Care Home: Signature at the Miramar (Operations) Ltd

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What the care home does well Comments from residents surveys included `the staff are very willing and helpful`, `general atmosphere and comfort very good` and `there are a variety of activities every day`. Comments from staff surveys included `the home does most things well, the care is very good and the residents like living here`, the food is homemade to residents requirements`, and `high standard of cleanliness` The Home provides a modern, spacious, light and airy environment for its residents. A clear management structure is in place ensuring lines of responsibility and accountability. Good quality assurance systems ensure that residents` views are listened to and that all systems operate well. The home offers a personalised service based on individualised care planning. Equality and Diversity is inherent in its design. Resident`s said, `the staff are kind and caring`, `the food is good`, another said `visitors are always welcome`. The home provides an excellent choice of activities for those who wish to take part, and one resident commented `there is a range of activities available and the home has a mini bus for shopping and outings`. Food is well prepared and well presented, and suitably varied and nutritious. All residents spoken with confirmed that the food was good and alternatives were available. The management team provides a clear lead for other staff, and the home is proactive in ensuring staff are suitably trained. What has improved since the last inspection? Action is being taken by management and staff to address issues of concern raised through Safeguarding of Vulnerable Adults investigation. It was indicated that management have endeavoured to build a good working relationship with the professionals involved. The home is currently being supported by the Safeguarding of Vulnerable Adults Team and the Social Services Contracting Team in order to raise the standards of care and to protect the people living at the home. What the care home could do better: Amendments to be made to the Statement of Purpose and Service User guide to ensure that the documentation meets the requirements of regulation. Introduce `end of life` person centred plans as appropriate. Ensure that medications are signed for and disposed of as appropriate, together with ensuring that medication adminitration is carried out at the correct time of day as prescribed. Provision of a suitable laundry facility, appropriate for the size of the home, and a facility that promotes good infection control procedures, and provides a safe working environment for staff. Consideration to be given to the immediate installation of a second passenger lift. Residents and staff commented about the nn-going difficulties with the nurse call system and this needs to be addressed. Key inspection report Care homes for older people Name: Address: Signature at the Miramar (Operations) Ltd 165-173 Reculver Road Beltinge Herne Bay Kent CT6 6PX     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: Sandra Crosby     Date: 2 4 0 7 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 28 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 28 Information about the care home Name of care home: Address: Signature at the Miramar (Operations) Ltd 165-173 Reculver Road Beltinge Herne Bay Kent CT6 6PX 01227374488 01227749837 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wellbeing.Miramar@signaturesl.co.uk Signature at the Miramar Operations Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 82 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 82. The registered person may provide the following category/ies of service only Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Physical disability (PD) Date of last inspection Brief description of the care home The Signature at the Miramar is a newly built, large, detached and innovative project providing flexible person-centred full-time or respite care. As stated in the Statement Care Homes for Older People Page 4 of 28 Over 65 0 82 0 82 0 82 Brief description of the care home of Purpose, it is a modern, revitalizing, high quality alternative to a traditional care home. The Miramar is a wellbeing community with residents living in their homes and having real choices about the home care services and communal activities they choose. The website states: The modern alternative to a care home. Signature. Quality Care with all the comforts of home. Even your own front door. The choice of accommodation comprises 10 en-suite rooms with showers, 17 onebedroom apartments and 14 two-bedroom apartments. Accommodation is provided on three floors served by a passenger lift. Many rooms have spectacular sea views. The home provides both nursing and residential care for older people, and has recently registered a 10 bedded independent unit for the provision of care for people who have dementia. The complex is surrounded by landscaped gardens and includes a sensory garden at the rear. It is situated by the sea in Beltinge village, close to Herne Bay, and is within easy access of the local village amenities. There is a main line railway station in Herne Bay and Beltinge is on several bus routes. The home is also easily accessible by car. Ample car parking is provided at the front of the property. The home is built adjacent to the old Miramar Nursing home, which is now closed. In due course the old building will be demolished and the current care complex extended. On completion, the new complex will be registered for 82 people. Weekly accommodation charges range from £527.00 to £1070.00 for a shared apartment. Care is charged separately from the accommodation to reflect individual peoples needs. Care Homes for Older People Page 5 of 28 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: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This report contains the findings of the homes key inspection and takes account of information obtained from various sources since the last Key Inspection of 15th July 2008, and a visit to the home. Since the last inspection visit, part of the premises has been registered as a ten bedded unit for the provision of care for people who have dementia. The key inspection visit was unannounced and carried out on Tuesday 21st July 2009 between 09.30 and 16.00, and on Friday 24th July 2009 between 10.00 and 16.00. During the inspection the inspector spoke with the General Manager, the Wellbeing Manager, the HR person, nurse responsible for medications, nurses, care staff, Care Homes for Older People Page 6 of 28 housekeeper and people who use the service. Various records were seen during the visit, together with an accompanied tour of some areas of the premises being made. Information contained in the completed Annual Quality Assurance Assessment (AQAA), completed by the appointed manager who has recently left the home, was clear and informative and has been used together with information gained and observations made at the time of the inspection visit all of which has been used when completing this report. Fifteen surveys for people who live in a care home for older people, and ten surveys for staff who work in a residential care home were sent out. Following completion of the draft report twelve completed residents surveys and seven completed staff surveys have been received at the Commission Office, mainly providing positive comments about the daily life for residents at the home. The aim of the visit was to carry out an inspection against the key standards of the National Minimum Standards for Older Persons in accordance with the Inspecting for Better Lives (IBL) process. Judgements have been made for each outcome area in this report and these have been made using the Key Lines of Regulatory Assessment (KLORA), which is guidance used to ensure that a fair and proportionate judgement is made in each outcome area. More information about KLORAs can be found on the Care Quality Commissions (CQC) website. The home has been involved in two adult protection investigations in the last twelve months, one of which has been closed. The Safeguarding Team and Social Services Contracting Team have provided action plans for the home to address issues raised. It was indicated at the inspection visit that some of the actions required have already been addressed, that for some issues action is in progress and every effort is being made to address the remaining outstanding issues. A telephone message from the General Manager on the 09 September 2009 provided information that although the Contracting Team are still monitoring the home, following an adult protection meeting the Level 3 flag has been now been reduced to a Level 2 flag indicating that action is being taken to address issues raised. The findings of this inspection were discussed with the General Manager throughout the visit. It is indicated that although there have been problems over the last few months, the General Manager and all of the staff team are working hard to promote good standards of care. Currently at the time of the visit it was judged that the home provides overall good outcomes for the clients and the quality judgement ratings throughout the report reflect this. Residents who transferred from the old Miramar are referred to as residents while residents admitted to the apartments since registration are called members. For the purpose of this report all people who use the services are referred to as residents. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Amendments to be made to the Statement of Purpose and Service User guide to ensure that the documentation meets the requirements of regulation. Introduce end of life person centred plans as appropriate. Ensure that medications are signed for and disposed of as appropriate, together with ensuring that medication adminitration is carried out at the correct time of day as prescribed. Care Homes for Older People Page 8 of 28 Provision of a suitable laundry facility, appropriate for the size of the home, and a facility that promotes good infection control procedures, and provides a safe working environment for staff. Consideration to be given to the immediate installation of a second passenger lift. Residents and staff commented about the nn-going difficulties with the nurse call system and this needs to be addressed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 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. The homes Statement of Purpose and Service User Guide mainly provides people with the information they need to make a decision about moving into the home. The assessment process is thorough and makes sure that the needs of the person can be met at the home. Evidence: The Statement of Purpose for the home was seen indicating that it was last updated in February 2009. It stated that it can be made available in large print, in tape form or other languages as required. Following discussion it was agreed that amendments were needed to ensure that this documentation complied with regulation, for example removal of the previous managers name and information about the services provided for persons with dementia to be added. A high quality brochure for the home was provided as the Service User guide and although this was well presented information, required updating and should include for example copy of contract/terms and conditions. The completed AQAA documentation stated that the service has launched a Care Homes for Older People Page 11 of 28 Evidence: website that will be regularly updated to effectively market the unique service provided. On the second day of the inspection visit the General Manager confirmed that the Statement of Purpose and current Brochure/Service User Guide were being reviewed. Pre-admission assessment visits are carried out prior to a persons admission to the home, and written documentation completed. This documentation was seen in the person centred plans viewed. The information obtained is used to inform the person centred plan. The Wellbeing Manager confirmed that she carries out the pre-assessment visits. People spoken with confirmed that a pre-assessment visit had been undertaken before admission to the home. The self-contained units seen, together with the various communal areas of the home enables the service to provide respite care facilities for people. Care Homes for Older People Page 12 of 28 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 benefit from care plans that show that person centred care is promoted. Health care needs are mainly met and personal care is offered in a way to protect peoples privacy and dignity. Evidence: Currently the home is being supported in developing person centred care plans by Nurse Practitioners from the East Kent and Coastal Community Services. A nurse practitioner was visiting the home on the first day of the inspection visit. A sample of three care plans were seen and overall contained all components as required by regulation for example daily records, reviews and risk assessments. From the information seen it was noted that some of the documentation was not completed for example Malnutrition Screening Tool and Fall Risk Assessment. Discussion with the General Manager and staff confirmed that comprehensive person centred plans are being worked on and implemented throughout the home with the support of the Nurse Practitioners. Wound Assessment documentation was seen, this was not signed and dated and the Care Homes for Older People Page 13 of 28 Evidence: record of renewal of dressings did not provide sufficient information. The documentation seen was discussed with the General Manager and she agreed that improvement was needed. The action plan provided by the home indicates that accredited training is being accessed and that a wound formulary is now in place. The General Manager commented about successful treatment of pressure areas that had recently taken place at the home. The medication storage areas were seen, and it was discussed that these areas did not provide enough space with sufficient lockable cupboards for storage. The General Manager said that a new system was being looked into whereby the medications would be stored individually in each persons room. The medication records known as MARS sheets were seen. A number of gaps were observed where medications had not been appropriately signed for. This issue was discussed with the person who has lead responsibility for medications and later with the General Manager. Medication audits are being undertaken, and it was seen that these highlighted issues that require action to be taken in order to ensure the safety of the people and staff that use the service. A further issue that was discussed in relation to the administration of medication was that it was observed on the second day of the inspection visit that an agency nurse was seen undertaking a medication round at 11.50am. When asked she said that she was administering the 8.00am medications. The nurse said that she would adjust the medication times for the rest of the day. People spoken with confirmed that they mainly had their medication at an appropriate time, but occasionally it was late. This issue was discussed with the General Manager who agreed to take immediate action to address this concern. The completed AQAA documentation confirms that the disposal of drugs is undertaken through contract with a specialist disposal service and states there have not been any serious incidents, involving controlled drugs within the last 12 months. People said that staff treat them with respect, and consider their privacy and dignity. It was observed that staff interacted with people in an unhurried and respectful manner. The home is able to meet palliative care needs, and information was seen in care plans in relation to advance decision to refuse treatment and wishes in relation to funeral arrangements. It was however discussed that an appropriate form of end of life care plan needs to be developed, together with staff undertaking training to enable them to support the needs of people who require palliative care. Care Homes for Older People Page 14 of 28 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. People can be confident they will have satisfactory opportunities regarding lifestyle choices. They are supported to maintain contacts with families and friends and enjoy a balanced and healthy diet. Evidence: A programme of activities is displayed on the notice board, and showed for example that an afternoon tea was planned for the 25 July, and a Harpist was due to perform on the 04 August 2009. The home has different activities available every day such as quizzes, bingo, armchair exercises, cookery, games etc. Shopping trips and outings are organised. The home has an air-conditioned minibus. A hairdressing and beauty salon is provided on the ground floor. On the first day of the inspection visit people had gone shopping in the mini bus, and on the second day of the inspection visit a group of people were enjoying a game of bowls using the electronic Wii game in one of the communal lounges. There is a wide range of activities offered to people who attend if they wish to do so. People spoken with talked about the activities provided even though they did not always want to join in. The last report stated that the home makes its grounds available for the local community for activities such as fetes and flower shows. Care Homes for Older People Page 15 of 28 Evidence: Visitors are made welcome at any time. The home has made provision for relatives/friends who visit to access refreshments and a variety of choices are available. The kitchen was not visited on this occasion. People reported only positive views on the food provided for example the food is good and choices are available. Menus were seen confirming choice and variety. During the accompanied tour of some areas of the home, a variety of meals were seen that included salmon, meat balls, battered fish all with accompanying potatoes and vegetables. A well presented soft diet meal was seen, together with a variety of sweets. The Inspector evidenced a good rapport between staff and residents. It is indicated that people feel their rights as citizens are recognised and promoted, including fairness, equality, dignity, respect, and autonomy over their chosen way of life. Care Homes for Older People Page 16 of 28 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. People know their complaints will be listened to and acted upon. The home has a suitable complaints procedure, together with suitable procedures, and training in place to ensure that people are protected from abuse. Evidence: The home has a policy and procedures in place for the handling of complaints. The completed AQAA states that thirteen complaints had been made in the last twelve months and that eleven of these had been upheld. The complaints folder was seen and showed that action had been taken and written responses made to complaints received. There have been two safeguarding investigations during the last twelve months, one of which has been closed. The other safeguarding investigation has involved the Safeguarding Team and Social Services Contracting Team providing action plans to the home and working to support the home. The General Manager has drawn up an action plan and this currently shows that some issues have already been addressed and that for others action is in progress. There still remains action to be taken for some of the items on the action plan. The General Manager and the team of staff at the home are all working hard to improve the standards of care provided at the home. The staff training matrix shows that twenty five members of staff have completed training in relation to the Safeguarding of Vulnerable Adults as part of the NVQ Level Care Homes for Older People Page 17 of 28 Evidence: 2. Twenty seven staff are booked to undertake training in the Safeguarding of Vulnerable Adults between the 14 and 17 September 2009. Staff need to undertake training in relation to the Mental Capacity Act. To date one nurse has completed a two day course with a third training day booked in September in relation to the Deprivation of Liberty. The General Manager confirmed that action is being taken to access training as quickly as possible. Care Homes for Older People Page 18 of 28 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 provides a modern, spacious, light, clean, safe and well-maintained environment for the people who live there. The home mainly provides sufficient equipment and facilities to meet their needs. Evidence: The home is newly built and furnished to high specification. An accompanied tour of some areas of the home and grounds was undertaken. Since the last inspection part of the premises has been developed to provide an independent ten bedded unit to provide care for people who have dementia. The people spoken with said they were very happy with their environment. The entrance hall (concierge) and bistro area provide a welcoming feel. There is an adjoining lounge and restaurant where people have their meals. A private room is also available for people to use for parties and celebrations. The home has a sun lounge and landscaped gardens with raised beds. These provide a pleasant and tranquil environment including patio areas with outdoor furniture and a sensory garden. All are accessible by wheel chair users. The single rooms are furnished and equipped to a high standard. People who prefer to live in an apartment will need to provide their own furniture. They can choose to live Care Homes for Older People Page 19 of 28 Evidence: alone or share with a partner or friend. Many rooms have sea views and a private balcony. Residents are encouraged to bring their own items of furniture and personal possessions. Evidence of this was seen when talking to people in their own rooms. The home provides two fully equipped assisted bathrooms For those residents requiring a high level of nursing care, profile beds have been purchased, which are designed to raise/lower the head/feet of the bed, or the whole of the bed. Other items such as pressure-relieving equipment are available. All residents have access to a nurse call system. The system is connected to a main computer and to all staff on duty via individual handsets. There are still teething problems with the system, and people spoken with confirmed that they sometimes experience problems when using the nurse call system. The General Manager said that issues were being addressed, one of which being the provision of extra handsets. These handsets have been ordered. The home provides a clean and bright environment. Good clinical waste disposal systems are in place as noted in a clean sluice room. It was however discussed with the Housekeeping Manager that a sluice room facility was needed on the first floor as current staff practices on this floor do not promote good infection control. Later in discussion with the General Manager she said that action was already being taken to address this issue. It was reported in the last report that an improved laundry facility was included in Phase 2 of the redevelopment of the Miramars site. The current laundry facility is not appropriate for a large nursing/residential home. Staff need to access the laundry room from outside, and this may put them at risk especially during bad weather. The setup does not promote good infection control practice as dirty laundry has to pass through the clean laundry area. Currently all sheets are washed on the premises, and there is only an iron and ironing board provided for the ironing of bed linen and clothes. A further concern voiced by people spoken with was in relation to the need for the provision of a second lift for the home. As the planned Phase 2 had not to date been started. Action should be taken to install this facility at the earliest time possible. Care Homes for Older People Page 20 of 28 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. People who live in the home benefit from the support of carefully selected and well trained staff who understand their needs. The homes practice regarding the recruitment of staff ensures that people are protected. Evidence: A copy of the staffing rota was provided, and indicated that sufficient staff were on duty at all times to meet the needs of the people living at the home. Where there was any shortfall in staffing numbers, agency staff were called in. In addition to the nursing and care staff there are catering, activities, administrative, housekeeping, maintenance, gardening and reception staff on duty. The home has experienced problems in maintaining sufficient staffing numbers during recent months, and the General Manager confirmed that a recruitment drive is currently being undertaken. In the interim action has been taken to access the same agency nurses to work at the home when required in order to ensure continuity of care. The completed AQAA documentation confirmed that all staff who have started work in the last twelve months have had satisfactory recruitment checks. Four staff files were examined and on the whole these files were organized and complied with the requirements of regulation for example application form, CRB and POVA check, Care Homes for Older People Page 21 of 28 Evidence: references and contract of employment. It was seen that there were not always two written references obtained and the HR person confirmed that these were currently being chased up. The induction programme documentation was viewed, and following discussion with the HR person and later with the General Manager. It was agreed that the documentation be reviewed to ensure that it meets the requirements the Skills for Care Induction criteria. A copy of the staff training matrix was initially provided and indicated shortfalls in training, however on the second day of the inspection visit management staff had worked hard to provide an updated version of the staff training matrix. This evidenced that staff training is ongoing and it was seen that training is booked in the near future for example for Diabetes Awareness, Epilepsy Awareness and Safeguarding Vulnerable Adults. Fire Safety training was being undertaken on the first day of the inspection visit. Staff supervision is being undertaken and written documentation relating to supervision was seen in one staff file. A visit by a Social Services Contract Officer on the 28 July 2009 confirmed that action was being taken to address issues raised and that supervision of staff was now being undertaken. Staff also confirmed they are receiving supervision. Care Homes for Older People Page 22 of 28 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. People are currently benefiting from good leadership from the General Manager who is qualified, competent and experienced. She is well supported by the senior staff team and people can be confident that their home is well run. The health, safety and welfare of residents and staff are promoted and mainly protected. Evidence: The home has been going through a period of change with the departure of the appointed manager who only worked at the home for a few months. The company provides a management structure with clear lines of responsibility and accountability and has placed a General Manager in the home to oversee the day to day operation of the home and to address issues of concern that have been raised. Discussion with people who use the service and staff indicate that the General Manager is creating a positive open and inclusive atmosphere. It was evidenced that the General Manager has worked hard to initiate changes in the home for the benefits of the people. Care Homes for Older People Page 23 of 28 Evidence: Quality Assurance is high on the agenda. The home is keen to ensure that the residents views on the service are ascertained. Seventy five quality assurance surveys were issued in May 2009, of which forty four were returned. The information is collated and the company provides a report as required by regulation. The General Manager and Wellbeing Manager have a visible presence in the home, and obtain further feedback via one to one conversations. Monthly visits are carried out by the Responsible Individual, who is involved in the general management and oversight of the home. The completed AQAA documentation indicated that regular review of policies and procedures are undertaken and regular audits are carried out. It was reported at the last inspection visit that some residents have requested that their personal allowances are managed in house. The Finance Manager demonstrated that these are stored separately and safely. Records of any transactions are maintained and audited. These were not seen at this inspection visit. The home mainly provides a safe environment, and the completed AQAA documentation indicates that all maintenance certificates are in order. Care Homes for Older People Page 24 of 28 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 25 of 28 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 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home Ensure all medicines are appropriately signed for when administered. Ensure that all medicines are appropriately disposed of Ensure that all mediciations are administered at the appropriate time 31/07/2009 2 26 13 The registered person shall 31/12/2009 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home Provision of appropriate laundry facilities that meet Care Homes for Older People Page 26 of 28 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 infection control standards and provide a safe working environment for staff 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 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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