Care Home: Sandylane Hotel

Similar services:

• Snydale Care Home
• Abbey The
• Larchfield Manor
• Hawkhills
• Beeches The - North Yorkshire County Council
• Carentan House
• Ravensworth Lodge

What the care home does well People are visited at home prior to their admission whenever this is possible and are invited to look around the home; this assists them with the decision making process. There are thorough care plans in place that are reviewed regularly. This means that staff are working with up to date information about the people they support. Senior staff sign to confirm that they have checked the content of the medication trolley at the beginning and end of each shift, and staff are well trained on the administration of medication. Blister packs stored in the medication trolley are clearly labelled and separated and including as required (PRN) medication. This provides a good check of how much PRN medication is being used by people living at the home. People are accompanied by staff to medical appointments (unless they request otherwise) and this helps with continuity of care and making people feel safe and secure. There is an activities coordinator employed at the home and this provides people with social activities, both as a group and on a one to one basis. The complaints procedure is displayed around the home and is adhered to when any complaints are made to the home. People are told of the outcome of any complaints or concerns. People are supported to keep in touch with family and friends through visits to the home, contact by telephone and now via the Internet. There are sufficient staff on duty to meet the needs of the people living at the home. National Vocational Qualification (NVQ) Level 2 in Care achievement by staff is good and some staff are continuing with training to achieve NVQ Level 3 in Care. This results in a well qualified staff group. There are effective quality assurance systems in place at the home and these allow people to affect the way in which the home is operated. Service user monies are handled safely and people have a storage facility in their room to enable them to store money and valuables safely. The home is well managed and there are clear lines of accountability within the home. What has improved since the last inspection? Sit-on scales have been purchased so that people with mobility problems can be weighed as part of nutritional screening. What the care home could do better: A full care needs assessment must be undertaken and recorded at the time a person is admitted to the home. This information, along with information obtained from other people, should then be used to develop an individual plan of care. Medication administration record (MAR) sheets must only be signed when the person has been seen to take their medication, not when it is taken out of blister packs. The amount of medication received from the pharmacist should be recorded on the MAR sheet and codes recorded on the MAR sheet should be used consistently. Staff recruitment and selection must be more robust. There must be a record of a person`s start date, the date that their induction training starts and ends, details of the supervision arrangements in place whilst waiting for Criminal Records Bureau (CRB) clearance and the date that they work unsupervised on shift for the first time. This is to ensure that all safety checks are in place before people work unsupervised with service users. Fire drills should take place consistently i.e. as recorded in the home`s fire risk assessment. This is needed to ensure that people know what action to take in the event of a fire. A receipt should be given to anyone who hands money to the home for safe keeping, to protect all parties concerned. When equipment or systems have been serviced, the home should obtain evidence at the time that this work has been undertaken. There must be a training and development plan in place that records the training achievements and needs for the full staff group; this would help to highlight any gaps in training and when refresher training is due. There should be evidence of the training staff have undertaken on safeguarding adults from abuse. Key inspection report Care homes for older people Name: Address: Sandylane Hotel 33 Sands Lane Bridlington East Yorkshire YO15 2JG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Wilkinson     Date: 0 2 1 0 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 31 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 31 Information about the care home Name of care home: Address: Sandylane Hotel 33 Sands Lane Bridlington East Yorkshire YO15 2JG 01262403037 01262403067 sandylaneandregent@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sandylane Ltd care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Sandylane Hotel is a purpose built, privately owned care home that is close to the sea front in Bridlington, in the East Riding of Yorkshire; some lounge areas and bedrooms have sea views. The home is registered to provide care and accommodation for 31 older people, including those with dementia related conditions. Accommodation is provided over three floors and a passenger lift goes to all floors so that all areas of the home are accessible to the people who live there. All bedrooms are single and have en-suite facilities. Commmunal space consists of three lounges and two dining rooms, and there are additional seating areas that can be used for activities and meetings. Information about the home is recorded in the homes statement of purpose and service users guide and these are available from the manager. Care Homes for Older People Page 4 of 31 Over 65 31 31 0 0 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Inspection of the home on the 6th October 2006, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day. It began at 10:45 am and ended at 5:45 pm. On the day of the site visit the inspector spoke on a one to one basis with four people living at the home, members of care staff, the administrator and the manager. Inspection of the premises and close examination of a range of documentation, incuding four care plans, were also undertaken. The manager submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Care Homes for Older People Page 5 of 31 As part of the inspection process we sent survey forms to some residents and staff; eight were returned from people living at the home and nine were returned by staff. Responses in surveys and comments from discussions on the day of the site visit were mainly positive, for example, everyone very helpful and all management are approachable and are willing to give advice and guidance. Other anonymised comments are included throughout the report. At the end of this site visit, feedback was given to the manager on our findings, including requirements and recommendations that would be made in the key inspection report. The manager told us the the current fee for residential care is from £362.04 to £575.00 per week. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: A full care needs assessment must be undertaken and recorded at the time a person is Care Homes for Older People Page 7 of 31 admitted to the home. This information, along with information obtained from other people, should then be used to develop an individual plan of care. Medication administration record (MAR) sheets must only be signed when the person has been seen to take their medication, not when it is taken out of blister packs. The amount of medication received from the pharmacist should be recorded on the MAR sheet and codes recorded on the MAR sheet should be used consistently. Staff recruitment and selection must be more robust. There must be a record of a persons start date, the date that their induction training starts and ends, details of the supervision arrangements in place whilst waiting for Criminal Records Bureau (CRB) clearance and the date that they work unsupervised on shift for the first time. This is to ensure that all safety checks are in place before people work unsupervised with service users. Fire drills should take place consistently i.e. as recorded in the homes fire risk assessment. This is needed to ensure that people know what action to take in the event of a fire. A receipt should be given to anyone who hands money to the home for safe keeping, to protect all parties concerned. When equipment or systems have been serviced, the home should obtain evidence at the time that this work has been undertaken. There must be a training and development plan in place that records the training achievements and needs for the full staff group; this would help to highlight any gaps in training and when refresher training is due. There should be evidence of the training staff have undertaken on safeguarding adults from abuse. 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 8 of 31 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 9 of 31 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. We looked at Standard 3. Standard 6 was not assessed as there is no intermediate care provision at the home. People have their care needs assessed prior to their admission and they (or a representative) are invited to look around the home. However, the information gathered at the time of assessment is not always recorded so cannot be referred to at a later date. Evidence: All of the people that returned a survey told us that they received enough information about the home before they moved in. One person added, while in hospital my wife talked to people, then visited three residential homes and then selected Sandylane Hotel. She was well received and shown round. The manager then visited me in hospital. Care Homes for Older People Page 10 of 31 Evidence: When a placement is commissioned by the local authority the home has obtained a copy of the community care assessment and care plan for the person concerned. Although the manager visits people prior to their admission to undertake an assessment of their care needs, this assessment is not always recorded. The manager told us that some of the people recently admitted to the home were admitted in emergency situations. We saw the records for someone recently admitted to the home and noted that this person had a full care plan in place but there is no recorded care needs assessment. We advised the manager that information gathered at the time of assessment should be recorded and that this information, along with information obtained from other people, should be used to make a decision about the persons suitability for admission, including if their needs can be met by staff working at the home. If a decision is made that a persons care needs can be met, the information is then used to develop an individual plan of care. Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a plan of care in place that is thorough and kept up to date; this ensures that people receive the care they need and that their health care needs are met. However, some medication practices need to improve to protect people from the risk of harm. Evidence: All of the records that we examined on the day of the site visit for people living at the home included an individual plan of care. These include one section on general social care and another section on personal care and are a thorough record of how care should be provided by staff to ensure that a persons needs are met. There is a record of short term and long term goals in place as well as risk assessments for moving and handling and mobility; these include information about the risk of falls. A daily evaluation sheet is completed for each person living at the home - this has a tick box section that records tasks that have been carried out each day such as assistance with bathing, dressing etc. plus another section where staff write information about any visitors seen, any contact with health care professionals and Care Homes for Older People Page 12 of 31 Evidence: food and fluid intake. Care records include a monthly review of the care plan; the home call this document a monthly case study. This document is signed by the manager to evidence that she is monitoring care records and then attached to the daily evaluation sheets for that month. This creates a clear audit trail for anyone checking care records and results in up to date information being available for staff. Nine staff returned a survey and when asked if they are always given up to date information about the needs of the people living at the home, eight said always and one said usually. Most care records include a photograph of the person concerned; a photograph is needed to assist new staff with identification and to help the emergency services should someone go missing from the home. Only care records for people recently admitted under emergency situations were waiting to have a photograph added. People had signed a document to record their agreement to their plan of care; this had been signed by a relative when people did not have the capacity to sign themselves. Eight people living at the home returned a survey and they all told us that they receive the care and support that they need. One person added, everyone very helpful. Care records include various risk assessment tools including those for nutrition and pressure care. We noted that there were risk assessments in place for the use of bed rails. We advised the manager to check the information suppled by the Medicines and Healthcare Regulatory Agency (MHRA) about the safe use of bedrails to ensure that they were working with the latest guidance and we were assured that this guidance is being used. There is a person centred continence assessment in use and following completion, people are provided with any continence equipment they require. There is also a pressure sore risk assessment in use and we saw that people had been provided with equipment to alleviate the risk of pressure sores developing if this had been identified as an area of risk. Body maps are used as part of the risk assessment process. There are records in place for any contacts with health care professionals and these evidence that people sometimes visit the GPs surgery as well as the GP being asked to visit the home. These records included information about the need for the contact and the outcome. The manager recorded in the AQAA that people are always accompanied by staff to medical appointments, unless they request otherwise. Medication is stored securely - there is a separate medication cupboard and the trolley Care Homes for Older People Page 13 of 31 Evidence: is locked in the cupboard when not in use. There is a medications fridge in use and we saw that the temperature was taken and recorded on a daily basis to ensure that medication is stored at the correct temperature. There is also a suitable cabinet in use for the storage of controlled drugs. Medication is supplied to the home in blister packs and these are stored in the medication trolley; these are colour coded to identify the time that medication should be administered. In addition to this, people who are prescribed a lot of medication throughout the day have a separate blister pack ring binder to store all of their medication for the day. We noted that the pharmacist supplies as required (PRN) medication in blister packs and this reduces the number of separate boxes that are supplied every month and provides a good record of the amount of PRN medication being taken by each individual. This is good practice. We observed the administration of medication and noted that tablets were transferred from blister packs into a small pot and that people were provided with a drink so that they could take their medication. The member of staff administering medication signed medication administration records (MAR) prior to ensuring that the person had actually taken their medication and we noted that, on occasions, a different code is used (/) instead of the code that should be used (R) for any medication that is refused; this could cause confusion for staff administering medication. Any handwritten entries on MAR sheets are signed by two members of staff to promote accuracy but we noted that, for people having respite care at the home, staff do not count the number of tablets that they bring into the home with them. In turn, this means that staff do not have an accurate record of the number of tablets that people should take home with them; this information must be included on the MAR sheet. Also, staff should check the amount of medication supplied each month by the pharmacist and enter this on the MAR sheet - this is needed to check that the medication supplied by the pharmacist each month is accurate. The manager told us that only senior staff are responsible for the administration of medication and they have all achieved NVQ Level 2 in Care, and that most are working towards Level 3 in Care. In addition to this, staff have undertaken distance learning training entitled Safe Handling of Medicines. The manager told us that, when staff first become senior carers and have received medications training, they work alongside an experience senior carer or manager so that their practice can be observed; this includes confirming that they are competent to administer medication. There is a checklist called drug trolley check that is signed by the senior member of Care Homes for Older People Page 14 of 31 Evidence: staff on duty when they start and finish their shift to record that the contents of the medication trolley have been checked. Some people at the home are prescribed Temazepam; this is provided by the homes pharmacist in blister packs or in separate packaging, depending on whether this is prescribed for daily use or as PRN. The manager told us that the pharmacist has told them that they do not need to store Temazepam in a controlled drugs cabinet and do not need the signatures of two staff when administering the drug. We advised the manager that Temazepam must be stored as a controlled drug and that it would be considered to be good practice to treat this medication as a controlled drug; the manager contacted us a short time later to confirm that this had been actioned. We observed on the day of the site visit that staff respect a persons privacy and dignity by using their preferred name and by knocking on doors before entering bedrooms, bathrooms and toilets. There is a sign to be used on each bedroom door that records Care in progress - knock before entering. A member of staff told us in a survey, Sandylane does not allow any discrimination of any kind and service users rights and preferences are adhered to. In most instances (but not all) we noted that staff spoke to people discreetly and sensitively when discussing care issues; staff need to take more care when discussing private information with people to ensure that it is not overheard by others. We also observed an inappropriate comment in a persons daily care notes. This was discussed with the manager who agreed to talk to staff about the need to ensure that comments written in care records are respectful. People are accommodated in single rooms so they are able to see visitors and health care professionals in private. We noted that some people have had a telephone installed in their bedroom; this allows them to keep in touch with people independently and in private. When asked in a survey if staff listened to them and acted on what they said, five people responded always and three people said usually. One person added, after a discussion!. Care Homes for Older People Page 15 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home where routines around activities, visitors and meal provision are flexible and where they are encouraged to be as independent as possible. People recieve a choice of meal at each lunch time and tell us that they are happy with meals provided by the home. Evidence: Information about a persons previous lifestyle and their hobbies and interests is recorded in care plans; leisure activities provided at the home take these into consideration. We observed on the day of the site visit that routines of daily living and activities are flexible; people can choose where and with who to spend their day. Some people spend most of the day in their room and go to the dining room for their meals and others spend their time in one of the lounge areas. There are several lounge areas at the home and most have about 10 chairs; this allows people to socialise in small groups rather than having one large lounge where everyone sits together, and people told us that they liked this aspect of the home. There is a pay phone in a booth in the entrance hall for people to use, and some people have had a telephone installed in their bedroom. In addition to this, the manager told us that people living at the home now have Internet access. These Care Homes for Older People Page 16 of 31 Evidence: arrangements enable people to keep in touch with family and friends. An activities coordinator is employed at the home and they keep their own record of activities undertaken by people living at the home, both as a group or one to one. Daily records completed by care staff also record any activities undertaken by people, including visits out of the home and any visitors seen. A mobile library visits the home and some people told us that they used this service as they enjoy reading. A hairdresser also visits the home on a regular basis. We saw notices advertising a singer who visits the home on a monthly basis. People told us that their visitors are made welcome at the home and that some people visit their relative almost daily. We saw that visitors were in and out of the home throughout the day and that some people were taken out by relatives and friends. One person went out into the town in a taxi. Information about Advocacy services, funding arrangements for residential care and other publications are displayed in the entrance hall in a display system. This enables people to obtain appropriate information independently and promotes privacy. We noted that people are able to bring personal possessions into the home (including small items of furniture) and that bedrooms had been personalised to reflect the persons interests and lifestyle. We noted that some people eat in one of the dining rooms but that other people eat in their own room, depending on their preference. We observed the serving of lunch in one of the dining rooms. There was a three course lunch being served and this was recorded on a daily menu that is displayed on each dining table. In addition to the daily menu, there was also a weekly menu on display. In returned surveys some people commented that meal provision could be improved, for example, food could be a little warmer. However, the people that we spoke to on the day of the site visit all told us that they were happy with the meals provided at the home and that there is always a choice of meal on offer. People commented that they would be provided with a drink if they were awake and unsettled during the night. We saw that people were offered appropriate assistance with eating and drinking and that the meal time was a social occasion when people enjoyed a chat and each others company. Care Homes for Older People Page 17 of 31 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 is a complaints procedure in place and this evidences that any complaints made by people living at the home are investigated throughly and that action is taken to deal with any concerns raised. Staff have had some training on safeguarding adults from abuse but there needs to be records held at the home to evidence this. Evidence: Eight people living at the home returned a survey and they all told us that there is someone they can speak to if they are not happy. Six people told us that they know how to make a formal complaint but two people said that they didnt. Nine staff returned a survey to the CQC and they all told us that they know what to do if someone has concerns about the home. There is information displayed around the home about the complaints procedure and how to make a complaint. We examined the complaints log and saw that there were three complaints made by people living at the home during the last year. The log recorded information about the complaint, the investigation undertaken and the outcome; in some instances this included giving feedback to the complainaint. There was evidence that meetings had been held with individual members of staff or staff groups to discuss issues raised during the investigation process. Training records evidence that there has been little specific training on safeguarding adults from abuse. However, some staff have achieved National Vocational Care Homes for Older People Page 18 of 31 Evidence: Qualification (NVQ) awards at Level 2 and 3 in Care and abuse is a topic covered on these training programmes. The manager told us that there has been discussion in staff meetings on this topic and that there is information about the homes adult protection policy in the staff handbook; all staff are given a copy. The manager has undertaken training at Level 1 and 2 and further training is planned for the staff group in the near future. Care staff have undertaken training on challenging behaviour and dementia care. One safeguarding alert has been sent to the local authority by the home during the last year. This was investigated by Social Services staff and the outcome was no further action. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and hygienic and provides people with a homely and comfortable place to live. Evidence: The home is purpose-built - accommodation is located over three floors and some of the lounges and bedrooms have sea views. There are various lounge areas available and this gives people a choice about where to spend their day and provides private areas for meeting with family, friends and health care professionals. The home is decorated and furnished in a comfortable and homely way. On the day of the site visit we saw that the grounds were overgrown but there was a gardener at the home tidying up the garden. There is a CCTV camera in use but it is restricted to the entrance area of the home so does not compromise privacy. A handyman is employed at the home and we saw that the premises were well maintained. The plans for maintenance are recorded in the homes business plan. We saw the laundry facilities at the home and noted that they were satisfactory. The manager told us in the AQAA form that seventeen staff have undertaken training on Care Homes for Older People Page 20 of 31 Evidence: the control of infection and we saw that staff followed good hygiene practices on the day of the site visit. Disinfecting gel is available throughout the home. The home was clean and hygienic on the day of the site visit and we saw that a test had taken place to detect the presence of Legionella in the water supply; this was negative. Care Homes for Older People Page 21 of 31 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. There are sufficient qualified staff on duty to meet the needs of the people living at the home but recruitment practices and staff training need to be more robust to promote the safety of people living at the home. Evidence: There is a staff rota in place that evidences that there are sufficient staff on duty to meet the needs of the people living at the home. We observed on the day of the site visit that the staff recorded on the rota were actually on duty. The staff rota records ancillary staff in addition to care staff, and each persons role is recorded. Training records seen on the day of the site visit and information recorded in the AQAA evidence that over 50 of staff have achieved NVQ Level 2 in Care and that some staff are continuing with training by working towards NVQ Level 3 in Care. We examined the recruitment records for four members of staff. These included an application form that recoded a persons employment history, the names of two referees, education and training and a criminal record declaration. Two written references and a Protection of Vulnerable Adults (POVA) first check are obtained prior to a new employee commencing work at the home and in some instances, a Criminal Records Bureau (CRB) check has been received prior to the person commencing work. The manager was reminded that POVA first checks should only be used in exceptional Care Homes for Older People Page 22 of 31 Evidence: circumstances, not routinely. However, some dates are not recorded clearly in staff records and this makes it difficult to be absolutely certain that all safety checks are in place prior to someone commencing work at the home. There is no record of the supervision arrangement in place for new staff who have commenced work following receipt of a POVA first check but waiting for CRB clearance. The manager was advised that they should record the date a persons POVA first check is received, the date they start and finish their induction training and the date they work unsupervised on the staff rota. In addition to this, there should be a record of the supervision arrangments in place whilst the home is waiting for CRB clearance to be received. Induction training is recorded in some staff records but not all and it is not clear what date this commenced and what date it was completed. There is no training and development plan in place but there are individual records in place for each member of staff recording their training achievements. This evidences that staff that have worked at the home for a number of years have had refresher training on some topics. We noted that one carer had not undertaken training on moving and handling or infection control, and that one domestic assistant had not undertaken training on infection control; these were staff members who had only worked at the home for a few months. Staff should have training on these topics very soon after commencing work at the home, or as part of their induction training. All other staff had completed training on these topics. Some staff need refresher training on topics such as moving and handling and dementia care. The manager was advised that there must be a training and development plan in place for the whole staff group. This would enable her to easily identify which staff have not had training on health and safety topics and which staff are due for refresher training. Care Homes for Older People Page 23 of 31 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. The home is managed by a experienced and skilled person who uses a quality assurance system that gives people the opportunity to affect the way in which the home is operated, and who ensures that money belonging to people living at the home is held safely. However, some improvements are needed to health and safety records to evidence that people are fully protected from harm. Evidence: The manager has the experience and skills to manage the home and is in the process of applying to the Care Quality Commission for registration. Prior to being appointed as the manager, she had been the deputy manager at the home for a year. She keeps her practice up to date by attending training sessions with the staff group and has recently attended training on the safe handling of medicines. Discussion with the manager and observation on the day of the site visit evidence that there are clear lines of accountability within the home. A member of staff told us in a survey, all management are approachable and are willing to give advice and guidance. Care Homes for Older People Page 24 of 31 Evidence: The home previously had a quality rating of excellent. Because they key inspection of the home raised some concerns about the administration of medication, staff training and the initial assessments of people who have expressed an interest in being admitted to the home, and the manager is not yet registered with the Care Quality Commission, the quality rating had been changed to good. We are confident that the home still provides good care for the people who live there. The home has achieved QDS (a local authoritys quality assurance scheme) parts 1 and 2 and has achieved the Investors in People award. We examined quality assurance documentation on the day of the site visit and saw that regular meetings take place for staff and for people living at the home. Surveys are distributed to people living at the home, staff and family members on a six monthly basis. The returned information is collated and the manager told us that the outcome is reported in the homes monthly newsletter. The manager undertakes monthly audits of systems in place at the home. These include audits of the fire book, care plans, water and fridge temperatures, service user reviews and the complaints book. This is good practice. In addition to this, information about quality is included in the homes business plan and the registered provider makes unannounced visits to the home and records details of their findings. We examined a sample of monies held on behalf of people living at the home and associated records; these were found to be accurate. Receipts are obtained for any expenditure made on behalf of people and we recommended that a receipt be given to relatives or friends when they hand money over for safe keeping. The administrator told us that a copy of the financial transaction form is sent to relatives as evidence of expenditure whenever they request more personal allowance for the person concerned. This is good practice. People have a lockable storage facility in their bedroom to enable them to store valuables and money safely. We examined some of the health and safety documentation in place at the home. All accidents are recorded and the manager monitors entries made in the accident book. There is a fire risk assessment in place and the fire book evidences that weekly inhouse fire tests take place. The home have identified that fire drills should take place every three months but these are not being undertaken consistently. The most recent fire drill took place in April 2009 and was overdue - the manager told us that one was arranged for 5/10/09. The administrator told us that the fire alarm system had been checked in September 2009 but there was no evidence of this at the home. A Care Homes for Older People Page 25 of 31 Evidence: telephone call was made to the contractor on the day of the site visit and they confirmed that the test had taken place. There is a a current electrical installation certificate and lifts and hoists have been serviced. The central heating was serviced in September 2009 but the gas safety certificate for some appliances was out of date. The administrator informed us that this equipment had been serviced in August 2009 but they had not yet received the certificate from the contractor. The manager must make sure that they receive evidence that equipment and services have been serviced at the time the work is undertaken. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 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 A full care needs assessment 20/11/2009 must be undertaken for each person who is interested in moving into the home before admission is agreed to. This is needed so that a decision can be made about whether the persons needs can be met and that the home is the right place for them before admission is agreed to. 2 9 13 Medication administration 20/11/2009 records must be completed accurately; records must only be signed when people have been seen to take their medication and the number of tablets received by the home and returned to a person (in the case of respite care) must be recorded. Care Homes for Older People Page 28 of 31 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 This is to ensure that people receive the medication that is prescribed to them to maintain good health. 3 29 19 Staff records must be clear - 20/11/2009 there must be a record of a persons start date, the date their POVA first check and CRB check were received and the date of their first shift on the rota unsupervised. This is needed to evidence that all safety checks are in place prior to a person commencing work at the home. This protects people from the risk of harm. 4 30 18 There must be a training and development plan in place that records a staff members training needs and training achievements, including the date the started and ended their induction training. This would provide an overview of the skills of the staff group, any gaps in training and the need for refresher training and would evidence that staff have the skills needed to support the people living at the home. 20/11/2009 Care Homes for Older People Page 29 of 31 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 9 9 It is considered to be good practice to treat Temazepam as a controlled drug. The code recorded on the MAR sheet to be used when medication is not given should be used consistently by staff when completing MAR sheets; using alternative codes could cause confusion. Staff should take more care when discussing personal information with people living at the home to ensure that they are not overheard by others. There should be a record of the training that staff have received on safeguarding adults from abuse so that the manager is able to evidence that staff have the knowledge needed to recognise poor practice and would know what to do should an incident occur. Protection of Vulnerable Adult (POVA) first checks should only be used as part of the recruitment and selection process in exceptional circumstances, not routinely. The manager should continue with plans to be registered with the Care Quality Commission. People who hand money to the home for safe keeping on behalf of people who live there should be given a receipt. Fire drills should take place consistently at intervals recorded in the homes Fire Risk Assessment. The manager should ensure that evidence of maintenance or service checks on equipment and systems is received at the time the work is undertaken. 3 10 4 18 5 29 6 7 8 9 31 35 38 38 Care Homes for Older People Page 30 of 31 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. 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. Care Homes for Older People Page 31 of 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!