Care Home: St Francis Residential Care Home

What the care home does well The registered manager and her staff are working hard to meet the needs of residents, the majority of whom are suffering from dementia. The home is comfortable, well decorated and maintained and meets people`s needs. A resident told us, "The home does everything well and has kept me going for a bit longer" A relative told us, "The home provides very caring staff". A district nurse told us, "Staff are very helpful when we visit, (people`s) privacy is respected, the home is very clean and the (people) are well cared for. The home is well organised and staff appear happy in their work". What has improved since the last inspection? This is the first inspection under the home`s new registration with the Commission. What the care home could do better: No statutory requirements have been made this inspection. Two good practice recommendations are made. The first is in relation to the work undertaken by key workers to try to improve on the home`s knowledge of people`s background and lifestyle before they needed residential care. The second is to further consult with residents and other stakeholders to review the use of the televisions and music players in the home`s lounges, to try to further maximise an atmosphere that is conducive for people with dementia to live in. Key inspection report Care homes for older people Name: Address: St Francis Residential Care Home 65-67 Falmouth Avenue London London E4 9QR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Peter Illes     Date: 2 9 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: St Francis Residential Care Home 65-67 Falmouth Avenue London London E4 9QR 02085273072 02085233992 stfrancis@ventry-care.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Brownlow Properties Limited Name of registered manager (if applicable) Ewa Maria Zalewska Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: 1. 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 caategory - Code OP Dementia - Code DE 2. The maximum number of service users who can be accommodated is: 29 Date of last inspection Brief description of the care home St Francis Residential Care Home is a privately run care home registered to care for 29 older people, who may also have a diagnosis of dementia. Brownlow Properties Limited, the provider organisation, also own and manage a number of other registered care homes in London. The home is a large and spacious converted residential property with accommodation provided on two floors that are connected by both stairs and a passenger lift. All but two of the bedrooms have en-suite facilities and the home Care Homes for Older People Page 4 of 28 Over 65 29 29 Brief description of the care home has an additional four suitably equipped bathrooms, two on each floor and an additional three toilets on the ground floor. The homes main communal areas are situated on the ground floor and consist of two large day rooms, a conservatory and a dining area that are all interconnected. The homes kitchen, office and staff facilities are also situated on the ground floor. The home has a large and pleasant landscaped rear garden with the laundry facilities and a food storage area being located in out buildings adjacent to the main building. The front garden is paved and provides off street parking for the home. A stated aim of the home is to provide a safe and homely environment where the unique needs of each individual are recognised and skilled staff are available to provide care and support in a way that encourages self-determination and enables each person to achieve their best possible quality of life. At the time of the inspection, the weekly fee was from £480 to £535 per week, depending on the persons assessed needs. Information about the service, including inspection reports, is kept available in the home for people living there and other stakeholders. Care Homes for Older People Page 5 of 28 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 owners of St Francis Residential Care Home formerly changed the registered provider company from Ventry Residential Care Ltd to Brownlow Properties Ltd. This meant that legally the home had to register again with the Commission as a new service and this is the first key inspection of the service since that new registration in May 2009. However, the home has continued to be owned and managed by the same provider organisation since 2007. This key inspection took approximately seven hours and was undertaken by the lead inspector. However, terms such as we, our and us are used where appropriate within this report to indicate that the inspection activity was undertaken on behalf of the Commission. The registered manager was available to assist throughout this inspection. There were 28 people living in the home and 1 vacancy at the time. The inspection activity included: meeting and speaking to the majority of the residents Care Homes for Older People Page 6 of 28 present although conversation with some people was limited due to their communication needs; detailed discussion with the registered manager; independent discussion with a number of senior and other care staff and the cook; independent discussion with a number of relatives and friends that visited on the day and feedback from a Commissioning Manager from L.B. of Waltham Forest. Further information was obtained from a tour of the building, documentation kept in the home and from survey forms sent to us by residents, (most of whom were supported by relatives to fill these in), healthcare professionals and from staff working at the home. The registered manager has sent us an Annual Quality Assurance Assessment (AQAA) when we asked for it in the past but we had not asked for one prior to this inspection. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 28 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 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has up to date information about the services it provides so that people can know what to expect from the home. The needs and preferences of people seeking to live at the home are properly assessed to help staff in meeting these. Evidence: The home has a statement of purpose and service user guide in a single document, which describes the services the home can offer. The document also contains the contract/ terms and conditions for living at the home, including the fee. Copies of those sampled during the inspection showed that that they had been signed by the person living in the home or their representative. We were told that the home was waiting for the return of the signed document for people that had only recently been admitted to the home. Residents and relatives spoken to during the inspection indicated that they had enough information about the home as part of the admission process. Care Homes for Older People Page 10 of 28 Evidence: We inspected the files of five residents, three of whom had been admitted to the home since the new registration with the Commission in May 2009, with the other two having lived at the home for a longer period. All of the files contained a range of satisfactory assessment information that had been available to the home prior to admission. This included assessment information from referring local authorities and specialist health assessments where applicable. All five files contained an in-house pre-admission assessment undertaken by staff at the home prior to the persons admission. The assessment information seen overall was detailed and allowed the home to be aware of the persons needs and preferences when they first moved in. It was also seen that the home reviews peoples needs and preferences at least monthly so that staff are aware of any changing needs. Independent feedback from a senior commissioning manager from L.B. of Waltham Forest stated that the local authority were satisfied with the service the home was offering to people referred there by the authority. The home does not provide intermediate care. Care Homes for Older People Page 11 of 28 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 living in the home benefit from their needs and preferences being properly recorded in their care plans, however, further input from key workers may assist this process further. People are supported to meet their health care needs, including by having access to a range of healthcare professionals. Satisfactory medication policies and procedures are in place to assist protect people living in the home. People are treated with respect and dignity, which they and their relatives appreciate. Evidence: We inspected care plans for five residents. The home has recently introduced a new format for writing care plans, that makes recording of peoples needs and particularly preferences, easier for staff and more simple for them to follow. The plans now include equalities information in the initial basic information section at the front of the plan including race, culture, sexuality and religion and also if the person has any preferences as to how these should be met. The plans also contained a section called Known Background, where the home records known information on the persons background and preferences before they needed residential care. In addition the plans also have a front section that indicates what sorts of decisions the person has the Care Homes for Older People Page 12 of 28 Evidence: mental capacity to make and also if the person is subject to a deprivation of liberty safeguard, (DOLS), authorisation in force. The plans then have more detailed sections on the persons needs and preferences in a range of different areas as well as guidance for staff on how to meet these. The plans seen contained information on core areas of need such as mobility, nutrition, feeding, hearing, vision, continence, mental health, night care and medication. The plans also contained other needs and preferences that were specific to that person. The plans seen were also informed by a range of risk assessments including a general risk assessment, a moving and handling assessment and a Waterlow assessment, the latter providing a framework to help staff assess the persons skin vulnerability. Both care plans and risk assessments were up to date and showed evidence that they were being reviewed at least monthly. It was noted that the home operates a key worker system in which a senior member of the care staff is allocated to each resident and holds monthly 1 to 1 sessions with them. We saw guidance to staff on how to conduct these sessions including that they should be relaxed and not rushed. However, the key workers were not keeping any written record of these key worker sessions. It was also noted that on some of the files inspected the Known Background sections had minimal information recorded. The registered manager told us that letters had been sent out to relatives asking for this background information but sometimes very little information was returned. A good practice recommendation is made that key workers should try to contact relatives on a regular basis to share information where appropriate and should also keep a record of the work undertaken during key worker sessions with the resident. This is to further assist the home to review and update the persons care plan. Evidence was seen that the home works hard to meet peoples health care needs. This included: evidence that residents are registered with a GP; that district nurses attend the home regularly to attend to peoples nursing needs, including recently to give a flu vaccination to people where appropriate; that people attend hospital appointments as necessary and that people also access a range of other community based healthcare professionals such as a dentist, optician and chiropodist. We received survey forms back from a number of healthcare professionals. A district nurse commented, (The home) contacts the district nursing service/ GP with any health concerns relating to patients and staff are friendly and helpful. Another district nurse commented, Staff are very helpful when we visit to attend Care Homes for Older People Page 13 of 28 Evidence: patients. Patients privacy is respected. The home is very clean and the patients well cared for. It is well organised and staff appear happy in their work. A GP indicated that they felt that reducing staff turnover in the home could help improve consistency of care but commented, I feel the service is improving overall. The home had a satisfactory medication policy and procedure that was seen, which included good practice information for the safe administration of medication that had been issued by the Commission. Records of medication received and disposed of by the home were seen and were up to date. The medication and medication administration record (MAR) charts for three residents were inspected and indicated that medication was being safely administered. None of the residents were prescribed controlled medication at the time although the home had a controlled drugs cupboard and register, should these be needed in future. Evidence was also seen that the local prescribing pharmacist visits the home to audit the medication procedures on a regular basis and the home was waiting the report from the latest visit. The registered manager stated that there had been no concerns raised when the pharmacist visited. Staff who administer medication were talked to and they confirmed that they were familiar with the medication systems and had received training in safe administration. Residents and visitors spoken to independently gave a range of positive feedback about the care provided at the home, including how staff provided personal care to them in a sensitive way. A relative told us they were very happy with the care staff gave their person, including that the resident had put on weight since living at the home (which was a positive thing) and that the home kept them informed of any events such as the person seeing the GP. We observed staff interacting in a relaxed and appropriate manner with residents throughout the inspection. One senior member of staff was observed reassuring a resident with a diagnosis of dementia when they became agitated during lunch and the person was observed to react positively to that attention. Residents were well presented throughout the inspection. We noted in the files inspected that the home had an appropriate record of the persons wishes, or that of a relative if appropriate, in the event of the persons death. Care Homes for Older People Page 14 of 28 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. People living at the home benefit from a range of leisure and recreational activities, which they enjoy, although further consideration to the noise levels in the lounges at times may further benefit some people. Relatives and other visitors are made welcome at the home, which they and people living there appreciate. People are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. They are also provided with a range of good quality meals that they enjoy. Evidence: The home has a daily activity programme that was displayed in the dining room. Regular activities include a gentle morning exercise session in the mornings and in addition more general activities such as sing-along sessions and reading newspapers. In the afternoons activities such as drawing, (foam) darts, cards, knitting, painting and bingo take place. We observed a number of residents enjoying the morning exercise session and craft activities in the afternoon. We were told that the home also has external entertainers, one that attends approximately every two weeks and another who attends every four weeks. This was confirmed by residents and relatives spoken to. Some residents either choose or were unable to take part in some of the communal activities and we observed staff spending time just quietly chatting to some Care Homes for Older People Page 15 of 28 Evidence: residents on a one to one basis, which the residents in question seemed to appreciate. However, one relative told us in a returned survey from that although they were happy with the overall care their person received they stated that they felt the home could provide more entertainment and activities instead of having televisions on all day on a loud volume. At one time during the inspection we noted that the television was on in one lounge and music playing in the adjoining lounge although the adjoining conservatory was quiet at the time. A good practice recommendation is made that the home consults with residents and other relevant stakeholders to agree when the television and/ or music should be played. This is to assist provide an atmosphere that promotes residents feelings of well being, especially those people with a diagnosis of dementia. We also saw evidence that the home records and monitors the activities each resident takes part in and that activities were sometimes also recorded on the daily notes on residents files inspected, although not always. Nearly all the residents at the home were of white European origin and we were told that both a Catholic and Protestant minister attends the home on a regular basis, which residents appreciate. We were pleased to see that the home has worked hard to develop care plans and other records to show more effectively if people have specific wishes and preferences, including regarding their cultural and religious needs. One resident was not white European in origin and that persons file gave information on their needs and preferences relating to their ethnic origin. Evidence was seen that the home makes relatives and visitors welcome to the home. One relative who was visiting with young children on the day told us they had to travel for approximately one and a half hours to visit and that they were always made to feel welcome by staff and offered refreshments. Another relative whose person was at the home on a respite basis at the time told us that they were also always made welcome and went on to tell us they were very keen for their persons placement to be made permanent. Feedback from relatives in returned survey forms was overwhelmingly positive about the reception they received when visiting the home and the care their loved ones received. One relative told us that they were always kept informed of any events, e.g. if their person had seen the GP or if there were any concerns about their well being. The registered manager told us that the home is not an appointee for any of the residents finances and holds no money for residents either, which is either dealt with by relatives or another stakeholder, independent from the home. Residents are able to Care Homes for Older People Page 16 of 28 Evidence: bring personal possessions to the home and residents bedrooms that were seen had been personalised to that persons taste. We spoke with the homes cook and also saw her talk to each resident during the morning to ask their preference regarding lunch. The choice of lunch on the day was either stewed lamb, roast chicken or a vegetarian option, either salad or an alternative that the cook stated she would provide if possible. We observed lunch and noted that the meals were well presented and feedback from residents was that the food was very good at the home. The cook told us that she provides vegetarian meals, suitable meals for people with diabetes and meals that are liquidised for those residents that need this. No other special diets were required at the time although the cook told us that a Muslim resident had recently been staying at the home on a respite basis and that the home had provided Halal meals for the person. The cook was also confident that the home could provide a range of meals to meet the needs and preferences of people from different religions and ethnic backgrounds. The home had a good supply of food that was properly stored. We also saw a range of satisfactory health and safety records relating to the kitchen and meals served. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has satisfactory procedures for dealing with concerns and complaints and people living at the home felt confident that any issues raised would be properly dealt with by the home. People living at the home are also protected by the homes safeguarding procedures, which staff are aware of. Evidence: The homes complaints policy is displayed in the entrance hall along with a supply of complaint forms and also a supply of suggestions/ feedback cards. The complaints policy is also included in the homes service user guide/ statement of purpose and we saw evidence that these were provided to residents/ stakeholders at the time of the persons admission. We looked at the complaints log and noted that three minor concerns had been recorded and evidenced that these had been dealt with satisfactorily. No formal complaints had been recorded at the home and none have been received by the Commission since its new registration. Feedback from residents and relatives indicated that people knew how to make a complaint. One relative told us, If I have any concerns at all I talk to the manager or staff on duty at the time and action is taken. We saw that the home has a satisfactory in-house safeguarding adults procedure as well as a copy of the L.B. of Waltham Forests safeguarding adults procedure. Both of these were seen and also evidence that staff have undertaken training/ refresher training in safeguarding adults. Staff spoken to were able to explain the actions they Care Homes for Older People Page 18 of 28 Evidence: need to take if an allegation or disclosure of abuse is made to them. One safeguarding concern had been raised since the homes new registration. This had been properly investigated under the multi-disciplinary safeguarding procedures and had been judged to be unsubstantiated. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well decorated, well furnished, well maintained and that meets their needs. The home was clean and tidy throughout creating a pleasant environment for people accommodated, staff and visitors. Evidence: Accommodation is provided on two floors that are connected by both stairs and a passenger lift. There are twenty-three single bedrooms and three double bedrooms, all but two of which have en-suite facilities. The home is well equipped and decorated, bedrooms have personal call bells and both residents and relatives spoken to confirmed that bedrooms had been personalised according to the wishes of the people living in them. People spoken to during the inspection stated that they were happy with the overall environment of the home. The home has an additional four suitably equipped bathrooms, two on each floor and an additional three toilets on the ground floor. The homes main communal areas are situated on the ground floor and consist of two large day rooms, a conservatory and a dining area that are all interconnected. The homes kitchen, office and staff facilities are also situated on the ground floor. The home has a large and pleasant landscaped rear garden with the laundry facilities and a food storage area being located in out buildings adjacent to the main building. The front garden is paved and provides off street parking for the home. Evidence was seen of a planned rolling maintenance schedule and a furniture/ Care Homes for Older People Page 20 of 28 Evidence: equipment replacement schedule. Overall, the home provides a suitable and pleasant environment to meet the needs of the people living there. The home has appropriate laundry facilities, which were seen, and which meets the needs of people living in the home. We noted during a tour of the building that hand wash gel containers were located in appropriate areas for the use of all and that the home had satisfactory procedures for disposing of soiled items. Staff spoken to confirmed that they had sufficient protective clothing and gloves and that refresher training in infection control was provided on a planned basis. The home was clean, tidy and free from unpleasant smells throughout the inspection and chemicals or substances that are hazardous to health (COSHH) were appropriately and securely stored. Care Homes for Older People Page 21 of 28 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. Staff receive the training they need, have a range of competencies and are appropriately deployed to support people living at the home. The homes recruitment procedure assists protect people living at the home. Evidence: The home employs a registered manager, a senior carer who also deputises for the manager, three other senior carers, ten care staff, two cooks, one domestic and has the use of the provider organisations peripatetic handy person. An up to date staffing rota was seen, which accurately recorded the staff on duty during the inspection. The rota indicated that a minimum of three care staff were on duty throughout the day, including one senior care worker and two other care workers, and two waking care staff at night. The registered managers hours are in addition to this. The registered manager told us that the ten care staff had either achieved or were working toward the national vocational qualification (NVQ) level 2 in care and that the senior staff had either achieved or were working toward either NVQ level 3 or 4 in care. Staff records sampled and staff spoken to supported this. The files of three care staff that had started work in the home since it was reCare Homes for Older People Page 22 of 28 Evidence: registered in May 2009 were inspected. All three files contained: evidence of a protection of vulnerable adults (POVA First) check obtained by the provider organisation prior to the staff member starting work where appropriate (if a full criminal records bureau check had not been returned by that time), an enhanced criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check, a clear application form, two references that had been verified by the home, proof of identity with a photograph and evidence of entitlement to work where appropriate. From the staff files seen and from discussion with the registered manager it is our judgement that the home works hard to implement a robust recruitment procedure to help keep residents safe. Evidence was seen from a staff training matrix that the home offers induction training and a rolling programme of core training. Records indicated that recent staff training has included: moving and handling; health and safety; fire safety; safeguarding adults; safe administration of medication and first aid. Evidence was seen that staff have received training in the mental capacity act and deprivation of liberty safeguards, (DOLS) and were working hard to implement these, including by recording the persons ability to make decisions on the new care plan format. We spoke to three care staff independently and they all told us in different ways that they felt the training they received was of good quality and helped them undertake their duties effectively by keeping their skills and knowledge up to date. Care Homes for Older People Page 23 of 28 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. People living at the home benefit from it being managed by a qualified, competent and enthusiastic registered manager. People accommodated and other stakeholders are consulted to monitor and improve the quality of the service the home provides. Peoples financial interests are appropriately safeguarded. Staff receive regular supervision to assist them meet the needs of residents and to assist in their own development. People living at the home are protected by the homes health and safety procedures. Evidence: The registered manager at the home has been in post since September 2008. She presents as being knowledgeable about the needs of older people with dementia and the management issues involved in managing a registered care home. The registered manager has achieved her registered managers award (RMA) and presented as being enthusiastic to develop the service further. We received a lot of positive feedback regarding her management style from residents, relatives and staff. One resident told us, Shes a sweetie, she is really interested in how people are getting on. A member Care Homes for Older People Page 24 of 28 Evidence: of staff told us, If we have any problems or issues we can always get support from the manager or one of the seniors. We were also pleased to see that the registered manager is keeping up to date with the practical implementation of the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards, (DOLS). This includes developing the homes records, including care plans, to record relevant information in this area and encouraging staff to write meaningful daily notes to support this. The home has a range of ways of monitoring the quality of care the home provides. We saw evidence of residents meetings where people living at the home are encouraged to express their views, the minutes of the last residents meeting on 02/10/2009 were seen to evidence this. The home sent out quality assurance questionnaires to relatives and other relevant stakeholders in August and September 2009 and those sampled provided positive and constructive feedback. Managers from the provider organisation undertake monthly monitoring visits to the home and we sampled the reports of these visits. It was noted that there was not a great deal of detail in the reports seen although the registered manager stated that managers from the provider organisation visit the home very frequently, that she receives useful feedback from them regularly and feels well supported by them. The registered manager confirmed that the home was not the appointee for any of the residents finances and does not hold money for them, she went on to say that residents money is usually managed by relatives or other nominated persons/ agencies. Evidence was gathered from staff files and from staff spoken to independently that staff receive regular formal and recorded supervision and staff confirmed that they felt that this was useful. A range of satisfactory health and safety documentation was seen including: a current gas safety certificate, a current portable appliance test certificate, a current electrical installation certificate and evidence that the homes water storage system is inspected to minimise the risk of legionella. We also inspected the homes fire log and saw evidence of a fire plan and a fire risk assessment that had been reviewed on 03/09/2009. The fire log also had a record that the homes fire fighting equipment was serviced regularly and that fire drills took place regularly, the last one being on 15/10/2009. Care Homes for Older People Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Key workers should try to contact relatives on a regular basis to share information where appropriate and should also keep a record of the work undertaken during key worker sessions with the resident. This is to further assist the home to review and update the persons care plan. The home should consult with residents and other relevant stakeholders to agree when the television and/ or music should be played. This is to assist provide an atmosphere that promotes residents feelings of well being, especially those people with a diagnosis of dementia. 2 12 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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