Care Home: Sheldon House

What the care home does well People who use the service and their representatives told us during discussion at the inspection and within surveys that `they have time for everyone in this home even making visitors very welcome`, `it is like one big happy family`, `all the residents are treated the same no matter what their disability is`, `carers are friendly and interact well with residents` and `my husband has been in Sheldon for four years and the staff and carers have been wonderful and to me when I get upset at seeing him helpless`. We asked staff in surveys what the home does well and were told `caring for residents and meeting their needs, supporting the families through difficult times`, `good food and residents can have what they want 24 hours a day`, `look after everyone including staff` and `make sure the service users needs come first`. What has improved since the last inspection? The last inspection report identified seven requirements relating to care planning, privacy and dignity of service users, complaints recording, hygiene standards, safe storage of valuables, supervision of staff and health and safety of service users. At this inspection we evidenced that these have all been met. Work has progressed to ensure that care planning documentation is up to date and reflects the individual needs of service users. A programme of refurbishment and decoration has been undertaken within the home. Service users are provided with a nutritious and wholesome diet that is supplemented with additional snacks throughout the day. Staff have access to the kitchen at all times of the 24 hour period so that service users can be provided with diet and fluid when required. What the care home could do better: Care planning should consistently direct and inform staff of the action they must take to meet peoples assessed personal care needs. Daily records should be developed to include full information on how the person spent their day. MAR sheets should consistently identify the service user by including a photograph. Infection control within the home should be improved by ensuring the floor and walls of the laundry are impermeable. Also we observed that water is pooling behind the washing machines in the laundry and this must be addressed. It is recommended that the system for assisting service users with their meals be reviewed to ensure staff have sufficient time to help individuals fully. Key inspection report Care homes for older people Name: Address: Sheldon House Sea View Road Falmouth Cornwall TR11 4EF     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: Melanie Hutton     Date: 2 2 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Sheldon House Sea View Road Falmouth Cornwall TR11 4EF 01326313411 01326317902 sheldon@comfortcaregroup.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Anne Louise Libby,Mr Charles Barry Libby,Mr Darren Libby Name of registered manager (if applicable) Type of registration: Number of places registered: care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Sheldon House is a long established care home and is registered to provide nursing care for up to 34 people who experience dementia or enduring mental illness who are over the age of sixty-five years of age. The current owners have run the home since November 2000. The accommodation is a former hotel that was initially converted around 1994 and since then has undergone further structural changes. It is located on a quiet residential road close to the town and beaches of Falmouth. It is easily accessible on foot and by transport from the town, this results in frequent visits to the home by relatives and friends. There is a car park at the front of the home and an attractive garden area. The accommodation is provided over three floors and is Care Homes for Older People Page 4 of 29 Over 65 34 34 0 0 0 2 0 6 2 0 0 9 Brief description of the care home accessible to people who experience a disability by a shaft lift. The building is not the best design to provide the care and support required by residents. The layout does not easily lend itself to meeting the needs of residents. However, there is limited scope to improve this within the existing building. The bedrooms are for both single and shared occupancy. There are three communal areas provided on the ground floor. One of these areas is used as a dining room. There is a garden to the rear of the home, which is accessible to residents through the lounge. Fees charged for the service range from 530 to 950 pounds per week. 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: 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 was an unannounced key inspection that was undertaken by two inspectors spending a total of 15 hours at the care home. We looked at records, care documentation, policies and procedures and inspected the environment. As part of the inspection we spent time talking with staff, service users and visitors - including visiting professionals, to the home. We also spent a period of time observing the interactions with staff, service users and visitors in the lounge area. We sent out surveys to service user and their relatives and staff prior to the inspection to seek their views of the service provided. We have received 5 completed surveys from the staff and 3 from service users and their representatives. An annual quality assurance assessments (AQAA) was sent to the registered provider prior to the inspection and returned informing us of the services provided within the home and any changes that have been made since the last inspection. Care Homes for Older People Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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 Care Homes for Older People Page 7 of 29 order line 0870 240 7535. Care Homes for Older People Page 8 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 9 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 who use the service are provided with detailed information to help them and / or their representative make an informed choice about the care service. The care needs of prospective service users are assessed prior to moving into the home to ensure that the service provided will meet their needs. Evidence: The statement of purpose and service users guide have been updated and are available to people who use the service and their representatives. We were able to access the documents on the day of inspection and evidenced that they provide detailed information so that people can make an informed choice about the service. The annual quality assurance assessment, completed by the manager, informed us that a simpler and shorter format is to be developed to give information to service users who may find the documentation difficult to read and / or understand. It is planned that this will include visual aids e.g. photographs of the rooms, menus and staff. We also discussed other formats in which the documents could be produced e.g. Care Homes for Older People Page 10 of 29 Evidence: large print or audio / video options. The registered person obtains information from the referring or commissioning body regarding the care needs of prospective service users, whenever possible. A care needs assessment is undertaken pre admission and also on admission to ensure that the home is able to meet the identified care needs. These assessments are generally undertaken by either the manager or one of the qualified nurses. The qualified nursing staff act as key workers for each resident and also participate in the assessment process. The pre admission assessments are undertaken with the prospective resident e.g. at home, hospital and representatives e.g. relatives / friends are invited to be part of the assessment process if that is the service users wish. We were informed by the registered provider that great effort is made to ensure that the care home can meet the needs of prospective service users and visits have been made out of county to conduct a care needs assessment. Care Homes for Older People Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are informed and guided of the action they must take to meet peoples assessed care needs within the individual care plans. The medication systems in place protect people who use the service. People who use the service are treated with respect. Evidence: Since the last inspection the care plans have been reviewed and developed and provide detailed guidance for staff on the action they must take to meet service users care needs. The exception to this is within the care plans relating to personal care, as some care plans we inspected do not provide such specific information of the action staff must take to meet peoples assessed care needs. Care plans evidenced that information from the risk assessments is included and staff are provided with instruction on the action they must take to reduce the risk. Separate moving and handling risk assessments are in place for people who use the service. The staff record the care they have provided using a coded system and additional narrative report. Whilst all of the daily records we inspected were legible, detailed and signed and dated, they varied in detail and some were brief and reflected only upon the service Care Homes for Older People Page 12 of 29 Evidence: users mood. We sent surveys out to service users and or their relatives before the inspection and asked if they always received the care and support they need. Two people said that they always did and one person that they usually did. People also told us that staff were always or usually available when they needed them and said that they always or usually listened to them and acted on what they said. Detailed records are held regarding the involvement of external professionals e.g. general practitioners, district nurse and community psychiatric nurses. We were able to see that the dentist, optician and chiropodist visit when necessary. We had a discussion with a visiting professional to the home on the day of inspection and they were positive in their comments about the care provided by the home. We asked people in surveys if the home makes sure they get the medical attention they need. Two people said that they always did and one that they they usually did. Continence assessments have been completed for the service users who need support with this and the care plans are directive and informative about the care people need. Pressure relieving equipment is in use when necessary and reflected in individual care plans. The manager told us that there are currently no service users suffering with pressure sores at the current time. Detailed nutritional assessments are in place for each service user and we observed people being given additional support and supplements to their diets. Food charts are completed if there are any concerns with the nutritional or fluid intake of any individual service user. A qualified nurse administers all medication using a monitored dosage system. Medication administration records (MAR) were inspected and were observed to be completed appropriately, evidencing why and when any medication has been omitted as well as administered. We observed the morning medication round during the inspection which was conducted by one of the trained nurses on duty. It is recommended that the MAR sheets consistently identify a photograph of the service user - some of these appear to be missing. Medications leaving the home e.g. those that are returned to the pharmacy are recorded. A policy and procedure is in place regarding medication to guide and inform staff. An audit of the controlled drugs showed that they are stored and recorded appropriately. Lockable facilities are available in service users bedrooms should they be able to administer their medication, currently nobody self administers their medication. The lockable cupboards are also used by staff to safely store creams and lotions belonging to individual service users. The staff were observed to treat service users with respect and promote their dignity. We saw staff knocking on doors prior to entering bedrooms and bathrooms. We heard staff using preferred names of service users. A relative visiting the home during the inspection, told us that the staff are excellent Care Homes for Older People Page 13 of 29 Evidence: and very supportive, kind and caring both to him and to his relative. A tool has been developed to evidence the choices made by service users regarding sharing double rooms, preferred gender of carer and preference of bathing or showering. These were not always signed by the service user or their representative but completed by staff. Double rooms provide screening to respect the privacy of the occupants. There are currently no service users from ethnic minorities, although it is understood the home would be able to accommodate people from other cultures. Care Homes for Older People Page 14 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. Service users are offered a varied programme of activities that is currently being developed. Visitors are welcome in the home at a time convenient to them and the resident. Service users receive a wholesome and appealing balanced diet. Evidence: The home employs two activities co-ordinators, one of whom spoke with us during the inspection and discussed the planned programme of activities with us. Most of the service users individual records show a detailed life history, including information of previous occupations, likes and dislikes and family history, that the activity coordinators refer to. We were told this helps them to plan meaningful activities for individuals. We were not able to see life histories on a minority of service users records, we were told by the registered provider that this is due to the length of time taken, to gather this information from relatives. A range of activities are available to service users including arts, crafts, board games, skittles and ball games. One to one time is also provided that may include manicures, hand massage, reading to residents or chatting with them. Records are made of the participation of the service user and some comment made regarding their perceived enjoyment of the activity. Some records showed that some individuals only participate in an activity once a week. On Care Homes for Older People Page 15 of 29 Evidence: discussion with the manager and activity co-ordinator it was thought that this is not an accurate record as staff spend more time with individuals than this. The activities co-ordinator told us that service users have been involved in planning the development of the garden and will, if wished, be included in planting seeds and plants later in the year. We asked people in a survey if there are activities arranged that they can take part in if they want to. Two said always and 1 person said there usually are. An additional comment was made by a relative that they would like to see more activities for the residents e.g. exercises, dancing and taking the residents out to the garden. The manager told us that the activities programme is being developed and will include outings for service users in the future. Activities are also due to be discussed at the forthcoming residents and relatives / representatives meeting. Visitors are able to visit the home at any time, information about this is included in the service users guide. The visitors book shows that the home receives many visitors at varied times of the day. Visitors attending the home on the day of inspection were observed to be greeted warmly by staff. We were able to speak with visitors to the care home and they were positive in their comments about the home, the staff and the care that their relative receives. Relatives also made comments in surveys They have time for everyone in this home, even making visitors very welcome and my husband has been at Sheldon House for a number of years and the staff and carers have been wonderful to him and to me. During the inspection we observed service users making choices about their daily lives. Some people were assisted by staff to make choices by being given suggestions and alternatives regarding their meal, where they wanted to sit. Service users are offered a choice of food, this was seen to take place at the mealtime or prior to the meal being brought to the service user. We saw from records and documentation that people choose when to go to bed. We observed during the inspection that in many cases the time of getting up in the morning was dictated by the service user. Care plans provide some information on the preferences and choices of service users regarding their daily lives. The home does not advocate managing finances for people, encouraging relatives or representatives to take on this role where people cannot manage their own finances. The kitchen was clean and orderly on the day of inspection. There was 1 chef on duty and a kitchen porter. The home provides 3 varied meals each day with a choice of food at each meal time. This is based on a 3 weekly rotating menu which is devised by the chefs with support from the deputy manager. The chef told us that they welcome any suggestion from service users or their representatives. 4 service users we spoke with said that they had liked the lunchtime meal and a relative told us that his wife Care Homes for Older People Page 16 of 29 Evidence: seemed to enjoy the meals provided. Between meals, additional drinks and snacks are offered to the service users including tea, coffee, juices, biscuits, homemade cakes and fresh fruit. On the day of inspection we observed that service users were offered fruit salad with clotted cream or ice cream cones with their afternoon cup of tea. We saw service users being helped to eat liquidised and thickened fruit salad where this was required. A variety of food is on offer at tea time and the chef told us that additional sandwiches are made and left in the refrigerator for anyone who is hungry during the evening or night. Staff also have access to the kitchen and all food during the evening or night time. A large variety of foods were observed in the store rooms and refrigerators and the chef stated that any service user who did not appear to enjoy or eat the menu choices would be offered several alternatives. We observed this happening during the main meal of the day and a total of 5 different meal choices were provided. Additional tables and chairs have been provided within the dining and lounge areas since the last inspection. These are laid prior to the meal time to assist people in recognising that their meal is on its way. Service users choose whether to sit at the dining table, in their easy chair in the lounge or in their rooms for their meals. We observed that some people chose not to eat their meal but were assured by the staff that they would be offered food at frequent intervals during the day to make sure that their nutritional intake is satisfactory. Many of the service users require assistance with their meal and whilst the overall impression of the meal time is one of improvement from the last inspection, it is advised that the systems in place be reviewed. This should enable staff to provide sufficient assistance to all service users when they require it. 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. Service users and their representatives know how to complain should they wish to do so and service users are protected from abuse. Evidence: There is a complaints procedure displayed within the home. This is also included within the service users guide. We have not received any formal complaints since the last inspection. The home has received 1 complaint since the last inspection which was concerning the laundering of a service users personal laundry. We were able to see the records relating to the investigation of this complaint and the outcome. Residents and their representatives who completed surveys told us that there was someone at the home who they could speak to informally if they were not happy and two people knew how to make a formal complaint, whilst one person did not. There is a procedure for the safeguarding of vulnerable adults that includes whistle blowing. This document provides information for staff on the types and symptoms of abuse and provides clear guidance on the action they must take should there be any suspected abuse. A clear flow chart is available within the home to guide staff through the process of making an alert should they need to. We spoke with staff during the inspection who told us they were clear about the action they must take should there be any suspected abuse. Staff are provided with safeguarding training at induction. There is an internal training programme in place that uses distance learning material of which safeguarding is one Care Homes for Older People Page 18 of 29 Evidence: module that staff are required to complete. A workshop has been arranged for the week following the inspection to assist staff with completing this training. Staff are also provided with the opportunity to attend external training in safeguarding as provided by the Cornwall Council. One of the directors of the care home is a trained trainer with Cornwall Council delivering safeguarding training. The manager has a good awareness of her responsibility regarding safeguarding people who use the service. Documentation inspected and observations during the inspection evidenced that physical and verbal aggression is dealt with appropriately by the staff. Care plans provide detailed guidance for staff on the action they should take to support individual service users and we were able to evidence that medical assistance is sought where necessary. Currently service users residing at Sheldon House do not have access to all parts of the home. The home is an older style property and there are steep and narrow staircases that could provide a risk to the service users. There is a passenger lift to reach the upper floors and staircases are secured by means of electronic key fobs. We have been informed at a previous inspection that should a service user have the capacity to hold an electronic key fob, subject to a satisfactory risk assessment, this would be provided. One member of staff told us that the current service users would not be physically able or have the capacity to return to their rooms unattended even without the restrictions in place. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a safe well maintained environment. Evidence: Since the last inspection a programme of decoration and refurbishment has taken place. We were told by staff members that the service users were included in the colour choices for the communal areas and in their own rooms. We were able to see that bathrooms have been refurbished and that there are new carpets in many communal areas The home is developing the garden area that is accessible from the rear lounge. On the morning of the inspection, the weather was warm and sunny. We observed that the garden doors were open and people who are physically able were accessing the garden. Staff helped other people out to the seating area, which consists of a bench and 2 chairs. One service user was observed eating his lunch outside with a member of staff. Staff were diligent about applying sun cream to service users prior to them sitting outside. The upstairs bathroom has been refurbished and bathrooms and toilets have been made to appear less clinical by the use of pictures and ornaments. We observed some clinical equipment e.g. skip trolleys, gloves and aprons being stored in a toilet and a bathroom. This was brought to the attention of the manager who addressed this issue. The home employs a maintenance person, shared with the sister care home and records are maintained of areas that need attention. A maintenance / refurbishment Care Homes for Older People Page 20 of 29 Evidence: plan is in place for the home. Fire risk assessments are in place and the home is subject to visits from the environmental health officer, the last visit being in November 2009. We checked the temperature of the hot water in a number of bathrooms and found that when testing with the thermometers provided for staff, the water was of a satisfactory temperature. One bathroom did not have water coming from the hot tap. Staff told us that this was not usually a problem. On discussion with the registered provider we were informed that a new system had been installed the previous day, the plumber was due to be in the home on the day of inspection, to continue with the work and would address this problem. At the last inspection we were concerned to note that not all service users had access to a call bell when in their bedroom. We observed at this inspection visit, through inspecting a number of bedrooms, that the rooms either had a call bell or alarmed mat beside their bed. Work has progressed to assist service users to locate their bedrooms by the provision of notices on their doors. These reflect the name of the service user and a picture. These notices have been made during arts and crafts activity sessions with the involvement of individual service users. Most parts of the home are pleasant, clean and hygienic. Some bedrooms had a distinct odour which we discussed with the registered provider and manager. We were told that in one bedroom the flooring had been replaced but the odour returned. Commodes have been replaced throughout the home and were seen to be in a good condition and clean. Sanitising gel is in place at the entrance to the home and throughout bathrooms and toilets. Liquid soap and paper towels are also available for staff and visitors to use. People who returned surveys to us told us that the home was always or usually fresh and clean. The laundry is located externally to the home. There are industrial washing machines and tumble dryers. Red disposable bags are used for soiled laundry and all bed linen and towels are sent out to be laundered. The flooring and walls in the laundry are permeable and pose an infection control risk, this has been commented on in previous reports. We observed that there was an area of pooled water behind the washing machines. The registered provider told us that this is leaking from a pipe behind the machines and will be addressed. 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. The recruitment procedures are robust and protect service users. The training for staff is currently being developed with training sessions booked in the near future to ensure that staff are trained and competent to meet the assessed needs of service users. Evidence: On the day of inspection there were 2 trained nurses on duty supported by the manager who is also a trained nurse. There were 6 care assistants on duty, one was a senior care assistant. Ancillary staff included a domestic assistant, the chef, kitchen porter and laundry staff. The duty rotas were inspected for a period of 3 weeks and showed these are the usual levels of staff in place. People who completed a survey said that staff were always or usually available when they needed them. Additional comments made were My relative adores all of the staff, from the dinner lad to the ladies who arrange the activities, the carers are friendly and have time for everyone in this home and there is a shortage of staff. Staff that we spoke with said that there was generally enough staff although some days were busier than others depending on the needs of the residents. The AQAA provided us with information relating to NVQ training. We were informed that 62 of staff have achieved NVQ level 2 or equivalent training. One member of staff told us that they were encouraged to commence their NVQ level 2 training on Care Homes for Older People Page 22 of 29 Evidence: completion of the probationary period. This member of staff was positive about this commitment from the providers. The home has employed a training manager for 2 days a week. This person is the previous registered manager of the home. We were able to discuss the training programme with the training manager and were told that training sessions are booked for the near future to update staff in certain areas. A training matrix is being developed to assist with the planning of the training programme. When first employed, staff are required to complete an induction programme. The training is provided to staff by resources purchased from an external training company, although we were told that this system is currently being reviewed. The external system requires staff to use the computer for e-learning modules and completing work book that are checked by the manager or one of the directors. Training provided includes moving and handling, first aid, food hygiene, dementia care, infection control and medication. Staff we spoke with or who completed surveys prior to the inspection told us that the induction training provided information about the job and that the training helped them to understand the individual needs of people and keeps them up to date with new ways of working. Staff were positive about the training and the support they are given to attend and complete training. The staff records for 3 newly recruited members of staff were inspected. The records show that all relevant checks are made and in place before appointment. The staff team appears to be stable with most people employed for significant periods of time. The home has a bank of staff that can be called on when needed. These bank staff are subject to the same recruitment and training programme as permanent members of 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. The service users benefit from the ethos and leadership of the manager. Feedback is sought from service users and their representatives regarding the way in which the home is run. Evidence: Since the last inspection the registered manager has resigned, but has remained working in the home as the training manager. A new manager has been appointed and is planning to apply for registration with CQC in the near future. The manager is employed on full time hours and is a registered nurse with experience of managing care homes. Staff that we spoke with were positive about the effect the manager has made to the home since appointment and felt able to discuss any issues with her. Staff meetings take place within the home with minutes from these meetings available for inspection. The views of people who use the service and their representatives are taken into consideration when planning for the home. We were told by relatives that they are able to make suggestions towards any changes in the menus. Staff told us about how the service users were consulted when redecorating the home. An annual Care Homes for Older People Page 24 of 29 Evidence: quality assurance survey is sent out to all service users and their representatives to seek their views on how the home is run. A newsletter is available to all service users, with copies in the entrance area for anyone who wishes to have a copy. This advises people of any changes or news that is taking place within the home. The home does not advocate holding money for service users, currently there is no money held for any of the service users. The manager told us that she plans to review this policy and procedure and may reconsider the homes position. Any ad hoc purchases on behalf of the service user are paid using petty cash and the representative of the service user retrospectively invoiced. Staff told us that they feel confident with the level of support they receive from their line manager and the manager. We were able to see that supervision takes place regularly in the home and supervision records are now kept on the personal file of each staff member. There is a clear structure in place regarding who each member and grade of staff are supervised by and when the supervision is due. The manager is responsible for health and safety within the home, with other members of staff having specific roles to support her. On the day of inspection an external company had been appointed by the registered provider to conduct a health and safety audit of the home. The provider agreed to let CQC know the outcome of this visit. We observed the fire risk assessment in place, this was dated 03.04.09 with no evidence of being updated. Fire records show that equipment is maintained as required by external contractors and that regular fire checks are made within the home e.g. checking alarms and systems within the home. Maintenance records show that contractors are appointed to conduct maintenance and servicing including gas safety, hoists, electrical checks. The AQAA also gave us detailed information regarding this area. There are moving and handling trainers in the home and staff we spoke with have received moving and handling training. COSHH assessments are completed and staff we spoke with were aware of these. Areas where COSHH substances are stored are locked securely to protect service users. 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 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 7 It is recommended that care plans consistently guide and inform staff of the action they must take to meet peoples assessed personal care needs. It is recommended that daily records provide information relating to the service users day and care provided as well as their mood during the day. It is recommended that MAR sheets consistently identify the photograph of each individaul service user. It is recommended that documentation detailing service users preferred choices regarding their care and life at the home be signed by the person or their representative. It is recommended that life histories are developed for each service user. It is recommended that the systems in place to serve and assist service users with their meals be reviewed so that staff are able to assist individuals with their meals when they require such assistance. It is recommended that work is undertaken to promote the control of infection within the laundry area e.g. the floors and walls should be impermeable and water should not be Page 27 of 29 2 3 9 10 4 5 12 15 6 26 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 pooled in this area on the floor. It is recommended that further action be taken to address odours within specific and localised areas of the home. 7 38 It is recommended that the fire risk assessment be reviewed and updated as necessary on an annual basis. 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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