Care Home: Spindrift Care Home

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What the care home does well Spindrift retains a strong family atmosphere and is run in such a way as to make everyone feel included. Feedback from relatives regarding the care provided at Spindrift, was extremely positive and included; "They have gone out of their way to meet my (relative`s) changing needs." "Spindrift is exceptional, really caring, not institutional and very considerate towards individual needs" And " They offer effective care in a kind and considerate way." Care plans address emotional and mental health needs and staff have undertaken training regarding working with people with dementia and also regarding responding to difficult or challenging behaviour. The focus on emotional wellbeing is a strength of the service. Staff keep good records of all health care appointments, such as visits by the district nurse and the outcome. This means that any health issues and associated treatment can be `tracked`, leading to people receiving a good level of support with any health problems. The home is very close to the central shopping area of Lytham St Annes, giving excellent access to community services and facilities. There is a very good range of communal rooms, with a large dining room, conservatory and four separate lounges. This means that people can choose where to spend their time. Much positive feedback was received about the staff at Spindrift. Comments from those living at the home included; "nothing is too much trouble" and "they are never too busy to help you." The staff team has remained generally stable, with few changes. The majority of staff have worked at Spindrift for a long time and have clearly built up good relationships with those living there. There is a strong focus on qualification training for staff, with the majority having achieved NVQ (national vocational qualification) at level 2 or above. This means that they have had their work practice assessed and have been deemed competent in their work role. Good records of staff training are maintained. This means that any gaps in the skills or knowledge required by staff are highlighted and then addressed. Feedback from staff via conversation and surveys confirmed that the management of Spindrift is good. Comments included; "We have a good manager and can approach her about anything," and "the support for clients and staff is second to none." What has improved since the last inspection? The areas highlighted for improvement at the last key inspection have all been addressed. The risk management of the use of bed rails has been strengthened. Where the individual is unable to give consent, the need to use such equipment is discussed with and agreed by relatives. A risk assessment is then put in place, which includes the need for the rails to be checked regularly and for protective bumpers to be in place. This helps to ensure that this equipment is being safely used.Care plans are being regularly reviewed and if necessary updated, meaning that staff have clear and up to date guidance regarding the support required. Relatives are invited to some of the care planning review meetings, giving good opportunity for their views to be taken into account. The majority of medication is provided in cassettes by the dispensing pharmacist and is accompanied by a pre printed medication sheet. Where handwritten records have to be made, these are checked and signed by two members of staff. This helps to reduce the chance of errors being made. Wheelchair access has been improved by providing a portable ramp at the back gate and installing a bell at this gate, which rings throught to the kitchen. People who use wheelchairs are now able to come and go via the back gate. What the care home could do better: The generally good medication arrangements could be further strengthened. If medication, which is not supplied in cartridges by the pharmacist is dated when it is opened, this will help to provide a clear audit trail and will also help to prevent `out of date` medication being used. Medication which is prescribed to be given when required should be supported by clear guidance, regarding under what circumstances it is to be administered. This will help to provide consistency in medication administration. The application form completed by prospective members of staff could be improved by including a section for a full employment history. This will help to ensure that any gaps in employment can be explored and that full information is provided before employment decisions are made. Quality monitoring surveys should be sent to relatives and other interested parties, at least on a annual basis. This will give opportunity to gain feedback about the quality of the service provided and could help to identify areas for improvement. All care staff should receive formal, recorded supervision at least six times a year. This will provide opportunity for work practice and training needs to be discussed and will help to promote good practice within the team. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Spindrift Care Home 36-39 Cleveland Road Lytham St Annes Lancashire FY8 5JH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Plant     Date: 1 5 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Spindrift Care Home 36-39 Cleveland Road Lytham St Annes Lancashire FY8 5JH 01253737014 01253794742 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Spindrift Care Home Limited care home 34 Number of places (if applicable): Under 65 Over 65 16 34 dementia old age, not falling within any other category Additional conditions: 0 0 The registered person may provide the following categories of service only:- Care home only - code PC, to service users of the folling gender:- Either Whose primary care needs on admission to the home are within the following categories:- Old age not falling within any other category - Code OP (maximum number of places 34). Dementia over 65 years - Code DE (E) (maximum number of places 16) One named person in the category of PD (adults with physical disabililty) Two named people in the category of LD (adults with learning disabilities) Date of last inspection Brief description of the care home Spindrift is located close to Lytham town centre, providing excellent access to a range of community facilities and services. The majority of bedrooms are single; however there are two double bedrooms available for people who may choose to share a room. Parking for visitors is provided at the rear of the home and there are enclosed rear garden areas for sitting out during the summer months. The good range of communal space, including a small conservatory, means that individuals can choose to join in activities or spend time alone/in smaller groups. Care Homes for Older People Page 4 of 30 Brief description of the care home The home is registered to provide personal care to up to 34 residents of both sexes who are aged 65 years and over, with up to 16 places for people with dementia. The three directors of the provider company, Spindrift Care Home Limited, are all closely involved in the running of the home, with one being the registered manager. Information regarding the current fees can be obtained from the manager of the home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The site visit was unannounced and looked at all the key national minimum standards for care homes for older people, plus the standard relating to staff supervision. At the time of the visit there were 31 people resident at the home. Discussions took place with the manager, staff, people living at the home and a relative who was visiting. Time was also spent observing staff and those living at the home, engaged in daily activities. Surveys providing feedback about the service were received from five people living at Care Homes for Older People Page 6 of 30 the home, five relatives and two members of staff. Information was also gained from the annual quality assurance assessment completed by the manager. This is a self assessment focusing on how well positive outcomes are being achieved for people using the service. What the care home does well: What has improved since the last inspection? The areas highlighted for improvement at the last key inspection have all been addressed. The risk management of the use of bed rails has been strengthened. Where the individual is unable to give consent, the need to use such equipment is discussed with and agreed by relatives. A risk assessment is then put in place, which includes the need for the rails to be checked regularly and for protective bumpers to be in place. This helps to ensure that this equipment is being safely used. Care Homes for Older People Page 8 of 30 Care plans are being regularly reviewed and if necessary updated, meaning that staff have clear and up to date guidance regarding the support required. Relatives are invited to some of the care planning review meetings, giving good opportunity for their views to be taken into account. The majority of medication is provided in cassettes by the dispensing pharmacist and is accompanied by a pre printed medication sheet. Where handwritten records have to be made, these are checked and signed by two members of staff. This helps to reduce the chance of errors being made. Wheelchair access has been improved by providing a portable ramp at the back gate and installing a bell at this gate, which rings throught to the kitchen. People who use wheelchairs are now able to come and go via the back gate. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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 assessment process helps to ensure that people are only admitted to Spindrift, if their needs can be met. Evidence: The manager or experienced senior staff carry out the assessments regarding new people moving into the home. This information gathering is carried out in hospital or in the persons own home, depending on their circumstances. Time is spent with the individual and their relatives and information is also gained from other professionals, such as hospital staff, as appropriate to the individual concerned. The records for one person recently admitted to the home were viewed. Relatives came to visit the home, have a look around and meet the staff. The individual was visited in hospital and at a later date came to Spindrift for lunch. The manager then attended the hospital discharge review meeting, giving opportunity to gain further Care Homes for Older People Page 11 of 30 Evidence: information. The assessment format used by the home addresses different areas of need including emotional needs and social interests. The records for this person also include a copy of both the care programme approach care plan and the social work assessment. This information is then used to build the care plan of the support to be provided at Spindrift. Intermediate care is not provided at Spindrift. Care Homes for Older People Page 12 of 30 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. Health and personal care needs are met, with the privacy and dignity of those living at the home being promoted. Additional safeguards would strengthen the current medication arrangements, which are generally good. Evidence: Files contain a useful overview of the main areas of need and are then supported by a specific care plan for each area of need identified. Care plans address a range of emotional, social and physical needs as relevant to the individual concerned and are regularly reviewed. Relatives are invited to some of the care planning review meetings and their views are recorded, such as at a recent review where relatives had commented that the person now seemed less anxious. A key worker system is in place and staff keep good daily records, completed at least once each day, with a separate report from night staff. These records are reviewed alongside the care plan. Feedback from relatives regarding the care provided, was extremely positive. To the question, what does the home do well? responses included; Spindrift looks after my Care Homes for Older People Page 13 of 30 Evidence: (relative) very well and copes with everything and has adapted to meet her needs. And from another relative They have gone out of their way to meet my (relatives) changing needs. Care plans address emotional and mental health needs. Such as for one person, where there is written guidance for staff to follow regarding communication and how to lessen this persons feelings of anxiety. Staff have undertaken training regarding working with people with dementia and also regarding responding to difficult or challenging behaviour. The manager explained that any such incidents are always talked through with staff after the event, to look at how staff have responded and if any lessons can be learned. Risk assessments are in place regarding moving and handling and where necessary detail the hoist, equipment or aids to be used. The risk of falls is also given a focus, with a care plan put in place if needed. Physical exercise is encouraged and their is a movement to music session held each week. Care plans address any specific or individual health care needs and staff keep good records of all health care appointments, such as visits by the district nurse, and the outcome. One person is attending appointments with a consultant regarding seizures. Staff keep records of any seizures or periods of ill health which can then be taken to these appointments and so help to inform decisions, such as regarding any medication changes which may be needed. This person was spoken with and was happy with the support given by staff and the involvement of staff at her hospital appointments. For another person, in quite frail physical health, the care plan states that she needs periods of bed rest. Records were being kept by staff to show regular pressure care relief was being provided and that food and fluid charts were also being maintained. This person also requires bed rails to prevent her falling from bed. A risk assessment is in place, which includes the need for the rails to be checked regularly and for protective bumpers to be in place. The family had been involved in discussing the use of bed rails and had provided written consent for this equipment to be used. Only staff who have received specific training administer medication. Medication is safely stored in a trolley which is secured to the wall and kept locked when not in use. The medication records contain a tick list of who has been given their breakfast medication. This is useful as some early medication may be given by night staff and some people may choose to get up late in the morning. This tick list helps to ensure that no one misses their morning medication. Staff sign a main record to confirm when each medication round has been completed. These records are in addition to the individual medication administration records kept for each person. Care Homes for Older People Page 14 of 30 Evidence: The medication records for three people living at the home were viewed. Each record includes a photo of the person concerned. The majority of medication is provided in cassettes by the dispensing pharmacist and is accompanied by a pre printed medication sheet. Where handwritten records have to be made, these are checked and signed by two members of staff. This helps to reduce the chance of errors being made. The records seen were completed appropriately. Separate storage facilities and recording arrangements are in place regarding controlled drugs. Quarterly audits are carried out by a senior member of staff, helping to ensure that all staff are following agreed procedures. Staff should sign any medication not supplied in cassettes, such as liquids, when it is first opened. This will help to ensure that medication is not given past its use by date and will also provide an audit trail of medication administered by staff. Improvements could also be made regarding medication which is prescribed to be administered when required. There should be written guidance regarding under what circumstances this medication is to be given. This is particularly important for those with dementia who may not be able to express when they require medication, such as pain relief. Written guidance will promote consistency in this area. The importance of promoting privacy and dignity are given focus during the induction programme for new staff and are also addressed within NVQ (national vocational qualification) training, which the majority of care staff have undertaken. The different lounges and the main dining room, which has recessed alcove areas, provide a good choice of rooms in which to receive visitors and people are also able to entertain visitors in their bedroom if this is preferred. During the inspection visit staff were observed responding to people with kindness and sensitivity and the ladies had been supported to dress nicely and wear their favourite jewelery and accessories. Surveys completed by relatives included comments such as; Spindrift is exceptional, really caring, not institutional and very considerate toward individual needs, They offer effective care in a kind and considerate way and of the staff team, Displays great patience. Staff always courteous and concerned. Care Homes for Older People Page 15 of 30 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. Activities and community contact are promoted, providing interest and pleasure. Meals are varied and of a good quality and are enjoyed by those living at the home. Evidence: Information regarding interests and social needs is gathered during the assessment process. The good range of communal dining, sitting rooms and conservatory mean that people can choose to join in activities or spend time alone. The noticeboard in the dining room displays details of forthcoming events. At the time of the inspection this included a weekly visit from a hairdresser, a weekly movement to music session, a forthcoming visit by an entertainer/singer and a canal boat trip followed by a fish and chip supper. Details of weekly trips out in the minibus were also on display and included going to the main park in Blackpool, a trip to an ice cream parlour/cafe and a meal at a country pub. A discussion took place with a group of four people in one of the lounges, with all agreeing that the trips out were very popular and enjoyable. Staff also sit and chat with people and spend time doing the ladies nails and hair. One person living at the home had recently celebrated a big birthday. On these occasions a birthday cake and special celebratory tea is provided and decorations from this Care Homes for Older People Page 16 of 30 Evidence: recent event were still evident at the home. A minister from a nearby church comes to the home each week to provide communion for those who want this. Another local church conduct services at the home at harvest time, Christmas and Easter. Visitors are made welcome as seen during this inspection visit. Much of the feedback from those living at the home and from relatives focused on the atmosphere at Spindrift. Comments included; nice friendly atmosphere, not too many rules and regulations, family atmosphere and Visitors made to feel welcome and not like intruders. People are encouraged to handle their own financial affairs according to their wishes and capabilities. For some people a relative may take on this responsibility. Information regarding advocacy services is available, should this be required. People are encouraged to bring their personal possessions into the home, to help them to feel more settled and comfortable and this has included small pets such as budgies. A menu board in the main dining room gives details of the meals for the day. Some people choose to have breakfast in their bedroom and people can choose to have a lie in and have a later breakfast if they want to. The main meal is served at lunch time and each morning people are told what the main meal is and can choose to have something different if they wish to. On the day of this inspection visit the main meal was fish and chips and some people chose to have egg instead of fish. The kitchen staff are aware of peoples preferences or specific dietary needs, which are recorded on their care plan. At tea time people can choose from a selection of snack meals, such as soup, sandwiches or something on toast. There is a four weekly menu in place, which is often reviewed and changed according to the preferences of those living at the home. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Spindrift and their relatives, have confidence that any concern would be responded to. Policies, procedures, good practice and staff training promote the protection of those living at the home. Evidence: A complaints procedure is in place. Feedback from those living at the home and their relatives confirms that people know how to raise a formal complaint if necessary and that any informal concerns or issues that are raised have been responded to appropriately. Several people made comments on their surveys regarding the informal, relaxed, family type atmosphere at the home. Relatives are made welcome and are also invited to some of the care planning reviews, giving good opportunity to give feedback about the service provided, or to raise any issues of concern. Residents committee meetings also take place. The manager is aware of locally agreed safeguarding procedures and the role of other agencies in responding to any such concerns. A copy of the local authority safeguarding reporting procedures is on the office noticeboard, available to guide senior staff in the absence of the manager. The staff noticeboard displays a copy of the homes whistle blowing procedures, ensuring that staff understand the responsibility they have in reporting any concerns or bad practice to the manager. Care Homes for Older People Page 18 of 30 Evidence: Staff undertake training regarding abuse and protection, with further courses planned to take place in the next two months. Issues of abuse and protection are also addressed within NVQ (national vocational qualification) programmes, which the majority of care staff have undertaken. Senior staff are soon to attend a seminar regarding the Deprivation of Liberty Safeguards and written information regarding these safeguards is available for staff to read. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, comfortable and well maintained, providing a homely environment for those living there. Evidence: The home is very close to the central shopping area of Lytham St Annes, giving excellent access to community services and facilities. There is a very good range of communal rooms, with a large dining room, conservatory and four separate lounges. This means that people can choose where to spend their time and that different activities can take place in different parts of the home. The home is registered to provide care to older people and also to people with dementia. Some parts of the building have a key pad entry system and one of the lounges is also used for dining, when main meals are served. There is no definite split in the parts of the home accessed by those with dementia, but main meals are generally served in the dining room and one of the smaller lounges, meaning that people who like a quiet atmosphere can eat their meal in a more tranquil atmosphere. There is an ongoing programme of maintenance and redecoration. Wheelchair access has been improved by providing a portable ramp at the back gate and installing a bell at this gate, which rings through to the kitchen. The back doors from the hallway and Care Homes for Older People Page 20 of 30 Evidence: the conservatory both have level access, meaning that people who use wheelchairs are able to come and go via the back gate. At the time of this inspection visit work was being carried out on the ground floor to provide a wet room/shower room, which will provide easy access for people with mobility difficulties. Since the last inspection, some bedrooms have also been decorated and refurbished. People are encouraged to bring their personal possessions into the home so that they can have their important things around them. Part of the ground floor corridor now has a pictorial display of memorabilia from the 1940s and 50s, entitled The way we used to live. This provides interest and a starting point for conversation, particularly for those people with dementia. Domestic staff are employed and the home appeared clean and fresh smelling. Night staff also carry out certain domestic cleaning duties. The staff training matrix shows that the majority of staff have undertaken food hygiene and infection control training and these courses are soon to be repeated. Policies and procedures are in place regarding infection control. Care Homes for Older People Page 21 of 30 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. The staff team has remained stable, providing consistency for those living at the home. The majority of care staff are qualified, have had their work practice assessed and have been deemed competent in their job. Evidence: There is a team of care staff, lead by managers and senior staff, plus kitchen, domestic and laundry staff. Rotas show that each morning there are four care staff plus two or three of the management team on duty, who also carry out some care related tasks. More staff are available in the afternoons, to allow for activities to take place and at night two working night staff are on duty, with the manager on call or a member of staff sleeping in at the home, providing extra support should any emergency arise. These staffing levels were reflected on the day of the inspection visit and appear to meet the needs of those currently living at the home. A discussion took place with a group of people living at the home and the general view was that staffing levels were good. Comments included; nothing is too much trouble and they are never too busy to help you. The staff team has remained generally stable, with few changes. The majority of staff have worked at Spindrift for a long time and have clearly built up good relationships with those living there. Care Homes for Older People Page 22 of 30 Evidence: There are 19 care staff, including those in senior positions who provide personal care support to those living at the home. 13 of these have achieved NVQ (national vocational qualification) at level 2 or above. This means that they have had their work practice assessed and have been deemed competent in their work role. This focus on qualification training for staff is excellent and demonstrates that the professional development of employees is promoted. Good recruitment procedures are in place. The recruitment records for a recently appointed member of staff were viewed. Records include an application form, references, criminal records bureau disclosure and a record of the check against the nationally held list of people who have been deemed unsuitable to work with vulnerable adults. The recruitment process and application form were discussed with manager. The current application form does not require applicants to provide an employment history. The manager explained that applicants would normally provide this information separately. It is advised that the application form completed by prospective members of staff is changed, to include a full employment history, with dates and reasons for leaving any previous job and is signed by the applicant. This will help to ensure that any gaps in employment can be explored and that full information is provided before employment decisions are made. New staff work through the Skills for Care, which is a national training organisation, induction standards. A work book is provided, with elements being signed off as they are addressed. Three such workbooks were viewed and show that the manager or senior staff are attempting to cover a great deal of information, with new staff, within a short space of time. The manager is advised to ensure that covering these induction standards is not rushed, but is spread over a period of time, which will allow for information to be understood and then put into practice. Good records of staff training are maintained. There is a training matrix for the staff team, clearly showing the training each person is; currently undertaking, has completed, is planned or is required. This means that any gaps can easily be highlighted and addressed. Two staff spoken to stated that they have both completed the core training programme and are soon to attend some planned training courses to update their knowledge and skills. Three member of staff have completed a key movers training programme, enabling them to induct new staff in safe moving and handling practices. The core training programme covers health and safety topics such as infection control and first aid, as well as courses which address working with people with dementia and managing challenging or difficult behaviour. The manager provided confirmation of Care Homes for Older People Page 23 of 30 Evidence: training, which is planned to take place during the next three months and the names of staff who will be attending. Along with the training matrix, this shows that any courses which may not have been already attended by certain staff, will be addressed within this next core programme of training. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and is run in the best interests of those living there. Policies, procedures, good practice and staff training, promote the health and safety of those living and working at Spindrift. Evidence: The manager is registered with the Care Quality Commission, has worked at the home for many years and is also a director of the company which owns Spindrift. Qualifications include the registered managers award, NVQ (national vocational qualification) level 4 in Care and the NVQ assessor award. A team of senior staff also carry out certain management duties, with each person having a specific role and function. Feedback from staff via conversation and surveys confirmed that the management of Spindrift is good. Comments included; We have a good manager and can approach her about anything, and The support for clients and staff is second to none. Care Homes for Older People Page 25 of 30 Evidence: There are some internal and external systems in place regarding quality monitoring at the home. Spindrift has gained the Investors in People award, an externally accredited national standard, which sets out a level of good practice for the training and development of staff. Residents meetings take place, giving good opportunity for people to air their views or make suggestions for improvement. One person spoken with told how they had raised an issue regarding the quality of the fish supplied to the home at one of these meetings. The manager had responded by arranging for a different supplier to deliver fish to the home. Staff also spend time talking and listening to individuals at the home, meaning that people with hearing problems who might find group discussions difficult are still able to air their views. Relatives are invited to some of the care plan review meetings and feedback from the surveys completed by relatives confirms that the manager and staff team are open to suggestions and will listen and respond to any concern or issue raised. In the past, the manager has distributed feedback questionnaires to relatives but this has not been done for some time. This should be carried out as it will give opportunity to gain feedback about the quality of the service provided and could help to identify areas for improvement. Some people at the home are able to manage their own financial affairs and for others a relative or representative will take on this responsibility. Records are kept of personal expenditure such as hairdressing costs, with the appropriate person then being periodically sent a bill. For a small number of people, some money for personal expenses is held by the manager of the home. This is securely stored in a locked safe. Records of income and expenditure for this money are kept. Informal supervision of staff takes place during the course of their day to day work, as there are always senior staff on duty to provide advice and guidance. Some formal supervision and staff appraisals take place and this is an area where the manager is planning to make improvements. Most of the care staff have had a recent one to one appraisal meeting with the manager and the staff noticeboard gives the dates of further meetings which are soon to take place. The records viewed show that these discussions address the staff members understanding of their role and of the philosophy of the home, relationships with colleagues and training needs, with personal objectives then being set. At present the manager has been conducting these meetings. The care manager has undertaken training regarding supervision and there are plans for one of the team leaders to also do this training. This will then mean that staff supervision can be carried out by several senior staff. All care staff should receive formal, recorded supervision at least six times a year. This will provide opportunity for work practice and training needs to be discussed and will help to promote good Care Homes for Older People Page 26 of 30 Evidence: practice within the team. The staff training matrix shows that staff undergo a good programme of health and safety related training. This includes moving and handling, health and safety, first aid, food hygiene and infection control. Most staff have undertaken this programme of training and staff who have not yet completed all of the courses will do so during the next two months. This pre arranged training will also give opportunity for experienced staff to update their knowledge. Regular maintenance checks and servicing of equipment take place. There is an electrical circuit test certificate and records to show that electrical equipment is also checked. Water temperatures are thermostatically controlled to reduce the chance of accidental scalding and checks of water temperatures also take place. The emergency lighting system, fire equipment and fire alarm system are regularly checked. Fire drills take place and fire safety training for staff is planned for June and July. During the visit the smoke alarm was accidentally triggered by builders working in the home. Staff, not immediately knowing what had caused the alarm to go off, responded quickly and with confidence. Risk assessments regarding safe working practices are in place and records are kept of any accidents incurred by staff and those living at the home. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 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 1 9 Medication not supplied in cartridges by the pharmacist should be dated when it is opened. This will help to provide a clear audit trail and will help to prevent out of date medication being used. Medication which is prescribed to be given when required should be supported by clear guidance, regarding under what circumstances it is to be administered. This will help to provide consistency in medication administration. Quality monitoring surveys should be sent to relatives and other interested parties, at least on a annual basis. This will give opportunity to gain feedback about the quality of the service provided and could help to identify areas for improvement. All care staff should receive formal, recorded supervision at least six times a year. This will provide opportunity for work practice and training needs to be discussed and will help to promote good practice within the team. 2 9 3 33 4 36 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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