Care Home: Southlands

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What the care home does well Residents continue to live in a comfortable, clean, homely environment with their private accommodation personalised to suit their needs and lifestyles. A residents said "lovely room it has everything which I need I keep it very clean and tidy". A good assessment process helps to ensure that the needs of any prospective residents are fully assessed prior to any admission. A social care professional fedback "the manager was very professional did a good assessment of my clients needs very thorough and got a real understanding of their needs". Residents continue to benefit from the relaxed and gentle lifestyle offered by the home. A resident said "It is a good place to live". A relative said "he is so well looked after there, it is such a good place for him I cant fault the place it is wonderful a home from home". A social care professional fedback "the team are particularly good at supporting clients who have challenged other services". Resident`s needs are met on an individual basis. The home is able to support people with difficult behaviour and have a good knowledge of mental health they look after their residents in a sympathetic and caring manner". A health care professional" said "very caring place residents all seem very content". Residents receive a good standard of health care support with prompt medical intervention and advice sought. Personal support is offered in ways, which promotes and protect resident`s privacy and dignity. Residents are treated as individuals and are able to exercise some choices over their daily lives. A residents commented "not too bad living her I can lock my door and I have the freedom to go out when I want get up and go to bed when I like". Resident`s lives are enriched when the home provides opportunities for occupation and stimulation through a varied programme of activities. A health care professional commented "the manager likes as many residents as possible to participate in the activities it seems a very active place". Staff make a positive contribution in residents lives. Residents were relaxed around staff with many signs of positive body language observed. A sample of feedback about staff included "very kind, considerate" "the staff are always helpful and friendly and my husband feels quite happy there and if I have any worries I talk to one of the staff and they put my mind at ease". The staff are always caring and responsive to my clients needs" and "staff helpful communication generally good each time I have had contact with them they have been able to answer my queries". What has improved since the last inspection? Significant work has been undertaken since the previous inspection to address the shortfalls noted. This has included the involvement of an external care organisation to support the manager in improving standards. A staff member fedback that they felt that the home is "improving on everything". Resident`s safety has improved through windows now being restricted to prevent the risk of accidental falls, medication practises are more robust and staff undergo a police check prior to employment commencing. More robust practises in the management of malodorous odours has created a more pleasant environment in which to live, work and visit. Comments about the environment included "environment is clean occasionally a few odours but they seem to manage it pretty well" and "environment is good, always clean". Staffing levels have been slightly increased and domestic staff employed which has removed care staffs responsibilities to cook and clean. This has improved practises at the home with staff now undertaking more activities with residents and outings. A staff member commented "staffing levels have improved which has made a big difference more time to spend with residents and on paper work no more cleaning". The introduction of a Person Centred Planning approach now provides staff with the guidance they need to provide individual consistent care. A staff member said " I personally have learnt a lot more about individual residents through completing the Person centred care plans". Aspects of management of the home have improved through the manager delegating tasks and gaining the guidance and support from an external care organisation. Staff and management have had access to a range of training this has helped to improve staffs skills and understanding of the needs of residents and of changes in legislation and good practise guidance in the care of vulnerable people. The home continues to undergo a refurbishment which has seen some flooring and windows being replaced. What the care home could do better: Meal times should provide more opportunities for social interaction, orientation and stimulation to help further enhance resident`s lives. In order to further promote good practises staff should be provided with additional guidance on the administration of some kinds of medication. To ensure that residents are aware of the menu choices or changes to menus a more accessible menu format should be provided. Residents need to be protected from the risk of cross infection through the use of staff wearing protective clothing when undertaking personal care or handling/serving food. Residents must be protected by the homes recruitment practises to ensure that all of the necessary documentation is obtained prior to employment commencing. This helps to ensure that only staff who are assessed as safe and eligible to work with vulnerable people are employed. Key inspection report Care homes for older people Name: Address: Southlands Southlands 7 Linkfield Lane Redhill Surrey RH1 1JF     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: Jane Jewell     Date: 1 4 1 2 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: Southlands Southlands 7 Linkfield Lane Redhill Surrey RH1 1JF 01737769146 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: southlandsresthome@hotmail.com Mr Ravind Sohun,Mrs Angela Sohun care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 19 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Mental Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home Southlands Rest Home is registered to provided residential care for up to nineteen people whos primary needs is elderly or have a past and present mental health condition. The home has been owned and operated by joint providers Mr and Mrs Care Homes for Older People Page 4 of 32 1 6 0 6 2 0 0 9 19 19 0 Over 65 0 0 19 Brief description of the care home Sohun since 1996, with Mrs Sohun also the registered manager. The home is situated in a residential street on the outskirts of Redhill town centre with all amenities including shops, post office, theatre cinema and good transport links to London and the southeast. The house is a large converted domestic detached property, set in its own grounds and is presented across three floors with a passenger lift providing access to each floor. Communal space consists of a dining and large living room situated on the ground floor, which leads out onto a raised balcony patio area that overlooks a rear garden. The garden is set to lawn with some flowerbeds and further patio area. Residents accommodation consists of fifteen single and two shared bedrooms, four of which provide en suite facilities. The home can provide some transport for the people who use the service The manager reported that the current range of fees are from £400 to £600 per week, depending on room, the services and facilities provided which are based on an individuals level of need. Extras such as newspapers, hairdressing, chiropody, toiletries are additional costs. 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: The quality rating for this service is TWO star. This means the people who use the service experience GOOD quality outcomes. The information contained in this report has been comprised from an unannounced inspection undertaken over six hours, from 11:00am to 5.00pm, and information gathered about the home before and after the inspection. The inspection was facilitated by the manager (Mrs Angela Sohun) and in part by the joint registered provider (Mr Ravind Sohun). This is the homes second key inspection within twelve months. The focus of the inspection was to look at the experiences of life at the home for people living there and the progress made towards addressing the shortfalls noted at the previous inspection. The inspection consisted of being shown the communal areas, and being invited to Care Homes for Older People Page 6 of 32 view residents bedrooms, examination of the homes documentation and observations of residents daily routines and in their interactions with staff, during lunch time and over the morning and afternoon period. Seven residents, five staff, two health or social care professional and a relative were consulted as part of the inspection process. Signs of residents well-being/ill-being (terminology used for observing behaviour for people with limited verbal communication) are also included in this report to help make judgements about residents wellbeing. Feedback surveys were sent to the home for distribution, in order to obtain the views on the quality of the services and facilities being provided. Fifteen were returned in total, one from a resident who were supported to complete the form, six from residents, three from staff, and five from health or social care professionals. Their feedback is included in this report. There were sixteen residents living at the home at the time 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? Significant work has been undertaken since the previous inspection to address the shortfalls noted. This has included the involvement of an external care organisation to support the manager in improving standards. A staff member fedback that they felt that the home is improving on everything. Residents safety has improved through windows now being restricted to prevent the Care Homes for Older People Page 8 of 32 risk of accidental falls, medication practises are more robust and staff undergo a police check prior to employment commencing. More robust practises in the management of malodorous odours has created a more pleasant environment in which to live, work and visit. Comments about the environment included environment is clean occasionally a few odours but they seem to manage it pretty well and environment is good, always clean. Staffing levels have been slightly increased and domestic staff employed which has removed care staffs responsibilities to cook and clean. This has improved practises at the home with staff now undertaking more activities with residents and outings. A staff member commented staffing levels have improved which has made a big difference more time to spend with residents and on paper work no more cleaning. The introduction of a Person Centred Planning approach now provides staff with the guidance they need to provide individual consistent care. A staff member said I personally have learnt a lot more about individual residents through completing the Person centred care plans. Aspects of management of the home have improved through the manager delegating tasks and gaining the guidance and support from an external care organisation. Staff and management have had access to a range of training this has helped to improve staffs skills and understanding of the needs of residents and of changes in legislation and good practise guidance in the care of vulnerable people. The home continues to undergo a refurbishment which has seen some flooring and windows being replaced. What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 9 of 32 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 10 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 11 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 provides both prospective and existing residents, with a range of information about the home and what to expect when living there to help them make informed choices. A good assessment process helps to ensure that the needs of any prospective residents are fully assessed prior to any admission, The home is able to meet the range of residents assessed needs and provides a relaxed and gentle lifestyle. Evidence: The homes statement of purpose, which is a book that tells people who the home is for and the service users guide, which is the book that tells people how the home works, provides a range of information about the home and the services it provides. These documents have been reviewed and now provide more detailed information about the range of services and facilities being provided at the home. Care Homes for Older People Page 12 of 32 Evidence: The home ensures that prospective residents are accommodated only following an assessment of their needs by the manager or placement authority. Advice is sought during the assessment process from health care professionals and others who know and understand the needs of the prospective resident. The needs assessment then forms the basis of their care plan. This helps ensure that staff are aware of the recorded needs of new residents prior to them moving into the home. A social care professional fedback the manager was very professional did a good assessment of my clients needs very thorough and got a real understanding of their needs. There continues to be a range of needs being accommodated at the home this includes older people who have long term enduring mental health needs, residents who have dementia and residents who live independent lifestyles. The majority of residents remain assessed as having low to medium needs. The home provides a quiet and relaxed lifestyle which clearly suites the residents being accommodated. Residents showed many positive signs of wellbeing including, smiling and showing affection and initiating conversation with staff. A resident said It is a good place to live. A relative said he is so well looked after there, it is such a good place for him I cant fault the place it is wonderful a home from home. A social care professional fedback the team are particularly good at supporting clients who have challenged other services. Residents needs are met on an individual basis. The home is able to support people with difficult behaviour and have a good knowledge of mental health they look after their residents in a sympathetic and caring manner. A health care professional said very caring place residents all seem very content. A staff member said that the best bit about the home was that is was so friendly. Residents consulted spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home. Intermediate care is not provided at the home and therefore this standard was no assessed. Care Homes for Older People Page 13 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. Residents benefit from a care planning system which guides staff on how to meet the personal and health care needs of residents in an individualised and consistent way. Residents receive a good standard of health care support with prompt medical intervention and advice sought. Medication practises are well managed promoting good health. Personal support is offered in ways, which promotes and protect residents privacy and dignity. Evidence: Much work has been undertaken to address the shortfalls in care planning noted at the last inspection. This has seen the introduction of person centred care planning which involves developing a care plan around the individual needs of each residents. The manager fedback that there remains only a few care plans to convert to the new format which they agreed to have completed within a month of the inspection. Care Homes for Older People Page 14 of 32 Evidence: Five care plans were examined and these showed that staff now have a range of guidance on the needs and preferences of residents. The information included in the care plans would enable staff to deliver consistent support to residents based on their individual needs and preferences. Staff spoke enthusiastically about the new care planning documentation and how it has helped to improve some practises at the home namely what residents like to do. A staff member said I personally have learnt a lot more about individual residents through completing the Person centred care plans. A health care professional fedback although the files are not always up to date the care staff are aware of the needs of their clients. Residents continue to express little interest in being involved in the development and review of their care plans, but felt able to ask to see them. The regular review of care plans has helped to ensure that changes in residents needs and preferences can be promptly identified. Records show that prompt action is taken to address any medical concerns, including the involving of specialist services including dietitians, and specialist nurses. A resident spoke of not being well recently and how quickly staff called the GP and of the support they get from staff to ensure that they follow the GPs instructions. A health care professional did however fedback that staff sometimes seem less than familiar with the health needs of their residents. None of the residents accommodated are assessed as self administering their own medication. Medication profiles are in place which provides information on how much medication is provided, how medication should be administered and when it is administered. Only trained staff dispense medication. Medicines were generally well organised and stored. The manager now undertakes regular audits of controlled medication to ensure accuracy of recording and administration. To further improve good practises it is recommended that additional instructions are provided for staff on the administration of As required medication, which make clear the individual requirements for when this medications was prescribed. This is necessary for staff to know when to administer these medicines. During the inspection staff were seen to treat residents with respect. Staff consulted with showed a good understanding of good practises in preserving residents rights to privacy and dignity. Staff were able to give many examples of how they promote these rights in their every day care practises. Residents were found to be dressed in well laundered clothing and enjoyed the regular input from the visiting hairdresser to help maintain a dignified appearance. The manager confirmed that the hairdresser no longer uses a residents bedroom as a communal hairdressing room. Care Homes for Older People Page 15 of 32 Evidence: Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lives are enriched when the home provides opportunities for occupation and stimulation through a varied programme of activities. Residents are treated as individuals and are able to exercise some choices over their daily lives. Links with families and friends remained valued and supported by the home. Residents generally spoke positively about the food but received, however some residents had a variable meal time experiences with some further work needed to enable choice and for meal times to promote a more social and stimulating experience. Evidence: The home employs two activity coordinators who develop and provide a flexible varied programme of activities. Residents spoke of undertaking gentle exercises, games, puzzles, hand massages, craft sessions and cooking. On the day of the inspection residents were involved in a reflexology and music therapist session. A resident spoke about being kept busy another residents spoke of how they preferred to occupy their own time and that this was respected by staff. A health care professional fedback the manager likes as many residents as possible to participate in the activities it seems a Care Homes for Older People Page 17 of 32 Evidence: very active place. Staff consistently spoke of the increased opportunities for outings that have been created. This has included groups of residents going to local pubs to play snooker/ pool and watch sporting events or visiting coffee shops. Staff spoke of how the introduction of person centred planning has highlighted the individual interests of residents and the involvement of the activities co-ordinator also in their development has enabled more individual based activities to be undertaken. All residents and relatives consulted with continue to confirm how welcome they or their visitors were made to feel when visiting and how they can visit at any reasonable time. A resident spoke of the support provided by external health care professionals and the staff The providers use their own cars or provide a taxi to help enable residents to access the local community such as shops, banks and health care facilities. A resident spoke of the reliable frequent bus service they use to go and visit their friends, day care services and access the town centre. There is evidence that residents are treated as individuals. Through observation and discussion with staff and residents it was confirmed that the routines of daily living are flexible to suit the needs and preferences of residents. For example with regard to bathing, rising, going to bed, meals and meal times. A sample of residents comments included I go out every day or whenever I want and not too bad living her I can lock my door and I have the freedom to go out when I want get up and go to bed when I like. Consideration has also now been given to new legislation (Mental Capacity Act) which affects residents rights to make decisions in their lives with some residents being supported to obtain independent advocates to assist them when making decisions. The inspector observed part of lunch time with the meal served being presented well with residents individual preferences respected and specialist diets catered food. Most residents preferred to eat their meal in a pleasant decorated dinning room. A resident preferred to eat the same meal each day in the lounge which was provided for them. A sample of feedback received regarding the food, included provides pretty good food alright I like the meal it was nice and it was a bit cold. The portion sizes of the pudding appeared small and when a resident asked for a further helping this was not able to be provided as there was none left. A staff member later reported that there was more in the kitchen but the staff member serving the meal did not know this. A relative stayed to eat lunch with their relative with the social interaction this created clearly being enjoyed by several residents. However for other residents little interaction was observed between staff and residents, with staff observed being very Care Homes for Older People Page 18 of 32 Evidence: task based. This did not create a social environment or provide stimulation or orientation for some residents. This was fedback to the manager who agreed to review the meal time arrangements to promote a more stimulation meal time experience. As well as the main meal residents are provided with regular hot drinks and snacks with cold drinks also easily accessible for residents or their guests. A printed menu was available which did not reflect the meal on offer on the day of the inspection. A staff member spoke of the menus being flexible depending on residents preferences at the time. In order to promote choice and enable this flexibility it is recommended that there is also a daily menu which is in a more accessible format, for example easy read or pictures. Care Homes for Older People Page 19 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. There is an accessible complaints system with evidence that residents and relatives feel that their views would be listened to. Staff have the guidance and training necessary to show them what to do if abuse is suspected. Evidence: There is an accessible complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. Residents, staff and relatives consulted continue to feel able to share any concerns they had with the manager. The manager reported that there have been no formal complaints made since the previous twelve months. The home has written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff consulted with said that they had undertaken the necessary training in safeguarding adults and prevention of abuse and showed an understanding of their roles and responsibilities under safeguarding adults guidelines. No safeguarding referrals which have been made to social services since the previous inspection have resulted in the need for changes to the homes practises. Care Homes for Older People Page 20 of 32 Evidence: Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to live in a comfortable, clean, homely environment with their private accommodation personalised to suit their needs and lifestyles. Standards of cleanliness are good however not all of the staffs practises protected residents from the risk of cross infection. Evidence: The provider reported that the premises are a grade II listed building which places some restrictions on them being able to sometimes promptly respond to maintenance issues while permission is sought to undertake certain upgrades. The standard of maintenance was seen to be good. Comments about the environment included very homely environment and the fixtures and fittings could do with updating. Since the previous inspection work has continued with the refurbishment of the home. This has seen the replacement of some windows and the fitting of draft excluders to some windows. Communal space consists of a dining room and large lounge that opens out onto a raised patio area. This contains seats and overlooks a well maintained and inviting garden. Residents bedrooms seen had been individualised to reflect their needs and preferences. Residents spoke about their bedrooms providing everything they needed Care Homes for Older People Page 22 of 32 Evidence: including being able to lock their bedroom doors. A residents said lovely room it has everything which I need I keep it very clean and tidy. In accordance with the previous requirement window locks had been fitted to windows that pose a risk of accidental falls. There is sufficient number of toilets and bathrooms located around the home, including a shower and assisted bathing facilities. The manager spoke of adapting a bath into a wet room/shower to meet the changing preferences of residents. There was a range of individual aids and adaptations to assist residents mobility and independence, including raised toilet seats, walking aids, hoist ramps and grab rails. Fitted throughout the home are call points, which enable assistance to be summoned when pressed. A resident confirmed that when they have called for assistance day or night, staff had always attended promptly. All areas inspected were observed to be clean with any odours confined to a bedroom. The source of the unpleasant odour was identified as being from a commode chair. The provider agreed to replace it immediately and review the standards of commodes around the home. In order to improve odour management further bedroom floors have or are in the process of being fitted with lino flooring. The home has its own carpet cleaner and a part time cleaner has been employed since the previous inspection and automatic air fresheners installed to help manage odours more effectively. Health care professional fedback there are the occasional odours but generally very good and environment is clean occasionally a few odours but they seem to manage it pretty well. A relative said that the environment is good, always clean. Although systems were in place for the control of infection and staff confirmed that they had have been trained in this area they were observed to not always be working in ways that minimised the risk of cross infection by not wearing protective clothing when either assisting with personal care or when serving food. The manager and staff confirmed that there is suitable protective clothing readily available. Care Homes for Older People Page 23 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. Staff contribute positively to the quality of life of residents, through their personal qualities and there now being sufficient numbers of staff on duty who are trained to work safely and effectively with residents. However, residents are not being protected by the homes recruitment policy and practises to ensure that only staff who have undergone all of the necessary checks and are safe to work with vulnerable people are employed. Evidence: Staff, relatives and residents felt that there was usually sufficient numbers of staff on duty for staff to undertake their roles in a timely manner and for residents to receive the support they needed when they wanted it. Staffing levels have been slightly increased during parts of the day. A cleaner and cook have now been employed with care staff no longer having to undertake these roles on a regular basis. Consistent feedback was received from staff of the improvements to care practises and of the individual time spend with residents that this has made. A staff member commenting staffing levels have improved which has made a big difference more time to spend with residents and on paper work no more cleaning. Positive signs of interactions were noted between staff and some residents during the afternoon period when most residents were sitting in the lounge. This included Care Homes for Older People Page 24 of 32 Evidence: smiling, touching and initiating conversation and recognising staff members voices. Some residents were observed being affectionate towards staff and were clearly at ease in their company. Without exception all persons consulted spoke positively about the caring qualities of staff and a sample of their comments included staff very kind considerate the staff are always helpful and friendly and my husband feels quite happy there and if I have any worries I talk to one of the staff and they put my mind at ease the staff are always caring and responsive to my clients needs supportive and very helpful and staff helpful communication generally good each time I have had contact with them they have been able to answer my queries. As previously noted, a health care professional did however feel that sometimes staff had a lack of knowledge on residents health care needs. A staff member fedback Southlands is a very nice place to work the staff are very friendly to work with good relationship with residents and their families. The manager reported that currently less than the recommended number of staff have obtained the recommended National Vocational Qualification (NVQ). There are immediate plans in place to increase this number. Since the previous inspection the home has been supported by an external care organisation and has had access to their training resources. Staff commented on the amount of training they have recently received including specialist training in person centred care planning, mental capacity, mental health and risk assessments. All staff consulted with confirmed that they have undertaken all of the mandatory areas of training needed to work safely with residents. This has included manual handling, first aid and food hygiene. The manager confirmed that new staff undertake the industry recommended minimum inductions standards. This is designed to help ensure that all new staff entering into the care industry have a minimum level of initial training. It was previously required that staff have undergone Criminal Records Bureau checks (CRB) to ensure that they are suitable to work with vulnerable people prior to employment commencement. This had been completed for the two individuals concerned. On the day of the inspection the manager was in the process of reorganising the staff files to make them more accessible and organised. As it proved difficult to retrieve the required documentation at the time of the inspection the manager was asked to provide this information within 24 hours. Although this was complied with it showed that there was a poor standard of recruitment practises. This included not obtaining written references prior to employment commencing or references from previous employers or a suitable explanation why this was not possible. Although the manager Care Homes for Older People Page 25 of 32 Evidence: reported that proof of identification documentation had been obtained at the point of a staff member applying for a CRB check copies had not been retained in order to confirm their identification and employment status. The provider was written to separately regarding this issue and immediately required to address this in order to safeguard residents. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from an approachable manager who has experience and who provides a sense of direction and ethos to help promote good care practises. A range of regular health and safety checks helps to promote the health and safety of residents and staff. Evidence: The manager who is also joint provider has many years experiences in the care of older people and confirm that they have undertaken the recommended qualification in management. Since the previous inspection they reported that they have had support from an external care organisation to help address the shortfalls noted at the last inspection. The manager and staff spoke of the manager now delegating tasks to a deputy and senior carers in order to assist in the management efficiency of the home. However as previously noted better management of the homes recruitment process must be completed. Without exception all person consulted spoke positively about the manager with particular references to their friendly approachable management style. Care Homes for Older People Page 27 of 32 Evidence: A relative fedback the manager is lovely, good with all the patients she seems to be able to understand them. Residents described the management of the home as being very good. Staff comments about the manager included hard working listens and takes action and now delegates more best one I have ever worked for really good understanding and good manager always willing to help you tells us if we are not doing things right. Some care staff spoke of receiving regular formal supervision and direct supervision when working with the manager and felt well supported by them to undertake their role. Written guidance is available on issues related to health and safety. Previous records submitted by the manager stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. Systems are in place to support fire safety, which include regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that a fire risk assessment had been completed by a fire safety expert, which recorded any significant findings and the actions taken to ensure adequate fire safety precautions in the home. The manager reported that recommendations made as a result of this fire risk assessment have been completed. It was previously required that residents are not be placed at risk of accidental falls from unguarded windows. This has now been completed through the fitting of window restrictors . Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 29 19 That only staff who have 18/12/2009 undergone all of the required recruitment checks are employed by the home prior to commencing employment. To ensure that only staff who are safe and eligible to work with vulnerable people are employed 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 26 13 That suitable arrangement are in place to prevent infection, toxic conditions and the spread of infection at the home through staff wearing the appropriate protective clothing when assisting with personal care or handling food. That suitable arrangement are in place to prevent infection, toxic conditions and the spread of infection at the home through staff wearing the appropriate protective clothing when assisting with personal care or handling food. 15/01/2010 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 9 That additional instructions are provided on the administration of As required medication, which make clear the individual requirements for when this medications was prescribed. That the days menu options are displayed in an accessible format for residents to be able to make choices from. 2 15 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. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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