Care Home: St Mary`s Care Home

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What the care home does well The residents` spiritual needs are well looked after. There is a purpose built Chapel in the home, and those residents who wish are visited daily by members of the Roman Catholic Church to receive daily Communion and spiritual comfort. The home is also open and supportive of ministers and lay persons of any other religion visiting the home. The home was clean and there were no unpleasant odours throughout our visits. There is an attractive garden at the rear of the home. Service users told us - the food is good - The staff are kind, I think that is why they employ them - It is alright Relatives told us: - they have helped (my relative) to settle in very quickly and have responded to her needs and wishes. - the staff speak nicely to the residents... have never heard a raised voice. - the food is good most of the time Staff told us: - the home gives enough training and support to their staff - the home is nice and clean, staff are hard working. What has improved since the last inspection? Requirements made at the last inspection have been addressed. This means that the records of complaints are kept in the home; there have been some improvements to health and safety matters and the reasons for medication discrepancies are made clear on records. Redecoration of the some areas of the home has been completed. The manager of the home is now registered under the Care Standards Act. What the care home could do better: We have made nine requirements and eleven recommendations as a result of this inspection. On the second day of inspection we made an immediate requirement. Seven of the requirements come from shortfalls in the area of Health and Personal Care. We found the need for staff to have a greater degree of clarity about whether residents have residential or nursing needs; for care plans to be written about every area of need, and then reviewed and to ensure that residents have access to health care professionals. There are four requirements about the management of medication. We have also made two recommendations for good practice in the area of Health and Personal Care.The remaining requirements are for the activity programme to be improved; for notifications to be made to CQC as required. We made an immediate requirement about the need to maintain safe conditions in all parts of the home to which residents have access. The recommendations concern the need to ensure that residents and relatives are given the information they require in the statement of purpose and service user guide; about the complaints procedure and that they have the opportunity to contribute to the care planning process. In addition we have made recommendations about activities; to ensure that visiting health care professionals receive assistance they require; to create a training and development plan and for the Registered Manager to undertake training in deprivation of liberty safeguards legislation. Two recommendations are made about staffing, the first to include questions about safeguarding issues in recruitment interviews and the second to keep staffing levels under review to ensure they are appropriate for residents` needs. We have been informed since the inspection that the home has taken action to address the requirements and recommendations of this report. Details are available from the home. Key inspection report Care homes for older people Name: Address: St Mary`s Care Home 3 Tooting Bec Gardens London SW16 1QY     The quality rating for this care home is:   one star adequate 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: Alison Pritchard     Date: 2 0 1 1 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 33 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 33 Information about the care home Name of care home: Address: St Mary`s Care Home 3 Tooting Bec Gardens London SW16 1QY 02086779677 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: stmaryscarehome@qmail.com St Mary`s Care Home Ltd care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home St. Marys Nursing and Residential Care Home is owned by a private company called St. Marys Care Limited. The home is registered for 39 places, both nursing and residential care. The homes stated aims are to provide excellent quality care to service users who will be encouraged to live life to the fullest and given every opportunity to lead as normal a life as possible. The home is on two levels, with two passenger lifts connecting the floors. All bedrooms and communal areas are wheelchair accessible. All bedrooms are single and there is a main lounge and dining room on the ground floor and attractive landscaped gardens. The home was formerly run by a religious order and there is a chapel on site where Catholic Mass can still be celebrated. The home is situated in its own grounds with parking space and gardens a few minutes walk from a main shopping centre that has the full range of community facilities and both rail and bus public transport. Copies of the most recent key inspection report are available in the reception area. The Care Homes for Older People Page 4 of 33 Over 65 39 0 0 39 Brief description of the care home homes weekly fees are £595 for residential care, and £735 for nursing care. Additional costs which are not covered by the fee include hairdressing, toiletries, newspapers and a private telephone. Care Homes for Older People Page 5 of 33 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: one star adequate 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: This inspection was unannounced and carried out over three days. Soon after the first day the Manager was on holiday, we visited once during this time and once after her return in November 2009. The inspection methods included discussion with service users, relatives, staff and involved professionals; inspection of records and a tour of the building. We sent surveys to a range of people and twelve completed surveys were returned to us. We are grateful to everyone who assisted us in the inspection process. Postal and administrative problems meant that the Registered Manager did not receive a document called an Annual Quality Assurance Assessment (AQAA) to complete and for us to take into account as part of the inspection process. Care Homes for Older People Page 6 of 33 What the care home does well: What has improved since the last inspection? What they could do better: We have made nine requirements and eleven recommendations as a result of this inspection. On the second day of inspection we made an immediate requirement. Seven of the requirements come from shortfalls in the area of Health and Personal Care. We found the need for staff to have a greater degree of clarity about whether residents have residential or nursing needs; for care plans to be written about every area of need, and then reviewed and to ensure that residents have access to health care professionals. There are four requirements about the management of medication. We have also made two recommendations for good practice in the area of Health and Personal Care. Care Homes for Older People Page 7 of 33 The remaining requirements are for the activity programme to be improved; for notifications to be made to CQC as required. We made an immediate requirement about the need to maintain safe conditions in all parts of the home to which residents have access. The recommendations concern the need to ensure that residents and relatives are given the information they require in the statement of purpose and service user guide; about the complaints procedure and that they have the opportunity to contribute to the care planning process. In addition we have made recommendations about activities; to ensure that visiting health care professionals receive assistance they require; to create a training and development plan and for the Registered Manager to undertake training in deprivation of liberty safeguards legislation. Two recommendations are made about staffing, the first to include questions about safeguarding issues in recruitment interviews and the second to keep staffing levels under review to ensure they are appropriate for residents needs. We have been informed since the inspection that the home has taken action to address the requirements and recommendations of this report. Details are available from the home. 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 33 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 33 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. As at the last inspection key pieces of information are not included in the service user guide and statement of purpose. Thorough assessments of potential residents needs are carried out. Evidence: When we asked for copies of the Service User Guide and Statement of Purpose on the first day of the inspection we were told that they were not available. We were given copies of the documents on the final day of our inspection. The Statement of Purpose was dated 1st June 2009, and the Service User Guide was undated. It was required at the last inspection in July 2008 that amendments must be made to the documents to ensure their accuracy and compliance with regulatory requirements. We found that some matters are not included in the documents. Although the Statement of Purpose states that the manager is experienced and fully Care Homes for Older People Page 10 of 33 Evidence: trained in all fundamental care practices it does not detail the qualifications held by the manager. It was previously required that the complaints procedures in the documents state the timescale within which the home would respond to complaints. This detail is not included. As at the last inspection the Service Users Guide states that information regarding the terms and conditions of accommodation provided, including the amount and method of payment of fees and a standard form of contract for the provision of service and facilities by the care home to the service user are too bulky for inclusion and are available to be read in the reception area. However, legislation states that these two pieces of information must be included in the Service Users Guide. An observation made by a relative was that they would have found it useful to have written information about the home at the time of their relatives admission. The service user guide and statement of purpose should be provided for residents and relatives before or at the time of their admission to the home. See recommendations 1 and 2. On the files of recently admitted residents we saw assessments of need completed by the placing social worker under the Community Care Act. In addition thorough assessments of need are conducted by senior staff in the home. We were told by a relative of a newly admitted resident that they have helped (my relative) to settle in very quickly and have responded to her needs and wishes. Care Homes for Older People Page 11 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents would benefit from staff being clear about whether they have residential or nursing needs to ensure that the appropriate help is available to them. Care plans are generally wide ranging but we found an instance where, as a care plan had not been written about a nutritional need, there was a delay in seeking advice from a dietician. Improvements are needed to the systems for dealing with medication. Residents privacy is protected and they are treated with respect. Evidence: The home provides care for some people who have nursing needs and others who do not need this level of care. The safe handling of medicines was assessed by a Commission pharmacist inspector. Care Homes for Older People Page 12 of 33 Evidence: They looked at medication records, medication storage, medication supplies and care plans for a selection of people at the home. They also observed people being given their medicines by the nursing staff. The medicines policy has recently been updated however there was evidence that all staff have not had the time to read and familiarise themselves with it e.g. one resident is being supported to store and take his own medicines; there is a risk assessment in place to ensure he can do this safely. There is a question on this form to record whether residents are managing their own medicines when they come into the home. Some staff have misinterpreted this question, showing that staff need to familiarise themselves with the homes policies and records to ensure safe and consistent practice. One blood glucose monitor was being used for more than 1 resident, increasing the risk of infection. There have been medicines safety notices issued to care homes about blood glucose monitoring, but some staff were not aware of this. Staff must keep up to date with current best practice. There has also been an independent audit by a primary care trust pharmacist, who has made some good recommendations for improvements in medication handling to ensure residents receive medicines safely and as prescribed. On the day of the inspection, all medicines were available, residents were receiving their medicines on time and as prescribed, controlled drugs stocks and records were accurate and medicines were being stored safely. Medicines are regularly reviewed by the GP who visits the home at least weekly, and there is also input from a Clinical Psychiatrist. There are some cases where medicines have been changed by the prescriber part way through the monthly cycle and it is not clear who has made the change and when. This has led to one instance where a resident did not receive a prescribed medicine for 2 months. This persons medicines had been changed 30 times in a 6 month period, so there are several factors which contributed to this error. The supplying pharmacist has supplied the home with a mid-cycle change form for medicines; the home must use this to ensure all changes made to residents medicines are made. The medicines policy has recently been updated however there was evidence that all staff have not had the time to read and familiarise themselves with it e.g. one resident is being supported to store and take his own medicines; there is a risk assessment in place to ensure he can do this safely. There is a question on this form to record Care Homes for Older People Page 13 of 33 Evidence: whether residents are managing their own medicines when they come into the home. Some staff have misinterpreted this question, showing that staff need to familiarise themselves with the homes policies and records to ensure safe and consistent practice. One blood glucose monitor was being used for more than 1 resident, increasing the risk of infection. There have been medicines safety notices issued to care homes about blood glucose monitoring, but some staff were not aware of this. Staff must keep up to date with current best practice. Records of medicines received, given and returned are generally good, except for when medicines are received part-way through the month, or when medicines are carried forward from the previous month. It is important for staff to record the quantities of medicine in stock to enable stock checks to be carried out easily to see if medicines can all be accounted for. Care Homes for Older People Page 14 of 33 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 residents spiritual needs are given priority at the home. More attention needs to be paid to the resources available for activities such as puzzles and games, as those which we saw were designed for children. This detracted from efforts to maintain residents dignity. Residents are assisted to maintain contact with family and friends. Residents enjoy their meals and choices are available which reflect their needs and wishes. Evidence: The home is welcoming and supportive of residents religious observation. It was formerly run by a Catholic congregation and there is a high percentage of Catholic residents. The Proprietors have respected this by continuing to support the use of the purpose built Chapel in the home, and by continuing to encourage and support members of the previous congregation to visit the home to give service users daily Communion and spiritual comfort. The home is also open and supportive of ministers / lay persons of any other religion visiting the home. Care Homes for Older People Page 15 of 33 Evidence: An activity coordinator is employed at the home for 30 hours a week. The post holder had previously worked as a full time member of the care staff team so is familiar to the residents and with their needs. Activities arranged include ball games, painting, colouring, games and puzzles, bingo and musical activities. Residents order daily newspapers. Earlier in the year a Summer Fete had been held to which relatives and friends had been invited and a Christmas Bazaar was planned. Outside entertainers visit the home, residents told us of a recent visit from a musician that they had enjoyed. The residents benefit from access to a minibus which is shared between the three care homes in the group. When we visited there were plans being made to take residents to see the Christmas lights in Central London. There is scope for further development of the activities programme to more closely meet residents needs and interests. This should be considered through the care planning process. We spent some time in the lounge and observed that the games and puzzles made available for the residents were designed for children. A relative made the observation that I have seen jigsaws being handed out to individual residents who dont seem interested in them, or colouring sheets left around - these would be activities for 5 year olds. This is inappropriate. The use of childrens resources does not help to maintain residents dignity and greater thought must be given to the resources used for residents activities. See requirement 8. While we were talking to residents in the lounge we noticed that the television was on with the sound down, and there was music playing from a CD. We found this confusing and disorienting and it is reasonable to assume that the residents could not become involved with the television programme because they could not hear it. A relative made the observation that The TV is on all the time but Im not sure how much thought is given to what programmes would be most appropriate for elderly people to watch. See recommendation 5. Visitors are able to come to the home at all reasonable times. We spoke to some visitors who said that they were pleased with the care their relative was receiving at the home. Another person said that had noticed that staff were patient and helpful when assisting residents at mealtimes. A third relative said that they think staff do their best to help but felt they would benefit from some specialist training. This is addressed further in the staffing section below. A response on a survey said The staff speak nicely to the residents and make visitors welcome. Residents told us that they are able to make choices about the times they retire to and rise from bed and can choose to spend time in their rooms if they wish to do so. Care Homes for Older People Page 16 of 33 Evidence: Residents meetings at which they can make their views known are held. Meetings were held in March, May and September 2009. There is a four weekly menu at the home, we were told that the menu had been reviewed earlier in the year and we saw that it had been the topic of discussion at a residents meeting in May 2009. Residents gave good feedback about the meals, they said that they enjoyed their meals and there was enough to eat. We observed that a resident had a different meal from others at lunch time and this was in keeping with her preferences. The kitchen staff demonstrated knowledge of the residents nutritional needs and had been provided with copies of dietary advice by the care and nursing staff. Care Homes for Older People Page 17 of 33 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 complaints procedure must be amended to include details of the relevant timescales. It would be worthwhile to remind residents, relatives and staff about how to raise or deal with a complaint. Records of complaints showed they are dealt with properly and changes to practice are made when necessary. Evidence: The complaints procedure is included in the service user guide. As stated in the section Choice of Home the document did not include details of the timescales within which the home will respond to complaints. Most of the people who responded to our surveys said that they were familiar with how to raise or deal with a concern about the home, but some people were not. These included residents, relatives and staff. We recommend that residents and their representatives are provided with copies of the complaints procedure (with details of relevant timescales) to ensure that they are aware of their rights in this regard, and that staff are reminded of the action to take if a concern is raised with them. See recommendation 6. We looked at records of complaints held in the home. We found that in the period since January 2009 two complaints had been made. The file contained details of the issue raised and the action taken to ensure that there would be no recurrence. One of these matters was dealt with by the placing authoritys safeguarding procedure. The Care Homes for Older People Page 18 of 33 Evidence: home had co-operated with the process and was awaiting minutes of the meeting about the matter. Staff told us that they had received training in safeguarding issues. Care Homes for Older People Page 19 of 33 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. The communal and private areas are clean, comfortable and well maintained. There are plans to refurbish the home to improve the facilities. Evidence: The location and layout of the home is suitable for its purpose and it is accessible, safe and homely. There are well kept, attractive and accessible grounds which service users were enjoying on one of the days of the inspection The main lounge is comfortable and homely, with a large flat screen television which makes visibility easy wherever service users are sitting in the lounge. The Proprietors have well developed plans to refurbish the home: changes include large single bedrooms with en-suite facilities. The previous report recommended that the Proprietors consider creating a separate, equipped hairdressing room rather than hairdressing taking place in the main lounge. This remains a need and one of the Proprietors told us that a hairdressing room is included in the refurbishment plan. The home has a dining room where residents can choose to eat meals. The room is only just big enough for the number of residents, this should be considered in the new designs for the building. The dining tables were all attractively laid out at mealtimes. The dining room has windows on one side and a glass panelled wall on the other, which means there are views and day light from both sides of the room, making it an Care Homes for Older People Page 20 of 33 Evidence: attractive and light. Several bedrooms were seen during the inspection. Some had en-suite rooms with toilet and washbasin. All of the bedrooms we saw were personalised, according to the service users individual tastes and interests. Several service users had brought in an item of furniture and ornamentation from their previous homes. Several bedrooms have been redecorated and the providers have plans to redecorate and upgrade all bedrooms. There is a small kitchenette on the ground floor which is used by staff to make service users and visitors tea. We noted on a report of a visit made on behalf of the Registered Provider in September 2009 that repairs were being done in the kitchenette. No problems were found with heating, lighting, water supply or ventilation at the inspection. On the days of inspection areas of the home seen were clean and hygienic. Care Homes for Older People Page 21 of 33 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. Staffing numbers have increased since our last inspection. Staff said that they are satisfied with the training provided for them. We recommend that a training and development plan is documented to ensure that staff training adequately reflects the needs of the residents. Evidence: In addition to the Registered Manager there are 11 Registered Nurses (one of whom is the Deputy Manager) and 18 care staff working at the home. There is an Activity Coordinator who works some of her hours as a care assistant. The ancillary staff team consists of a Maintenance Officer; two chefs, two catering assistants and two dining room assistants; a laundry assistant and three house keeping staff. During the day there are two nurses on duty with six or seven care staff in the morning and two nurses on duty with five care staff in the afternoon and early evening. Overnight one nurse and three care staff are on duty. Staff told us that these staffing levels represent an increase on those previously in place. There has been an increase in the staff team. Fifteen staff (three nurses; nine care staff and three ancillary staff) have joined the team since October 2008. This is a fairly high number of new staff, but there is a core of longer standing staff which has provided stability. The consequent reduction in the use of temporary staff has been beneficial to the residents. Care Homes for Older People Page 22 of 33 Evidence: The information available at the time of the inspection was that these numbers are sufficient to meet residents needs, but conversely, we have received some information on surveys that sometimes staffing levels are lower than would be ideal in the afternoons. The lack of clarity about the needs of the residents (as detailed above in the section on Health and Personal Care) and the fact that the information contained on the AQAA was unavailable to us meant that these conflicting views are difficult to reconcile. The Registered Manager should keep staffing levels under continual review to ensure that they meet residents needs. See recommendation 7. We looked at a selection of recruitment records and found that they contained references from previous employers, enhanced criminal record bureau checks and evidence of induction training. We looked at interview notes and saw that the questions did not include queries about safeguarding issues. This is addressed below as a recommendation for good practice as is the need to introduce a checklist for the files to monitor that the required documents are in them. For instance, in one file we did not see a photograph or a copy of the persons PIN number confirming their registration as a nurse with the NMC. See recommendations 8 and 9. We did not see a training and development plan for the home. This is recommended to ensure that the training provided reflects the specialist needs of the residents. See recommendation 10. A training matrix was not available to illustrate the numbers of care staff who have achieved NVQ2 or above. The Registered Manager stated that the majority of care staff have achieved or are working towards the NVQ 2 and said that some have achieved NVQ 3. Some of the staff with whom we discussed training said that the training provided by the home was relevant and helped them to do their work effectively. Specific courses that staff stated they had completed included safeguarding; a range of health and safety issues and working with people with dementia. Nurses at the home are undertaking training in end of life care. Care Homes for Older People Page 23 of 33 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 Registered Manager is appropriately qualified and would benefit from training about deprivation of liberty safeguards legislation. Senior management conduct visits to monitor the quality of the service. More attention should be paid to ensuring that notifications are sent to CQC as required as some had been missed. Some health and safety issues needed addressing at the time of our visits. Evidence: The Manager of the home was appointed to her post on a permanent basis in April 2009. An application for her registration under the Care Standards Act was made and she was registered in December 2009. She has the nursing and care experience and management experience relevant to her role. The Registered Manager is due to complete and attain a leadership and Management of Care Services qualification by December 2009. She and some members of the nursing team at the home are completing the gold standard framework course for end of life care. We recommend that the Registered Manager undertakes training in and Care Homes for Older People Page 24 of 33 Evidence: develops her understanding of her responsibilities under the deprivation of liberty safeguards legislation. See recommendation 11. We received mixed reports about the management style in the home: we received some comments, from a range of sources, which made us concerned about the management approach. Some people told us that issues that should be addressed privately with staff were sometimes discussed in public areas; we were also told that sometimes staff speak to each other in languages other than English and the matter is not addressed. We did not hear this happening but noted that this problem had been raised by residents with the organisations Internal Auditor in late October 2009. We raised the matter with the Registered Manager who agreed that it is not acceptable. We also received positive feedback including that the management team is friendly, welcoming and informative; and another person said that the management is doing well in organising and running the home. Management arrangements will continue to be monitored in future inspections of the home. Visits to the home on behalf of the Registered Provider are carried out and reports were available for us. We found that reports were available for all but one month since April 2009. The visits include discussions with residents and staff who have the opportunity to raise matters of concern with the auditor. A range of other issues are covered on the visits including medication, health and safety, provision of activities and record keeping. We saw issues on residents files and in the accident records about which notifications should have been made to CQC. There were some instances in which the wrong address had been used, but others which had not been the subject of notification at all. See requirement 9. We checked a range of health and safety records and discussed monitoring arrangements with the Maintenance Officer. The fire alarm and emergency lighting systems are tested weekly, and fire drills are carried out regularly. Fire extinguishers have been inspected and found safe. The fire risk assessment had been completed by the Internal Auditor. Staff have received training in fire safety matters. Other courses we were told had been provided included infection control; health and safety; COSHH and first aid. We looked at the records of hot water temperatures and found that two rooms were recorded as having water in excess of the recommended temperature of 42C. We raised this and by our next visit the water had been adjusted by fitting devices to limit the temperature. Care Homes for Older People Page 25 of 33 Evidence: We toured the building and found that overall the building was safe but there were two issues of concern. A sluice room on the first floor was unlocked. Hazardous chemicals were in the room and could have presented a risk to residents. An immediate requirement was made about this matter on 20th November 2009. The Registered Manager informed us on 23rd November that a keypad was fitted to the door to ensure that residents are not at risk. New doors had been fitted to some rooms on the first floor; one of these was propped open with a chair on 20th November. This compromised fire safety arrangements. We were told that devices to safely hold the doors open were on order and that they were fitted by 23rd November. Care Homes for Older People Page 26 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 33 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 1 38 13 The Registered Person must 22/11/2009 ensure that all parts of the home to which service users have access are so far as is reasonably possible free from hazards to their safety. To ensure the safety of service users. 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 7 15 The Registered Person must ensure that a care plan is written about all identified needs and that it is subject to review. To address residents health and welfare needs. 24/03/2010 2 7 13 The Registered Person must 24/03/2010 ensure that nursing staff are clear about which people living in the home have nursing needs and those for whom community health services must be accessed to meet any nursing needs. To ensure that residnets needs are appropriately met. Care Homes for Older People Page 28 of 33 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 3 8 13 The Registered Person must ensure that people living in the home receive, where necessary, treatment, advice and other services from any health care professional. To ensure residents health and welfare needs are met. 24/03/2010 4 9 13 The Registered Provider 24/03/2010 must ensure that PRN protocols are available for all medicine given on an as required basis which provides information on when these should be used, the maximum dose in 24 hours and the time interval between doses to avoid overuse. To ensure medication practice is safe. 5 9 13 The Registered Provider 24/03/2010 must ensure that all staff are familiar with the homes medicines policy and records and keep up to date with current best practice for medicines. So that residents are protected by the homes medication practices. Care Homes for Older People Page 29 of 33 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 6 9 13 The Registered Provider must ensure that accurate records are kept of all medicines received into the home. So that medication practices are safe. 24/03/2010 7 9 13 The Registered Provider 24/03/2010 must ensure that all changes to medicines are implemented. So that residents receive their medicines as prescribed. 8 12 16 The Registered Person must consult residents or their representatives about the programme of activities and provide suitable facilities for recreation. This will ensure that activities are provided which meet residents interests and needs. 24/03/2010 9 37 37 The Registered Person must ensure that notifications are made to the CQC as required by regulation. This will ensure that legal requirements are met. 24/03/2010 Care Homes for Older People Page 30 of 33 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 and statement of purpose should be provided for residents at the time of their admission to the home. If there are any residents or relatives who did not receive it at that time this should be provided as soon as possible. The Registered Person should ensure all of the information required by legislation is present in the Statement of Purpose and Service Users Guide. This is restated from our previous inspection report when it was a requirement. 2 1 3 7 Residents and or their representatives should be cinsulted as part of the care planning process and this should be confirmed in the residenets files by, for example, their signature. The Registered Manager should ensure that visiting professionals receive the necessary assistance so that residents receive the treatment, advice and other services that they require to meet their assessed needs. Music should not be playing in the residents lounge when the television is on in the same room. We recommend that residents and their representatives are provided with copies of the complaints procedure (with details of the relevant timescales) to ensure that they are aware of their rights in this regard, and that staff are reminded of the action to take if a coincern is raised with them. The Registered Manager should keep staffing levels under continual review to ensure that they meet residents needs. Recruitment interviews should include questions about the candidates understanding of safeguarding issues. We recommend that a checklist for recruitment files is introduced to assist with monitoring that the required documents are in them. We recommend that a training and development plan for the home is introduced to ensure that the training reflects the specialist needs of the residents. The Registered Manager should undertake training in, and improve her knowledge of her responsibilities under the Page 31 of 33 4 8 5 6 12 16 7 8 9 27 29 29 10 30 11 31 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Deprivation of Liberty Safeguarding legislation. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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