Care Home: St Albans House

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What the care home does well All people living at the home are seen as individuals with life experiences and these are valued and respected. The statement of purpose and brochure makes it clear that people from all sections of the community will be made welcome and their needs accommodated. People are able to continue to pursue their spiritual needs and this is supported by the homes staff. The homes equal opportunities policy is relevant to people living at the home and staff and makes the value system of the home clear, that is to provide a safe environment for all who live and work there. One person said that `I am extremely happy here and have no regrets about giving up my home` and another person said `I don`t think there is anywhere better to stay`. A visitor to the home commented that the home `makes each person feel special`. The home produces a statement of purpose that is readily available in the entrance hall. All people spoken to had been given enough information to make a decision when they were looking at moving into the home. All people are given a terms and conditions of residency. Admission does not take place unless the prospective resident has been assessed by a member of staff and it has been confirmed in writing that the home is able to meet their needs. Prospective residents have the opportunity to visit and spend time in the home before they make a decision about residency. All people living at the home have a care plan that details their health, social and care needs and how staff will meet these in an individual way that respects dignity and privacy. Risk assessments are in place but individuals rights to take risks and retain their independence is recognised. The routines of the home are flexible to suit the needs, preferences and choices of residents. People living at the home are on the whole satisfied with the quality and range of the food served and mealtimes in the dining room are social occasions. The food was described as `lovely`, `excellent` and `very good`. Visitors are made encouraged in the home and are made welcome, enabling people to maintain their relationships with family and friends. One visitor to the home said `It is like one big family, everyone is so friendly, nothing is too much trouble`. Another person commented that the home `far exceeded expectations` in the care they received and that the home was `truly remarkable`. The whistle blowing and complaints policy are clearly written and contain all the information recommended. All people spoken to were aware of how to raise any concerns and were confident that they would be listened to and taken seriously. The home provides a high standard of furnishings and fittings. People are encouraged and supported to bring in small items of their own furniture and are able to personalise their private rooms in line with their preferences and choices. All areas of the home were very clean, tidy and there were no unpleasant odours. There is sufficient staff to meet peoples needs. People were very satisfied with the care they receive from staff. Some of care staff are qualified to NVQ level 2 or above to make sure they have the skills and experience to provide a high standard of care. People spoken to were very positive about the staff and Mr and Mrs Culley who were described as `very good and helpful` and `very kind`. The staff team is stable with many staff having worked at the home for some years this gives the people continuity of care and confidence that they will be well looked after. Mr and Mrs Culley have the required skills and experience and are competent to run the home. Staff described the atmosphere within the home as `very supportive`. One person living at the home said that `I only have praise for the way I am treated by management and staff`. The home works to a clear health and safety policy and procedure that safeguards people living at the home and staff. What has improved since the last inspection? Since the last inspection improvements have been seen in the care planning process. This now meets the required standard. Staff have now received up to date training including the induction of new staff. This ensures that staff can meet the needs of people living at the home. Staff recruitment has improved with all new staff now receiving Criminal Record Bureau checks. Staff recruitment process continue to require some additional minor amendments. Staffing levels have been reviewed and are now in adequate numbers to meet the needs of the people living at the home. What the care home could do better: The home must ensure that people living at the home who continue to take charge of their own medication sometimes called "self medicating" are competent to do so. This would take the form of regular risk assessments. The management need to ensure that staff dispense medication in line with the homes policy and procedure and in line with good practice guidelines. A number of people living at the home stated that they would like their evening meal at a later time. In addition a number of people stated that they would like the range of vegetables extended. The management need to ensure that they take peoples views in to account with regard to the delivery of food and mealtimes. The home meets the majority of infection control measures however paper towels need to be provided in communal toilets and where staff are required to wash their hands. The homes hot water is not restricted. This may pose a risk to the health and safety of people at the home. The management need to liaise with the Health and Safety Executive to ensure that the current safe guards that are in place are adequate. The home does not currently provide potential staff with an application form. The development of such a form would ensure that the management can robustly assess if individuals have the skills and competencies to meet the job role for which they are applying. In additional all induction including that completed in house is documented as part of the staff professional development. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Albans House 59-61 St Albans Avenue Queens Park Bournemouth Dorset BH8 9EG     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: Justine Button     Date: 3 0 0 3 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: St Albans House 59-61 St Albans Avenue Queens Park Bournemouth Dorset BH8 9EG 01202397817 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Sally Eileen Culley,Mr Timothy Martin Culley care home 28 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home St Albans House is located in a quiet residential area of Bournemouth between Queens Park and Charminster. Most local amenities are available in Charminster, approximately a miles level walk from the home. The home is registered for 28 residents in the category of older people (OP) and is run by the owner/managers Mr and Mrs Culley. The care home comprises two houses linked together at ground and first floor levels. Accommodation is provided on the ground and first floor as follows: Ground floor 9 bedrooms, 6 with full ensuite, 3 with toilet and wash hand basins. First floor 13 bedrooms, all with private wash and toilet facilities. Residents have access to a variety of communal areas. The home has a large lounge area linking to a dining room. Care Homes for Older People Page 4 of 30 Over 65 28 0 Brief description of the care home Along the length of the home to the rear of the property is a large conservatory overlooking the garden. The large grounds are well maintained and contain an oriental sunken garden area in addition to the large lawn area. Seating is provided outside in the summer months. Upstairs the two properties are linked via a covered sun terrace providing further communal seating. All communal areas are tastefully decorated and plants and flowers add to the domestic character of these rooms. All food is cooked on the premises and the menus offer a range of choices. St Albans offers a wide variety of activities on a regular basis including physical exercise, musical evenings, card and board games, reminiscence therapy and regular interdenominational church services. Current fees are 495 pounds to 620 pounds per week. See the following website for further guidance on fees and contracts: /www.csci.org.uk/about_csci/press_releases/better_advice_for_people_choos.aspx 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 peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: This inspection was conducted using the Inspecting for Better Lives methodology introduced by the Commission for Social Care Inspection in April 2006.The inspection methodology used by the Commission for Social Care Inspection enables the us to make a judgment on the quality of the service delivery based on the outcomes for people living at the home. The inspection took place over the course of one day in April 2009. We looked at selected staff and residents files, policies and procedures and other documentation related to the running of the home. The inspector looked around the home and also viewed several private rooms and the garden. As part of the inspection we spoke to people living at the home, staff relatives/representatives and people living at the home. The responses and comments Care Homes for Older People Page 6 of 30 are incorporated into this report. In addition the home sent us information in the form of an Annual Quality Assurance Assessment (AQAA). This document help us form a judgment on the improvements made at the home. What the care home does well: All people living at the home are seen as individuals with life experiences and these are valued and respected. The statement of purpose and brochure makes it clear that people from all sections of the community will be made welcome and their needs accommodated. People are able to continue to pursue their spiritual needs and this is supported by the homes staff. The homes equal opportunities policy is relevant to people living at the home and staff and makes the value system of the home clear, that is to provide a safe environment for all who live and work there. One person said that I am extremely happy here and have no regrets about giving up my home and another person said I dont think there is anywhere better to stay. A visitor to the home commented that the home makes each person feel special. The home produces a statement of purpose that is readily available in the entrance hall. All people spoken to had been given enough information to make a decision when they were looking at moving into the home. All people are given a terms and conditions of residency. Admission does not take place unless the prospective resident has been assessed by a member of staff and it has been confirmed in writing that the home is able to meet their needs. Prospective residents have the opportunity to visit and spend time in the home before they make a decision about residency. All people living at the home have a care plan that details their health, social and care needs and how staff will meet these in an individual way that respects dignity and privacy. Risk assessments are in place but individuals rights to take risks and retain their independence is recognised. The routines of the home are flexible to suit the needs, preferences and choices of residents. People living at the home are on the whole satisfied with the quality and range of the food served and mealtimes in the dining room are social occasions. The food was described as lovely, excellent and very good. Visitors are made encouraged in the home and are made welcome, enabling people to maintain their relationships with family and friends. One visitor to the home said It is like one big family, everyone is so friendly, nothing is too much trouble. Another person commented that the home far exceeded expectations in the care they received and that the home was truly remarkable. The whistle blowing and complaints policy are clearly written and contain all the information recommended. All people spoken to were aware of how to raise any concerns and were confident that they would be listened to and taken seriously. The home provides a high standard of furnishings and fittings. People are encouraged and supported to bring in small items of their own furniture and are able to personalise their private rooms in line with their preferences and choices. All areas of the home were very clean, tidy and there were no unpleasant odours. There is sufficient staff to meet peoples needs. People were very satisfied with the care they receive from staff. Some of care staff are qualified to NVQ level 2 or above to make sure they have the skills and experience to provide a high standard of care. People spoken to were very positive about the staff and Mr and Mrs Culley who were described as very good and Care Homes for Older People Page 8 of 30 helpful and very kind. The staff team is stable with many staff having worked at the home for some years this gives the people continuity of care and confidence that they will be well looked after. Mr and Mrs Culley have the required skills and experience and are competent to run the home. Staff described the atmosphere within the home as very supportive. One person living at the home said that I only have praise for the way I am treated by management and staff. The home works to a clear health and safety policy and procedure that safeguards people living at the home and staff. What has improved since the last inspection? What they could do better: The home must ensure that people living at the home who continue to take charge of their own medication sometimes called self medicating are competent to do so. This would take the form of regular risk assessments. The management need to ensure that staff dispense medication in line with the homes policy and procedure and in line with good practice guidelines. A number of people living at the home stated that they would like their evening meal at a later time. In addition a number of people stated that they would like the range of vegetables extended. The management need to ensure that they take peoples views in to account with regard to the delivery of food and mealtimes. The home meets the majority of infection control measures however paper towels need to be provided in communal toilets and where staff are required to wash their hands. The homes hot water is not restricted. This may pose a risk to the health and safety of people at the home. The management need to liaise with the Health and Safety Executive to ensure that the current safe guards that are in place are adequate. The home does not currently provide potential staff with an application form. The development of such a form would ensure that the management can robustly assess if individuals have the skills and competencies to meet the job role for which they are applying. In additional all induction including that completed in house is documented as part of the staff professional development. Care Homes for Older People Page 9 of 30 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 10 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 11 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. People wishing to move to home receive adequate information about the home to help them to decide if it is the right place for them. Everyone has their needs assessed before they move in to ensure that the home is able to meet their specific needs and expectations Evidence: The home has a colour brochure, service user guide and statement of purpose that enables people to gain information about the home before making any decisions about moving in. People spoken with during the inspection said that they or their representative had visited the home before they moved in. Everyone wishing to move into the home has their needs fully assessed by a senior member of staff, this ensures that the home is able to meet their needs. The home also obtains copies of assessments carried out by other professionals. Copies of assessments were seen in care plans. Care Homes for Older People Page 12 of 30 Evidence: The home provides a copy of terms and conditions to all people who live at the home. This document states that the first four weeks is considered a trial period. This ensures that the home can meet the needs of the individual. Fees are payable monthly in advance. If an individual is admitted to hospital for a period over two weeks the fees are reduced by 25 . Fees are reviewed on an annual basis every April. examples of services not included in the fees are hairdressing, private chiropody or dentistry, newspapers and magazines, personal telephone calls, personal television and personal toiletries. Care Homes for Older People Page 13 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. The care planning process has improved since the last inspection however some require additional development. People have access to healthcare professionals according to their individual needs. Medication policies and procedures promote do not always promote safe practice. Evidence: Since the last inspection the care planning process has been updated. Three of these care plans were sampled. All had been personalised to the individual and contained information about the person and their needs. Some of the comments contained in the plans require additional clarification. Statements such as encourage fluids or regularly assess competency to self medicate need to be avoided as they are ambiguous and do not give clear guidance to staff. Comments in plans should contain the amount of fluids that the individual required or how staff should assess the individuals ability to self medicate. The plans and or risk assessment should also state the frequency that any assessment to self medicate should be completed. There was Care Homes for Older People Page 14 of 30 Evidence: some information about personal preferences and lifestyle choices in all the care plans viewed. Assessments are now carried out in respect of physical health such as nutrition, skin care and moving and handling. Specialist equipment is made available where required. Records of personal weights are maintained and referrals are made to appropriate professionals where there are significant losses or gains. Records are kept of all appointments with outside health care professionals. People living at the home said that they were able to see GPs, District Nurses and a Chiropodist at the home. One person had recently been referred to the Psychiatry department to seek advice to ensure that staff at the home were able to appropriately support the person. Medication administration, documentation and storage was viewed during the inspection. Medication is delivered to the home on a monthly basis along with pre printed Medication Administration records often called MAR charts. Sometimes however the GP may alter the dose required or make additional prescriptions for example antibiotics in between the monthly medication and MAR charts being delivered. When this occurs staff will need to hand write the new medication on to the MAR charts. In order to reduce the risk of medication errors this hand written entry must be checked by a second person to ensure that the correct medication, dose and times have been entered. The second staff member should also sign the MAR to confirm that this has been completed. This was not seen on some of the MARs viewed during the inspection. Some hand written entries on the MARs contained only one signature with other containing no signatures. For another individual the dose had just been crossed out and the new dose entered. In this case the whole prescription should be re written with the new dose. Again this should be checked by a second person. It is the responsibility of the staff member who has dispensed the medication to ensure that it is received by the individual and taken. The staff member should only sign the MAR when the medication has been taken. If the medication is not taken then the staff member who has dispensed this is responsible for entering the on the MAR the reason why the medication has not been taken and to ensure that it is destroyed appropriately. This ensures that there is a clear audit trail for all medication and reduces the risk of drug errors and potential drug misuse. During the inspection it was observed that one staff member handed medication to another staff member to dispense to an individual living at the home. This is not in line with the good practice guidelines as described above and this practice must cease. Care Homes for Older People Page 15 of 30 Evidence: Some people living at the home self medicate. When this occurs staff at the home should conduct regular risk assessments to ensure that the individual is able to manage this process. No such assessments had been completed for some people at the home who were self medicating. People spoken with during the inspection said that their privacy was respected and they were treated with dignity. People said that they were free to spend time in the communal areas of the home or in the privacy of bedrooms. It was observed that staff knocked on doors before entering . Care Homes for Older People Page 16 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 are no strict routines in the home and people are able to make choices about how, and where, they spend their day. Social and recreational opportunities are available Meals and mealtimes are a pleasant experience for people living at the home. Visitors are welcome at anytime. Evidence: The Annual Quality Assurance Assessment (AQAA) demonstrates that the manager has a commitment to listening to people who live and the home and providing choices for everyone. As such the numbers and availability of social and recreational opportunities has increased. People spoken to during the inspection stated that there are things going on for them to do. Some people stated that they did not like to join in these activities and that staff respected their wishes not to do so. On the day of the inspection some people went for a walk with staff. A number of people stated that they particularly enjoyed the immaculate gardens at the rear of the home. These gardens are accessible t all including those who require the use of a wheelchair. Care Homes for Older People Page 17 of 30 Evidence: People living at the home said that they are able to choose what time they got up, when they went to bed and how they spent their day. One person at the hone told us that they visited a local church although a communion services is also available at the home. People are free to see representatives of all religious denominations at the home. A hairdresser visits the home on a regular basis. People told us that they are free to receive friends and family at any time and that visitors are made welcome by the staff. Lunch was observed on the day of the inspection. All but one person stated that they were happy with quality of the food provided although a number of other people stated that they would like the range of vegetables to be extended. One comment included I am fed up with peas and carrots and would like more variety. Another person also made a similar comment with regard to the frequency that peas and carrots were served. It should be noted however that a range of vegetables were on offer on the day of the inspection visit. The main meal is served at lunch time. On the day of the inspection this consisted of a choice of fish and mashed potatoes with vegetables which did include peas and carrots but also broccoli of curry and rice. Melon or soup was served prior to the main course. It was observed that despite this choice an additional person had cold meat and mashed potato. Additional another person stated when her meal was served that she did not fancy this Staff immediately offered a choice of alternatives and an alternative meal was provided A range of puddings were available to include apple crumble, jelly, egg custard, yogurt and fresh fruit. Custard and/or cream were also available The tables in the dining room were nicely set with linen table cloths napkins and glasses. Water or fruit juice were available although some people had a sherry from the homes bar area. The evening meal is a lighter option although a cooked choice is available. A number of people told us that they found that this meal was served to early and that this meant that there was a long time before breakfast. We were tole by people that an evening drink and biscuit is served prior to bed. A number of people told us that they had raised this issue with staff and that their evening meal was held back until they wanted it. A number of other people told us that they were unaware that they could do this. It is recommended that the management ensure that all people are aware that this option is available to them or alternatively consider if the majority of people living at the home would like their evening meal served at a later time. Care Homes for Older People Page 18 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. Residents and others understand how to make a complaint and are confident that they will be listened to and taken seriously. An adult protection policy to safeguard residents from the risk of abuse is in place but needs revising to reflect good practice advice. Detailed information is available to staff about whistle blowing. Staff recruitment practice needs to be more robust to ensure the safety of people living at the home. Evidence: The home has a clear complaints policy that includes the timescales within which a complaint would be investigated and makes clear that complainants are able to contact us at any stage of a complaint. The home has a whistle blowing policy for staff that is detailed and includes the telephone number of Public Concern at Work and the us. The home has an adult abuse policy and a copy of the Safeguarding Vulnerable Adults Adult Protection in Somerset Multi Agency Policy and Practice Guidance. Care Homes for Older People Page 19 of 30 Evidence: The home must review their staff recruitment procedures to ensure the safety of people living at the home. (See outcome area for staffing.) Care Homes for Older People Page 20 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. People who use services are encouraged to see the home as their own. It is a very well maintained, attractive home and has good access to local community facilities. One aspect of infection control was identified to the home managers as requiring attention. Hoy water is not controlled and therefore may pose a risk to people living at the home. Evidence: Accommodation is arranged over the ground and first floor. All bedrooms have en suite facilities. There is an assisted bathroom stair lift and call system available to people living at the home. Communal space comprises of a large lounge, dining room and first floor sun terrace. Adaptations have been provided as required. Peoples bedrooms have been personalised to reflect individual tastes and preferences. The home has been decorated and furnished to a high standard and is well maintained. The home has a large immaculately kept garden at the rear, which was being used by several people on the day of the inspection. Garden furniture is available. There is emergency lighting available throughout the home. This is tested on a Care Homes for Older People Page 21 of 30 Evidence: monthly basis. The home is maintained to a high standard. The laundry facilities are adequate for the size of the home. All people spoken to said that they were satisfied with the laundry service and that they always received their own clothes back promptly. The home follows good practice in relation to infection control the majority of areas. Protective clothing is readily available to staff. It was noted however that in the bathrooms and toilets Cotton hand towels are used. The use of Cotton hand towels is satisfactory for the use of individuals living at the home in their en-suite bathrooms. In communal toilets and areas for staff hand washing paper towels should be available. This reduces the spread and risk of infection. Paper towels should be disposed of in a foot operated flip top bin. The bin would require regular emptying. This was discussed with the management of the home at the end of the inspection whoa greed to address this issue. During the inspection it was noted that the temperature of hot water to baths and hand basins is not regulated. The hot water was found to be over 50 degrees in the baths tested. At water temperatures over 50 degrees there is a risk of scalding which rises with increasing temperatures. The risk is increased in care homes as residents are elderly and may be prone to sensory loss. For situations where whole body immersion takes place, such as baths and showers and these are accessible to residents, water temperatures should be controlled to 43 degrees. Circulating hot water should be at over 60degrees, to avoid risks associated with Legionella. The proprietor stated that he was aware that the water temperatures were high however this was at the request of people living at the home and had been risk assessed. It is advised that the proprietors consult with the Health and safety Executive (HSE) to ensure that these safeguards are satisfactory. Care Homes for Older People Page 22 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. There is sufficient staff to meet indivduals needs. People living at the are very satisfied with the care they receive from staff. Some of the care staff are qualified to NVQ level 2 or above to make sure they have the skills and experience to provide a high standard of care. New staff recieve an induction although some minor amendments are required. Recruitment checks need to be more robust to protect residents. Evidence: Duty rotas are maintained. Feedback from people living at the home and staff indicated that there was sufficient staff to meet the needs of individuals. All the people spoken to said that they always or usually received the care they needed and the majority said that there was always staff available when needed. All people living at the home spoken to knew the names of all the staff and were confident they were very well looked after. Information supplied by the home confirmed that a number of staff have undertaken an NVQ. We looked at three staff files. All the files viewed contained a Criminal Record Care Homes for Older People Page 23 of 30 Evidence: Bureau check and references. None however contained an application form or information relating to the individuals past employment history. It is good practice to seek this information in order that any gaps in work history can be discussed and to ensure that one of the references obtained is from the last employer. This helps to safeguard the people living at the home. The use of an application form would also provide information on the suitability of the candidate for the post and any previous training of qualification gained. The home must ask applicants to make a declaration with regard to any convictions and must make it clear the posts at the home are exempt from the Rehabilitation of Offenders Act. Staff should also be given copies of the General Social Care Council code of conduct. Staff are provided with regular opportunities to undertake training and since the last inspection training had included dementia care, medicines administration, first aid appointed person, infection control and manual handling up dates. The service focuses training to improve outcomes for people living at the home. Staff are paid to attend training and the home pays course fees. All new staff now undertakes the common induction standards. This is provided by an outside organisation and may not happen for some time after the individual has commenced employment at the home. The home therefore completes an in house induction with all new staff. The manager explained that this includes such things as fire safety and care planning. This induction however is not documented. This was discussed with the manager who stated in future she would ensure that all induction is documented. 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 manager has the required skills and experience and is competent to run the home. The home works to a clear health and safety policy and procedure that safeguards residents and staff in the majoirty of areas. Evidence: There was a relaxed and open atmosphere within the home. Residents spoke highly of the Mr & Mrs Culley and their role within the home. One person described Mr and Mrs Culley as excellent, very good. Mrs Culley is a qualified nurse. People views are regularly sought informally on an individual basis and in surveys as part of the home quality assurance procedures. The last survey was completed in May 2008 and as a result the home increased the number o social and recreational opportunities available. Appropriate Employers Liability Insurance is displayed. There is evidence of ongoing investment in the maintenance of the interior, exterior and furnishings and fittings of the home. Care Homes for Older People Page 25 of 30 Evidence: Policies and procedures are in place, these should be reviewed and updated as necessary to reflect changes in legislation and current good practice advice. Records were stored securely. The home does not keep any money on behalf of residents. The home has a finance policy; advice was given on making it clear that staff cant accept gifts from people living at the home. The fire system had been regularly serviced and tested on a weekly basis. All staff has undertaken training in fire safety. Emergency lighting is checked weekly. All staff have qualifications in moving and handling. Staff spoken to confirmed that they contribute to the running of the home and their views are listened to. Hazardous substances had been stored securely and were not accessible to people living at the home. Accidents had been recorded and reported as required. The comments in the outcome area environment with regard to hot water temperatures and infection control should be noted however. Care Homes for Older People Page 26 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 27 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 All hand writen entries on 02/06/2009 the Mediaction Adminstration Record should be checked and signed by a second person This will reduce the risk of mediaction errors. 2 9 13 The home must ensure that 02/06/2009 risk assessments are completed for all people who self medicate. This will ensure the safety of all indivduals living at the home. 3 9 13 Mediaction should not be handed to a second staff member to be given. The staff member who has dispensed the mediaction should ensure has been taken. If it is not taken then it is the responsibility of the dispensing staff member to record this. 02/06/2009 Care Homes for Older People Page 28 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 This will reduce the risk of drug errors and ensure the health and safety of people living at the home. 4 26 13 It is required that the home introduce the use of paper towels in communal toilets and in all areas were staff are required to wash their hands. This will reduce the risk of the spread of infection. 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 02/06/2009 1 15 It is recommended that the management review the time that the evening meal is served or ensure that peolpe are aware that they can have a snack of meal at a later time. It is advised that the proprietors consult with the Health and Safety Executive to ensure that the safeguards in place with regard to the hot water temperatures are satisfactory. It is recommended that the home introduce an application form for all new staff thinking of taking a post at the home. It is recommended that all induction including that undertaken in house is documented. 2 25 3 4 29 30 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. 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