Care Home: South Chowdene Care Home

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What the care home does well The home offers a very pleasant, atmosphere and there were examples of friendly but respectful exchanges between staff and residents. The staff assist the residents to maintain their health care needs in a way that promotes their dignity and independence. The residents were very complimentary about the staff and the care they receive. Comments include "the staff are always kind and helpful", and "there is always staff around to make sure that I can do what I want". The current manager is offering the staff good leadership and there is good senior management systems in place to support her to make the necessary improvements. Residents and their representatives spoken to during the visits and the returned surveys suggested that they were happy living in the home and felt that the staff were helpful. They were particularly positive about the quality of the food being provided. What has improved since the last inspection? At the last inspection it was judged the people living there experienced excellent outcomes. There have been no areas of improvement since that time. What the care home could do better: The care plans must be improved so that they show how care is being planned and delivered. They should be reviewed and updated. This will make sure that the home can show how the residents are cared for and that the staff are clear about how to give good care. The arrangements for safe administration of medicines received into the care home must be maintained at a good standard to ensure the safety of the people living in the home. This was particularly the management of the fluids that were being given subcutaneously as the general medication management was satisfactory. The reliance on agency staff must be reduced through recruitment of additional staff. The provision of temporary staff can impact on t he consistency of care provided and the standards of the records kept. Staff must be given adequate training to make sure that they are competent to carry out their role. This will protect the residents and make sure that they have their needs met safely. Additional information collected about peoples previous life histories and individual personal profiles should be used to create a more person centered programme of lifestyle choices this should include more choices in areas such as meal times. There should be a review of the meal time experiences to make sure that it is positive for the residents and that meals times offer an opportunity for them to maintain their independence. It is recommended that the home review the way that the lounge area is used and as part of that a loop system be installed in the areas with a television to assist people who have a hearing deficit. It is recommended that there is a review the bathing facilities to make sure that there are enough facilities and that people living in the home are given choice in how they receive their personal care. Key inspection report Care homes for older people Name: Address: South Chowdene Care Home Chowdene Bank Low Fell Gateshead Tyne & Wear NE9 6JE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Suzanne McKean     Date: 0 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: South Chowdene Care Home Chowdene Bank Low Fell Gateshead Tyne & Wear NE9 6JE 01914910861 01914821423 Carol.Locker@barchester.com www.barchester.com Barchester Healthcare Homes Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability sensory impairment Additional conditions: The Service may be from time-to-time admit persons under the age of 65 in the OP category Date of last inspection Brief description of the care home South Chowdene is a purpose built home set in its own grounds and it is situated in a residential area of Low Fell in Gateshead. It is registered to accommodate up to 40 older people who require nursing care. All bedrooms in the home provide en-suite toilet facilities, and access between floors is available by stairs or passenger lift. Corridors and doorways are wide enough to Care Homes for Older People Page 4 of 31 0 4 2 Over 65 42 0 0 Brief description of the care home accommodate wheelchair users and appropriate equipment and aids are provided for those people who need assistance. There is a public house, shops, library and churches close by, and a regular bus service runs to Gateshead town centre and Newcastle. There is easy level access into the home from both the front and rear entrances and car-parking facilities are provided. The garden provides a sensory and herb garden, lawned areas with a pleasant water feature and provides pleasant sitting areas for the people who live there. The home has a conservatory that opens onto a sheltered garden and paved areas that are easily accessible. The bathrooms and communal toilets have handrails and lifting equipment for service users requiring assistance and facilities are appropriate for the people who live there. The weekly fees are £418 to £633 per week depending upon care needs. Residents who require nursing care have the nursing care fees paid in addition to these charges. Additional charges are made for hairdressing, newspapers, chiropody and personal items such as toiletries. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Summary: This is an overview of what the inspector found during the inspection. How the inspection we carried out:- Before the visit we looked at, the information we have received since the last visit on 26th July 2007. How the service dealt with any complaints and concerns or protection of vulnerable Care Homes for Older People Page 6 of 31 adult issues since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service and their relatives, staff and other professionals. Used surveys to find out the views of residents their relatives or representatives and professionals who visit the home. The visit: An unannounced visit was made on 31st March 2010 and the inspector returned on 1st April 2010 by arrangement. The total time taken for the visits was eight hours. During the visit we: Talked with people who use the service, the staff and the manager. A number of visitors were present during the visit and three were spoken to in private. Looked at information about the people who use the service and how well their needs are met. Looked at the records which must be kept. Checked the staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building and parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. We told the manager what we found. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The care plans must be improved so that they show how care is being planned and delivered. They should be reviewed and updated. This will make sure that the home can show how the residents are cared for and that the staff are clear about how to give good care. The arrangements for safe administration of medicines received into the care home must be maintained at a good standard to ensure the safety of the people living in the home. This was particularly the management of the fluids that were being given subcutaneously as the general medication management was satisfactory. The reliance on agency staff must be reduced through recruitment of additional staff. The provision of temporary staff can impact on t he consistency of care provided and the standards of the records kept. Staff must be given adequate training to make sure that they are competent to carry out their role. This will protect the residents and make sure that they have their needs met safely. Additional information collected about peoples previous life histories and individual personal profiles should be used to create a more person centered programme of lifestyle choices this should include more choices in areas such as meal times. There should be a review of the meal time experiences to make sure that it is positive for the residents and that meals times offer an opportunity for them to maintain their independence. It is recommended that the home review the way that the lounge area is used and as Care Homes for Older People Page 8 of 31 part of that a loop system be installed in the areas with a television to assist people who have a hearing deficit. It is recommended that there is a review the bathing facilities to make sure that there are enough facilities and that people living in the home are given choice in how they receive their personal care. 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 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good admission assessments and information gathered before the placement makes sure that the home is prepared for the person moving in and that the person can be confident their needs will be met. Evidence: The company has in place an assessment document, which is designed to give a way of recording information about the needs of the people who are considering moving into the home or staying for a short period. A re-assessment is carried out for residents who have been admitted to hospital and have had a change of needs. The tool assists the staff to find out about all of the aspects of peoples lives and needs. Potential permanent residents can visit the home and spend time in the communal areas prior to making the decision to move in but those spoken to on the day had relied on their relatives to make the choice for them. Care Homes for Older People Page 11 of 31 Evidence: During the inspection a visitor explained that they had looked at a number of homes when looking for a place for his relative and was very happy that they had chosen South Chowdene. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have their health and personal care needs met but care plans and documentation does not support the care that is delivered. Evidence: Each person living in the home has an individual care plan which is developed from the assessment and added to throughout their stay. These care plans are designed to show how the personal and health care needs of the resident are to be met. The staff spoken to were knowledgeable about the needs of the residents. They were able to describe the way that they gave support to the residents and the need to report any relevant issues to senior staff. Care plans are in place around both the physical needs and the social care needs of the people living in the home. Necessary risk assessments are completed for a selection of areas including falls, nutrition and deterioration in skin condition. These have not always being reviewed and at the frequency identified as being needed. The care plans are not always in enough detail or up to date, an example being one saying that a residents wife visits frequently when she had not visited for a number of Care Homes for Older People Page 13 of 31 Evidence: months as she was unwell and unable to do so. This was known by the staff but not recorded, or a plan put in place to support the resident at this time. Some care plans and risk assessments for individuals had not been reviewed for February although March had been done without any reference to the gap. In one the Waterlow assessment for risk of deterioration in the persons skin and potential for developing wounds had not been carried out since January 2010. The records of wound care were not always in sufficient detail. Some entries have a detailed description of the condition of the wound but other entries not showing the same detail making it difficult to assess the progress or deterioration taking place. Another record had no care plan in place for the management of the residents catheter although there was some recording how it was being managed. A recent audit of the care plan by a senior manager had identified similar issues in the care plan examined and it was evident that the manager was aware of the improvements that were necessary and had started to take action to make the necessary improvements. Records of food and fluid intake was poor. The records were not being completed in sufficient detail and no attempt was made for the daily totals of fluid intake to be calculated so that and assessment could be made of the residents intake to determine if they are receiving enough fluids to maintain their health. The residents have their personal hygiene needs met and are supported to access NHS services and facilities as and when they need to. The care plans showed that the specialist advisors such as the Speech and Language Team and the Challenging behavior team are used for individual people living in the home and their advice is followed. The residents and their representatives are supported to take part in making decisions but comments from relatives suggest that this could be improved to make it more effective and formal. Residents said that they felt well cared for by the staff and an example of this was the staff are nice they look after me Relatives spoken to during the visit were very positive about the care given to their relative, an example of the was that a relative said I think that the staff at the home do a good job, another said the staff are always friendly and they keep me up to date with what is going on. Returned resident surveys were positive although some noted issues around improvements that could be made to the environment (see that section for details) Care Homes for Older People Page 14 of 31 Evidence: Residents were dressed for the activities they were undertaking and looked comfortable and tidy. A number of residents were positive about the care they were being given and were very complementary about the staff. The staff were being kind and polite although pressure to complete the tasks leaving them little time for more relaxed conversation with the residents. The residents are encouraged to maintain contact with their families, friends and visitors and can use either their own rooms or the communal areas. The home generally manages the administration of prescribed medication appropriately. There are appropriate systems in place to arrange for the ordering of the residents medication and the records were up to date and in good order. The home has a contract for the disposal of the medication which is no longer required and the records of this were in place. Controlled drugs are managed appropriately. Specific routes of administration are followed and any omissions or changes to the way that the medications are given are recorded. The records of the administration of sub-cutaneous fluids was not in sufficient detail. Although three litre bags of fluid were checked into the home in line with the procedure the individual bag used was not being recorded by its batch number at the time it is administered. It was also being recorded on the fluid balance sheet without any reference to any other fluids being offered or any record of fluid output for example urine output (it is acknowledged that the individual was incontinent of urine so a precise measurement would not be possible). Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to live in active and fulfilled way in line with their choices, abilities and condition, the way that the residents have their nutritional needs met could be better. Evidence: Residents have the choice to spend time either in their own rooms or in the communal lounges and during the visits some of them were in their bedrooms spending time watching television, reading or listening to the radio. There is a formal social programme in place, and on the day of the visit a number of residents were involved listening to entertainers who had been organised to visit the home. On the second visit residents were observed playing a game of Bingo, which they said they enjoyed. Others were spending time in their rooms or in the communal areas watching television or spending time with their visitors. There is an activities person employed, and the activity programme is being developed further. The manager told us that because the residents do not all like to participate in group activities they try to provide one to one activities and this was confirmed by the activities co-ordintor. Care Homes for Older People Page 16 of 31 Evidence: The staff have been working on improving the information in the care plans about peoples previous life histories, and there is an individual personal profile of each resident so that an individualised social plan can be developed. This will assist the introduction of a more person centered approach to the way residents spend their lives. Residents spoken to said that their families are always welcomed and others said they regularly go out with their family. There is a small patio/garden area to the rear of the home. This benefits the residents as it is the only outdoor area for people to enjoy in the better weather. There is a rotational menu in place, which offers choice and variety. The lunch time choice on the day of the first visit was savory mince, turnip, sprouts, mashed potatoes and peas or chicken and chips with coleslaw and salad. However the cook had to be prompted to provide the salad as she believed that the choice was coleslaw salad. This is particularly important as the residents rely on being offered a balanced diet including vegetables, salad and fruit. One resident had a plate guard but none had any specialist cutlery. One resident was given a table spoon for a yogurt (in a pot)and although she managed she is on a specialist diet and needs particular support to make sure that she continues with it. Resident surveys included comments about the food being lovely and another said good food. The meal time was calm and residents were enjoying the meal time experience. Most of the residents took their meals in the dining room but a some chose to eat in their own rooms and they were supported to do so. Lunchtime was a busy time but pleasant time but could have been made better by giving more attention to the way that the dining room is presented and organised. There was no place settings and only one table had condiments on it. More choice could be given at the tables around condiments, sizes of the portions of individual items on the plate. There was no planning in place for those people who need a pureed or soft diet to have supplementary snacks, except for prescribed supplements and yoghurts. Additional choices should be available for high calorie tasty options for those who can not eat the cakes or biscuits available on the trolleys. Several people need help to eat their food and the staff sat with them and assisted in a sensitive manner. There is some flexibility in the meal times and the breakfast is Care Homes for Older People Page 17 of 31 Evidence: available over a period of time allowing for residents to rise at the time they prefer. Cold and hot drinks were readily available throughout the day and there is a tea trolley taken around in the morning, afternoon and in the evening. There is now information in the home to tell the residents and the staff about the food being served although there are plans to improve this further. This would not only inform them but give a good topic of conversation through the day. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good procedures are in place to protect residents from risk of harm and enable their concerns to be effectively dealt with. Evidence: The home has a complaints policy and procedure, which is displayed and given to everyone when they come into the home. All of the residents and visitors spoken to said they knew who to complain to although they said that they felt that there was little to complain about. Records show that there have been no formal complaints made in the last year. The organisation has a good system for recording and dealing with complaints and the documentation is available in the home. Fifteen out of seventeen of the care staff and seven out of nine nurses have received Safeguarding Adults training either in house or by attending training with Gateshead Council. Staff had an understanding of what constitutes abuse and would be able to use the procedures if necessary. There has been one safeguarding alerts since the last inspection. The Manager and senior staff understand the process and worked with the local Authority Safeguarding team in dealing with the issues raised. This is not yet completed. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers the residents a clean, safe, comfortable and pleasant environment to live in. Evidence: South Chowdene is a purpose built care home with the main communal lounges and dining rooms on the ground floor and bedrooms on both the ground floor and the first floor. There is access to the first floor via stairs and passenger lifts. There are planted gardens around the home and a sitting area at the rear of the home which is layed out very pleasantly with raised border and seating. There is a very large lounge area on the ground floor with a conservatory area from this room to the garden. The lounge is arranged in three areas and the current manager has made them different by making one a non television area. The other two areas have large televisions in them. There is no loop system available which would helps those with hearing problems hear the television, which is at the far end of the lounge. These areas are being reviewed so that the residents can be offered some choice in the way they use the areas. There are adequate numbers of toilet and bathing facilities however not all can be Care Homes for Older People Page 20 of 31 Evidence: used for people needing assistance. The bathroom and the shower room on the first floor are not being used although there is a bath on this floor which is a good facility and used by residents. However if a resident from the first floor wishes to have a bath they have to use the one on the ground floor. One of the returned surveys from a resident specifically said when the question asks what could the home do better said get another shower upstairs. The ground floor has a shower and a bath which is designed for those people who are not able to be bathed in an ordinary bath. The numbers of facilities in use are satisfactory for the current number of residents however should more residents move into the home the out of use bath and shower will need to be made available for use. There are plans in place to do this. All of the bedrooms are for single use, people have brought small items of furniture and keepsakes with them making the rooms individualised. They reflect their previous lifestyles and religious beliefs. Many of the bedrooms are cluttered with the personal items of residents but were clean and organised according to the choices of individual occupant. The laundry has adequate facilities, and the area was generally well organised and the area was being used as it was planned with clean to dirty areas identified. There was a liquid soap and paper towels in this area so staff can wash their hands effectively. The sluices were being kept closed and clinical waste is being managed satisfactorily. Wheelchairs and other care items were clean and there is a process to have them cleaned. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are protected by a good recruitment and selection procedures although staff could be better supported through training to make them able to fulfill the role they undertake. Evidence: There is no registered/permanent manager in post although the company has a manager from another of its services working in the home. The home benefits from a stable care staff team, many of who have worked in the home for some considerable time. They were working hard on the day and were supporting residents to carry out their daily tasks and provided them with the care they needed. During the first site visit the staffing was:- the acting manager, two qualified nurses, five carers in the morning and afternoon and then four carers from four oclock until eight forty five. The night staff on duty for that night was one nurse and three carers, domestics, cook, kitchen assistant, handyman and an activities co-ordinator. The home has recently had two nurses leave and active recruitment is being carried out to replace them. The home uses agency staff to fill the gaps on the rota and the manager has requested that the same agency staff are supplied to maintain continuity for the residents. Care Homes for Older People Page 22 of 31 Evidence: The home has a good policy for recruitment and selection on staff. This is being followed. Staff records were held safely to maintain confidentiality with limited access to these and the supervision records. Two staff files looked at showed that job descriptions and roles are clear and each file had an application form completed. There was evidence of Criminal Record Bureau checks, of Vulnerable Adult checks, and proof of identity. Two references are sought before employment is offered. All of staff working in the home have received initial training in moving and handling, fire training and safeguarding, however they have not had updates to this training in line with the company policy. A training programme has been put in place to address this and evidence was available as to the dates this is being provided and the list of staff who are to attend. This includes a safeguarding training course being delivered by an external provider and is over twelve weeks including distance learning. A comprehensive training course in Infection Control was planned for May to be provided by the representatives of the Primary Healthcare Team. The manager had already arranged training for the nurse in catherterisation and on the second day of the visit the care staff were having dementia care training from the companys Clinical lead. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While the current management and administration of the home is adequate, recent lapses in the quality of the management and leadership resulted in a deterioration in the standards of record keeping and training. Evidence: The Registered manager for the home left the in February 2010, there is also no deputy manager as she left soon after the manager. On the week of the inspection visit two permanent nurses resigned. These changes have generally destabilized the team. Few changes in the care staff have occurred, and a number of these staff have worked in the home for some time. However the gap in the leadership has resulted in the care staff becoming more responsible for the way that the care is organised. There is now a very experienced manager working at South Chowdene and although she has only been in the home for two weeks there is good evidence that she has put in place management strategies to ensure that the residents are cared for safely. She is a registered manager for another home in the company so is knowledgeable in the Care Homes for Older People Page 24 of 31 Evidence: company policies and procedures. The organisation is actively recruiting for a new manager although the current management arrangements are to be left in place until a new manager is appointed and inducted into the role. She is aware of the need for the staff to keep up to date with current best practice and has organised for all staff to undertake training to make sure staff are knowledgeable and trained to care for the people who are using the service. The company has a good quality assurance programme including a number of audits, there were not effectively carried out for example the Health and Safety audit for January 2010 identified that all staff were up to date with their fire training, on examining the training records this was not the case. Immediate steps were taken by the manager to arrange training for all staff and records of the training was being organised to identify any shortfalls and put in place a training programme. The surveys returned to CQC and comments on the day from people living in the home were very positive about the staff and the care provision. One visitor said that she felt that the staff seemed to work well for the new manager and that they were happy with the care their relative received. Records relating to peoples monies were checked. Accounts are held individually. Receipts are kept for all expenditure. Two amounts of money were checked and were correct. There are good records of staff meetings for March 2010 for both day and night staff however the records for any meetings before this time could not be produced. Records for the supervision of staff showed that they were not in being carried six times a year for all staff although the company have a good procedure for doing this. The acting manager has identified this as a priority and has begun the process. Maintenance records for day-to-day safety were in place including recording of water temperatures, checking window restrictors and general health and safety checks for the safety of staff .the people who live in the home and any visitor. These checks are carried out by the maintenance person/handyman. Staff have not completed fire training, infection control, moving and handling and health and safety in line with good practice guidance. Accidents are recorded and there is a system to audits to track trends and look at Care Homes for Older People Page 25 of 31 Evidence: when accidents occur to prevent them happening again. Audits have been carried out for medicines and this will feed into the quality assurance process. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must show how care is being planned and delivered. They should be reviewed and updated at least monthly. This will make sure that the home can show how the residents are cared for and that the staff are clear about how to give good care. 23/07/2010 2 9 13 The registered person shall make arrangements for safe administration of subcutaneous fluids. This will ensure the safety of the people living in the home. 26/05/2010 3 27 18 The reliance on agency staff must be reduced through recruitment of additional staff. The provision of temporary staff can impact on t he consistency of care provided 01/07/2010 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action and the standards of the records kept. 4 30 18 Staff must be given adequate training to make sure that they are competent to carry out their role. This will protect the residents and make sure that they have their needs met safely. 5 38 13 All staff must receive training to ensure that they can perform their role effectively and safely. This will protect the residents from harm. 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 01/07/2010 28/05/2010 1 14 Additional information collected about peoples previous life histories and individual personal profiles should be used to create a more person centered programme of lifestyle choices this should include more choices in areas such as meal times. There should be a review of the meal time experiences to make sure that it is positive for the residents and that meals times offer an opportunity for them to maintain their independence. It is recommended that the home review the way that the lounge area is used and as part of that a loop system be installed in the areas with a television to assist people who have a hearing deficit. Page 29 of 31 2 15 3 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 21 It is recommended that there is a review the bathing facilities to make sure that there are enough facilities and that people living in the home are given choice in how they receive their personal care. The long term management arrangements should be reviewed to ensure that consistency is maintained. The quality assurance processes should be repeated to make sure that they are accurate and reflect the quality of the service provided. 5 6 31 33 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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