Care Home: Spencer House

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What the care home does well Care guideline records reflect some of the the needs of residents and their aspirations. These contain some information about how residents are progressing, aims of care identified by staff and agreed with residents, their health requirements and risks associated with their daily living and activities. Members of staff treat residents with kindness and respect. The owners have considerable experience in the care of older people. The AQAA referrred to an on-going committment to ensure that each individual is valued and listened too. The garden is suitable for use by residents, staff and visitors. Emphasis is placed on enabling staff to administer medicines safely. What has improved since the last inspection? The AQAA referrred to an on-going committment to ensure that each individual is valued and listened too. The previous inspection report recommended that improvements be made to the induction procedure. This has been carried out but the procedure needs further modification so that induction is based on competency testing over variable time periods defined by "Skills for Care". A new stair lift has been fitted. Further refurbishment is taking place. What the care home could do better: This report contains no recommendations or requirements. Recommendations to improve practices for the benefit of residents, staff and advocates are contained within the report. There is room for essential improvement for the benefit of residents, staff and advocates in the way care support records are maintained. Better biographical profiles would be useful. The care plan information needs to be more accurate, up-to-date and comprehensive for maximum effectiveness in meeting resident`s extensive health needs. It was agreed with the owners that the the plans of care should be more specific rather than general. This would make them genuinely person-centred. The owners are aware that they should admit new residents within the admission criteria relating to their registration. Residents receive support on a day-to-day basis to remain mentally and physically active and alert. The objective of the home is to help residents gain and retain their independence. Residents are not receiving, in all cases, the levels of support they need. The premises are suitable for use by frail older people. Shared bedrooms are not equipped to enable occupants to have privacy. Residents are protected by the use of a range of checks in the recruitment of staff. The training provided to staff is not extensive enough to enable them to meet the full support needs of residents. Key inspection report Care homes for older people Name: Address: Spencer House Spencer Road Birchington Kent CT7 9EZ     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: Eamonn Kelly     Date: 2 8 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 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 29 Information about the care home Name of care home: Address: Spencer House Spencer Road Birchington Kent CT7 9EZ 01843841460 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Vinaigum Pillay Cooppen,Mrs Simee Cooppen care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 25 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 Date of last inspection Brief description of the care home Services for residents are provided over three floors of the premises: laundry facilities are on the ground floor at the back, dining and lounge areas are on the ground and first floors and bedrooms are on the ground, first and second floors. Stair lifts are in place to assist residents. At the time of the inspection, most residents had single occupancy of bedrooms. Three bedrooms are available for people who wish to share. Bedrooms and other areas have call bells and five have an en-suite facility. The seaside is within easy reach. On-street parking is available at the front of the premises. Information about fees and other possible charges may be obtained from Care Homes for Older People Page 4 of 29 Over 65 25 0 Brief description of the care home the owners as can written information about services and facilities. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2-Star. This means that people who use the service experience good quality outcomes. The inspection took place on 28th July 2009. It comprised discussions with the owners, Mr and Mrs Cooppen, two support workers, two visitors and four residents. A case tracking exercise relating to three residents was carried out to assess how they were being supported. Care practices were discussed and all parts of the premises were visited. Some records were seen during the visit principally those addressing the personal and healthcare support of residents. The Commission received an annual quality assurance assessment (AQAA) from Mr Cooppen. This provided information about how residents are currently supported and Care Homes for Older People Page 6 of 29 how the service is being developed. The previous inspection report (September 2007) and the annual service review (August 2008) were checked as part of this inspection. There were no requirements in the previous inspection report. The evidence of this inspection visit and that contained in the AQAA (annual quality assurance assessment) indicated that progress is being made in the interests of resident welfare and comfort and towards meeting the overall objectives of the service. This report contains no recommendations or requirements. Recommendations to improve practices for the benefit of residents, staff and advocates are contained within the report. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: This report contains no recommendations or requirements. Recommendations to improve practices for the benefit of residents, staff and advocates are contained within the report. There is room for essential improvement for the benefit of residents, staff and advocates in the way care support records are maintained. Better biographical profiles would be useful. The care plan information needs to be more accurate, up-to-date and comprehensive for maximum effectiveness in meeting residents extensive health needs. It was agreed with the owners that the the plans of care should be more specific rather than general. This would make them genuinely person-centred. The owners are aware that they should admit new residents within the admission criteria relating to their registration. Residents receive support on a day-to-day basis to remain mentally and physically active and alert. The objective of the home is to help residents gain and retain their Care Homes for Older People Page 8 of 29 independence. Residents are not receiving, in all cases, the levels of support they need. The premises are suitable for use by frail older people. Shared bedrooms are not equipped to enable occupants to have privacy. Residents are protected by the use of a range of checks in the recruitment of staff. The training provided to staff is not extensive enough to enable them to meet the full support needs of residents. 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 29 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 29 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. Prospective residents and their supporters receive initial advice and guidance to help them assess the facilities and suitability of the service. An assessment is carried out to see if the service can provide support that meets their needs. Evidence: Prospective residents and their representatives receive assistance and guidance to help them decide if the home is able to meet their support needs. New residents receive a personal contract that contains information on the rights and responsibilities of both parties. The owners carry out an assessment of prospective residents support needs with assistance where necessary from Social Services care managers. Some residents have support needs associated with the onset of dementia as well as substantial mobility problems and other disabilities. A checklist and associated notes are taken at Care Homes for Older People Page 11 of 29 Evidence: this stage that form part of subsequent care plan records. The care plan record begun at this stage outlines the support needs of the prospective resident and how these needs would be met. A review of two care plans that contained completed preadmission assessments provided useful insights into how residents are supported at this stage. The owners were advised to prepare an initial description of the residents background at this stage for inclusion in the care plan folder. This biographical outline could then be updated as soon as possible when more information was obtained. In most instances, this type of information would need to be obtained by staff and added to when additional relevant biographical information became available. This pre-admission assessment is very necessary because the service has traditionally sought to meet the needs of people with significantly lower dependency levels. Discussion of some four profiles of residents with the owners and observation of residents current circumstances indicated that support needs are very high and that relatively high staffing levels are needed to meet the assessed and changing needs. Potential residents may not always visit the home prior to taking up residence. However they (and their representatives) are invited to do so. The home occasionally admits residents for respite care and this information is carried in the Statement of Purpose of the service. Two visitors stated that the residents they were visiting received good support from staff. Care Homes for Older People Page 12 of 29 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 health, personal and social care needs are met. Individual plans of care have the potential of contributing to better knowledge by staff of residents changing support needs. Evidence: Care plan folders seen for three residents contained information about residents support needs and how these were being met. These included risk assessment information, pre-admission outline, fluid charts, weight records pressure sore prevention/treatment record, healthcare checks and access to healthcare services, and care plans outlining assessed needs and how to address the needs. In the case of three residents who were met during the inspection and whose care folders were checked, there is room for essential improvement for the benefit of residents and staff. Better biographical profiles would be useful. The care plan information needs to be more accurate, up-to-date and comprehensive for maximum effectiveness in meeting residents extensive health needs. Care Homes for Older People Page 13 of 29 Evidence: Examples that emerged during the inspection and discussed in some detail with the owners concerned the similarity of entries for each resident with some amendments to each for the purpose of personalisation. It was agreed with the owners that the plans of care should be more specific rather than general. This would make them genuinely person-centred. In the care plan records checked, the risk assessments covered moving and handling issues and did not cover the range of risks posed to the health of residents with high physical and mental health support needs. The owners said that this part of the service is being developed and would be outlined in the next AQAA. According to the owners, care plans are an increasingly effective operational tool for staff. The evidence was that members of staff are using care plans to identify the changing needs of residents and record how support should be provided. Members of staff complete daily records in respect of important aspects of residents health and changes in health or disposition. These issues were said to be discussed during staff changeover to enable in-coming staff to be aware of changes in residents temperament or health. During the inspection visit, members of staff treated residents with understanding and respect. Discussions about the profiles of residents and how they are supported also indicated a high level of understanding of and respect for clients. Where difficulties occur in the continuing support for some residents, there was evidence that care managers and family members are involved in reviews and any necessary changes in the levels of support. Where a care plan record was signed by a residents advocate, the advocate had no knowledge of some of the wrong information contained in the care plan. Analysis of the areas where wrong information was included in care plans indicated that carers were being given potentially misleading information about assessed needs and how to make suitable support interventions. GPs visit as necessary. The services of district nurses are, according to the owners, routinely obtained and they have an increasingly important role as the support needs of residents increase. Residents have good access, according to profiles of residents discussed during the inspection and records checked, to local NHS community services. The owners stated that there is close contact with local PCT nurses who, for example, provide and change dressings. Care Homes for Older People Page 14 of 29 Evidence: Two residents said they receive very good healthcare support particularly when they were feeling most vulnerable. They also said that carers have a good understanding of the difficulties faced by residents and are skilful in providing the personal support needed. The owners said it is believed that residents have good access to dentists, chiropodists and opticians. Some evidence for this was provided from statements by a resident and a visitor. Mrs Cooppen explained how medications are administered. MAR sheets are completed at the time of administration. A photograph of each resident does not accompany their MAR sheet. In the case of residents receiving respite care, a MAR sheet was said to be completed manually to control and supervise their medication. Staff training is undertaken by Mrs Cooppen who said she believes her training as a nurse underlines her competency in this area of practice. The owners were advised to provide staff training from an independent source and to audit the current policy and practice. The owners attention was drawn to how medicines are located in two areas of the premises and prescribed medicine was located in a locked cupboard away from the main medicine storage area. In their response to the draft inspection report, the owners advised the Commission that theoretical training was given to staff from an outside source and that day-to-day support and supervision is provided by Mrs Cooppen. An important declared aim of support is to help residents remain as independent as possible. This involves encouraging them to move around on their own with any necessary staff observation. Members of staff help residents who have hearing aids to keep them in working order and they encourage them to continue using the aids. Records indicate that residents weights are recorded monthly or more often if necessary. Care plans seen and discussion of profiles of residents indicate that better end-of-life planning would be of benefit to residents. This could involve, for example, research on the Liverpool Pathway for more information and improvement in the ways residents wishes are discovered and how these are recorded in care plan records. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive support on a day-to-day basis to remain mentally and physically active and alert. The objective of the home is to help residents gain and retain their independence. Residents are not receiving, in all cases, the levels of support they need. Evidence: The registered providers stated that members of staff help residents to remain physically and mentally active. There are a number of activities provided in the mornings and afternoons by staff and some were observed on this occasion. The service does not employ an activities co-ordinator. As the service is admitting people with higher dependency need, it is likely that residents and staff would benefit from the employment of a person with specific skills in this field of resident support. In their response to the draft report, the owners said they encourage residents to remain physically and mentally active and they are considering the benefits of employing an experienced activities co-ordinator to further this work. Residents said that relatives and visitors provide good support and that they may visit at any time. Care Homes for Older People Page 16 of 29 Evidence: Residents are encouraged to continue the patterns of their former lives as far as possible within their changing circumstances and to exercise control over longer and shorter-term decisions. The owners said they would enhance the importance of having relevant biographical details of each resident included in care plans. This is to enable members of staff to more fully appreciate and understand the nature of residents previous lives and occupations. Weight charts and nutritional assessments were said by the manager to be maintained maintained. Residents are able to have their meal over an extended period in either of two dining areas and members of staff give them assistance as needed. The AQAA indicates that residents and family members are encouraged to say what they feel and to give their views about any issue they feel affects them. Residents gave examples of particular activities promoted by the service. There were a number of examples seen during the inspection that suggested they are helped in a number of ways to remain mentally and physically active. This included staff assisting residents on a one to one basis, helping them to walk about the premises including using the stairs and stair lifts, provision of books and newspapers, talking to them, providing music and helping residents visit the garden. During the inspection, there was a positive atmosphere and carers were working actively with residents when they were not engaged in household activities. The AQAA outlines how special consideration is given towards enabling residents to continue practicing their religion. Residents having their midday meal in the dining room areas said that they enjoy their meals. Two visitors said that, as far as they could ascertain, meals provided were good. Different meals were provided in some instances where the cook knew that residents preferred a particular food. Residents said that they were not asked about a choice of meal and that the cook made the decisions in this regard based on knowledge of their preferences. Observations made during the inspection were that some residents were spending a significant time alone in their bedrooms. At about 3 PM, some 7 residents were alone in bedrooms. In other cases, some residents were sleeping in their chairs in lounge areas. In some cases, residents were not receiving the support recommended by a Care Homes for Older People Page 17 of 29 Evidence: healthcare consultant to remain active in light of the residents medical deteriotation. Care Homes for Older People Page 18 of 29 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. Residents views and concerns are taken notice of and acted on and they are protected from abuse. Evidence: The service has a complaints procedure and residents are encouraged to express any views they have. The AQAA stated the home encourages residents and their relatives to express their views, comments, complaints and suggestions in order to enhance the service. Examples discussed with the owners suggested that careful consideration is given to outcomes of direct contact with users of the service. Mrs Cooppen said that they have reviewed the outcomes of a Social Services Adult Protection investigation into why and how a resident did not receive immediate medical assistance. Discussion with the owners about the background to that adult protection referral suggested that procedures are being adopted to lessen the chances of residents injuries from falls. An outcome is that risk assessments are being updated and GP/hospital assistance is obtained immediately. One such outcome is that concentrated efforts are being made to enable liaison with District Nurses to be optimised for the benefit of staff and residents. Policies and procedures for safeguarding adults are available to all members of staff and these give specific guidance to those using them. Staff working at the service said they know when incidents need external input and who to refer the incident to for Care Homes for Older People Page 19 of 29 Evidence: guidance. The owners said they were confident that carers understand local authority procedures for Safeguarding Adults. The Commission has been notified of incidents that occurred and reflection on these is reportedly used as part of quality assurance measures for the protection of residents. The recruitment procedure contains the checks (including CRB checks) necessary to help contribute to the protection of residents and all members of staff receive training for their responsibilities under current POVA arrangements. The owners said that they are updating all staff about the implications of the new ISA (independent safeguarding authority). The AQAA stated that all members of staff are aware of the rights of residents and of how their interests must be identified and promoted. It outlined how the quality assurance system focuses on issues consistent with current care standards with emphasis on making residents quality of life progressively better. It also highlighted the fact that current stable management conditions have had a positive effect on residents and on the staff team and the evidence of the inspection supports that conclusion. Reference was also made to staff guidance on relevant aspects of the Mental Capacity Act and how essential procedures might be affected as these measures come into being more fully. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are suitable for use by frail older people. Shared bedrooms are not equipped to enable occupants to have privacy. Evidence: The premises contain mostly single bedrooms for residents (with currently three rooms for people wishing to share), a kitchen, two dining areas and two lounge areas. Residents bedrooms are situated on the ground, first and second floors. Stairlifts are in place for the convenience of residents. Some bedrooms have an en-suite facility (toilet/washbasin). One of the three available shared bedrooms has been converted to single occupancy. This provides a comfortable environment for the occupant. The remaining two shared rooms are marginally suitable for purposes of sharing. Occupants are not provided with individual and separate facilities for storage of their toiletries. The washbasin is not curtained from the communal area to enable each resident to have privacy. This issue is important also in relation to admission procedures of the service. The owners said that residents, as their dementia develops, are less concerned with aspects of bedroom accommodation and facilities. This reflection on residents Care Homes for Older People Page 21 of 29 Evidence: changing disposition assumes that the service is now routinely catering, outside its registration, for people with high levels of depenedency including dementia. The owners should strongly consider the need, as part of their progressive development of the service, refurbishment that meets the requirements and aspirations of residents at admission stage. This is in contrast to justifying basic standards of shared accommodation on the basis that residents are unable to exercise discrimination. The garden is a major asset for staff, visitors and residents. Handrails have been fitted throughout the premises for residents safety. Bedrooms have been personalised with residents possessions. A laundry assistant is on duty throughout the week. The AQAA referred to the practice of identifying areas which require maintenance and some areas that are earmarked for refurbishment were outlined. It also included a declaration that all essential safety certificates are in place and are up-to-date. The premises were maintained in a clean and tidy way at the time of the inspection visit. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by the use of a range of checks in the recruitment of staff. The training provided to staff is not extensive enough to enable them to meet the full support needs of residents. Evidence: The AQAA contains a statement that most members of care staff have achieved an NVQ 2 or 3 qualification and all are encouraged to do so. Two members of staff on duty had recently achieved the qualification. Mr Cooppen said that members of staff also undertake training in moving and handling, infection control, health and safety, and medication administration. He said that he and Mrs Cooppen place a high priority on enabling members of staff to receive relevant training focussed on delivering improved outcomes for residents. This is included in the process of formal supervision carried out at intervals with each member of staff. The owners were advised that the level of training may not be sufficient in meeting the very high, and increasing, needs of most residents. Medication training is carried out by one of the owners who relies on her previous experience as a nurse to provide the tuition, assess competency and review procedures. Staff receive a short introduction to dementia from an external source. On the basis of this, they are led to believe that they are dementia trained. There is currently no intention of enabling all staff working with residents to obtain an Care Homes for Older People Page 23 of 29 Evidence: appropriate qualification in dementia care. The owners were advised to make progress in this respect and an appropriate training course discussed was the RVQ Certificate in Dementia Care. Earlier in this report, reference was made to the practice of admitting people with very high support needs. The owners know how admission criteria have changed in the 5 years since they took over the service. The shortfalls in delivering proper support for residents were highlighted in examples discussed with the owners during the inspection and, to another extent, through the Adult Protection investigation earlier in the year. Similarly, an introduction to infection control procedures is given to staff but more extensive training such as the Certificate in Infection Control (as in the case of the Certificate in Dementia Care, taken by distance learning over about 3 months with competency testing by a visiting trainer) would equip staff better in this important area of practice. Staff files seen indicated that job descriptions and specifications define the roles and responsibilities of staff. Residents and visitors met during the inspection reported that staff work hard in caring for residents. According to three staff files seen and statements contained in the AQAA, new staff are subject to full checks before they start work. These include CRB checks, references and other recruitment checks. During the inspection, there were three carers on duty in the morning as well as both owners. In the afternoon and evening period, the number of carers reduced by one. In a previous section of this report, reference was made to how many residents spent much time alone either in a communal area or in their bedrooms. The Skills for Care induction procedure is not fully following the recommendations of that organisation in assessing competence at differing levels over the required period of time. In the examples discussed with Mr Cooppen, large sections were marked off by the assessors (Mr and Mrs Cooppen) when the individual had clearly not received sufficient tuition in the various topics listed in the Skills for Care induction form. Care Homes for Older People Page 24 of 29 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 live in a residential service that generally acts in their best interests. Aspects of how the service is conducted are not in the best interests of residents, visitors or staff. Evidence: Mrs Cooppen is a registered nurse and has completed the registered managers award. Mr Cooppen has previous experience in management of Social Services care provision. The service aims, according to the AQAA, to provide a good quality of life for residents. There is said to be a focus on person centred thinking with residents centrally involved in shaping the support they require. There was evidence during the inspection that the service is making progress towards a more person-centred approach but the way support records are maintained makes it more difficult for the actual needs of residents to be met. This judgment is based on the fact that support records are currently of a general nature rather than properly person-centred. In the Care Homes for Older People Page 25 of 29 Evidence: examples checked during the inspection, misleading information was contained and this obviously led to poor information about delivering support being given to carers. The owners said they would improve this aspect of resident support. The owners are aware that they must only admit people according to their registration criteria and that, since they took control of the service some 5 years ago, it is increasingly difficult to obtain local authority funding for the care od older people. The training of staff to meet the high care needs of residents needs to be improved and the owners said they would make the necessary improvements. The owners said they were confident that the staffing hours they have arranged are sufficient for meeting residents assessed and changing needs. During the inspection, there were fewer carers on duty in the afternoon and evening period than during the morning period. There was some evidence that a significant number of people returned to their bedrooms and were alone for long periods. Residents and staff would benefit from improvements in the way staff are trained and in how staff induction is promoted through competency testing over variable periods of time. The AQAA contains a declaration that all necessary safety checks and associated certificates are in place. The service has a file of policies and procedures that are said to be available to staff for their information and professional updating. Quality assurance and monitoring procedures are said to be in place for efficient running of the home, to give value for money and deliver effective outcomes for the people who use the service. Residents receive advice on how to obtain impartial legal and financial advice if they need this. The service does not act as an appointee for any resident. The owners said that a written record of all financial transactions is maintained where additional charges are made to residents. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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