to people who live in the home, and people are provided with opportunities to carry out domestic tasks if they choose. The people we talked with said that the food supply was good in general. Staff training is detailed and extensive. The Registered Manager provides support to everyone to ensure there is a quality service, and quickly acts on issues that need to be changed. What has improved since the last inspection? Health and safety systems have been improved to reduce the risk of harm to people living in service. Staffing levels have improved so as to provide a more responsive service to people. The access and range of training available to staff has been improved to reflect the needs of people living at the home to ensure that the care people receive meets their needs. What the care home could do better: Peoples welfare could be more effectively met by ensuring that: All aspects of care e.g. proper toileting programmes, prevention of pressure sores etc are detailed in Care Plans to assist staff to meet all peoples needs. Toileting must be carried out to meet people`s needs so that they are not put at risk from lack of toileting with consequent risk to their dignity, and their skin. Peoples dignity needs to be promoted at all times. Management need to ensure that people`s wishes are always carried out, e.g. in relation to what time they wish to get up, or to follow their previous known preferences, if these are still relevant, for people with dementia. The Complaints Procedure needs to be clearer for people and their representatives so that complainants can go to the proper Lead Agency. Staff need to know the full abuse procedure so as to be able to protect people effectively. Odour control needs to be always in place and that accidents are tackled swiftly as they occur. The time that domestic staff work is limited, which means that care staff have to carry out domestic tasks, if they have time to do them, which is not guaranteed. Laundry arrangements must be in place to ensure that peoples clothing is kept to a good standard, which will help promote their dignity. Staffing levels need to increase this if the home is to provide proper individual care to people. All staff must be aware of the full fire procedure to be able to protect people in case of fire. Key inspection report Care homes for older people Name: Address: Saffron House 2a High Street Barwell Leicestershire LE9 8DQ     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: Keith Charlton     Date: 2 8 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Saffron House 2a High Street Barwell Leicestershire LE9 8DQ 01455842222 01455841222 saffronhouse@dsl.pipex.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Downing (Barwell) Limited Name of registered manager (if applicable) Miss Rebecca Woodley Type of registration: Number of places registered: care home 47 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 47 The registered person may provide the following category of service only, Care home Code PC, to service users of the following gender Either, Whose primary care needs on admission to the home are within the following categories, Dementia - Code DE, Old Age, not falling within any other category, Code OP Date of last inspection Brief description of the care home The last key inspection of the service was on 3/9/2009. Saffron House is a purpose built care home situated in the centre of Barwell, Leicestershire. It is registered for forty seven service users within the categories of old age, dementia and physical disability. The home is not registered to provide nursing care. The home is situated on two floors and these are accessed by a passenger lift. The home has a dining room and Care Homes for Older People Page 4 of 29 Over 65 0 47 47 0 2 2 1 2 2 0 0 9 Brief description of the care home lounge on each floor and a further five lounges throughout the home. The home has forty-two single bedrooms, which have ensuite facilities. Close to the home are a number of hotels and restaurants and is within close proximity of Mallory Park Race track and Market Bosworth. The home has a sensory garden for residents to enjoy at the back of the property and a circular walkway. The home has electric gates fitted to the exterior of the home for safety and to prevent intruders. The weekly fees are from #341 to #525 - this information was provided by the Manager on the day of the inspection. There are additional costs for individual expenditure such as hairdressing, toiletries, etc. A Statement of Purpose and Service Users Guide to the services the home offers can be supplied to applicants and the last Inspection Report is available in reception, to enable prospective residents to make an informed choice as to whether they wish to live at the home. Care Homes for Older People Page 5 of 29 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: The quality rating for this service is One Star. This means the people who use this service experience adequate quality outcomes. We, as it appears throughout the Inspection Report, refers to The Care Quality Commission. The inspection process consisted of pre-planning the inspection, which included reviewing the last Inspection Reports, the Annual Quality Assurance Assessment (AQAA), and other information we have received about the service. We have sent surveys to people who use the service and to with staff. We received nine surveys back from people and eight back from staff. Their comments are reflected in this Report. Care Homes for Older People Page 6 of 29 The unannounced site visit commenced on the 27th of May 2010 and was carried out by Keith Charlton. The focus of the inspection is based upon the outcomes for people who use the service. The method of inspection was case tracking. This involved identifying people with varying levels of care needs and looking at how these are being met by the staff at Saffron House. Three people who live in the service were selected. Discussions were held with seven people who use the service, two relatives, the Manager, a Community Nurse, the Responsible Individual and two members of staff. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Peoples welfare could be more effectively met by ensuring that: All aspects of care e.g. proper toileting programmes, prevention of pressure sores etc are detailed in Care Plans to assist staff to meet all peoples needs. Toileting must be carried out to meet peoples needs so that they are not put at risk from lack of toileting with consequent risk to their dignity, and their skin. Peoples dignity needs to be promoted at all times. Management need to ensure that peoples wishes are always carried out, e.g. in relation to what time they wish to get up, or to follow their previous known Care Homes for Older People Page 8 of 29 preferences, if these are still relevant, for people with dementia. The Complaints Procedure needs to be clearer for people and their representatives so that complainants can go to the proper Lead Agency. Staff need to know the full abuse procedure so as to be able to protect people effectively. Odour control needs to be always in place and that accidents are tackled swiftly as they occur. The time that domestic staff work is limited, which means that care staff have to carry out domestic tasks, if they have time to do them, which is not guaranteed. Laundry arrangements must be in place to ensure that peoples clothing is kept to a good standard, which will help promote their dignity. Staffing levels need to increase this if the home is to provide proper individual care to people. All staff must be aware of the full fire procedure to be able to protect people in case of fire. 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 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Saffron House have their needs generally well assessed before moving into the home, though this needs be strengthened to ensure all their care needs are fully met. Evidence: A relative confirmed that relevant information had been provided about the homes services and an assessment was carried out by the service. A person who lived in the home said, Yes, I was asked questions about myself so that they could care for me properly. Another person who lived in the home confirmed that she had been provided with sufficient written information about the home at the time of the admission to make up her mind about what services the home had to offer her. Care Homes for Older People Page 11 of 29 Evidence: We case tracked a person living in the home who had moved into Saffron House in the past. We also checked that this person had her needs properly assessed prior to moving in, to ensure that the staff at the home could meet her needs and we found that the assessment system had detailed information regarding peoples needs though some sections had not been acted on - e.g. past health checks had been included, which is useful to prompt these checks and improve the health and daily quality of life for people, but there was no information that the home had arranged these, if needed, to improve peoples health and welfare. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Saffron House receive adequate health and social care practice, which needs to be more thoroughly provided to meet all of the needs of people. Evidence: My mum has a care plan and I have been involved in setting this up and reviewing it every year, one relative said. People who use the service said they had a care plan and were invited to the review of the care plan. We checked the care plans of three people living at the home who were case tracked. Plans showed detail regarding the support provided by staff to ensure the physical health of people living at the home, and there was information to inform staff of some of peoples personal histories or preferred daily living routines, which ensures their social and emotional well being is fully supported. Changes in Care Plans were documented in monthly reviews of assessed need, but not always in the care plan itself, which needs to be done to ensure staff are following the correct plan. A care plan lacked detail as to how often someone needed to go to the toilet, and Care Homes for Older People Page 13 of 29 Evidence: whilst assessments of the potential of the likelihood of pressure sores occurring was assessed, there was no detailed information as to measures needed to be in place to prevent these. The Manager then amended the care plan we looked at, before the inspection was completed, though whether equipment was needed to prevent sores was not recorded. The Manager said this would be followed up. A care plan recorded that someone had poor eyesight, but it then did not follow up to state if the optician had visited or whether it would be feasible for the person to have glasses. Another care plan stated that the last dental visit was not known, but no follow-up information to see whether the person needed or wanted to have a dental check. This will not ensure peoples health and welfare of fully promoted. In some sections of the care plan there was good detail as to peoples individual preferences, for example, their preferred perfume, nail varnish, toothpaste etc, which promotes their individuality. A Community Nurse we spoke with said that in general staff were very good in terms of acting on peoples needs, contacting medical services when necessary, listening to her guidance and, in particular, palliative care was of a high standard. However, she had recently visited the home and found that only a small minority of people that needed regular toileting assistance as part of a proper individual continence programme to meet their needs had received this care. This meant that they wore incontinence pads when they did not need to. She had taken this up with the Manager, and thought the Manager had followed this important issue up to ensure staff meet the continence needs of people living in the home. Staff said they had read some, though not all, of the Care Plans - this is necessary so that they can fully understand and act on the needs of people who use the service. Accident records were checked and appropriate action had been taken by staff to protect the welfare of people who use the service. We checked the medication records, and found that there was generally good recording of the administration of the medicines in the home, though there were a small number of gaps. There was information on records as to how people liked to take their medication on their medication sheets, so that peoples preferences can be supported. Controlled medicines storage was in a secured cabinet which appeared to conform to the latest legal requirements. Staff were observed as being gentle and kind to people living in the home . We saw people who use the service were treated with respect in the way they were spoken Care Homes for Older People Page 14 of 29 Evidence: with by staff. There was one comment from a person who said that some staff ignore her, though the person did not want to give any more detail as to this behavior or put any names forward of the people in question so it could not be followed up in any detailed way. The Manager said she would try to progress this. We observed one person in bed with the door open to all passers by, in a state of undress which compromise this persons dignity. The Manager then wrote out an amendment to the care plan, as she said that the person did like the door open, and the door was then positioned so that it did not show that person to anyone who passed the room. The relatives we spoke with on the day confirmed that staff were very caring. One relative said that the Manager was very approachable and would always try to solve any queries you had,Care is second to none this person said. Both relatives said that they were involved with reviews, that medical assistance would be sought for their relatives when necessary, and that they thought the activities were good. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are opportunities for people at Saffron House to take part in activities and have a generally relaxed lifestyle, though management need to ensure that people can rise when they choose. Evidence: People who use the service said that in general the activities provided suited them. We have activities every day which is good. It would be nice if the staff had time to talk to us, one person said. People said that there were outings, and one person said she was able to go out whenever she wanted. There was one comment in a survey from the staff member, I feel that we would benefit from an extra person on activities. Staff said that there is a flexible routine, with individual and group activities. However we received information from Hinckley Social Services Department that one of their staff, an Occupational Therapist, had visited the home, which was coincidentally on the second day of the inspection, to observe staff practice and she had seen that approximately seven people on each floor had been got up by 6.30 in the morning, which does not suggest people are getting up at the time they choose. The Manager was contacted, and she said that this would be investigated as she has already Care Homes for Older People Page 16 of 29 Evidence: informed staff only to help people to get up when they want to do so. We saw a record of activities that individual people participated in, and we saw staff providing activities to people. The Manager said that she had tried to organise memory boxes of people and she had written to relatives to provide valuable personal material so this could take place, which will be useful for reminiscence work in one to one sessions with people with dementia, and we also saw that laminated sheets with comforting words on them displayed in corridors to provide stimulation for people who use the service. Staff said there were activities - playing ball, playing games, music and movement, watching TV, listening to music etc, and staff said they took people out to the garden in good weather, which people said had occurred. One person said that there was to be a vegetable garden, so he can still participate in gardening, which he loved. We saw the Activities Organiser providing activities for people, and we also saw other people being provided with materials to provide stimulation for them, such as a soft toy, colouring book, newspapers,lego etc. The Manager agreed that some of the soft toys needed to given to people to provide stimulation rather than just being kept in a small lounge. We saw the relations between staff and people who use the service were observed to be relaxed. The home supports residents with dementia and staff are provided with training on this issue to ensure they understand the symptoms of dementia and can effectively support people with this condition. Staff said visitors were always welcome and the relative spoken with on this visit confirmed that staff are welcoming and they thought the care the staff supplied was of a high standard. People said that food was good in general and there is a choice, and people who use the service can request an alternative if they wish. There was one comment on a survey which stated that better dinners were needed sometimes. The Manager said that there had been a change of kitchen personnel and the food was now of more consistent quality. On the day of inspection the meal was chicken pie with three vegetables and mashed potato, which was well cooked and tasty, and provided evidence of healthy eating options. Dessert was lacking in taste. The Manager said that this would be followed up. Care Homes for Older People Page 17 of 29 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. Complaints are taken seriously and there is a system in place to protect people who use the service from abuse at Saffron House, though this needs to be strengthened to ensure people are fully protected. Evidence: I would not be afraid of going to Becky (the Manager) with a complaint if I needed to as I am sure she would follow this up properly, one person who uses the service said. The Manager stated that staff have been trained in protecting people from abuse and we saw from records that this was the case. We spoke with staff and asked what they would do if it was reported that a member of staff had been seen abusing a resident. They were clear that this was unacceptable and needed to be reported to the Management though staff did not know how to contact all the relevant Agencies. The Manager said that this would be followed up so all staff knew the complete procedure they needed to follow. There have been a number of complaints since the last inspection. We found these to be recorded in detail and followed up appropriately by the Manager. The Complaint Procedure was seen but not found to be completely correct as is stated that the lead agency was the CQC and not the Adult Care Department. The Manager said this would be changed. Care Homes for Older People Page 18 of 29 Evidence: Staff were found to have proper checks to protect people from unsuitable staff. Care Homes for Older People Page 19 of 29 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. People living at Saffron House live in a generally homely environment, though management and staff need to be proactive in ensuring that there is an odour free environment and that any damaged furniture is dealt with immediately . Evidence: All people spoken with said they liked their bedrooms: I can have my bedroom the way I want it, and its comfortable , one person said. We saw people at Saffron House living in a maintained environment, though there were a number of comments that were unacceptable odours in the home. We noticed that there was a low-level odour to many communal areas, and that there was a strong odour to a ground floor lounge, where someone had an accident and it had not been cleared up straight away. The Manager then arranged for this carpet to be cleaned. There was a comment that it would help with odour control if laminate flooring could be installed. A relative told us in a survey that she sometimes found that her relatives bed had not been made by mid afternoon, and his toilet had not been flushed, the dining room sometimes looked very messy in the evening as there were things like crumbs and crisps on the floor, often she found the reception area looking messy in the evening with bins on top of a trolley, and chipped crockery needed replacing. Care Homes for Older People Page 20 of 29 Evidence: We also saw a badly damaged sofa in a ground floor lounge which had a large hole in one of the arms and there was other chairs which had small holes in them. The Manager then arranged for the sofa to be taken away, and she said she had already arranged for the whole home to be redecorated and new furniture was ordered, so that facilities would be improved in the near future. A relative commented that the lift was out of order at times and this needed to be replaced. The environment was signed to help people with dementia, e.g. signs on bathroom and toilet doors, though this could be extended to have pictures of peoples favourite scenes on bedroom doors etc to make facilities clearer for people to, and orientate people to go to their own bedrooms etc. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and generally meet peoples basic needs but that staffing levels mean that the stated aim of the home to provide individual care is not met. Evidence: Speaking to people, their relatives and the community nurse we found that there were many positive comments about the staff: Staff will go out there way to do anything for you, though you have to wait sometimes because they are really busy, one person said. However there was one remark that some staff have ignored a persons needs, though this person did not want to make a formal complaint and did not supply us with details as to when these incidents allegedly occurred. The Manager said she would follow up this comment as best she could. A relative in a survey stated that she wished all staff would be as professional as the administrator, as some staff who smoked sat down outside and this did not give a good impression. There has been an increase in staffing in the morning period since the last inspection though there was still comments on this inspection that staff could not provide individual one to one time to people as they did not have time to do this. It also needs to be borne in mind that the number of people accommodated has increased by five beds since the last key inspection. The homes literature states that personalised individual care is provided but it appears that this is not always the case. There are two night staff on each floor from 8.00pm to 7.00am, which considering the Care Homes for Older People Page 22 of 29 Evidence: dependency needs of people in the home may not be sufficient to meet their individual needs and preferences. The Community Nurses comments reinforce this picture in terms of people not having their toileting needs being fully met, which could be an indication that staff do not have enough time to carry out this essential personal care. Coupled with the information from the Occupational Therapist about people rising very early, this is also an indication that staff do not have time to observe peoples preferences and instead people are assisted to rise on a staggered basis in line with work demands. A staff member said that although she had only been working at the home for only just over a year, she had been encouraged by management to do the NVQ 2 course and had already completed a number of training courses and a thorough induction. We found that staff have been on a number of training events to help update their practice on areas such as Moving and Handling, Fire Safety, Infection Control, Dementia training, Challenging Behavior training, Mental Capacity Act training, falls prevention, caring for the dying person, individual choices, and training regarding peoples health conditions - e.g. Sight and Hearing Impairment, Stroke, Parkinsons Disease, Diabetes, etc. Staff records showed that proper checks had been carried out to protect people from unsuitable staff. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems are in place to protect the health and safety of people, but this needs to be strengthened regarding fire practices. Evidence: Rebecca Woodley is the Registered Manager and has Management qualifications in care. She is currently undertaking a course in providing care to people with dementia. People we spoke to praised Rebeccas management skills and said that she provides support to try to ensure that the best possible care is provided to people live in the home. She has been updating staff with extensive training training, and this was confirmed by the staff spoken with and the staff training matrix that we saw. There is a quality assurance system in place to measure peoples views of the service so as to be able to make improvements if needed. This did not have an action plan in place to ensure that peoples comments are taken forward. The Manager said that this Care Homes for Older People Page 24 of 29 Evidence: would be done in the future. Most of the comments were very positive but there were some comments regarding someone wanting more one to one time with staff, and a comment be kind, which the Manager is to follow up. Written records regarding finances for people were properly in place with two signatures to witness that transactions are correct. Monies were checked for two people and totals found to be correct. There was evidence of a recent Residents/Relatives Meetings discussing relevant issues - activities, food etc, which were detailed and comprehensive and showed that people are involved in the running of the home. The AQAA stated that people could be involved in the selection of new staff if they chose. This again showed that participation in the running of the home was encouraged by management. Risk Assessments for safe working practices were place though there was no risk assessment regarding the temperature of food, which on the day was hot and could have been uncomfortable for people to eat. The Manager said that this would be followed up. Staff informed us that they were able to tell management of the problems they were facing and there were regular meetings and supervision to support them. Supervision records were seen to evidence this. In previous inspections health and safety has been compromised by fire doors not being locked for cupboards, and bathrooms being used as storage areas, causing tripping hazards. This was not found to be the case on this inspection, so this had been rectified and the risk to people removed. Fire records were in place. Regular fire drills had taken place this year, though fire bells had not always been tested weekly. Staff were asked about the fire drill and one staff, when asked what she would do if she found a fire and could not locate Senior staff, did not state the necessity to ring the Fire Brigade. The Manager said that she would ensure that all staff knew the full file procedure. We tested the hot water which was found to be within the National Standard. Records showed hot water temperatures are regularly tested to protect people from scalding. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 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 7 15 Care plans must be fully detailed and carried out by staff. To ensure that peoples needs are always met. 27/06/2010 2 26 16 The home must be free of offensive odours. To ensure a homely and fresh environment for people who live in the home. 27/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 5 3 9 10 14 16 All health checks need to be assessed and acted upon. Medication recording should be complete so that it is certain people have received their prescribed medication. Peoples dignity needs to be protected at all times. People should be able to deceide what lifestyle they wish to follow. The Complaints Procedure needs to state the correct Lead Page 27 of 29 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 Agency that people can complain to. 6 7 8 18 19 27 All staff need to know the full safeguarding procedure. Furniture needs to be kept in good repair and quickly replaced when necessary. Staffing needs to be reviewed and increased as needed to provide more one to one time for people who live in the home, and domestic shift times expanded to cover for when there are accidents that need cleaning up. Staff need to be aware of the full fire procedure and tests of equipment carried out on a regular basis. 9 38 Care Homes for Older People Page 28 of 29 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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