Care Home: Southgate Beaumont Nursing Home

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What the care home does well Southgate Beaumont Nursing Home has a relaxed and friendly atmosphere and is decorated and furnished to an excellent standard. The management and staff are professional and people are treated with respect and their right to privacy is upheld. A large number of residents are very frail and have complex needs. The staff are working very hard to meet people`s needs. Pre assessments of peoples` needs are carried out before the person moves into the home to make sure the home can support the person appropriately. Staff demonstrated a good knowledge of residents needs and every resident has a plan of care which gives staff important information about how best to care for them. People who use the service have good access to outside health professionals. Visitors to the home are encouraged and made welcome. The food provided by the home is of good quality and menus are reviewed with residents on a regular basis. Staff understand the importance of reporting any potential safeguarding matters to the appropriate authorities so that residents are safe from harm. What has improved since the last inspection? Eleven requirements were issued at the last inspection. The majority of these requirements have now been complied with. Three requirements from the last inspection have been amended. The service is better at reviewing care plans with residents so care needs can be updated as appropriate. Clinical procedures at the home have improved with particular regard to pressure care and dental hygiene. Medication procedures at the home have also improved considerably. Staff now have more regular supervision and staff training is better organised. The home keeps in touch with us and notifies us of significant issues. The provision of activities had improved however due to the resignation of the activities worker, the home must employ another activities worker to build on the improvements made. Peoples` choices around meals have improved however there is still further improvement needed in this area. Although the home has reviewed staffing levels, further reviews should be undertaken with regard to the current needs of the residents at the home. Good practice recommendations issued at the last inspection with regard to medication, staff reporting procedures and health and safety have all been complied with. What the care home could do better: As a result of this inspection six new requirements and two good practice recommendations have been issued. Care plans must detail residents` likes and dislikes, preferences and their expectations of how their care is to be delivered. This should ensure that the care approach in the home is more person centred. The home must employ an activities worker to build on the improvements already made. The systems for ordering continence aids and hygiene products must be reviewed so that the home does not run out of these items. Staffing levels and working practices must be reviewed with the consultation of both residents and staff to ensure that people`s expectations of care are fully met. NVQ training must continue to be provided for staff so that more staff attain this qualification. Following the recent resignation of the home`s manager, the service must recruit a new manager who has the experience and qualifications needed to manage this busy home. The two good practice recommendations relate to staff training in dementia care and obtaining further verifications of professional references within staff recruitment checks. Key inspection report Care homes for older people Name: Address: Southgate Beaumont Nursing Home 15 Cannon Hill Old Southgate London N14 7DJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David Hastings     Date: 1 4 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Southgate Beaumont Nursing Home 15 Cannon Hill Old Southgate London N14 7DJ 02088829222 02088865381 barbara.rees@barchester.net www.barchester.com Barchester Healthcare Homes Ltd care home 52 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Rooms 1;7;20;27 & 40 may not be used by heavily dependent persons. Date of last inspection Brief description of the care home The Southgate Beaumont is a care home registered to provide nursing care for up to 52 people over the age of 65. A section of the first floor has been converted into a residential unit for seven service users who do not need nursing care. The service is provided in a listed building, which has been converted for use as a care home. There are five communal lounge areas, a dining room and a hairdressing salon. All bedrooms have en suite facilities. The home is owned and managed by Barchester Healthcare Homes Limited. The home is located close to public transport links and is walking distance to Palmers Green and Southgate. The stated aim of the home is to create circumstances in which residents can maintain their dignity, identity and independence and also to provide an environment for individuals that supports their physical and mental well being. Weekly fees as at November 2009 are 750GBP - 1200 GBP for nursing care. The most recent CQC inspection reports can be obtained from the managers office or from the CQC website. Care Homes for Older People Page 4 of 32 Over 65 52 0 1 2 1 2 2 0 0 8 Brief description of the care home 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 Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This Key Unannounced inspection started on Friday 13th October 2009 and lasted two days. We were assisted with the inspection by an Expert by Experience who spent time talking to the residents. An Expert by Experience is a person who has had experience of either receiving care services themselves or of having contact with care services through a person close to them. They help to ensure that the inspection focuses on the people who are receiving the service. We spoke with eight staff on duty during the inspection. We spoke with twelve residents of the home and we met four visitors. We observed the interactions between staff and residents. We inspected the building and examined various care records as well as a number of policies and procedures. Prior to this inspection we sent out surveys to staff and residents. We received six surveys back from staff and three surveys from residents or their relatives. The home also prepared a self-assessment (AQAA) and this was submitted to the Care Homes for Older People Page 6 of 32 Commission. This information was used as part of the inspection. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: As a result of this inspection six new requirements and two good practice recommendations have been issued. Care plans must detail residents likes and dislikes, preferences and their expectations of how their care is to be delivered. This should ensure that the care approach in the home is more person centred. The home must employ an activities worker to build on the improvements already made. The systems for ordering continence aids and hygiene products must be reviewed so that the home does not run out of these items. Care Homes for Older People Page 8 of 32 Staffing levels and working practices must be reviewed with the consultation of both residents and staff to ensure that peoples expectations of care are fully met. NVQ training must continue to be provided for staff so that more staff attain this qualification. Following the recent resignation of the homes manager, the service must recruit a new manager who has the experience and qualifications needed to manage this busy home. The two good practice recommendations relate to staff training in dementia care and obtaining further verifications of professional references within staff recruitment checks. 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 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. The home carries out an assessment of individuals needs so that they know that the home is able to meet their needs before they decide to move in on a trial basis. Evidence: Pre admission assessments were examined for four people who are now living at the home. The information was satisfactory and clearly outlined each persons individual needs. The assessments carried out by the home, were detailed and also gave information about the persons social history. There was evidence that these identified needs were also being recorded in each persons individual care plan. People who use the service and their relatives told us that they were involved in this assessment process and, where possible, had visited the home before moving in on a trial basis. We also saw evidence in three peoples files that they have a review of their Care Homes for Older People Page 11 of 32 Evidence: placement after 4-6 weeks to see if they would like to stay at the home on a permanent basis. It is important that the records of these reviews are maintained in residents files in order to evidence that these review meetings have taken place. We were assured that residents have these reviews after four to six weeks of being at the home. The annual quality assurance assessment, recently sent to us by the service states, All permanent admissions are on a four week trial to enable the Resident to see if they are happy and feel that we can become their home. 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. Care plans clearly set out residents health and social care needs so that staff know how best to support everyone at the home. Some more improvements are required so that care plans are person centred in approach. Residents have good access to health care professionals and they are treated with respect. Residents get the medication they require, at the right times and by appropriately trained staff. Evidence: We examined eight peoples care plans. Each plan gave clear instructions to staff about how best to care for that person. Staff that we spoke with had a good understanding of the care needs of residents they supported. Peoples health, personal and social care needs were recorded on each plan. Care plans contained information about how to maintain an individuals privacy and dignity. Care plans also detailed peoples cultural and spiritual needs. Each persons plan of care included an assessment of the risk of falling and how staff are to reduce this risk. Other risk assessments were seen including moving and handling, pressure care and nutrition. Residents weight is being monitored on a regular basis and action is taken if any Care Homes for Older People Page 13 of 32 Evidence: problems are highlighted. Where residents have been assessed as having problems with eating and drinking, fluid charts have been put into place to monitor how much people eat and drink each day. Care plans were being reviewed on a regular basis and updated where needed. At the time of this inspection two people were being treated for pressure sores and the nursing staff told us that in both cases, the residents condition was improving. It was positive to see that a number of residents health conditions have improved considerably since they moved to the home. The staff at the home told us that there are now good clinical procedures and policies in place to monitor and meet peoples health needs. Residents told us they were happy with the way staff met their medical and health needs. A number of residents told us that they did not feel the staff were able to offer flexible support with regard to getting up in the mornings, times for meals, times for personal care and going to bed of an evening. Care plans did not always provide staff with this information about residents likes, dislikes and preferences with regard to their general care provision. It would appear from the evidence we obtained that the home is run using the medical model rather than a person centred approach to care. This is also a view held by the service. In the recent AQQA, the manager comments, Person centred care is a priority for us to develop for our residents. Care plans could better reflect a sense of personhood rather than primarily focus on health care needs. A new requirement has been issued relating to this matter. There was evidence from care plans that people have good access to health care professionals such as doctors, chiropodists, dentists and opticians. These visits were being recorded on residents care plans with any action needed as a result. With particular reference to dental care, the manager stated in their recent AQQA, Staff support Residents with a good standard of oral hygiene backed up with Domiciliary visits from a Dentist. The doctor for the home visits every week. People who use the service confirmed that they had good access to health care professionals. On the day of the inspection people using the service looked well cared for, their clothes were clean and they were appropriately dressed. Satisfactory records were examined in relation to the receipt, storage, administration and disposal of medication. Records indicated that only qualified staff administer and deal with medication at the home. There have been a number of problems with medication in the past and the manager and staff are to be commended for the clear improvement in this area. Care Homes for Older People Page 14 of 32 Evidence: A staff member commented, The home has got much better from a clinical point of view, care plans are updated on a monthly basis or more often if required. Wound documentation has improved and there are no medication errors. We saw a number of examples of supportive staff interactions with people and staff were able to describe to us how they ensure the privacy of people they support. We saw staff knocking on residents bedroom doors before entering. People we spoke with told us that the staff were respectful and kind towards them. 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. The home provides varied activities for people who use the service. The home encourages visitors, which ensures an interesting and lively atmosphere. Residents are generally able to exercise choice and control over their lives. The home provides people with a wholesome appealing balanced diet. Evidence: There was a full time activity worker at the home but she has since resigned and one part time activity worker remains. Residents we spoke with told us they were happy with the activities on offer at the home but were concerned that activities would not take place so often due to the activity worker vacancy. We were assured by the operations manager that the post will be advertised shortly. Residents files outlined each month activities undertaken by individual residents with additional comments about the therapeutic benefits of these activities. This is very good practice and should continue when the new activity worker is employed. A number of residents are very poorly and mostly stay in their rooms. We discussed with the staff the need to keep these residents suitably occupied and engaged. Although we saw staff visiting residents it would be useful for training to be given to all staff regarding activities for those residents who have developed dementia or are not able to join in communal activities. This is a challenging area as staff were very busy with residents carrying out Care Homes for Older People Page 16 of 32 Evidence: personal and clinical tasks. The building is very impressive and there are a number of very nice lounges and sitting rooms throughout the home. Residents told us these were underused and we saw this on the days of the inspection. There appears to be a culture of residents remaining in their rooms throughout the day. This is a great shame and it is hoped that the new manager and staff will explore how these lounges can be better utilised by residents. A relative commented that the service should, Make a more positive effort to encourage new residents to come out of their rooms and use the communal spaces that are largely empty and soulless as a result. We saw a large number of visitors to the home during the inspection. Visitors told us that they could visit at any reasonable time and that they were made welcome by the management and staff. Residents we spoke with confirmed this. A number of residents we spoke with told us that they felt they had choice and control over their lives. We did speak with some residents who felt that they had to fit into the routines of the home rather than the other way around. Residents were observed enjoying their lunch in relaxed and pleasant surroundings. The menu for the day was clearly displayed and people told us there was always a choice. Residents told us they generally enjoyed their meals and that there was always enough to eat. One resident told us, I have no complaints about the food. Another resident commented, The catering is excellent. Some residents have their meals in their room. We noticed that one person had not eaten much of their lunch but were told by staff that this is recorded and action taken to ensure that people eat properly. We spoke with three residents in the residential unit. They told us that they attended catering meetings with the management and cooks. They told us there were some issues with the evening meal not always being hot enough. It is hoped that these issues can be identified and resolved at the next catering meeting. We visited the kitchen during the inspection. Freezer and fridge temperatures were being routinely recorded. The kitchen was clean and well maintained and there was plenty of fresh fruit and vegetables available. Care Homes for Older People Page 17 of 32 Evidence: The cooks were interviewed and had a good knowledge of individual residents dietary needs and preferences including cultural or religious needs. The kitchen has recently been inspected by the environmental health department and was awarded four scores on the doors. 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. People who use the service can be assured that any complaint will be taken seriously and dealt with in an open manner and within set timescales. People who use the service are protected from abuse by clear policies and procedures and by a well-informed, trained staff group. Evidence: The home has satisfactory policies and procedures in relation to complaints and the protection of residents from abuse. In the AQQA, which was recently sent to the Commission, the manager states, We are fully up to date with the new Safeguarding Adults policies and procedures provided by the local authority and CQC. All the residents and visitors we spoke with said they were aware of the complaints procedure and knew what to do if they wanted to raise a concern. We examined the complaints record. There have been a number of complaints since the last inspection. Each complaint was clearly recorded and included a written response to the complainant and any action taken as a result of the investigation by the manager. Some complaints had been upheld and clearly identified the action needed to resolve the problem. Staff were able to describe how vulnerable people could be at risk of abuse in a Care Homes for Older People Page 19 of 32 Evidence: residential care setting. All staff interviewed were clear of their responsibility to report any suspicions of abuse to the appropriate authorities. Residents that we spoke to said they felt safe and well supported at the home. Records indicated that most staff have undertaken training in the protection of vulnerable people. There has been one safeguarding issue at the home since the last inspection. Records indicated that this was dealt with properly and in accordance with the relevant policies and procedures. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, safe and maintained to an excellent standard. People who use the service are protected by clear policies and procedures in relation to infection control. Evidence: We looked around the home with a member of the nursing staff and visited a number of residents rooms with their permission. The home is well maintained and is furnished and decorated to an excellent standard. There is a full time maintenance person who checks and ensures that the building and equipment are maintained and repaired. On the day of the inspection the home was clean, tidy and free from offensive odours. The residents and visitors we spoke with confirmed that the home was always clean. The housekeeping staff are to be commended for the high standards of cleanliness that have consistently been maintained in the home. The home has sufficient communal areas that remain furnished and decorated to a very high standard. In addition to en suite toilets for every bedroom, there are also adequate shared bathroom and toilet facilities, which are kept clean and in a good state of repair. Residents had personalised their own rooms, which were well furnished and decorated. Keypads are installed both inside and outside of the main entrance to Care Homes for Older People Page 21 of 32 Evidence: the home and an increased presence in reception ensures adequate but safe access for people in and out of the home. The laundry area was clean and washing machines included a sluice cycle for soiled laundry. The house keeper we met understood the need to maintain good levels of hygiene and there are good systems in place to deal with soiled laundry. Bathrooms and toilets were clean and contained anti bacterial soap and paper towels to limit the risk of cross infection. A number of staff commented that on some occasions hand towels were not available and this was embarrassing when visitors needed them. Staff also commented that incontinent products were not always available for residents needs. We spoke with the manager about this and were told this did happen on one occasion however staff indicated this problem has occurred a number of times. We have issued a requirement that the systems for ordering and supplying continence items and basic hygiene products such as paper towels are reviewed. 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 staff at the home work hard to meet the needs of the residents and are generally provided with good training opportunities to further enhance their knowledge and skills. More management support and clarity for staff would ensure that residents expectations are better met. Recruitment practices are sufficiently detailed in order to protect residents at the home. Evidence: On the days of the inspection there were thirty residents at the home. There were three residents in the residential unit which would normally have seven residents. There were twenty eight residents in the nursing units which would normally have forty three residents. This means there are currently twenty vacancies. As a result of these vacancies the organisation has reduced the staffing levels at the home. This has caused concern to both residents and staff. The staff told us they had not been consulted about these reductions and felt uncertain about their roles and responsibilities as well as feeling under pressure to meet peoples needs. The residential unit does not have any dedicated staff at present and staff from the nursing units are expected to provide care and support to the three residents. Although this would seem reasonable, in practice residents we spoke with were Care Homes for Older People Page 23 of 32 Evidence: frustrated that staff were not always around to help them. It would seem from talking with staff that they were not always available to assist these residents as they were often busy on the nursing units. The management informed us that staffing levels will be reviewed as new residents are admitted to the home. These issues may not just be about staffing levels but also how staff are managed in the home. Care staff said they wanted to do a good job but felt undervalued and unsupported. A new requirement has been issued that staffing levels and working practices are reviewed with consultation from both residents and staff. This should ensure that all staff are aware of what they need to do so that residents are properly supported. We spoke with the operations manager who is taking over the management of the home until a new manager is recruited. He told us that he will be looking into this issue as a matter of priority. Residents we spoke with were generally very happy with the staff team and confirmed that staff were kind, respectful and professional. Staff we interviewed were generally very positive about the training opportunities available to them and records we examined indicated that staff were undertaking the training relevant to their work. One staff member commented, We get a lot of training. Another staff member commented that dementia training would be very useful for all staff as the number of people with dementia at the home has increased. A good practice recommendation has been given that all staff undertake dementia training and this training should include communication with and activities for people with dementia. We saw evidence that mandatory training has been booked for those staff who require it or need refresher training. Information provided by the service prior to this inspection indicated that eight care staff out of twenty nine have completed their NVQ level 2 qualification or equivalent. This does not meet the requirements of this standard and a new requirement has been made in the relevant section of this report. Six staff files were examined from staff recently employed by the home. We checked these files to see if the homes recruitment procedures were being followed so that residents are protected from unsuitable staff working at the home. The files examined contained all the information needed to protect residents including two written references, proof of identity and criminal record checks. Some references we examined did not contain a company stamp or letter headed paper to further confirm the authenticity of the reference. A good practice Care Homes for Older People Page 24 of 32 Evidence: recommendation has been made relating to this issue. 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. The manager has ensured that clinical procedures within the home have improved. However due to her resignation, a new manager for the home is needed so that staff can be appropriately supported to provide a consistent approach to care. Residents do have opportunities to have a say in how the home is run. Residents financial interests are being safeguarded. Staff are supported in their work. The health and safety of residents and staff are promoted and protected. Evidence: Unfortunately the manager of the home, who has been in post for about a year, has now resigned. The operations manager is taking over the management of the home until a new manager has been recruited and inducted. The nursing staff told us they appreciated the managers input and work with regard to clinical care and medication at the home. We could see evidence that these areas in the home have improved considerably. We met with the operations manager on both days of the inspection and it was clear that he understood what further improvements Care Homes for Older People Page 26 of 32 Evidence: are needed for this home. A new requirement has been issued that the service employs a manager for the home. The service undertakes a number of quality assurance exercises to obtain the views from residents and their representatives about their experiences in the home. Prior to this inspection the service sent us the following information about quality assurance systems, Monthly internal audits are undertaken as directed by the Director of Quality of Care. In addition to this, a monthly visit is carried out under Regulation 26. The Organisation has recently appointed a Compliance Officer who undertakes audits in line with the NMS and Care Home Regulations. The home has been inspected by our internal regulation team in August 2009. We saw the most recent clinical audit undertaken by the organisation. This was detailed and contained timescales for action. The operations manager is aware of the need to engage residents to obtain their views about their care needs and told us he would be setting up these meetings very soon. The home does not hold money on behalf of residents. Instead residents or their representatives are invoiced on a regular basis. A sample of these invoices were examined and found to be accurate and included clear audit trails. Staff supervision records indicated that care staff receive regular support and staff confirmed that they received supervision every two months. Satisfactory health and safety records were seen in relation to electrical installation, PAT testing, gas safety and equipment servicing such as hoists and lifts. We also checked records in relation to fire safety. Records indicated that staff were undertaking fire drills on a regular basis. Fire training has been given to staff and staff confirmed they have undertaken this training. Records of checks for the fire alarm, emergency lighting and fire extinguishers were also satisfactory. The maintenance person carries out regular health and safety checks in the home and had an excellent knowledge of his responsibilities in this area. Care Homes for Older People Page 27 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 28 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 7 12 The registered person must 01/01/2010 ensure that care plans detail residents likes, dislikes, preferences and their expectations of how their care is to be delivered. This should ensure that the care approach at the home is more person centred and that residents are consulted about their care. 2 12 16 The registered person must ensure that an activity worker is employed at the home to build on the good work undertaken by the previous worker. This should ensure that all residents are kept suitably occupied and engaged. 01/01/2010 3 26 16 The registered person must ensure that the systems for ordering and supplying continence items and basic 01/12/2009 Care Homes for Older People Page 29 of 32 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 hygiene products such as paper towels are reviewed. This should ensure that the home does not run out of continence aids or hygiene products. 4 27 18 The registered person must ensure that staffing levels and working practices are reviewed with consultation from both residents and staff. This should ensure that all staff are aware of what they need to do so that residents are properly supported. 5 28 18 The registered person must 31/03/2010 ensure that staff NVQ level 2 training takes place so that over 50 of staff have this qualification. This is to ensure that staff have the required training for the work they carry out. 6 31 8 The registered person must ensure that a manager is appointed at the home. This is to ensure that staff are properly supported to care for residents. 01/01/2010 01/12/2009 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 29 The registered person should ensure that any professional references obtained for staff recruitment have a company stamp or letter headed paper attached to further confirm its authenticity. The registered person should ensure that all staff undertake dementia training with particular regard to communication and the engagement of people with dementia. 2 30 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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