Care Home: St Anne`s Residential Home

What the care home does well There is a relaxed and homely atmosphere. People say that the care workers are kind and attentive. They also say that they receive the support and assistance they need. There are interesting social things that people can do. People are helped to stay in good health. This includes keeping an eye on how everyone is and then calling doctors as soon as they`re needed. People`s medicines are handled safely so that they take them in the right way at the right time Sensible things are done to help prevent people having accidents. People are served with good quality meals. What has improved since the last inspection? When we did our last inspection, we found five things in particular that needed to be put right. These included the need to improve parts of the quality assurance process and to make the complaints procedure for effective. They also involved the need to strengthen parts of the system used to ensure that care workers have the skills and knowledge they need. The Assessment says that all of our requirements have been met. We looked at each of them during the present inspection. We found that they largely have been done. Various improvements have been made to the accommodation. These have contributed to people having a homely and comfortable place in which to live. The individual plans of care have been strengthened. This includes the preparation of individual life histories. These give care workers more information about the things that each person is likely to find interesting and useful. A new system of quality checks has been introduced. These are designed to double check that people are being helped in ways that are right for them. The system used to give new care workers introductory training has been strengthened. This has been done to make sure that they learn everything they need to know. Existing care workers have completed various relevant training courses. Care workers are receiving more individual support. They meet with someone senior to discuss their work and to plan for their personal development. The Registered Provider has strengthened the senior management team by appointing an Operations Manager. She is available to provide support and advice for the Manager. The Registered Provider has arranged for regular quality audits to be completed by the Operations Manager. What the care home could do better: There is an error in the written complaints procedure. This needs to be put right so that people know about all of their rights. Parts of the recruitment system need to be strengthened. This is important because the Registered Provider needs to be clear that all of the necessary security checks have been completed. Some care workers have not completed all of the training that is intended for them. This may result in them not having the opportunity to develop fully parts of their knowledge and skills. The Manager isn`t registered in her post. This is necessary because we need to know that the management arrangements in the Service are reliable and clear. Parts of the arrangements used to consult with the people who live in the Service are not well developed. This is important because they`re the experts on the place. They need to have a direct say in how things are run. The system used to provide fire safety training for members of staff needs to be improved. This is so that at least once every six months everyone is checked to make sure that they know how to use the fire safety procedure. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Anne`s Residential Home St Anne`s Residential Home Clifton Deddington Banbury Oxfordshire OX15 0PA     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: Mark Hemmings     Date: 2 7 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 35 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 35 Information about the care home Name of care home: Address: St Anne`s Residential Home St Anne`s Residential Home Clifton Deddington Banbury Oxfordshire OX15 0PA 01869338295 Telephone number: Fax number: Email address: Provider web address: ruralcareltd@aol.com Name of registered provider(s): Type of registration: Number of places registered: Mr Prashant Brahmbhatt care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 22 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - D Date of last inspection Brief description of the care home Up to 22 older people can make their home in St Annes Residential Care Home (the Service). The people who live in the Service need extra help because they have developed problems with understanding things. The property is a detached older house thats been extended and adapted for its present use. The accommodation is on the ground floor and the first floor. There is a stair-lift between the floors for people who cant manage the stairs. When full, four of the bedrooms can be shared by two people Care Homes for Older People Page 4 of 35 Over 65 0 22 Brief description of the care home each. All of the other bedrooms are for single occupancy. All of the bedrooms have a private wash hand basin and all but two of them also have a private toilet. There are two bathrooms which also have toilets and two separate toilets. There isnt a walk-in shower. There is a call bell system. This has call points in each of the bedrooms, bathrooms and toilets. This means that people can ring for assistance should it be needed. The Service is set back a bit from a quiet road. Its a rural location and there arent any shops within easy walking distance. There isnt any private parking. However, there is some on-road parking available. The Service doesnt have its own vehicle. The Registered Provider is a private individual. If you want to find out more about the Service and about the fees charged, you can phone the Service and speak with the Manager. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of care services. This inspection of the Service was an unannounced Key Inspection. We arrived at the Service at about a quarter to eight in the morning and we were there for about eight and half hours. It was a thorough look at how well things are going. We took into account quite detailed information provided by the Registered Provider in his self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with five of the people who live in the Service. We also spoke with the Registered Provider, the Manager, with six of the care workers and with two of the cooks. We walked around parts of the Care Homes for Older People Page 6 of 35 accommodation and we looked at a selection of key records and documents. After we visited the Service, the Managers sent us an email with some more information that wed asked for. Before we visited the Service, we asked ten of the people who live there and 10 members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of St Annes Residential Care Home. Seven members of staff kindly filled them out for us and returned them. The Registered Provider sends a questionnaire every six months or so to peoples relatives and to members of staff. In these he asks them about how things are going in the Service. As we go through our report well tell you some of the things that members of staff are saying in our questionnaires. Well also tell you some of the things that the relatives have told the Registered Provider. What the care home does well: What has improved since the last inspection? When we did our last inspection, we found five things in particular that needed to be put right. These included the need to improve parts of the quality assurance process and to make the complaints procedure for effective. They also involved the need to strengthen parts of the system used to ensure that care workers have the skills and knowledge they need. The Assessment says that all of our requirements have been met. We looked at each of them during the present inspection. We found that they largely have been done. Various improvements have been made to the accommodation. These have contributed to people having a homely and comfortable place in which to live. The individual plans of care have been strengthened. This includes the preparation of individual life histories. These give care workers more information about the things that each person is likely to find interesting and useful. A new system of quality checks has been introduced. These are designed to double check that people are being helped in ways that are right for them. The system used to give new care workers introductory training has been strengthened. This has been done to make sure that they learn everything they need to know. Existing care workers have completed various relevant training courses. Care workers are receiving more individual support. They meet with someone senior to discuss their work and to plan for their personal development. The Registered Provider has strengthened the senior management team by appointing an Operations Manager. She is available to provide support and advice for the Manager. Care Homes for Older People Page 8 of 35 The Registered Provider has arranged for regular quality audits to be completed by the Operations Manager. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 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 who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods will be helped to go back home. Evidence: The Manager asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving in St Annes Residential Care Home is the right thing for them. She also talks with family members and with people like care managers (social workers). All of this information is collected so that the Manager can build up a really good picture of how the person can best be supported. After shes got all of this information, she can then decide if St Annes Residential Care Home can meet the persons needs for help. We looked at the information that has been collected for one person who has recently moved into the Service. We wanted to see what sorts of things are being considered. Care Homes for Older People Page 11 of 35 Evidence: There is lots of useful information. Theres information about practical things such as the help needed in the bathroom and about health care. But there is also other information about quality of life things. Such as the sorts of social activities the person likes to do. The Manager says that when she gets the information she shares it with care workers. This is done so that care workers know in advance about what support they will need to provide. We asked two care workers about how all of this works out in practice. They say that they are indeed told about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days, while they get to know them better. The Manager recognises that moving into a residential care setting is a big step. She says that she wants to do everything possible to put the persons mind at rest. We agree that this is really important. She says that as part of the introduction process, the person concerned and/or their family are invited to visit the Service. This is so that they can see what the place is like first hand. During these visits, people can ask any questions they want. There are also some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Manager is quite happy for them to take away a copy if they want to have a look at them at their leisure. The Assessment says that she also makes sure that people know about our Inspection Reports and that shes happy to show them the most recent one of these. One of the care workers says, we know how hard it can be for someone to come to somewhere new. Especially, if theyre finding it hard because theyre confused about things. Each person has their own key worker from the start, someone who they can get to know. We always make a fuss of the person without going over the top and we get to know them. People need time to settle in and we recognise that. We asked someone who has recently moved in to the Service how things went. They say, Im okay here, things are okay with me. Nearly all of the people who move into the Service do so with the intention of making it their longer term home. However, there is the chance that someone will only want to stay for a shorter period. This might be so that someone who cares for them at home can have some time to themselves. When someone moves into a residential care setting theres always the risk that their stay might become longer than is necessary. The Manager is aware of this. She says that people are helped to make any arrangements that are necessary for them to go home as planned. Care Homes for Older People Page 12 of 35 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. People are provided with the personal and health care they need. Medicines are handled safely. People are treated with kindness and respect. Evidence: The people who live in the Service say that the care workers offer them all the assistance they need. There is a written individual plan of support for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to care workers so that they know what to do. We looked at three of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as helping people in the bathroom, about health care and about keeping people safe. In more detail, one person needs to be supported in a special way if they become anxious and distressed. Another person isnt able to get up much and needs quite a lot of care to be given in their bedroom. This includes help with managing their continence. We asked four care workers about some of these things. We wanted to know what all Care Homes for Older People Page 13 of 35 Evidence: of this written information means in practice. They know all about it. The Registered Providers questionnaire for relatives asks, how do you rate the overall quality of care? Everyone says that its good or very good. The care plans are kept up to date so that theyre accurate. This involves care workers making daily notes about how things are going. There are then monthly reviews. This is when the Manager checks out with the care workers how things are going and what might need to be changed. As weve already said, the care plans are very detailed. While this is useful for members of staff it can make it difficult for the people their written about to fully appreciate whats being written in their name. The Manager recognises this to be an issue. Shes already been looking into what more can be done to make the whole process more straight-forward and more user-friendly. As part of this she has prepared quite detailed life histories for each person. These give care workers lots of useful information about the different things that each person is likely to find interesting and useful. Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, some of the people who live in the Service find it difficult to use the call bells. They have been given special mats that operate the call bell system for them if they get out of bed at night and need help. Since our last inspection, the Manager has prepared a Personal Emergency Evacuation Plan for each person. These are written assessments that say how best to help each person in the event of a fire safety emergency. We think that these are a very good idea. People are helped to keep healthy. Care workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, people have seen their doctors as and when necessary. As part of the medical care arrangements, the local doctor now calls to the Service every fortnight or so to check out how his patients are doing. This is done in addition to any other consultations that he may be requested by the Service to do. There have also been visits by other professionals such as district nurses and a special nurse who helps people if they are having falls. We looked at some of the records about how quickly doctors are being called after the need for medical attention is first noted. Its being done straightaway. Care workers also contact other people such as opticians and dentists when they are needed. For example, a dentist has recently been contacted. This was because a care worker noticed that someones false teeth were becoming loose and uncomfortable. Care Homes for Older People Page 14 of 35 Evidence: None of the people who currently live in the Service can manage their own medication. Therefore, members of staff do it for them. There is a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. The Assessment says that all members of staff who give out medication have been trained so that they know what theyre doing. There is a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. We saw a care worker giving out some medication. This was done in a kind way. The person wasnt rushed at all and they were given a drink to help get the tablet down. After theyd taken it, the care worker signed the necessary record in the correct way to show that the medicine had been administered. We examined three sets of these records for a period of several recent days. They are correctly completed. We looked at three medicines in more detail. This was done to see if the remaining stock matches what should be there. Again, we found things to be in order. We looked at other things too. For example, we noted that a record is kept when eye drops are opened. This is important to know, so that theyre not used after they go out of date. People say that the care workers are courteous and attentive. When we were in the Service we talked with people a lot about this. They are very positive about the care workers. One person summarises the general mood in their comments to us. They say, the staff are very good and I am quite okay here. I get muddled and have to tell them things but they seem to know what I mean even when Im not quite sure what I mean. The Registered Providers questionnaire asks, how well do you feel your relatives privacy is being respected? Everyone answers good or very good. We saw lots of occasions when care workers were supporting people. In all of them they were kind and helpful. For example, one person needed a lot of support to have their breakfast. The care worker sat with them and talked quietly about what was on the tray. Then she offered things in different orders until the person decided that they did want to have something. After 10 minutes or so, the person enjoyed some porridge and a few sips of tea. Another example happened when someone spilt their afternoon cup of tea down them. The care worker who was nearest immediately went to them. She tactfully checked that they hadnt scalded themselves, which they hadnt. She then helped them to leave the lounge so that they could change their clothes. When people want to use the bathroom, they are helped to leave the lounge without drawing attention to themselves. Then they are helped in the bathroom with the door closed so that they can have privacy. People are helped to wear neat and clean clothes so that they can present themselves how they want. The Manager says that whenever possible people are helped to do things for Care Homes for Older People Page 15 of 35 Evidence: themselves. This means that the care workers are careful not to take over doing things for people when theres no need. We saw lots of examples of this too. People are given the time and space they need to do things in their own way. This principle is confirmed in some of the written policies and procedures that care workers follow. For example, one piece of guidance reads, do you see the person trying to do things for themselves and then there is a note that reads, the important thing is that the person is still trying to do things, not that they are getting it right. Care Homes for Older People Page 16 of 35 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 some interesting things for people to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: The Manager says that the plan is that each day there is a social thing that people can do. These events involve various things. Some of them are when outside entertainers come in to play music. At other times, care workers do things such as games and quizzes. Theres a record kept of the social things that take place. We had a look at it to see what sorts of things people have had the chance to do over the course of a few recent days. They include things like games and artwork. Some people dont like to be in groups and they prefer one to one things. We saw this happening quite a lot. Over a 10 minute period in the main lounge, we saw one person chatting with a care worker while she drank her tea. Another person was asked about a treasured object she was holding. When we were in the Service we chatted with people about social activities and in general we got positive comments. No one says that theyre bored. We think that in general theres quite a lively and engaged atmosphere in the Service. Care Homes for Older People Page 17 of 35 Evidence: There isnt a definite plan to the social things that are done and so care workers make their mind up on the day. While its often useful to keep things flexible, the Manager wants to make the arrangements a little more organised. She is going to start this by preparing a more detailed account of the activities that each person might like to have offered to them. Theres also going to be a more detailed record of who has done what social things. We think that this is a really good idea. This is because it will help to double check that no one gets overlooked. As weve already mentioned, the Service doesnt have its own vehicle. This must make it very difficult to organise trips out when the weathers nice. We asked members of staff about this. No one can remember when the last trip out was. People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Manager keeps in touch with family members so that they know how things are going. For example, if someone is not well or if they are admitted to hospital. The Registered Provider doesnt get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Instead, most people get help from members of their family. People are encouraged to make their bedrooms their own private space. They are asked to bring in things for their own homes so that they can have personal items around them. We saw lots of examples of this. People have their own photographs and ornaments so that their bedrooms feel more like being home. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. One person summarises the general view when they say, the meals are good and I have what I want. I can be fussy I suppose but Ive never had cause to complain here, its good really. There is a choice of dish at each meal time. We looked at the records of the meals provided over several recent days. We wanted to see if different people are actually having different things. They are. We also looked at the variety of meals provided over a period of two or three days. There is a reasonable balance. The dishes include things like sausage casserole, vegetable slice and roast lamb. People can have drinks and snacks throughout the night. This is important. Otherwise, it can be a long time for some people between the late evening milky drink and breakfast the next day. The dining room is very small. This means that some people have to have their meals Care Homes for Older People Page 18 of 35 Evidence: in the lounge. The Registered Provider recognises that this is not an ideal arrangement. He hopes to extend the dining room. This will be done when he completes more general building work that will also add extra bedrooms to the Service. The timescale for beginning the work isnt set yet. However, he hopes that it will be within the course of this year. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure but it needs to be strengthened. There are arrangements to make sure that complaints are dealt with properly. There are arrangements in place that are designed to safeguard people. Evidence: We asked several people about making complaints. They say and show by their relaxed manner they would feel quite okay about raising a complaint should they need to. Theres a written complaints procedure. This explains how to go about making a complaint or raising a concern about something. Its the Registered Providers responsibility to sort out complaints. However, people can also tell us about things that are concerning them. This isnt clearly explained in the current procedure. The Manager is going to sort this out by 1 June 2009. Since our last inspection, the Registered Provider has looked into two complaints. One was from a relative and it was about a number of things. These included things such as one of the two wardrobes in their mothers bedroom having been removed and some items of clothing having gone missing. The Registered Provider promptly met with the relative and sorted things out. A second wardrobe has since been provided and the missing clothes have been replaced with new items in line with the Registered Care Homes for Older People Page 20 of 35 Evidence: Providers policy. The second matter was an internal thing within the staff team. Again, the Registered Provider looked into in a timely and thorough manner. Suitable steps have since been taken to sort out the problem. Its very important that people are confident that theyre safe from being mistreated in some way. The Assessment commits the Registered Provider to ensuring that people who live in the Service are indeed kept safe. When we were in the Service, people didnt comment to us directly about this matter. However, they showed us by how they were in themselves that they feel safe in the company of the care workers. There is a written policy and procedure that says about what a care worker should do if they become concerned about someones wellbeing. The Assessment says that all care workers have had one to one tuition about how to use the procedure and about how to keep people safe. We asked two care workers about this and they know what to do if theyre worried at all. Neither said that they have any concerns. One person sums up the general mood when they say, everything possible is done here for the residents to make sure theyre happy and safe. We take care of our residents and would never let anything wrong go on. Its just not like that here. We do this work because we care about older people not because we want to get rich. The residents always come first here and everyone in the place knows that. Care Homes for Older People Page 21 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most of the accommodation is comfortable and pleasant. There is a modern fire safety system. The kitchen is well equipped. There is a separate laundry. Evidence: The building is well maintained on the outside. However, there is a padlock and chain on the front gate. This is very off-putting. Its not at all the sort of domestic arrangement we expect to see. At the back, there is a large garden. Its not very well kept and parts of it are quite overgrown. The Assessment recognises the need to get this area sorted out. On the inside, the accommodation is generally well decorated and furnished. When we were there, the atmosphere was fresh and pleasant. A number of improvements have been made since our last inspection. Some additional special beds have been bought. This means that everyone now has one of these beds. Theyre designed so that people can adjust their shape to suit their own needs. New suits of furniture have been provided in all of the bedrooms. These include lockable bed side cabinets. In some of the communal areas, new carpets have been laid. New tables and chairs have been bought for the dining room. On the outside of the building, there are new security lights. At the moment, there are various training certificates, no-smoking signs and health Care Homes for Older People Page 22 of 35 Evidence: and safety posters put up on some of the walls. Some people find it reassuring to know that these things are in place. However, we think that they take away from the homely feeling of these areas. There isnt a lock on the ground floor bathroom door. The Registered Provider is going to fit one by 1 June 2009. Its going to be a special one that can be opened from the outside should the need arise. The bath in this bathroom used to have a mixer tap that had an integral shower hose attached to it. This has broken off at some stages. The hole that its left has been filled with mastic. This is a very unsightly arrangement. Indeed, at the moment, there isnt any shower facility in the Service. This must make it very difficult for people to rinse their hair in comfort. The Registered Provider has says that he will now repair the broken tap by fitting a proper shower hose attachment. This is going to be done by 1 June 2009. The building is fitted with an automatic fire detection system. This provides a high level of fire safety protection. We understand that the fire brigade people say that the system meets the national standard. The Registered Provider does a regular fire safety risk assessment. This is where someone goes around the place to check out that everything is still working in the right way. We looked at the record of the most recent one. It says that the fire safety system remains well organised and safe. The people from the local Department of Environmental Health called to look at the kitchen in 2008. We looked at their report. It looks at things such as the cleanliness of the kitchen and the way that food is handled and prepared. The report recommends a small number of improvements. These have since been completed. We looked in the kitchen too. Its well equipped, clean and well organised. Sensible food handling things are done. For example, the fridges are checked to make sure that theyre cold enough. Hot foods are checked to make sure that theyre properly cooked through. Theres also a system to date mark foods when theyre opened. This is done to make sure that they arent kept in store for too long. The cooks know about the importance of good hygiene. People who need it are helped to get about. Both of the baths have got hoists. This means that there is a seat that goes up and down. One of the hoists has got a swivel action. This means that you can sit on it outside the bath before it goes up and lifts you in. There are three mobile hoists. These can be used in the bedrooms and in the lounge areas. They might be needed if someone cant manage at all to get out of bed or cant get up and down from their armchair. At key places, there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. More generally, there are banister rails along corridors. There are frames near to the toilets. People find these very helpful when they are getting down and Care Homes for Older People Page 23 of 35 Evidence: getting back up again. There are other less obvious things to help people get about. For example, there are special belts. These have got handles so that care workers can gently hold people if theyre a bit unsteady on their feet. Also, there are special sheets that can be used to help people change position in bed. When someone moves into the Service, the Manager makes a note of what assistance they need to get about. She looks at things such as the help someone needs in the bedroom and in the bathroom. We asked care workers about this. They know what theyre doing. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. When we arrived in the Service the central heating was on and it was on when we left. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. The hot water taps that are used by the people who live in the Service are temperature controlled. This means that they wont get hot enough to scald someone. We tested a few taps and the temperature seems alright to us. There is no hot water supply to one of the bedrooms at the moment. This is because there is a problem with the temperature control valve. The Registered Provider has assured us that this is about to be sorted out. The laundry has two large washing machines. They have an extra cycle for items that need an especially hot wash. There are two tumble dryers. We looked in the laundry. Its generally well organised and clean. However, the insides of the washing machines doors have got encrusted with what looks like to be old washing powder and general grime. They need to be cleaned. The Manager says that this will be done straight away. New rules have been introduced to help make sure that used water doesnt leak back from things like washing machines into the drinking water supply. It looks like the Service already meets these rules. However, just to be on the safe side the Manager is going to contact the local water supply company to find out. Shes going to do this by 1 May 2009. The Manager says that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. We asked people about this. They say that they do nearly always get their own clothes back from the laundry. Care Homes for Older People Page 24 of 35 Evidence: The Registered Providers questionnaire for relatives asks, is the laundry service for your relatives clothing satisfactory? Everyone says that its good or very good. Care Homes for Older People Page 25 of 35 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 are enough care workers around. Care workers are given training and they know what theyre doing. Parts of the recruitment system need to be strengthened. Evidence: The Manager says that there are five care workers on duty from early in the morning until later in the evening when the night care workers come on duty. Each day there is a cook on duty and each weekday there is also a housekeeper. We looked at the written roster for several recent days to check this out in more detail. It confirms what the Manager says. In our questionnaire for staff we ask, are there enough staff to meet the individual needs of all the people who use the Service? Six people say that there always are and one person says that there usually are. The latter person then adds, there is normally enough staff unless there is a few people off sick at the same time but this does not happen often and if it does we all pull together as a team. When we were in the Service, one care worker told us, we have the time we need to give quiet time to each person and not to be rushed. This is really important because our people cant be rushed or if they are it will upset them. No, we have all the time we need to make this a calm and relaxing place. We kept a look out for things that might give us a clue about how well the place is Care Homes for Older People Page 26 of 35 Evidence: being staffed. We noticed that two people who asked to be helped to use the toilet were assisted straight away. We also noticed that on the two occasions the call bell sounded it was answered in less than a minute. Its very important that only honest and trustworthy people are employed as care workers. With this in mind, the Registered Provider completes a number of security checks on new care workers. These include things such as confirming their identity, taking up references and doing a police check. We looked at the records for one recently appointed care worker. The checks have been done. However, the employment history theyve given is a bit muddled in that the dates dont add up. This means that the Registered Provider cant be sure that he has taken up all of the references that are needed. The Manager is going to sort this out by 1 May 2009. More generally, shes going to check the employment records for all other care workers appointed since our last inspection. Shes going to do this by 1 June 2009. The Manager says that new care workers have introductory training before they work on their own. In our questionnaire for staff we ask about this. We say to members of staff, did your introductory training cover everything you needed to know to do the job when you started? Five people say that it met their needs very well. The people who are less positive started some time ago before the present manager was in post. There is a checklist of the subjects that new care workers are told about. We looked at one of these checklists. It shows that important things are being covered. For example, new care workers are told about the individual care plans we spoke about earlier. They are also told about health and safety things. These include how to help people who have difficulty getting about and fire safety things. Recently, the Manager has strengthened some of this initial training. Shes done this by buying some special training DVDs for people to watch. Also, there is a new workbook that has to be completed both by the trainee and by their mentor. This latter person is an experienced care worker. They take a special interest in making sure that the new person learns what they need to know. The Manager says that this initial training is just to get the care workers started. Theres a lot to learn after that. The Manager says that all care workers are expected to do regular training in important subjects. This is mainly done by outside trainers coming into the Service. Various subjects are covered. For example, how to promote the welfare of people who have problems understanding things, how to safely support people move about, how to administer basic first aid, how to keep people safe and how to go about effective infection control. The records show that care workers are doing quite a lot of training in relevant subjects. However, there are some gaps. For example, most care workers havent done the course intended for them on responding Care Homes for Older People Page 27 of 35 Evidence: to people who have comprehension problems. There is a similar situation for the course on how to support people who communicate through difficult behaviour. Some people havent done the main course planned for them on how to keep people safe from being mistreated. However, when we ask care workers about this they are positive about the training they receive. In our questionnaire we ask, are you being given training that is relevant to your role and that keeps you up to date with new ways of working? Everyone answers yes to this question. Several people then comment some more. One person says, the training programme is excellent and is tailored to meet individual needs. When we were in the Service one care worker observed to us that, Ive done lots and lots of training since I came here and if I want to do a course I just ask. I think that we learn a lot form each other and that we learn from the residents whats right and how they like to be helped. Youve got to care about the residents otherwise all the training in the world wont make up for that. We do genuinely care here about our ladies and gentlemen. The Manager is now going to assess the skills and knowledge that each care worker already has. Shes going to do this using a new national model that we think is very useful. When its done shell have a clearer idea about what might need to be done to address some of the gaps in the training programme that weve noted above. Nearly all of the care workers have completed a National Vocational Qualification (NVQ) in health and personal care or they have an equivalent overseas nursing qualification. The National Vocational Qualification is a very good idea. This is because it helps care workers to deliver high quality residential care services. The Manager says that as necessary all new care workers will be encouraged to work towards the qualification. We spoke with four care workers to find out what they know about particular bits of the support they will need to give people. As we have said earlier in this Report, they know a lot about how each of the people who live in the Service likes to be supported. More generally, they know about helping older people to take care of their skin. They also know about how to respectfully help people who need assistance to manage their continence. Care Homes for Older People Page 28 of 35 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. Things are well managed. People are asked what they think, butt his needs to be developed further. People are helped to buy what they want. There are sensible health and safety things. Evidence: The Manager has a good knowledge of how things are going. She has one of the formal qualifications that are recommended by the Standards. She hopes to start working towards the second qualification in the near future. These qualifications are important. This is because theyre designed to help managers ensure that high quality support is reliably provided. The Manager isnt registered with us yet. She has begun the process. This is important because we need to have the chance to have a thorough look at how she proposes to manage and develop the Service. Its also a legal requirement that the Registered Provider have a registered manager in charge of the day to day running of the Service. Since our last inspection, the Registered Provider has strengthened his senior Care Homes for Older People Page 29 of 35 Evidence: management team by appointing an Operations Manager. She is a qualified nurse. Her job is to support and advise the Manager. Care workers say that there is good team work between them. There are handover meetings at the beginning and end of each shift. These are held so that care workers can be kept up to date with developments. We sat in on the handover meeting that took place between the night care workers and the morning staff shortly after we arrived in the Service. The night care workers gave an update about how people had been that night. Then the morning staff planned what needed to be done during the forthcoming shift. There are team meetings every couple of months or so. We looked at the records of the most recent one to see what sorts of things that are being discussed. Theyre practical and relevant. For example, care workers talked about how best to organise helping people to wash and get ready in the morning. They also discussed the importance of not getting distracted by their mobile phones ringing when they are at work. In our questionnaire for members of staff we ask, do the ways you pass information about people who use the Service between staff (including the manager) work well? Two people reply that they always work well and five people say that they usually do. Weve already mentioned about the questionnaires that peoples relatives and members of staff are asked to complete. The Manager does a summary of whats been said. She then sends a letter about this to relatives and to members of staff. This is done so that everyone is kept up to date with whats been said and with what improvements are going to be made. Its really important that the people who live in the Service have a direct say on how things are going. Theyre the experts because they live there. The Assessment says that people who live in the Service are regularly asked what they think about their home as part of everyday life. We saw this process in action and its very valuable. However, there is nothing more organised than this to find out what they think about their home and about how they think it might be improved. The Manager is going to look into what more can be done to address this matter. Since our last inspection, the Registered Provider has arranged for the new Operations Manager to complete formal monthly quality audits in the Service. When she does these shes talking with members of staff, checking out some key records and having a look at the building. The Manager also does spot checks. This is when she double checks that people are being offered the support they need. For example, that they are wearing clean clothes of their choice. Care Homes for Older People Page 30 of 35 Evidence: The Service holds small amounts of money for some of the people who live there. This is done so that they have enough to buy things like cigarettes and toiletries. We looked at the records for one person. We wanted to see if the sums add up. We also wanted to see if the purchases are supported by a receipt to prove that the money in question has been spent. Things are in order. The Assessment says that theres a system where each care worker can get individual support and guidance from the Manager or from one of the senior care workers. In our questionnaire for staff we ask, do you feel you have the right support, experience and knowledge to meet the different needs of the people who use the Service? Five people reply that they always do and two people think that they usually do. One of the former people says, the Service is well managed, staff feel supported and important. Another person says that, the Service does well by giving the residents the care and attention they need. The managers are approachable and listen to what you have to say. All in all, the Home runs very well and in my opinion this is due to communication, trust and loyalty. Regular checks are completed to ensure that the Services fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells. At the moment, a routine visual check of the fire extinguishers isnt being done. The Manager is going to put this oversight right from the day of our inspection visit. More detailed checks of the fire safety equipment are completed every now and then by an outside engineer. There are regular fire drills. Most but not all members of staff, have recently received fire safety training. This training is very important. This is because the level of fire safety protection largely depends upon members of staff doing the right thing when there is a fire safety emergency. The Manager is now going to strengthen the training system. Shes going to do this to make sure that every member of staff has the required training frequently enough. Shes going to complete this development by 1 June 2009. There are up to date reports from engineers about the gas appliances and the mobile hoists. They say that everything is in good working order. The Registered Provider says that an electrician has just inspected the wiring installation to make sure that it remains in good working order. The report hasnt been received yet. However, we understand that the electrician has said that everything is okay. We looked at the record of accidents that have occurred in the Service over the past several months. There hasnt been that many. Most have been minor bumps and bruises. The Manager keeps an eye on who has had an accident and what has happened. This is done so that she can do something if there is a particular problem that is causing the accidents. For example, one person was having quite a lot of falls. The Manager called Care Homes for Older People Page 31 of 35 Evidence: in a specialist nurse for advice. This then resulted in the persons medication being changed. Since that was done the person has had fewer falls. The Manager says that she and the care workers regularly check the accommodation. They do this to make sure that nothing is broken. Also, they want to see that there are no hazards that might cause someone to have an accident. The Manager says that they havent noticed anything in particular that needs attention. We kept our eyes open when we were walking around. We didnt notice any particular hazards Care Homes for Older People Page 32 of 35 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 33 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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