Care Home: Slate House

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• St Vincents
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• The Maypole Nursing Centre
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What the care home does well The staff demonstrate an in depth knowledge of each individual residents` needs, abilities and preferences in how they wish their care to be delivered. Of the six residents who returned survey forms, all stated that they felt the staff always listen and act on what they say and all residents spoken with said that they felt safe living at the home. One resident commented that: `Staff are very kind and helpful` and one relative that: `Staff are very kind and thoughtful, very well looked after.` Residents benefit from the ethos, leadership and clear management approach of the home. From observations made on the day and from comments made on the staff survey forms it is clear that the home has a close and happy staff team. Staff comments on the survey forms returned included: `The care being given to every resident is very good, happy atmosphere`, `I like working here` and `The staff, residents, relatives and other people are like one big family.` What has improved since the last inspection? The ongoing maintenance, redecoration and refurbishment programme provides residents with a comfortable and homely environment in which to live. The one requirement and four of the five recommendations made at the last inspection have been met. The manager plans to take action to meet the fifth recommendation within the next week. To demonstrate changes that have been made as a result of listening to the residents, the manager stated in the AQAA that: `We have implemented a new activity schedule. Upgraded bedroom according to their needs and wishes. Changed menu based from resident meetings. Organised different activities and special menus for holidays.` What the care home could do better: A requirement has been made regarding introducing risk assessments to monitor and identify each resident`s potential for falls, skin breakdown and nutritional problems so that action can be taken promptly to reduce or resolve the identified risks. A second requirement has been made regarding improving future staff recruitment practices in order to protect the residents from the potential risk of harm or abuse. The manager is aware that care plans need to be more person centred, as work on developing and introducing a more detailed and integrated care planning system has already begun, no additional requirements or recommendations have been made relating to care plans. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Slate House The Slate House 26 Wellington Road Sandhurst Berkshire GU47 9AN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Denise Debieux     Date: 1 5 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Slate House 26 Wellington Road The Slate House Sandhurst Berkshire GU47 9AN 01344773358 01344773358 slatehouse@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Liza Sabrina Khan,Mr Nasar Khan,Mr Ahmad Issac Beeharry,Mrs Anne-Marie Antoinette Beeharry The registered provider is responsible for running the service care home 13 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 13 dementia old age, not falling within any other category Additional conditions: 13 0 The maximum number of service users to be accommodated is 13 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission ot the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Slate House is a privately owned care home and is registered to provide care and accommodation for thirteen older people. The home is a detached three storey building Care Homes for Older People Page 4 of 32 Brief description of the care home with a lounge and dining room on the ground floor and a stair lift to access the first and second floors. Single and double bedrooms are provided with wash hand basins, one single room on the ground floor has ensuite facilities. Bathrooms are located on the ground and first floor, and toilet facilities are on each floor. There is a small garden with seating that can be accessed from patio doors in the lounge. The home is situated in a residential area of Sandhurst close to local amenities, and public transport. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out by Denise Debieux, Regulation Inspector. The Registered Manager was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager and any information that CSCI/CQC has received about the service since the last inspection on 11 July 2007. Service users at this home prefer to be referred to as residents. For clarity and consistency this term will be used throughout this report. Care Homes for Older People Page 6 of 32 On the day of this visit the inspector spoke with ten residents and four on duty staff. Prior to the inspection, survey forms were sent to residents, staff employed at the home, care managers, GPs and other health professionals. Survey forms were returned by six residents, five members of staff and one health professional. These survey forms were correlated and the results were shared with the manager during the inspection. Comments made on the survey forms, both positive and negative, were included in the correlation and shared with the manager. Care was taken to exclude any comments that could identify the writer. The manager demonstrated a very pro active attitude to the results of our survey and plans to explore any concerns raised further as part of the homes quality assurance process. Some of the comments made to the inspector and made on the survey forms are quoted in this report. The home had completed an annual quality assurance assessment (AQAA) and residents care plans, staff recruitment and training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all sampled on the day of this visit. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Fees range from 386 to 625 pounds per week. This information was provided on 15th June 2009. The inspector would like to thank the residents and staff for their time, assistance and hospitality during this visit and the residents, staff and health professional who participated in the surveys. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get Care Homes for Older People Page 8 of 32 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident is only admitted to the home following a needs assessment to ensure that the home can meet the residents identified needs. This home does not offer intermediate care. Evidence: In the AQAA, to demonstrate what the home does well, the manager stated that: We encourage prospective residents and their relatives/key friends to view the home and spend time at the home (half or full day trial) before coming to a decision. We encourage them to ask questions about the service we provide. We also spend time with them personally and gain detailed information on their health and social needs to ensure that we can provide them with the right level of care and support. We give a detailed insight into the homes routines, culture, staff, activities, menus etc to ensure that prospective residents can make an informed choice. We also encourage people when viewing to chat to staff, families and existing residents and we aim to be open Care Homes for Older People Page 11 of 32 Evidence: about the home and the service that we provide. The management personally spend a lot of time gathering information from different people involved in the admission process to ensure that our pre-admission assessment is thorough. This statement was supported by the findings on the day of this visit, three of the residents spoken with confirmed they had visited the home and that the manager had visited them and spoken with them about the home before they decided to move in. One resident, on their survey form, said that they had not received enough information about the home before they moved in but that: Im well pleased with the kindness and help received, sure it couldnt be better. Three care plans were sampled during this visit. In each case, pre admission assessment forms were seen in the files. However, it was not possible to establish when the forms had been completed, or by whom, as the forms were not dated or signed. There was no evidence to demonstrate that the resident had been involved in, or had agreed to the findings of the assessment. The information contained on the forms was basic, with some sections being left blank. In discussion with the manager she advised that either herself or the deputy always carry out the pre admission assessment themselves but complete the form on return to the home, using the information they have obtained. The person carrying out the assessment then draws up the initial care plan shortly after the resident moves into the home. The manager acknowledged that the information on the pre admission forms did not match the information they had gathered and advised that she and the deputy manager are currently looking at different care planning systems as they feel that the current documentation they are using does not meet their needs, needs to be more streamlined and that the pre admission forms and care plans need to flow naturally from one to the next. Data provided in the homes AQAA does not identify any residents with specific religious, racial or cultural needs at this time. However, from the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care and healthcare support and assistance was seen to be provided, where needed, in a respectful and sensitive manner. Policies, procedures and practices are in place to ensure the safe administration of medication. Evidence: The home has a small and close care team and the staff demonstrate an in depth knowledge of each individual residents needs, abilities and preferences in how they wish their care to be delivered. Of the six residents who returned survey forms, four said they always received the care and support they need, one answered usually and one did not answer this question. All stated that they felt the staff always listen and act on what they say. In the AQAA, to demonstrate what the home does well, the manager stated that: Each resident has a care plan that is constantly reviewed and updated to reflect their current status. Residents, relatives and health professionals are all involved in the care planning process, with attention paid to ensuring this is carried out in a dignified Care Homes for Older People Page 13 of 32 Evidence: manner and with due respect to confidentiality. A GP visits the home weekly, and is also available for when requested. Slate House draws on the support of many other health professionals, such as community nurses, continence advisory service and consultant psychiatrist, optician etc. to ensure that when referrals are necessary these are made promptly and appropriately. Residents, relatives and staff are all involved in this process to ensure that the desired outcome is achieved in the best interests of the residents. Staff handovers are detailed to show that important information is relayed properly. Handovers are done both in writing and verbally. A daily diary encourages good communication and this is used by everyone. The management are also involved in the handovers twice daily, either in person or via the telephone, to ensure that they are aware of significant changes in residents health and wellbeing, and to monitor/assist with any action that has been or needs to be taken. Three residents care plans were sampled during this visit. All three had been drawn up by either the manager or the deputy manager and, although the plans were not dated or signed, the manager advised that they were originally written shortly after the residents admission to the home. However, the care plans sampled did not cover all needs identified on assessment and actions staff should take to meet the residents needs did not go into detail of their preferences or choices. There was no evidence to show that residents or their representatives had been involved in or agreed to their care of plan. The care plans included some risk assessments, e.g. manual handling and mobility, but there were not always preventative care plans in place to manage and reduce the potential risks identified. The manager plans to introduce the Malnutrition Universal Screening Tool with all residents shortly but the home also needs to introduce routine risk assessments related to the potential for skin breakdown and the risk of falls and a requirement has been made. The deputy reviews each care plan on a monthly basis and daily notes are kept that reflect the care given. These daily notes demonstrated that any changes or new concerns are promptly acted upon, although not always added to the care plan. Comments made to the inspector by residents, and all interactions observed on the day of this visit, evidenced that care and support is provided to residents in a person centred way. Staff spoken with demonstrated a sound knowledge of the way residents prefer their care to be delivered and are aware of their personal likes and dislikes. The manager is aware that care plans need to be more person centred and, as work on developing and introducing a more detailed and integrated care planning system has already begun, no additional requirements or recommendations have been made relating to care plans. The one health professional who returned a survey form said that they felt the home Care Homes for Older People Page 14 of 32 Evidence: always sought advice and acted upon it and that the home always met residents health care needs. The medication administration records, medication storage, policies and procedures were all sampled and found to be in order. In the AQAA, to demonstrate what the home does well, the manager stated that: The medication policy and procedure is reviewed regularly and staff are trained to administer medication and monitor side effects. Slate House also ensures that records are kept properly and that medication is administered and stored in line with guidelines set. We work closely with the pharmacy to ensure that any problems that may arise with the medication can be dealt with in a prompt manner. This statement was supported by evidence seen at this inspection. At the last inspection it was found that the glass in the door leading from the downstairs bathroom to the laundry did not promote the residents privacy. Since that inspection the bathroom has been refurbished but the glass in the door, although privacy glass, remains the same. This was discussed with the manager who stated that steps will now be taken to cover the glass without delay. Residents spoken with all stated that they felt their privacy and dignity was always respected. Staff were observed to always knock before entering the residents bedrooms and all interactions observed between staff and residents were seen to be caring and respectful. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the opportunity to participate in a range of activities which include contact with the local community both within and outside the home. Contacts with family and friends are encouraged. Meals are well balanced and varied with individual choices and preferences catered for. Evidence: The routines of daily living are arranged to suit individual residents preferences and choices. This was confirmed by residents spoken with. On arrival at the home on the morning of this visit, a sing-a-long exercise activity was taking place, led by one of the care assistants. Residents were actively encouraged to participate and it was seen that the staff member was taking into account peoples different abilities whilst trying to ensure everyone present was able to take part. In the afternoon of this visit a care assistant was talking through the government advisory leaflet about swine flu with a group of residents, ensuring that residents are encouraged to stay in touch with current affairs. Residents spoken with said that there were always activities they could participate in. Care Homes for Older People Page 16 of 32 Evidence: One resident commented on how much she had enjoyed the sing-a-long that morning. The inspector was advised that the home have developed individual activity plans with each resident. However, on the day of this visit they could not be located. In the AQAA, to demonstrate what the home does well, the manager stated that: The home has recently started using a nationally recognised tool identifying residents abilities and then tailoring meaningful activities and occupation to match their ability levels (PAL Instrument for Occupational Profiling). Several staff and management have completed training (Activities and Meaningful Occupation for People with Dementia) to ensure that activities are wide ranging and suitable, the benefit of this training and information is also passed on to other staff. The home has different activities and games suited to the residents and their level of dementia/confusion if necessary. We carry out activities at least twice daily that all the residents are welcome to participate, activities are varied, adaptable and adult like such as flower arranging, skittles etc. The home has external activities that come into the home e.g. visiting theatre groups, entertainers, mobile library service etc. We carry out activities for individual residents as well as group activities. Residents can continue with interests and social life outside of the home and be involved in the community if they wish. We involve the residents in activity planning and they decide what should be done. Residents can invite family and friends as they wish and have the opportunity to see them privately. This statement was supported by the evidence seen during this inspection. Menus sampled showed that the home offers a varied and well balanced menu, with residents able to choose alternatives if they do not want the dish that is on the menu on the day. The lunchtime meal was taking place during this visit, the food was well presented, the atmosphere in the dining room was pleasant and relaxed and there were ample staff available to offer help and assistance as needed. Residents spoken with confirmed they had enjoyed their lunch, with one resident saying: the food is very good here. In the AQAA, to demonstrate what the home does well, the manager stated that: The residents are actively involved in planning the menus for the home and deciding on ingredients and food related events (e.g. Valentines dinner, Mothers Day menu etc) and their suggestions and requests are noted and acted on. The management closely supervise the menu planning with senior staff to ensure that meals are nutritionally adequate and balanced, two members of staff have received formal Nutrition and Healthy Eating training, and Nutrition for People with Dementia. Due to the small size of the home we can cater for individual tastes and choices and are pro active in ensuring these are met, e.g. drinks, main meal choices, fruit and vegetable selection etc. This statement was supported by the evidence seen during this inspection. Care Homes for Older People Page 17 of 32 Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. Policies and procedures are in place to protect residents from potential harm or abuse. Evidence: The home has a complaints procedure in place that is available to all residents and their relatives and is also included in the service users guide. No complainant has contacted the Commission with information regarding a complaint or allegation made to the service since the last inspection. All residents surveyed said that the staff always listen and act on what they say. There is a whistle blowing policy in place and the home have a copy of the latest Berkshire Safeguarding Adults Policy and Procedure. Training in safeguarding adults is included in the homes staff induction and the health professional who returned a survey form said that the home has always responded appropriately if they have raised any concerns. In the AQAA, to demonstrate what the home does well, the manager stated that: On induction, all staff are trained in the Safeguarding Adults and this training is continual. The management promote an open and positive culture within the home to ensure that residents safety and wellbeing is promoted and paramount. We attend the regular Care Homes for Older People Page 19 of 32 Evidence: Bracknell Forest Borough Council Adult Protection Forum to keep abreast of news and developments, and the information is then relayed. Staff are trained in dealing with residents with varying degrees of confusion and dementia and how to defuse potentially difficult situations. All residents spoken with said that they felt safe at the home with one resident adding: the staff are very kind. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The location and layout of the home and gardens are suitable for their stated purpose. An ongoing maintenance and redecoration programme provides the residents with clean, pleasant and homely surroundings in which to live. Evidence: Slate House is a detached, three storey building with a communal lounge and dining room on the ground floor. A stair lift provides access to the first and second floors. Single and double bedrooms are provided with wash hand basins, one single room on the ground floor has ensuite facilities. Bathrooms are located on the ground and first floor, and toilet facilities are on each floor. There is a garden with seating that can be accessed via patio doors from the lounge. The home is situated in a residential area of Sandhurst close to local amenities, and public transport. Residents spoken with expressed their satisfaction with the accommodation provided at the home. Five of the residents surveyed all said that the home was always fresh and clean, one person left this question blank. On the day of this visit the inspector was shown around all areas of the home and grounds, with the exception of four bedrooms. Personal bedrooms were seen to be personalised to the individual residents wishes and one resident confirmed that she had brought personal items with her when she moved in. The maintenance and Care Homes for Older People Page 21 of 32 Evidence: redecoration programme for the home was seen to be ongoing, with plans underway to redecorate some of the bedrooms. Following a recommendation made at the last inspection the manager stated that the home have now implemented the occupational therapists recommendations and the communal television has been replaced for one with a larger screen. Laundry facilities are sited on the ground floor with washing machines suitable for the needs of the residents at the home. In the AQAA, to demonstrate what the home does well, the manager stated that: We take into account the needs of the individuals when planning the environment. We ask the opinion of staff and people using the service when planning the environment and involve them in key decisions. The residents are able to personalise their bedrooms and communal settings with their own belongings if they wish. We have commissioned an occupational therapist report to ensure that the environment has suitable aid and adaptations for the people using the service. We have recently used the Alzheimers Society Dementia Care Environment book as a reference to ensure that the environment can better meet the needs of residents with dementia. This statement is supported by the evidence seen at this inspection. On the day of this visit the home was found to be warm and bright with a homely atmosphere and a high standard of housekeeping apparent. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels and skill mix of staff are sufficient to meet the current residents needs. Residents are cared for by staff who get the relevant training and support from their managers but staff recruitment practices have been potentially placing residents at risk. Evidence: The staff team consists of the registered manager, one assistant manager, eight care assistants and a housekeeper. The morning (7.30am to 2pm) shift is covered by two care workers, two care workers cover the afternoon/evening shift (1.45pm to 9pm) and one care worker works the night shift from 8.45pm to 8am. The care staff also do the cooking and laundry for the home with a housekeeper who works Monday to Friday from 9am to 1pm. The manager advised that there is always a member of the management team on call and available if needed. From Monday to Friday either the manager or the deputy manager work supernumerary to the rota and are also available to facilitate any outings that have been arranged. At the last inspection concern was raised as one care worker had been left alone at the home for a period during the day when the second care worker went to collect an urgent prescription and a requirement was made. This requirement has been met, the following information was received from the home to explain the subsequent actions Care Homes for Older People Page 23 of 32 Evidence: that were taken: Since the last inspection, as well as reiterating the Homes policies, we have promoted a senior staff member to the position of Assistant Manager and he is employed in a supernumerary position on a number of days during the week. This ensures that he can perform additional tasks and is on site as an additional person to the care staff and ancillary staff. Of the six residents surveyed, five said that staff are always available when needed and one answered usually. One resident commented that: Staff are very kind and helpful and one relative that: Staff are very kind and thoughtful, very well looked after. Of the nine care staff, five hold a National Vocational Qualification (NVQ) level 2 or above in care, with the remainder currently undertaking the training. During this visit the files of three recently recruited members of staff were sampled. All files were seen to contain proof of identity, two references and a completed application form. An enhanced Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) list check had been obtained for two of the three staff members. The third person was working pending receipt of a completed CRB certificate, on the basis of a POVAfirst check, but the manager was not aware of the required measures that have to be in place for this to be allowed and the person did not have an allocated staff member as required. The management were unaware of new regulations that came into force in July 2004 and had not been verifying applicants reasons for leaving previous employment with vulnerable adults; had not been obtaining full employment histories and some gaps in employment had not been explained or explored. The dates on one reference did not correspond with those given by the referee but this discrepancy had not been identified or clarified. The amended Schedule 2 of The Care Homes Regulations 2001 was reviewed with the manager and the manager downloaded a copy of the CQC guidance on the changes to legislation and recruitment requirements, from the CQC website, for future reference. A requirement has been made. It is positive to note that, on the day following this inspection, the manager took prompt action and contacted the inspector and advised that: one employee will not work further until we can verify full employment history, two most recent employment (care) references and photo ID. We are actively working towards this. Once this is received, the employee will be under named supervision until the full CRB disclosure is received. We have reviewed all the (other) staff files and all the information required is in place. We will also be using the checklist going forward to ensure that we continue to meet our legislative requirements re recruiting employees, and I will also update Care Homes for Older People Page 24 of 32 Evidence: our recruitment policy and procedure to this effect. In the AQAA, to demonstrate what the home does well, the manager stated that: We became successfully recognised as an Investor in People organisation. The management ensures that the duty rota is completed in advance, and the staff work closely with the management to ensure that shifts are always covered with the correct numbers and skills, and that staff have the time/days off they request. The staff team have an excellent mix of skills, training and experience directly related to meeting the needs of older people with dementia. We have a thorough training plan for each individual staff member and for the organisation, this goes above the minimum mandatory requirements. The training and development plans are focused on how to meet the needs of the home and residents, as well as developing the staff members skills. The staff team feel able to talk openly to the management about issues concerning them, and regularly give good and constructive feedback, make suggestions, initiate and implement new ideas that will benefit Slate House, take on additional duties and tasks and complete them efficiently and competently. Staff induction is in line with the new, mandatory Skills for Care common induction standards and staff that returned survey forms all felt they were given training which is relevant to their role, helps them to understand and meet the individual needs of the residents and keeps them up to date with new ways of working. The health professional who returned a survey form felt that the care staff usually have the right skills and experience to support the residents social and health care needs. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the clear management approach at the home providing an open, positive and inclusive atmosphere. The home has an effective quality assurance and monitoring system in place that is based on seeking the views of the residents. Policies and procedures are in place to protect residents financial interests. All policies, procedures and practices are in place to ensure, so far as is reasonably practicable, the health safety and welfare of residents and staff. Evidence: The manager has been the registered manager at the home for the past five and a half years and holds her Registered Managers Award qualification. Her management style is inclusive and the residents benefit from the ethos, leadership and clear management approach of the home. The home has an effective quality assurance and monitoring system in place that is Care Homes for Older People Page 26 of 32 Evidence: based on seeking the views of the residents and their relatives. The inspector was advised that the home carry out yearly resident and relative surveys, correlate the responses and then take action to address any issues that are raised. Monthly residents meetings are held and minutes are kept. To demonstrate changes that have been made as a result of listening to the residents, the manager stated in the AQAA that: We have implemented a new activity schedule. Upgraded bedroom according to their needs and wishes. Changed menu based from resident meetings. Organised different activities and special menus for holidays. This statement is supported by evidence seen at this inspection. Policies and procedures are in place to protect residents financial interests. The manager stated that the home does not handle the financial affairs for any residents. Health and safety monitoring check sheets were sampled and found to be well maintained and up to date. All staff have received required safe working practice training and updates. Staff were observed to be following appropriate health and safety practices as they went about their work. In the AQAA, to demonstrate what the home does well, the manager stated that: We continuously strive to achieve high standards of care and accommodation at the home, whilst developing our skills and knowledge and that of the staff. We consistently achieve positive and highly rated feedback from our quality assurance questionnaires. We lead our staff team by setting good examples and promoting best practice and an open, honest culture - therefore they respect us and are highly motivated and open in return. We appraise each others performance so that we can develop and learn what we do right and wrong. We ensure that we keep up to date with current knowledge and practice by attending relevant training and development courses and meetings, and reading current journals and care magazines. Staff that returned survey forms all confirmed that their manager meets with them to give them support and discuss how they are working. From observations made on the day and from comments made on the staff questionnaire it is clear that the home have a close and happy staff team. Staff comments on the survey forms returned included: The care being given to every resident is very good, happy atmosphere, I like working here and The staff, residents, relatives and other people are like one big family. All interactions observed between the staff and residents were inclusive, caring and respectful. Care Homes for Older People Page 27 of 32 Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 The registered person must 15/07/2009 ensure that unnecessary risks to the health and safety of residents are identified and, so far as possible, eliminated. Risk assessments related to identifying and minimising risks associated with the potential for falls, skin breakdown and nutritional problems must be carried out for all residents and kept under review. In order that residents can be confident that their health, safety and welfare is promoted and protected. 2 29 19 The registered person must 15/07/2009 ensure that no person is employed to work at the home without all the checks and documents having first been obtained in line with the requirements of the Care Homes Regulations 2001, as amended by The Care Care Homes for Older People Page 30 of 32 Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004. In order to protect the residents from the potential risk of harm or abuse. 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 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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