Care Home: St Anthonys Residential Home

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What the care home does well The people living in the home told us they were very happy with the service they received. Comments included: `Good attention.` `Good care and plenty of choices.` `The home helps residents at all times.` `Wonderful care.` `Provides a very high standard of care.` `The all round general and personal care is of a very high standard.` `Good care.` `The home does what we need and always helps every body.` People were provided with information about the home and were able to visit before moving in to see if they liked the home. There was a good range of activities available so people did not become bored and were able to lead fulfilling lives. People were happy that they were listened to and that their views were acted on. The meals at the home were varied and nutritious and people were very satisfied with the standard of catering. Comments included: `Good quality home cooked food.` `Food is wonderful, really lovely.` `Food is very good, they vary it. Menu on the board let you have what you want.` `Food is wonderful, really lovely, don`t like can have something else.` The relationships between the staff and the people living in the home were good ensuring people were comfortable in their presence. The health and safety of the people living in the home were well managed ensuring their well being. The home was well managed and run in the best interests of the people living there. What has improved since the last inspection? A trolley has been purchased for the safe storage and transportation of the medicines in the home.Staff recruitment procedures had improved ensuring new staff were safe to work with the people living in the home. Staff had undertaken further training in safe working practices to ensure they were able to work safely with the people living in the home. What the care home could do better: Care plans should reflect the current needs of the people living in the home to ensure they receive person centred care on an ongoing basis. The quality of the record keeping should be improved to enable the home to demonstrate that people receive the care they need in a way they want. Food records should be improved so that it can be determined people are eating a varied and nutritious diet. All staff should receive training in adult protection issues to ensure the people living in the home are fully safeguarded. Induction training for new staff should be improved to ensure they have all the necessary skills and knowledge to acre for the people living in the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Anthonys Residential Home 126 Sutton Road Erdington Birmingham B23 5TJ     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: Brenda ONeill     Date: 2 1 0 7 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 32 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 32 Information about the care home Name of care home: Address: St Anthonys Residential Home 126 Sutton Road Erdington Birmingham B23 5TJ 01213737900 01213827911 tkelly.stanthonys@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Tim Kelly care home 18 Number of places (if applicable): Under 65 Over 65 18 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 18 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 18 Date of last inspection Brief description of the care home St Anthonys residential home offers residential care for eighteen older people. The home is a large detached two storey property which has been extensively renovated, extended and decorated to a high standard. The home is situated close to local amenities such as shops, pubs, restaurants and health centres. Public transport links are very good. St Anthonys provides a total of fifteen bedrooms consisting of twelve single and three double bedrooms, which are situated on both the ground and first floors. There is an attractive dining room and two lounges. All bedrooms and communal areas have access to a call system. Whilst none of the bedrooms have en suite facilities there are Care Homes for Older People Page 4 of 32 Brief description of the care home ample assisted bathing and toilet facilities to meet the current needs of the people living in the home. The home has vertical lift access to the first floor. The rooms are all suitably furnished and equipped to meet the needs of the occupants. The decor throughout is homely. There is limited parking at the front of the home. The range of fees charged at the home was not included in the service user guide. People should contact the home directly for this information. The most recent inspection report is on display in the entrance hall of the home. Care Homes for Older People Page 5 of 32 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 last key inspection at the home was carried out on July 21st 2008. This inspection was carried out over one day by one inspector. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that Care Homes for Older People Page 6 of 32 have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Two of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. During the course of the inspection we spoke with five of the people living in the home, the manager, owner and four staff to get their views on the home. We sent ten Have your Say surveys to people who live in the home and these included surveys for relatives if they wished to complete them. Surveys were also sent to six staff members. A total of seventeen were returned, eight from people living in the home, three from relatives and six from staff. These views have been included in the report. What the care home does well: What has improved since the last inspection? A trolley has been purchased for the safe storage and transportation of the medicines in the home. Care Homes for Older People Page 8 of 32 Staff recruitment procedures had improved ensuring new staff were safe to work with the people living in the home. Staff had undertaken further training in safe working practices to ensure they were able to work safely with the people living in the home. 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 32 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 32 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. Arrangements are in place so that people can be confident that their needs will be met upon admission to the home. Evidence: The service user guide for the home had been updated in January 2009 and included the vast majority of the information people would need to help them decide if the home was suitable for them. The document was available in large print to make it easier for people with impaired vision to read. It would have been useful to include the range of fees charged at the home so that people had some idea of what the costs would be. The surveys returned to us before the inspection indicated that people had received enough information to help them decide if the home was the right place for them. All the people living in the home had a copy of the service user guide in their bedrooms that they could refer to if they wanted any information. Care Homes for Older People Page 11 of 32 Evidence: The pre admission assessment procedure was looked at for one of the people who had been admitted to the home since the last inspection. The individuals file showed that the manager of the home had asked them some questions about what they needed from the staff at the home. Areas covered included physical needs, likes, dislikes, interests and hobbies. The comments on the form were very brief and there was no indication of where or when the assessment was undertaken. The manager and the person concerned confirmed that the assessment took place before the individual moved into the home. This ensured the home was able to meet their needs before admission. Staff were also able to tell us about the individual and what their needs were on admission and how these had changed since admission. Two of the people spoken to confirmed they had been offered a visit to the home before they moved in to see if they liked it there. The surveys returned to us indicated that people living in the home had been given information about the terms and conditions of residence at the home. The file sampled included a copy of this document and it gave people the information they would need so they knew what to expect from the home and what their rights were. Care Homes for Older People Page 12 of 32 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 lack of detail in the homes recording systems means that there could be a risk that people will not consistently get the care they need in a way they prefer. Medication management was good and ensured people received their medication as prescribed. Evidence: We tracked the care for two of the people living in the home. This involved sampling their care plans, risk assessments and daily records, speaking to them and the staff that work with them. The care plan files included personal profiles which gave details of the individuals history and the circumstances leading to their admission to the home. Both people had care plans which detailed some of their needs in relation to personal care, diet, and their social needs. The care plans also included some details of peoples abilities, preferences, likes and dislikes. The details in the care plans were quite limited and they did not detail how all the needs of the individuals were to be met by the staff. For Care Homes for Older People Page 13 of 32 Evidence: example, ensure she keeps her independence with no detail of how this was to be achieved. One person did not communicate verbally. There was no detail of how staff were to communicate with this person on their care plan. The only mention was able to communicate pain but there was no detail of how staff would recognise this. Files included monthly evaluations and these included some details that should have updated into the care plans, for example, when one persons relatives visited and activities the person was involved in on a regular basis. One persons evaluations were the same for three months. There was an action plan each month but it was the same which made it look as if this had not been achieved when in reality it had. The manager of the home and the staff we spoke with were able to tell us very clearly what the needs of the people living in the home were and how people liked their care delivered. Staff told us how the individual was able to indicate pain by facial expressions and made her needs known by gestures and pointing things out to staff. They told us one person liked to wear make up and perfume this was not in the care plan but the person was seen wearing her make up. They were also able to tell us how another person had particular needs in relation to how their laundry was done and given back to them this was not mentioned in the care plan. The levels of care people were seen to receive, and what they told us they were receiving were not reflected in their care plans.This could mean people may not receive the care they need and prefer. The comments we received about the care people received were very positive and indicated people received the care they needed in a way they liked. These included: Everything that I could expect is done well. Good attention. Good care and plenty of choices. The home helps residents at all times. Wonderful care. Provides a very high standard of care. The all round general and personal care is of a very high standard. Good care. Care Homes for Older People Page 14 of 32 Evidence: The home does what we need and always helps every body. There were risk assessments in place on both files sampled for manual handling, falls, personal risks, mental health, behaviour, physical health and nutrition. These mostly highlighted if people were at high or low risk. Those seen indicated no particular risks. One person did have a basic management plan for lack of motivation which detailed staff were to encourage the person with daily tasks. Staff did tell us they were doing this with this person and they were aware she needed a lot of encouragement to do things for herself. The nutritional risk assessments had not been scored. It was clear from one persons daily records, GP notes and staff comments that she had recently been put on a diet by the G.P. This needed to be reflected on the persons assessment and in the care plan. This should include some guidance on the foods to be given/avoided so that all staff were consistent. The daily records and the appearance of the people living in the home showed that people were having their personal care needs met. People were seen to be dressed appropriately in styles that refelcted their age, gender and personal choices. Without exception the surveys returned to us, eight in total, said the home always ensured people got the medical care they needed. People we spoke with told us I can see the G.P. when I want, I get my toe nails cut and I am registered with the GP next door, had some blood tests and am waiting for the results. and I am going to Good Hope Hospital for an assessment. The records of visits by health care professionals were not easy to track and did not always include the outcomes of the visits. Some visits were on the sheets specifically for this others were detailed in daily records. The outcomes for some were not detailed at all. The manager and the staff were able to tell us what people had seen the doctor for and what they were going to the hospital for. However records needed to ensure the health care needs of the people living in the home could be tracked so that it could be ensured their well being was being monitored. We audited the medication system for the people whose care was being tracked and sampled some other boxed medication. The records for the receipt and administration of the medication were adequate and showed us that people were receiving their medication as prescribed. The balances of medication held in the home tallied with what had been received and administered. A drugs trolley had been purchased since the last inspection to ensure the safe storage and transportation of the medicines in the home. Care Homes for Older People Page 15 of 32 Evidence: We were told there were no homely remedies or controlled medication in the home at the time of this inspection. We spoke to one person who told he managed his own medication and wanted to continue doing this. The manager had undertaken a risk assessment with him to ensure he was able to do this. It was noted that there were no compliance checks to ensure he was taking his medication on a regular basis. The people living in the home were treated with respect and their rights to privacy upheld. Staff were very polite and interacted well with the people living in the home. Individuals could spend time in their bedrooms without being disturbed if they wished. Double bedrooms had appropriate screening in place. Assistance with personal care was offered discreetly. All comments received about the service offered at the home were very positive. Care Homes for Older People Page 16 of 32 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. The people living in the home had the opportunity to experience a lifestyle that met their needs and expectations. The people living in the home received a wholesome and varied diet that met any special dietary requirements. Evidence: There were no rigid rules or routines in the home. One person commented no restrictions what so ever, my car is on the front, I come and go as I please. Other people told us they chose when to go to bed and get up, what they ate and what they did with their time while in the home. Being able to make choices enhanced peoples individuality and promoted their independence. Peoples preferred activities and hobbies were detailed in their care plans and there was some evidence in daily records that some of these were enabled by staff. There was also a folder for staff to record the activities that had taken place in the home. The records in this were quite poor and only detailed thirteen entries over the year so far which were quite repetitious. The observations made and comments from staff and the people living in the home contradicted this. Care Homes for Older People Page 17 of 32 Evidence: We were told by the people living there and the staff that staff facilitated such things as card games, board games, people going out for coffee, having their nails done and so on. Some of the people living in the home also helped with activities one person ran a card game, another had played some music for people on the day of the inspection. Keep fit was facilitated every week by people from outside the home and people spoken with seemed to enjoy these sessions. There was evidence in daily records that people undertook activities in small groups and individually at times. Comments received included: Do a lot of reading, play the key board in my room Keep myself amused, like to go out, like reading, sit with ladies an talk. Keep fit once a week, sometimes a game of cards, music this afternoon. Can go out if you want to. One person said we are allowed to keep our religion as we want, still practice our religion every Saturday. We were told the vicar visits the home every Saturday and there is Communion once a week. Staff did comment it would be nice if they could take people out of the home more. The manager and proprietor were aware of this and were planning to arrange more trips out of the home for those wanting to take part. People were supported to maintain relationships that were important to them. Comments received from the people living in the home and their relatives showed that visitors were welcome at any time and they were made welcome . These included: Welcoming reception at any time of the day for visitors. The home is good with the family visitors. Can have visitors at any time they are given tea or coffee. People also told us they were able to go out with their friends and families when they wanted to. The menus in the home were varied and nutritious. Although the paper menus did not detail any choices these were available and were detailed on the menu boards in the lounges. People spoken to confirmed they could have choices at meal times and if the menu was not to their liking they could have something different. Care Homes for Older People Page 18 of 32 Evidence: Staff spoken with were able to tell us the likes and dislikes of people. The care plan for one person was clear that they had particular likes and dislikes, for example, no red meat. Staff knew this and the person concerned told us staff never gave her what she did not like. This ensured people got the meals they liked. One person was on a weight reducing diet and staff were able to tell us about this and what the person should and should not have. They confirmed that the appropriate foods were available and cooked for the person. These foods were not always reflected on the records of food. Food records also needed to include details of such things as vegetables to show people were receiving a variety and that healthy eating guidelines were being followed. It was also noted that on occasions staff were ticking items of food that people did not like even though people confirmed they were not given these. The people living in the home were very satisfied with the meals that were served to them. Comments received included: Nice food. Good quality home cooked food. Food is wonderful, really lovely. Food is very good, they vary it. Menu on the board let you have what you want. Food is wonderful, really lovely, Dont like can have something else. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were confident any issues they raised would be listened to and acted on. Arrangements were in place to ensure people were safeguarded from abuse. Evidence: People had received a copy of the complaints procedure in the service user guide. This was in large print to make it easier for people with any sight impairment to to read. The surveys returned to us indicated people know who to speak to both informally and formally if they are unhappy about anything. Comments received from indicated people were confident any issues they raised would be listened to and acted on. These included: If some thing not right I tell Isabel (manager) she is always willing to listen and put it right for you. Not happy speak to Isabel she puts it right straight away. Go to Isabel if something wrong, I think a lot of her. If not happy I would see the manager, Isabel would sort it out, shes very good The home had not received any complaints since the last key inspection and none had Care Homes for Older People Page 20 of 32 Evidence: been raised with us. There were adult protection policies and procedures on site that were accessible to staff should they need them. Staff spoken with were able to tell us what they must do should they suspect or witness any abuse in the home. They were aware of how important it was to note any changes in peoples behaviour and if they appeared upset as this could indicate something was wrong. They were very clear that must report any issues immediately to the manager and if she was involved they would go to the proprietor who they had a contact number for. This ensured people were safeguarded from harm. The training matrix for the home showed that only seven of the fifteen staff employed at the home had received formal training in the protection of vulnerable adults. Clearly from talking to staff it was evident they had been given some guidance on the issues involved but they did need to have training to ensure they had all the necessary knowledge. Issues were raised at the last inspection in relation to recruitment procedures not being robust and leaving people at risk. This had been addressed at the time of this inspection. Care Homes for Older People Page 21 of 32 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. St. Anthonys provides the people living there with a safe, comfortable, homely and clean environment in which to live. Evidence: During the course of the inspection the communal areas and some bedrooms were seen. The home was very well maintained, safe and comfortable. The home has an ongoing plan for refurbishment and redecoration. The people living in the home were clearly very comfortable and those spoken with stated they were very happy with the environment. Comments received about the home in general and peoples individual bedrooms included: Nice homely surroundings. Good level of cleanliness. My room is very good. They changed my room around for me without any fuss. This is my second room, bigger, nicer downstairs. There was ample communal space in the home with two lounges and a dining room. One of the lounges was a quieter area for people to use should they want to read or just be quiet. All the communal areas were well furnished and decorated. There was a safe, accessible and well maintained garden area for people to use in the Care Homes for Older People Page 22 of 32 Evidence: warmer weather with seating available. There were adequate numbers of toilets throughout the home. The people living in the home had a choice of either having a bath or a shower. Both the bathroom and shower room were fully assisted facilities. There was a range of aids and adaptations to help people maintain their independence including, ramps, handrails, shaft lift, raised toilet seats and grab rails. Bedrooms that were seen were pleasant and nicely furnished and decorated. People had been encouraged to bring personal possessions in to the home to make their rooms more individualised. One double bedroom was seen this had adequate screening available so that the occupants privacy could be upheld. The home was clean and odour free throughout. There were appropriate systems in place to ensure good infection control throughout the home. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were being cared for by a well recruited, trained, stable staff team that was able to meet their needs. Evidence: Staff turnover at the home is very low and many of the staff have worked there for a considerable amount of time. This is very good for the continuity of care of the people living in the home. It was evident throughout the day that relationships between the staff and the people living in the home were very good. Without exception all the comments received about the staff team were very positive. These Included: Pleasant staff and competent. Staff always available to listen. Its a very nice home and Isabel and all the staff are good to us. Staff treat us really well, friendly and helpful. Very good indeed. Staff work very hard will always help if you need it. Staff are friendly and patient. Care Homes for Older People Page 24 of 32 Evidence: Rotas indicated that there were always adequate numbers of staff available to meet the needs of the people living in the home. People living in the home confirmed there were always staff around when they needed them. Staff spoken with felt the staffing levels in the home were appropriate and allowed them enough time with the people living there. Cooks and domestic assistants were also employed at the home leaving care staff free most of the time to spend time with the people living in the home. Staff spoken with were very knowledgeable about the needs of the people living in the home and how they liked to be cared for. They confirmed they received a range of training including manual handling, first aid, food hygiene, medicines management, fire awareness and most recently an NVQ in customer service. These training courses were confirmed by the dates on the training matrix and by certificates on the files that were sampled. This showed staff received a good range of training to ensure they could care for the people in the home competently and safely. It was noted that the induction training detailed on staff files was quite brief and did not cover all the topics required by Skills for Care to ensure staff have all the required basic knowledge and skills to care effectively for people. It was of particular importance that this be covered when staff had not had any previous experience in a caring role. The training matrix detailed that eight out of the ten staff staff employed at the home had an NVQ level 2 or above. This is above the required fifty percent. This ensured people could be confident that staff had the skills and knowledge to meet their needs. At the time of the last inspection some issues were raised about staff recruitment and it not being robust. The issues had been addressed at the time of this inspection. The recruitment files for three staff were sampled. All the required checks and documentation had been obtained before people started work at the home. These included, CRB (Criminal Records Bureau) checks, POVA (Protection of Vulnerable Adults) checks, two written references and medical checks. There was also evidence that any gaps in previous employment had been explored with staff. Care Homes for Older People Page 25 of 32 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 ensured the home was run in a competent manner and in the best interests of the people living there. Evidence: The manager of the home had been in post for a considerable amount of time. She demonstrated throughout the inspection that she has a very good knowledge of the needs of the people living in the home and how they liked to be cared for. She had a very good relationship with the proprietor and stated he was very supportive and a regular visitor to the home. We received many very positive comments from staff, people living in the home and relatives about the management of the home. These included: its a very nice home and Isabel and all the staff are good to us. Happy to work here, fantastic manager. Care Homes for Older People Page 26 of 32 Evidence: Well run home good standard. Manager superb in every way. I am quite satisfied with everything about St. Anthonys. The people living in the home were clearly very comfortable with the manager and approached her about a variety of things during the day. It was evident throughout the day that the people living in the home received a very good standard of individualised care. This was not always reflected in the records kept in the home such as the care plans and activity records. Both the manager and the owner of the home were very receptive to our comments and committed to improving the record keeping in the home. There was a quality monitoring system in the home but this had not been fully implemented at the time of the inspection. The system included internal quality audits being undertaken on such things as care plans, accident recording, complaints and so on. The outcomes of the audits together with the comments received off the satisfaction surveys issued to the people living in the home and their relatives would for the basis of an annual report stating how the service was to be improved. The people living in the home also had regular meeting with the manager of the home. Topics covered included, how to lodge a complaint, care plans, people being involved in choosing decor for their rooms, activities, menus and if people felt safe in the home. The home was managing some money on behalf of some of the people living there. The records for this were sampled. All income and expenditure was detailed with receipts obtained for all expenditure. The records were held on computer and as such there were no staff signatures. It was suggested that the system was audited on a regular basis by two staff to ensure the person overseeing the system and the people living in the home were fully protected. The balances of the money held in the home that were checked were correct. The health and safety of the people living in the home and the staff were well managed. The home was well maintained and safe and staff had received training in how to work safely with people. The AQAA indicated that all the equipment in the home was regularly serviced. The servicing records were sampled and found to agree with the information in the AQAA. The in house checks on the fire system were all up to date and there had been a recent fire drill. It was noted that earlier in the year the fire alarm had not been tested every week. This had now been resolved. Care Homes for Older People Page 27 of 32 Evidence: Accident and incident reporting and recording were appropriate this showed us that both being managed in the best interests of the people living in the home. Care Homes for Older People Page 28 of 32 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 29 of 32 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 33 24 The home should have a development plan in place. This will ensure the service is improved for the benefit of the people living in the home. 31/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The service user guide should include the range of fees charged so people would have some idea of the costs of living at the home. Pre admission assessment documentation should include all the necessary information so it can be determined that the assessment has been undertaken before people have admitted to the home and that the staff are able to meet the individuals needs. Care plan should include all the current individual needs of the people living in the home to ensure they receive person centred care. Nutritional assessments should be scored so that it can be determined if people are at risk or not. 2 3 3 7 4 8 Care Homes for Older People Page 30 of 32 5 8 There must be a system in place to ensure the visits by health care professionals can be easily tracked so that it can be assured the well beign of the people living in the home is being overseen. Compliance checks should be undertaken for people self administering their medication so that it can be assured they are having their medication as prescribed. Staff should record how people are spending their time so it can be shown their social care needs are being met. Food records should be a true reflection of what people are eating so that it can be determined that peoples nutritional needs are being met. All staff should receive training in adult protection issues to ensure the people living in the home are fully safeguarded. 6 9 7 8 12 15 9 18 Care Homes for Older People Page 31 of 32 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. 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