Care Home: St Marys Care Home

What the care home does well A kind and caring atmosphere is evident on entering the care home, we can see that staff and people using the service have good relationships with each other and they both confirm this to be so. People using the service tell us that they are happy and settled living at the care home and their needs are met. Staff spoken with have a good understanding of people`s individual needs and are able to tell us the support that they require to ensure that these are met. People are assured that their needs will be assessed prior to admission to the care home so that they know that staff can meet these before they decide to move in. People are supported to access specialist services and equipment as needed to ensure that their health care needs are met. The Mental Capacity Act and the Deprivation of Liberty is in use to ensure that people`s rights and choices are maintained and they are supported as needed in all areas to make decisions about their life. A wholesome and nutritious menu is on offer and people using the service tell us that the food is good and plentiful. Complaints are dealt with and resolved quickly so that people are assured that these will be listened to and acted upon. Staff are recruited safely and remain dedicated to improving their knowledge and skill and they show a good understanding of people`s individual needs and how they can support people to feel valued and cared for. What has improved since the last inspection? Care planning and the development of risk assessments has improved since the last inspection, working towards ensuring that these contain all the necessary information to ensure that people`s needs are fully met and they remain safe and protected. The use of the Mental Capacity Act has improved and risks assessments are now in place in regards to each area of a person`s need to make sure that at their best interest is protected. Activities have further developed and people using the service are enjoying these. Staff practices in regard to maintain people`s dignity and treating them with respect has improved to make sure that people are treated in a way that they deserve. Some improvements in regard to the environment have taken place, working towards ensuring that people live in a well maintained and comfortable environment. The quality assurance procedures have been improved upon, working towards ensuring that people using the service and their relatives are enabled to have a say which is acted upon.Accident recording has improved upon to make sure that accidents are monitored and reduced. What the care home could do better: Further improvement is required in regard to the care planning and risk assessment process, to make sure that there is sufficient information available to meet people`s needs and ensuring that they are protected at all times. Further maintenance work is required, to make sure that people live in a well maintained environment. Further development in regard to the quality assurances systems is needed to make sure that all issues raised are addressed and the service is monitored in all areas. Liaison with the fire authority is needed in regard to the testing of the fire alarm systems and the practice of propping open fire doors, to make sure that people using the service are protected. The risk assessments in regard to the hot radiator surfaces and the propping open of fire doors needs to be addressed to make sure that staff follow the necessary practices and people are protected. Key inspection report Care homes for older people Name: Address: St Marys Care Home The Old Vicarage Main Street Blidworth Nottinghamshire NG21 0QH     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: Karmon Hawley     Date: 0 7 0 1 2 0 1 0 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 34 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 34 Information about the care home Name of care home: Address: St Marys Care Home The Old Vicarage Main Street Blidworth Nottinghamshire NG21 0QH 01623795231 01623795231 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Broadoak Group of Care Homes Name of registered manager (if applicable) Mrs Rachael Rodgers Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The Home is registered to provide personal care for service users of both sexes Whose primary needs fall witin the following categories Old age, not falling with in any other category (OP) (23) Dementia - Over 65 years of Age (DE[E]) (23) Date of last inspection Brief description of the care home St Marys Care home provides personal care and accommodation for 23 older people. St Marys Care home is owned by the Broadoak Group that is a company which provides care for older people in Nottinghamshire and some of the surrounding counties. St Marys is a large converted vicarage situated on the main road in the village of Blidworth Nottinghamshire, fairly close to local amenities. All the bedrooms are furnished in a similar style and well appointed, many of these are well personalised. Six of the bedrooms have en-suite facilities. Most of the rooms have Care Homes for Older People Page 4 of 34 Over 65 23 23 0 0 1 0 0 2 2 0 0 9 Brief description of the care home views over the rolling countryside. The lounge areas are situated on the ground floor of the home both lounge areas overlook the garden areas. Car parking is available. The current weekly fees are £335 per week, these do not include hairdressing and chiropody fees. This information is made available on the point of enquiry. Care Homes for Older People Page 5 of 34 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: The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people living at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. One regulatory inspector conducted the unannounced visit over 1 day, including the lunchtime period. A review of all the information we have received about the home from the provider and the general public since the last inspection was considered in planning this visit and this helped decide what areas were looked at. The main method of inspection we use is called case tracking which involves selecting the care plans of 3 people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. Care Homes for Older People Page 6 of 34 The Manager, members of staff and people who use the service were spoken with as part of this visit. Documents were read as part of this visit and medication was inspected to form an opinion about the health and safety of people using the service. A partial tour of the care home was undertaken, communal areas were seen and a sample of bedrooms to make sure that the environment is safe and homely. The provider sent their latest Annual Quality Assurance Assessment which is a document that outlines the services development over the last year and areas where they intend to make improvements, some information received in the AQAA has been utilised within the main body of the report. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? Care planning and the development of risk assessments has improved since the last inspection, working towards ensuring that these contain all the necessary information to ensure that peoples needs are fully met and they remain safe and protected. The use of the Mental Capacity Act has improved and risks assessments are now in place in regards to each area of a persons need to make sure that at their best interest is protected. Activities have further developed and people using the service are enjoying these. Staff practices in regard to maintain peoples dignity and treating them with respect has improved to make sure that people are treated in a way that they deserve. Some improvements in regard to the environment have taken place, working towards ensuring that people live in a well maintained and comfortable environment. The quality assurance procedures have been improved upon, working towards ensuring that people using the service and their relatives are enabled to have a say which is acted upon. Care Homes for Older People Page 8 of 34 Accident recording has improved upon to make sure that accidents are monitored and reduced. 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 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured that their needs will be assessed before they make a decision to move into the care home. The service does not offer intermediate care. Evidence: The manager visits people within the community to carry out a preadmission assessment to see if the staff can meet their needs before they move into the care home. We saw evidence of these assessments taking place within the case files that we examined. People may also visit the care home and spend some time there to get a feel for what it would be like to live at the service. Staff spoken with tell us that they are informed of the needs of people before they enter the care home and that people can come and have a look around before they Care Homes for Older People Page 11 of 34 Evidence: move in. One person using the service tells us that their son visited the home to have a look around for them and then decided it was suitable for them, so they moved in and are now settled and content. Another tells us that they used to come to the care home for respite during the day and now they have moved in permanently. The service does not offer intermediate care. Care Homes for Older People Page 12 of 34 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. Although plans of care and risk assessments have been improved upon, there may be instances when people are not fully supported due to the lack of information provided. Staff practices have improved in regard to maintaining peoples dignity, however they can unknowingly be disrespectful in the language used within the daily records. Evidence: Plans of care are completed using a computerised system, are more personalised and contain more detailed information about the help and support people may need. Nevertheless we did see within three plans of care that some information in regard to complex needs such as diabetes mellitus and managing behaviour that may challenge was not in as much depth as it needs to be, to ensure that staff have all the necessary information that they need to support people and keep them safe. However on speaking with staff they do have a good understanding of peoples needs and are able to discuss how they support them and the action that they would take to ensure that peoples needs are met and they remain safe. Further attention has been given to the Mental Capacity Act and Deprivation of Liberty Care Homes for Older People Page 13 of 34 Evidence: to make sure that peoples rights are maintained. We can see that following each section of the plan of care where needs have been highlighted that an assessment takes place, followed by a risk assessment to ensure that peoples rights are fully considered and maintained. To ensure that risk are managed and reduced, risk assessments for highlighted needs are in place with the exception of the noted deficits in complex needs. Staff complete daily records to demonstrate the support that people have had or any significant events. Whilst these provide a good amount of information they do not always provide follow up information when a event has occurred, such as behaviour that may challenged to ensure that the necessary action has been taken to address any issues. We can also see that sometimes staff label people because of their behaviour, with their use of language such as, she/he is their normal agitated self. This was discussed with the manager who states that she will address these issues as it does not reflect the care and support that staff are actually offering. People using the service tell us they are happy and settled at the care home and that staff support them to meet their needs. We saw staff support people when needed throughout the visit and offer reassurance to people as required. People using the service are supporting in accessing specialist services such as the doctor, district nurse and community psychiatric nurse when required and we can see within plans of care that peoples health care needs are maintained. Both staff and people using the service confirm that they can access specialist service when they need to. During the tour of the care home we can see that specialist equipment such as mattresses and cushions to maintain healthy skin are in place. Staff who administer medication have been trained to do so and medication practices observed show that staff are following good practice recommendations. On examining the medication charts we can see that people using the service are receiving their medication as prescribed. Throughout our visit we saw that staff treat people with respect and maintain their dignity at all times. Care Homes for Older People Page 14 of 34 Evidence: On speaking with staff they are able to discuss how they ensure that peoples dignity and privacy is maintained and people using the service tell us that they have no problems in this area. Care Homes for Older People Page 15 of 34 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. Although the activities on offer have improved and people enjoy these, further development in regard to maintaining life skills and offering people a structured day may prove beneficial to some people using the service. People using the service are supported and enabled by staff to make their own choices and decisions as able. Evidence: Despite the service advertising for an activities coordinator, this post has yet to be filled. Therefore staff are currently supporting people with various activities such as dominoes, cooking sessions, sing alongs and games. However staff state that there is not always time to fit these in and despite the improvements there could be more for people to do and having an activities coordinator would be advantageous. There is usually some type of activity on offer everyday and we can see that the activities have improved since the previous inspection. There are times though throughout the day that people aimlessly wander around the care home, and although staff offer activities, these are limited in regard to providing people with structure to their day and promoting and maintaining existing skills. Care Homes for Older People Page 16 of 34 Evidence: We can see that currently there is no budget allocated for activities, therefore staff are raising funds to finance additional activities. Because of the fund raising, several people using the service have been able to visit the pantomime and a brass band recently. During our observation we saw several people join in and enjoy a game of dominoes and later in the day join in a singing session. There is evidence of a good rapport during these times and staff support people to participate in the activity in a helpful way. People using the service tell us that they enjoy the activities on offer and that they can spend their time as they wish and make their own choices in this regard; I enjoy the activities, I have been busy today, I played dominoes, I enjoy any of the activities and join in them all, I am happy and settled here, we had a very good Christmas, I enjoyed it, I had three glasses of sherry. I spend my time watching TV, I am very happy doing this; I do not want to do anything else. I have good relations with staff , they are polite and respectful but I can also have a laugh and a joke with them, which is important, and I dont tend to join in many activities as I cant, but I get enjoyment from watching them. So that people can maintain contact with those that are important to them there are no restrictions on visiting and visitors may be received in private. People using the service tell us that their family and friends can come to see them at any time and that they are made welcome. Staff spoken with confirm that there are no restrictions on visiting and people may see their family in private if they want to. Staff are now more aware of the Mental Capacity Act and why this is in place, they talk about ensuring that people are supported in making their own decision and spending their time as they wish; it is important to ensure that peoples needs are met and they are respected at all times, they are given the time that they need and are loved, there is a variety of choices offered to people, from what they want to eat to what they want to do. People receive individual care as they have individual needs and we are not all alike. There is also additional information about peoples capacity to consent followed by a risk assessment to make sure that peoples best interest are maintained and where able people are able to make their own choices and decisions with or without support. Care Homes for Older People Page 17 of 34 Evidence: People using the service said that the routine of the care home is generally flexible and they can do as they want to. The menu on offer is a traditional type menu with choices available at each meal. Charts are available in the kitchen which inform staff of peoples likes and dislikes and whether they need assistance to eat, to ensure that their needs are met. Special diets such as diabetic diets are also catered for and staff spoken with are able to discuss the needs for these. Two people using the service tell us that the food is good, plentiful and there are choices at each meal time. The manager tells us that special cutlery has been ordered for some people using the service so that they can be more independent at meal times. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are assured that their complaints will be listened to and acted upon and that they are protected from abuse. Evidence: So that people know how to make a complaint the complaints policy is on display in the main entrance and this is also issued to people in the service user guide when they first enter the care home. The service has received seven complaints since the previous inspection in regard to missing personal items such as glasses, a lack of communication from specialist services and being unable to launder a double quilt. There is evidence that these issues have investigated and resolved quickly. Staff spoken with are able to discuss their roles and responsibilities in regard to complaints and the action that they would take should they receive one, to make sure that this is dealt with and resolved quickly. People using the service did not express any concerns during the inspection and one person tells us, I have no problems and if I had I could tell them and I know they would act upon them. Staff have received training in safeguarding adults, and on speaking with them they Care Homes for Older People Page 19 of 34 Evidence: are clear about their roles and responsibilities in regard to protecting people using the service and responding to poor practice if the need arises to make sure that people are safe. People using the service tell us that they feel safe living at the care home. One allegation in regard to physical abuse due to manual handling techniques when bathing was reported to the Local Authority last March, this has been investigated and actions taken to ensure that issues have been addressed to prevent re-occurrence. Care Homes for Older People Page 20 of 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although some work has taken place to improve the environment outstanding work is detracting from peoples comfort and the opportunity to live in a well maintained environment. Evidence: We can see that maintenance work is still ongoing in the care home. There have been changes to the facilities in both bathrooms making these more accessible and user friendly for people using the service. In addition to this redecoration of peoples rooms and the main communal areas has taken place. New carpets have been laid in the communal areas and some bedrooms and new curtains and blinds have been put up at windows. Nevertheless there are still some areas that are outstanding since the previous inspection. Some windows remain in a state of disrepair and we saw during the tour, where one window had dropped and was due to be repaired, that the gap in this was being filled with a towel to keep the draft out. The manager stated that this was due to be repaired on the day of the visit; however this was still in the same state when we left. We can see in the meetings that have taken place with relatives and the replies received in the questionnaires that have been sent out, that issues of concern in regard to the windows have been brought up several times. The minutes highlight that these issues are to be addressed but these are still outstanding. The manager Care Homes for Older People Page 21 of 34 Evidence: tells us that there are plans for replacement windows in the near future; however she was unable to evidence this to us. Whilst some furniture has been replaced there is still some furniture which is in need of attention, a chair in the communal area had a hole in the arm of it and stuffing had been picked out and some tables and dining chairs are in need of re varnishing. We can also see that despite redecoration taking place that the boarder on the upper floor corridor has been peeled off and left in a state of disrepair. Also the ceilings in some rooms where these are suspended are sagging and also in need of redecoration. During the tour of the care home we can see that all areas are clean and tidy, however one room had a very strong offensive odour that needs addressing. Also during the tour we found that some radiators in communal areas on the ground floor remain extremely hot to the touch and one fire door was propped open. This area of concern is further discussed in the management section. Staff spoken with tell us that whilst improvements have taken place they feel that additional maintenance work is needed. One person using the service tells us that they have a very nice room with a lovely view. Care Homes for Older People Page 22 of 34 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. People using the service are supported by sufficient numbers of staff who have been recruited safely to ensure that they are protected from unsuitable people supporting them. Evidence: We can see that the staff are available to assist and support people using the service when needed and this support is carried out with thoughtfulness and consideration for peoples dignity. Staff spoken with tell us that there are sufficient staff on duty to be able to support people using the service as needed. we now do 12 hour shifts and staff work together more, there are enough staff available at the moment and enough time to spend with people with the exception of being able to do activities all the time, we need a dedicated activities coordinator as we cant always fit things in. there are enough staff available to care for and support people. People using the service tell us that staff are available when needed and they support them to do the things that they need to do; the staff help with the things we need help with, which is good, staff are very good and help as needed, there are enough staff available, and I am content, the staff are very dedicated and good at their jobs, it is a hard job to do and they are always patient and kind. Care Homes for Older People Page 23 of 34 Evidence: Seven people have attained the National Vocational Qualification (a nationally recognised work and theory based qualification, which is designed to enhance knowledge and skills in caring for people) level 2 and 3 have attained level 3 and some staff are working toward these qualifications. Two members of staff spoken with confirm they have undertaken this training. So that new staff members are aware of their roles and responsibilities when they first start employment, they undertake an induction. This involves them learning more about the service and people living at the care home and working with senior members of staff. One member of staff spoken with tells us; I had an induction, the manager showed me around, I read policies and procedures and had a general discussion. I got an induction booklet which I have nearly finished; it has taken me longer as I have been doing my NVQ. This all helps as it tells us about certain situations and how to cope. Staff files examined show us that all the documentation required by law, such as references, proof of identity and a criminal record bureau check (a police check to see if an individual has a police record or caution) are in place to ensure that people using the service are protected from unsuitable people being employed. Two members of staff spoken with confirmed that they had undertaken a criminal record bureau check before they began employment and one tells us that they had not been able to start working at the care home until this and their references were received by the manager. A staff training matrix shows us that staff are working towards completing compulsory training such as manual handling, fire and food hygiene however there are some noted deficits in dementia care, challenging behaviour and first aid. The manager tells us that more staff have undertaken this training however certificates to confirm this have not yet arrived. On speaking with staff they offer the following comments in regard to their training; I had training on dementia awareness which ensures that people are given our full support and we encourage them to do what they can physically do. We need to remind them as they may have forgotten how to use the tools. We tell them and remind them a lot as they forget. People can get aggressive and we intervene to stop this. We try to explain but we are not always understood, we try to divert them so that they forget what they had been frustrated about. We always make sure that we reassure them and the other people if something has happened to make sure they are ok. I feel comfortable dealing with this type of behaviour. I have had training in diabetes, fire, food hygiene and infection control. I have done my NVQ level 2 and I am now doing level 3, it has given me more insight into what it is like for them so that we can Care Homes for Older People Page 24 of 34 Evidence: understand and deal with situations when the arise, and I have done my NVQ level 2 and started 3. I have also done first aid, manual handling, food hygiene, infection control and health and safety but I am waiting for my certificates. We get enough training and I think I am good at my job and I enjoy it. I have not done dementia care training yet, I have in the past but I want to do it again to refresh and be up to date, but I feel confident in dealing with challenging behaviour, we need to be patient and explain in ways that suit them and not shout. We lead people, tell them what they are doing is wrong and explain why; we try to draw them away from the situation. At the previous inspection staffs knowledge in regard to the Mental Capacity Act to make sure that peoples rights and choices are maintained was limited, however staff now have more knowledge of this and are able to discuss how they ensure that peoples rights are maintained. Care Homes for Older People Page 25 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite improvements in regard to the management of the service, people using the service remain at risk due to the environmental risks not being fully monitored. Evidence: The manager is now registered with the Commission for Social Care Inspection. She has previous experience in managing a care home and has completed the Registered Managers Award (a nationally recognised work and theory based qualification designed to enhance management knowledge and skills.) Staff spoken with tell us that they feel supported by the manager and many changes have taken place which has ensured that the service runs well, they also feel that she is approachable and deals with any issues of concerns if they arise. To ensure that people using the service and their relatives are able to spend time with the manager to discuss any issues, she holds a managers surgery where people can drop in to have a chat should they wish. Care Homes for Older People Page 26 of 34 Evidence: Time has been spent working towards improving the quality assurance practices of the service and people using the service and their relatives have now had the opportunity to complete questionnaires about the service and the support that they receive and attend meeting if they wish. On looking at the results from the most recent questionnaires we can see that the following issues have been highlighted; positive comments in regard to the decoration and peoples bedrooms, positive comments in regard to the staff and care received, positive comments about the food provided, and expressions of concern in regard to the windows needing replacing and more activities to be available. As discussed in the environment section the issue in regard to the windows has yet to be resolved, despite these concerns being raised in February of last year. We can see that quality circle meetings have taken place in May and December of last year. The minutes of these meetings show us that relatives feel that the new manager has improved thing considerably and that they are encouraged by the changes made so far and they hope these continue. They feel that the activities on offer have brought the place to life. In the December meeting we can see that the problems in regard to the windows were raised again. People using the service are able to have their personal money kept in the care home safe should they wish. We examined three peoples personal allowances, which show us that receipts are available for all transactions and the money in each account corresponds with the accounting sheet. On examining the fire records we can see that the emergency lights have not been tested as required by the fire authority, nor have the weekly fire alarm systems testing to ensure that these are in good working order. During the tour of the care home we saw that one fire door was propped open with a flannel, we asked the manager to remove this, the flannel had got stuck and it then took two people to remove this to enable the door to be closed. We discussed the practice of propping fire doors open with the staff who understand that this should not happen, however they state that people using the service have difficulty getting them open. On discussing this with the manager, she stated that she had discussed this with the Fire Authority and they had instructed that doors must not be propped open, following this discussion she stated that the provider had been made aware of this so that they can look at alternatives to keep the door open. There is evidence that staff have attended a fire drill and undertaken mock evacuations to ensure that people using the service are protected in the event of a Care Homes for Older People Page 27 of 34 Evidence: fire. There has been a noted improvement in the monitoring and recording of accidents. We can see that if a person has an accident that a full body check takes place and if needed specialist assistance is sought. Also following the accident a risk assessment is undertaken to ensure that any risk of the accident occurring again is minimised. During the tour of the care home we observed that the radiators in the main corridor leading to the bottom lounge, one radiator in the bottom lounge and one in the smoking room are very hot to the touch. There are no radiator guards in place to make sure that people using the service are protected from burns. We had left an immediate requirement form at the previous inspection asking that a risk assessment was put onto place to monitor and reduce the risk of this. On examining the risk assessments in place we can see that this initially was done, however has not been updated since February of last year and no radiator guards have been fitted. On discussing this with the manager she stated that touch test are done on a regular basis, however there are no records of these. On discussing this with staff they tell us that they are aware that the radiators are hot and that as people wander around the building there is a risk that they may fall near to or next to these. We contacted the provider and discussed this along with other maintenance issues and he has informed us that radiator guards will be fitted within the next two weeks to ensure that people using the service are protected. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 19 23 You must ensure that the 05/05/2009 premises are kept in a good state of repair both internally and externally. This will ensure that people using the service live in a well maintained environment. Care Homes for Older People Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 You must ensure that risk 26/02/2010 assessments are in place for all identified risks. This will ensure that risks are managed and reduced and people using the service are protected. This requirement initially had a compliance date of 10/04/09 and has not been fully met. Further development is required to ensure full compliance. 2 7 15 You must ensure that plans 26/02/2010 of care for highlighted needs such as diabetes mellitus and behaviour that may challenge contain sufficient information about the support that people require. This will ensure that staff have all the necessary information they need and peoples needs are fully met. Care Homes for Older People Page 30 of 34 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 19 23 You must continue to address the areas that still require redecoration. This will ensure that people live in a well maintained environment which is comfortable. 26/03/2010 4 33 24 You must continue to develop the quality assurance systems. This will ensure that people using the service and their relatives are enabled to have a say and this is listened to an acted upon. This will ensure that a quality service is offered. 26/03/2010 5 38 13 You must ensure that the 12/02/2010 risk assessments in place for the radiator surface temperatures and the propping open of fire doors are reviewed and maintained at all times. You must ensure that staff follow these assessments at all times. This will ensure that people using the service are protected. 6 38 13 You must ensure that the practice of propping open fire doors is stopped. 12/02/2010 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that people using the service are protected. 7 38 23 You must liaise with the fire authority in regards to the fire alarm system testing and the practice of propping open fire doors. This will ensure that you follow the fire authority legislation and people using the service are protected. 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 19/02/2010 1 2 7 10 Ensure that daily records fully reflect any follow up action that has taken place following an event of significance. Ensure that staff consider the language that they use within daily running records to ensure that they are not being disrespectful to people or labelling them because of the behaviour that they may present. Consider the allocation of a budget for activities and recreation so that people using the service are enabled and supported to live a satisfying and fulfilling lifestyle. Consider the introduction of activities that build upon and enhance peoples life skills to provide them with a structured day. Consider the replacement of the armchair on the communal area which is damaged. Address the odour in the identified room so that people using the service live in a comfortable environment. 3 12 4 12 5 6 19 26 Care Homes for Older People Page 32 of 34 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 7 30 Ensure that the staff training matrix is up to date at all times to accurately reflect the training that staff have undertaken. Care Homes for Older People Page 33 of 34 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. 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