Care Home: Springdene

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What the care home does well The home provides an excellent standard of accommodation. The home is purpose built and very well maintained, clean and comfortable. There is a choice of communal spaces for residents to enjoy, with a dedicated room for activities. There is a very well equipped rehabilitation unit within the home, referred to as "the clinic". The unit provides a flexible service to people who require rehabilitation and the length of stay is tailored to their needs ranging from five days to three months. Staff are well qualified and enthusiastic about working with residents to improve aspects of care. What has improved since the last inspection? We were pleased to note improvements in the management of medication, ensuring residents receive their medication safely. The home has worked hard to improve on the quality of the care documentation and have introduced a new system for recording the needs of residents. Risk assessments now cover areas such as the use of bed rails and falls and wound care documentation is now in place. Records show an improvement in the management of complaints and there is now a formal staff handover process in place. There have been improvements in monitoring the quality of care in the home and the Manager has been given better support. What the care home could do better: Regular auditing of the home`s medication should be continued to maintain the improvements in the safe handling of medication. Action must be taken to ensure that Controlled Drugs are always correctly de-natured when disposed of and the instructions for medication are always clearly documented on the MAR The wishes of residents and their families in respect of health deterioration and end of life care must be discussed and clearly recorded. Care must be taken to ensure the wording within the care plans are inclusive of the resident and support individuals to make choices. Staff must document residents` preferred activities and the home must ensure that activities offered are appropriate to the needs of each residents.This is to ensure that each resident is given the opportunity to engage in meaningful activities. Consideration should be given to improving signage for residents living on the second floor, so that they can better identify their own bedrooms and bathroom and WCs. Individual training records must be drawn up for each member of staff so that it is clear what training has been undertaken and is required. Training in Equalities and Diversity and understanding the Jewish faith should be included in the training programme as the home provides care to a number of residents of Jewish faith. Consideration should be given to introducing creative ways of involving residents with dementia in the quality assurance process. Key inspection report Care homes for older people Name: Address: Springdene 55 Oakleigh Park North Whetstone London N20 9AT     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: Ffion Simmons     Date: 1 3 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 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 30 Information about the care home Name of care home: Address: Springdene 55 Oakleigh Park North Whetstone London N20 9AT 02084462117 02084462110 gaye.summers@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Springdene Nursing & Care Homes Limited care home 56 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 56 The registered person may provide the following category of service only: Care Home with nursing - Code N 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 - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Springdene is a purpose built care home registered to provide nursing care for 56 elderly people, some of whom may also have dementia. A short stay rehabilitation service for people between hospital and home is also provided. The stated aim of the home is to provide a service that is safe, sociable, comfortable and healthy to live in. The home is owned by a company called Springdene Nursing and Care Homes Ltd. The company also has three other care homes in London. The company is led by a board of directors. The home is built on four levels and there are two shaft lifts. On Care Homes for Older People Page 4 of 30 Over 65 0 56 56 0 3 0 0 3 2 0 0 9 Brief description of the care home the lower floor there is the kitchen and laundry as well as some bedrooms overlooking the garden. On the ground floor there is the main lounge area and bedrooms. The first floor has a small lounge and the main dining area. The second floor provides a designated service to people who have a higher range of needs and includes a lounge and dining area for these service users. The top floor provides a large activity room and hairdressing room. There are 55 single bedrooms and these all have en suite shower rooms. There are also four assisted bathrooms. The staff team consists of a manager, two deputy managers, nursing staff and a team of carers. There is a team of ancillary staff including catering staff, laundry assistant, cleaning staff a handyman and reception staff. The current scale of charges are £895 -£995 per week. 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: The key inspection took place on the 13th January 2010 and lasted a total of 8 1/4 hours. The inspection was carried out by two inspectors, one of which is a specialist Pharmacy Inspector. During the inspection, we spoke with residents, staff and observed care practices. We tracked the care of three residents and in doing so, we checked their personal records. A number of other records and documentation were examined during the inspection, including care plans and risk assessments, staff files, health and safety documentation, the homes complaint records and incident records and quality assurance documentation. A full audit of the homes management of medication was carried out. As part of the inspection, questionnaires were sent to residents, professionals and staff to seek their views about the service. Information within these questionnaires has been used as evidence to inform this report. Care Homes for Older People Page 6 of 30 The Operations Director took time to complete the Annual Quality Assurance Assessment (AQAA), which has also been used as evidence to inform this report. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 30 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 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 home provides a good level of information to enable prospective residents and/or their representatives to decide whether the home is suitable for meeting their needs. Residents needs are assessed by a skilled person. The homes rehabilitation unit provides a flexible service by skilled staff. Evidence: The home has a Statement of Purpose and Service Users guide, which include information about the services offered within the home. The Operations Director confirmed within the AQAA, that this information is made available to prospective residents and relatives and other interested parties. We noted during the inspection, that this information had been updated since the homes last Key Inspection on the 30/03/09. As per the recommendation of the last key inspection report, the brochure now makes reference to the rehabilitation unit, which is known as the clinic. The clinic is managed by a Registered General Nurse and is situated on the lower Care Homes for Older People Page 11 of 30 Evidence: ground floor of the home. The team include physiotherapists and Occupational Therapists. The unit provides a flexible service to people who require rehabilitation and the length of stay is tailored to their needs and can range from five days to three months. On the day of the inspection, four people were receiving care. The unit is well equipped and has a hydrotherapy pool and gym. During the inspection, we tracked the care of three residents and in doing so, we checked their personal records. We saw that the needs of each resident had been assessed. The Operations Director confirmed within the AQAA that a full assessment before admission is undertaken by competent and able people who must be either the Registered Manager, Admissions Manager or a named R.G.N./R.M.N. Assessments will take place at the home, referring hospital or potential patients current place of abode. 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. Each resident has a plan of care in place outlining their needs. The wishes of residents and their families about end of life care is not always featured in the care plans and this is an area for further development to make sure that residents end of life wishes are identified and met. Medication was safely handled in the home and the home but the auditing processes needs to continue to maintain the improvement . Evidence: During the inspection, we checked a total of six care plans and tracked the care of three residents. The home has worked hard to improve the recording of residents needs since the last key inspection. A new care planning system (standex system) has been introduced to record residents needs. The Operations Manager told us in the AQAA that all staff have received training so that they are familiar with the care planning process, and they find it easier to use. We found that the care plans contained a good level of detail about the needs of residents and that the care plans were updated monthly or sooner should there be a change in the needs of residents. Some of the detail relating to frequency of blood glucose monitoring and urinalysis was missing from one of the care plans checked. It is a good practice recommendation Care Homes for Older People Page 13 of 30 Evidence: for staff to document these frequencies so that staff know when these checks are due. Further work is also necessary to identify and record residents preferences for social activities as gaps were noted in this area. Care must also be taken in the wording of some care plans, for example we saw documented in the care plans relating to personal care that staff to choose clean clothes for resident. There is a danger that this statement assumes that the resident has no capacity for making their own choices. Information relating to the wishes of residents and their families in respect of deteriorating health and end of life care was not available in the care plans checked. It is acknowledged that this is a sensitive area and steps are being taken by the home to train staff in end of life care. The Operations Manager also told us that the home is looking to recruit a nurse with specialist experience in terminal care to support staff in this area. Since the last inspection, we found that the home had worked hard to improve on assessing risks to residents. The home assesses the risks for developing pressure ulcers and assessments were updated monthly. Wound care documentation was in place outlining the dressing regime and photographs of wounds have been taken to assist staff in assessing wound healing. A pharmacist inspection was undertaken to review progress made in improving the safe handling of medication and to check the requirements made at a random inspection on 1/6/09. We looked at the storage of medication including Controlled Drugs and the recording of receipts, administration and disposal. We counted several packs of medicines supplied in their original packs to see if they had been given as prescribed. The Medication Administration Records (MAR) were well completed and we noticed no gaps in records of receipts or administration. When a medicine was not given, the appropriate endorsement was used so we knew the reason why. All variable doses were well recorded and balances of medicines carried over from the previous medication cycles were documented. This means that we were able to audit or count several medicines supplied in their original packs to confirm safe administration. We counted a total of 24 samples of medication over all four floors and with the exception of one all could be reconciled. A count of this frequently prescribed medication suggested that one dose had been signed but not given. We noticed the good practice in that all residents had medication profiles. Sometimes these were not always uptodate with newly prescribed or discontinued medicines. We noticed that sip Care Homes for Older People Page 14 of 30 Evidence: feeds were documented on the MAR but not feeds given by tube into the stomach. There were however protocols in place for administering the latter, fluid balance charts and an unsigned feed chart. Anticoagulants were prescribed for some residents in the home and we noticed that the current dose was not documented under the instructions on the MAR. The anticoagulant book had not been returned to the home after a blood test the previous day and we had difficulty determining what the dose prescribed was. The current dose should always be clearly available for cross checking to prevent error. We noted that the instructions on the MAR were not always printed by the supplying pharmacist- eg topical medicines and laxatives and a medicine prescribed several times a day. One resident was self-administering their medication and the medicines were kept securely with weekly risk assessments being carried out to check compliance. We noted that blood glucose was tested for residents with diabetes and the lancing devices in use were for professional use to prevent the risk of blood borne infections. Storage in the clinical room and other locked medicines cupboards in residents rooms were secure and well organised . The home now had a CD cupboard meeting the requirements of the Misuse of Drugs Act and all controlled drugs were stored securely in the home. We checked the balances and found them to be correct. We looked at the disposal of controlled drugs and noted that they were not being denatured safely to ensure that they did not get into the wrong hands. The matter was resolved at the time of the inspection and the manager said that she would also order larger Doop kits to dispose of larger quantities of liquid CD. Other medicines which were no longer needed were recorded and the home used a licensed waste collection company for disposal We noticed that the home kept patient information leaflets and had a current BNF for reference to medicines information. There was an agreed list of homely remedies and records were kept of when they were administered. The homes medicines policies and procedures were all uptodate with a list of specimen signatures and initials and were kept in the managers office. We looked at three of the new care plans and noticed risk assessments for managing pain and that there was evidence of medication reviews. Visits by the GP and other healthcare professionals were all well documented. Overall we were very satisfied that medication was safely handled in the home and the home had met previous medication requirements. The auditing processes need to continue to maintain the improvement . Some attention is needed in ensuring that the instructions are clear on the MAR and balances of medicines carried forward from the previous medicines cycle are always accurate to prevent errors from occurring. 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. There is an activities programme in place, which meets the needs of some but not all residents living at the home. Further work is needed to tailor the programme to meet the needs of residents living with dementia. Meals are varied and nutritious. Evidence: Since the last inspection, the home has been successful in recruiting an activities coordinator. The Manager told us that the activities co-ordinator also has an assistant. This means that the home now has two full time equivalent staff to organise activities for residents. There is a separate activities room within the home. When we toured the building, we noted that a number of residents were attending a group session in the activities room. Staff told us that an art therapist visits the home twice weekly and a music therapist visits weekly. Residents commented that there are generally activities that they can take part in. A relative commented that there has been an improvement in the provision of activities. We checked residents records and found gaps in the recording of residents preferences and wishes with regards to activities. There were also gaps in the care records, where there were a number of days that residents had not been involved in any one to one or group activities. The care records did not provide evidence that Care Homes for Older People Page 16 of 30 Evidence: residents on the second floor were being consistently supported to take part in meaningful activities, which suited their needs and abilities. During our visit, we noticed some good one-to-one interaction between staff and residents. Care however should be taken to ensure that the resources used are age appropriate. The home acknowledges that work needs to be undertaken to improve on the activities offered to people with dementia living at the home. Training is going to be provided to enable staff to co-ordinate more appropriate activities. Lunch was observed being served on the second floor. The meals looked appetising and there was a good choice offered. We observed staff supporting residents with their meals in a calm and relaxed manner. Food is freshly prepared on the premises and fresh food is delivered daily. The Operations Manager told us in the AQAA that menus are reviewed on a regular basis and residents can request an alternative choice if the menu is not to their liking. Residents commented that they generally like the meals at the home and a relative commented that its the highlight of my mothers day. Since the last inspection, we noted that risks associated with malnutrition are assessed and that residents weights are monitored. A number of residents living at the home are of Jewish faith. The homes Manager told us that Kosher meals are provided only during the Jewish festivals and that this is clearly documented in the homes brochure. 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. The homes complaints policy and procedures allow for residents concerns to be listened to and investigated. Staff have received training and policies are in place for safeguarding adults from abuse. Evidence: During the inspection, we viewed the homes complaint records. Since the homes last key inspection on the 30/03/09, the home has received seven complaints. We found the homes records to be clear and they gave a good account of the action taken to investigate the complaints. We could see from the most recent complaint that the home had met with the residents family and advocate to draw up a plan for resolving their complaint. Residents commented that there was always someone they could talk to if they were not happy with the service they were receiving. Not all residents however were aware of the procedures for making a complaint. The feedback received about the service was largely positive. The Manager confirmed during the inspection that there have been no safeguarding investigations since our last Key Inspection. We evidenced by checking the Annual Quality Assurance Assessment that the home have policies and procedures in place for dealing with suspicions and allegations of abuse. Training records demonstrated that staff receive training in Safeguarding Vulnerable Adults from abuse. Some staff but Care Homes for Older People Page 18 of 30 Evidence: not all have receive training in the Mental Capacity Act and the Deprivation of Liberty Safeguards. 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 excellent 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 comfortable, clean and well maintained home. There is a selection of communal areas both inside and outside the home, which meet the needs of the residents. Evidence: During the inspection, we toured the building and viewed communal areas and some of the residents rooms. The home was clean and tidy and comfortably furnished. The home is well located, close to public transport links. The home is purpose built providing accommodation over four floors. There is a lift access to all floors. Residents have a single bedroom with en suite facilities. The home was clean and tidy and comfortably furnished. The home provides a range of communal spaces and separate dining areas on each floor. The home also has a separate activity room. In view of complaints received by the home, it is a good practice recommendation, that better signage is available for residents living on the second floor, so that they can better identify their own bedrooms and bathroom and WCs. Since the last inspection, the carpets in the main corridors and stair-wells have been replaced with good quality wood flooring. The Operations Manager told us within the AQAA that also since the last inspection, air-conditioning has been installed in the corridors. Care Homes for Older People Page 20 of 30 Evidence: Residents were satisfied with the homes environment and commented that it was kept clean. A resident commented its bright and cheerful and visitors are made very welcome at all times. My room is welcoming as I have my pictures on the wall and lots of ornaments, photos, chocolates, TV etc on trolley, chest of drawers and window sill. My room is cleaned thoroughly every day. The home has a variety of hoists to get me in and out of bed. A relative commented that there is always a homely atmosphere. 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. All staff receive relevant training that is focused on delivering improved outcomes for residents. Staff report that they are supported through training to meet the individual needs of residents in their care. Residents are protected by the homes recruitment policies and procedures. Evidence: The staff rotas were checked, and we discussed staffing levels with the Manager. On the day of the inspection, there was an adequate number of staff on duty. Staff also commented that there are usually or always adequate number of staff on duty. Staff told us that when there had been an increase in the needs of residents in the past, the Manager had been supportive in assessing the need for more staff and ensuring that the team was given more support. Staff commented that they enjoyed working at the home and that they were part of a good team. Staff told us within a survey that commented the home does well in caring for vulnerable adults. The home is staffed with experienced nurses and senior carers and carers. We observed some positive and supportive interactions between staff and residents, and we found staff to be willing to work to improve on aspects of care provided. Positive comments were received about the staffing team and included Most of the staff are lovely. Care Homes for Older People Page 22 of 30 Evidence: Since the last inspection, the home has recruited three additional staff who are Registered Mental Health Nurses to improve care in the dementia care unit. The Operations Manager confirmed within the AQAA that the home does not use temporary staff and only use agency staff in an emergency to ensure adequate staffing levels at all times. The home has an established pool of bank staff. The Operations Manager also confirmed within the AQAA that the home employs senior care staff to support the RGN team. The senior care staff are qualified Nurses from abroad but not eligible to practise in the UK. This means that a high percentage (85 ) of the staff team are qualified to NVQ level 2 or above. We checked the recruitment records of two recently recruited members of staff, and found that all relevant checks are undertaken. All staff commented that they had undergone relevant recruitment checks prior to commencing work. Staff commented that they were well supported to undergo relevant training. Recent training had been arranged in response to staff requests and included wound management study days. Staff were scheduled to undergo training in end of life care shortly after this inspection. We checked training records and found that staff had attended a range of relevant training and there was certificates on file. The home had not drawn up an individual training record for each member of staff and this remains a requirement so that the training need of each individual staff member is clear. The Manager told us that staff have not received training in equality and diversity although staff have received dementia awareness training. It is a recommendation that staff attend training in equality and diversity and should include training in understanding the Jewish faith. Care Homes for Older People Page 23 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 manager has the required qualifications and experience and is competent to run the home. Residents financial interests are safeguarded by robust policies and procedures. Staff have received training to promote and protect residents health and safety. Evidence: The home has a Registered Manager in post, who holds the Registered Managers Award at NVQ level 4. Since the homes last Key Inspection, steps have been taken to improve the support offered to the Registered Manager. The Manager receives good support from the Operations Manager who visits the home approximately four days a week and undertakes weekly audits of the care plans and documentation. Steps have also been taken to delegate responsibilities for arranging and recording staff training to another member of staff. Staff commented that they felt well-supported by the Manager who is approachable and willing to listen. Staff also commented that there are clear lines of accountability in the home. It was documented within the Annual Quality Assurance Assessment that weekly management meetings take place, which Care Homes for Older People Page 24 of 30 Evidence: are chaired by either the Administrator or Chairman. Since the last inspection, improvements were noted in the quality and frequency of staff supervision. Staff commented that they felt well supported and that they receive adequate supervision. We observed the afternoon handover, which provided staff with good information about each resident. Residents and relatives views are sought through the use of customer satisfaction questionnaires. The results were seen and were generally positive. The Manager told us that there are no residents meetings held in the home. It is a recommendation that the home consider additional ways of involving residents with dementia in the quality assurance process. The system for looking after residents money was discussed with the Manager. Only small amounts of money (up to £100) is looked after securely for residents and records are kept. The Operations Manager confirmed within the AQAA that monies are audited monthly by the accounts team. The homes fire records were checked and we found that weekly fire alarm checks are undertaken and three monthly fire drills performed, ensuring that night staff are part of these drills. Staff receive training in safe working practices, including Health and Safety, Manual Handling and Infection Control. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 11 12 The wishes of residents and 01/06/2009 their families in respect of health deterioration and end of life care must be discussed and clearly recorded. To ensure that residents and families wishes about end of life care are met. Care Homes for Older People Page 26 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 1 9 13 That the instructions for the 01/03/2010 administration of medication are always clearly documented on the MAR to prevent the risk of error. 2 9 13 That regular auditing of medication is continued. To maintain the improvements in the safe handling of medication. 01/03/2010 3 9 13 That Controlled Drugs are always correctly de-natured when disposed of. This is to ensure that Controlled Drugs are denatured correctly. 01/03/2010 4 10 12 The wishes of residents and 01/04/2010 their families in respect of health deterioration and end of life care must be discussed and clearly recorded. Care Homes for Older People Page 27 of 30 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 To ensure that residents and families wishes about end of life care are met. 5 12 16 Staff must document residents preferred activities and the home must ensure that activities offered are appropriate to the needs of each residents. This is to ensure that each resident is given the opportunity to engage in meaningful activities. 6 29 18 Individual training records must be drawn up for each member of staff. This will enable the Manager to be clear as to the training needs of each member of staff. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 01/04/2010 31/03/2010 1 7 Care must be taken to ensure the wording within the care plans are inclusive of the resident and support individuals to make choices. Staff should document the frequencies of blood glucose monitoring and urinalysis so that staff know when these checks are due and to ensure that the checks are completed as necessary. That enteral feeds are documented on the MAR . Page 28 of 30 2 8 3 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 9 That the maximum and minimum temperature of the fridge is recorded so that the temperature range over 24 hours is documented. Consideration should be given to improving signage for residents living on the second floor, so that they can better identify their own bedrooms and bathroom and WCs. Staff should attend training in equality and diversity and understanding the Jewish faith. Consideration should be given to intruding creative ways of involving residents with dementia in the quality assurance process. 5 22 6 7 29 33 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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