Care Home: Stamford House Residential House

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What the care home does well The home had some good procedures that were followed when some people were admitted to the home (see below). The senior staff always met people before they came to live in the home in order to help them make a decision about whether or not the home could look after them. People were also encouraged to visit the home first to give them a chance to see if they liked the home or not. Some of the written information about people`s needs provided useful instructions and guidance to staff to help them support people (see below). People told us that they felt they were well looked after and that staff treated them properly. One person said, "the staff are all very nice" and another said, "they look after me very well". A visitor spoken with also felt that the relative she visited was well looked after, and also that the home was welcoming, and that they could visit at any reasonable time. She also told us that staff were good at communicating with them about the health and welfare of their relative, and any changes in their well being. Residents said that the food served was good and there was a choice each day of 2 main hot meals so that there was always an alternative for people. The home was clean, and maintained and furnished to a satisfactory standard. This helped to make a pleasant environment for the residents. Most staff had worked in the home for a number of years and had the right qualifications for looking after older people (see below). This meant that older residents were looked after by experienced trained people who they knew. The manager had also been in post for a considerable number of years, and had the right qualification for the manager of a care home. This meant that she knew the home, the staff and the residents, and that there was continuity of management and leadership. What has improved since the last inspection? A few matters were identified for improvement at the last inspection and we found that some of these had been addressed, such as there was now an appropriate cabinet for the storage of controlled drugs, and there were no unpleasant odours in the lounges at the time of our visit. Work was also being undertaken to try and establish people`s interests and preferences for leisure activities so that more individual activities could be planned. What the care home could do better: Though there was some good practices concerning some admissions to the home (see above), some people were being admitted to Stamford House whose needs were not primarily those associated with old age and without a satisfactory plan for how they should be specifically supported and assisted. Staff also did not have the training and the knowledge to look after different groups of people with different needs. Admitting people to the home in this way could mean that they do not receive the individual and specific support needed.The written information in the care plans about what, and how, staff need to do to look after people properly could be further improved. Some care plans looked at did not include sufficient information on all matters relating to health and personal care, such as about falls, alcohol consumption, diet and leisure activities. Detailed written information about the care that people need is necessary to guide staff and ensure the correct care is given. Also at the time of the site visit improvements were needed in the assessment of risks associated with everyday life and in such a way as to identify the risk, the level of risk and what staff need to do to reduce or eliminate the risk. This included the risk of falling, falling out of bed and the risks associated with people smoking in their bedrooms. This is necessary to help ensure people are looked after safely and the manager subsequently provided us with information that showed that these matters were being addressed. The way medication is managed and organised in the home needs to be improved. The systems for recording the medication coming into the home, and tracking that medication, should be improved so that checks can be made on whether people are taking the correct medication. Staff should also have written guidance about whether certain medicines are to be given only when required to ensure that this is given correctly. For medicines that are to be give as "when required", including pain relief, there should be written guidance for staff about when and why to administer these medicines and it what dose. This is so that residents receive this medication correctly and consistently according to their needs. There should also be written and formal systems for assessing whether staff are competent and safe to adminsiter medication and also for completing regular checks of the medication systems and practices. The management of complaints in the home should be improved. Records of complaints made in the home must be recorded and the details of the investigations, the conclusions and any action taken. This must be done so that there is evidence that complaints have been dealt with properly and so that it is clear what action has been taken. We were told after the site visit that a new recording system had been set up, and this should make sure that proper records were kept. The smoking practices must be in accordance with the current legislation so that the residents and staff are not affected by smoke. We were told following the site visit that action was being taken on this matter, and the commission expects to be notified when the necessary action has been completed. The training that is offered to staff could be improved. Even though most of the staff had completed the relevant National Vocational Qualifications staff had not undertaken suitable training in some specific areas relating to some of the residents. The staff recruitment procedures could be more thorough to help ensure that unsuitable people are not employed in the home. All the necessary checks should be completed before people start work and the risks of employing people with relevant convictions should be properly assessed. Key inspection report Care homes for older people Name: Address: Stamford House Residential House 3 Stamford Street Rochdale Lancs OL16 5DS     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: Pat White     Date: 0 3 0 6 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 32 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Stamford House Residential House 3 Stamford Street Rochdale Lancs OL16 5DS 01706645401 01706645410 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Antonipillai Gnanabalan Name of registered manager (if applicable) Ms Collette Heaton Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the category of service only: Care home only: Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP The maximum number of people who can be accommodated is: 23 Date of last inspection Brief description of the care home Stamford House is a care home registered to provide care and accommodation to 23 older people. It is an older type property situated on a main road on the outskirts of Rochdale town centre. There are two floors linked by a passenger lift and there is equipment to assits people with mobilty problems. None of the bedrooms are ensuite but there are assited bathing facilities on both floors. There is written information about the home - the Statement of Purpose and the Care Homes for Older People Page 4 of 32 0 Over 65 23 Brief description of the care home Service User Guide - which should be given to people to inform them about the services and facilties in the home. At the time this report was written the current weekly fees were from 376 pounds and 45 pence to 380 pounds. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 inspection visit to Stamford House care home was carried out on the 3rd June 2010 in order to meet the requirements of the Care Standards Act for the inspection of new services. The care home had changed ownership last year and as such was classed as a new service. This visit was part of a key inspection to determine an overall assessment on the quality of the services provided by the home. It included checking important areas of life in the home that should be checked against the National Minimum Standards for Older People. At the last main inspection in 2008 the home was rated as a good service, so there were no serious concerns at that time that required checking at this visit. This key inspection included: talking to residents, touring the premises, observation of life in the home, looking at residents care records and other documents and discussion with the manager, deputy manager and other staff. Some residents who were spoken with gave their views about the home and some of their views are included in this Care Homes for Older People Page 6 of 32 report. Two relatives visiting the home at the time of the site visit were also spoken with and some of their comments are referred to in the report. Survey questionnaires from the commission were sent to some residents and staff for distribution. At the time of writing this report no completed questionnaires had been received. In addition we have used and included information that the home provided, as required under the Care Homes Regulations, prior to the site. This includes information about the care, the premises, facilities and staffing matters, and their own views of the quality of the service provided in the home. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Though there was some good practices concerning some admissions to the home (see above), some people were being admitted to Stamford House whose needs were not primarily those associated with old age and without a satisfactory plan for how they should be specifically supported and assisted. Staff also did not have the training and the knowledge to look after different groups of people with different needs. Admitting people to the home in this way could mean that they do not receive the individual and specific support needed. Care Homes for Older People Page 8 of 32 The written information in the care plans about what, and how, staff need to do to look after people properly could be further improved. Some care plans looked at did not include sufficient information on all matters relating to health and personal care, such as about falls, alcohol consumption, diet and leisure activities. Detailed written information about the care that people need is necessary to guide staff and ensure the correct care is given. Also at the time of the site visit improvements were needed in the assessment of risks associated with everyday life and in such a way as to identify the risk, the level of risk and what staff need to do to reduce or eliminate the risk. This included the risk of falling, falling out of bed and the risks associated with people smoking in their bedrooms. This is necessary to help ensure people are looked after safely and the manager subsequently provided us with information that showed that these matters were being addressed. The way medication is managed and organised in the home needs to be improved. The systems for recording the medication coming into the home, and tracking that medication, should be improved so that checks can be made on whether people are taking the correct medication. Staff should also have written guidance about whether certain medicines are to be given only when required to ensure that this is given correctly. For medicines that are to be give as when required, including pain relief, there should be written guidance for staff about when and why to administer these medicines and it what dose. This is so that residents receive this medication correctly and consistently according to their needs. There should also be written and formal systems for assessing whether staff are competent and safe to adminsiter medication and also for completing regular checks of the medication systems and practices. The management of complaints in the home should be improved. Records of complaints made in the home must be recorded and the details of the investigations, the conclusions and any action taken. This must be done so that there is evidence that complaints have been dealt with properly and so that it is clear what action has been taken. We were told after the site visit that a new recording system had been set up, and this should make sure that proper records were kept. The smoking practices must be in accordance with the current legislation so that the residents and staff are not affected by smoke. We were told following the site visit that action was being taken on this matter, and the commission expects to be notified when the necessary action has been completed. The training that is offered to staff could be improved. Even though most of the staff had completed the relevant National Vocational Qualifications staff had not undertaken suitable training in some specific areas relating to some of the residents. The staff recruitment procedures could be more thorough to help ensure that unsuitable people are not employed in the home. All the necessary checks should be completed before people start work and the risks of employing people with relevant convictions should be properly assessed. If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 9 of 32 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 10 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedures helped to determine whether or not people wanted to live in the home but it was not clear whether or not the home could meet the needs of the different people living there. Evidence: There was written information about the home (the service user guide and the statement of purpose) to inform people of the services and facilities at Stamford House. However these documents were not up to date with respect to some recent changes about the ownership, the smoking arrangements or with respect to the needs of people that Stamford House feels they can meet. This means that people living in the home may not have up to date and accurate information about the home that enables them to make the decision about whether or not Stamford House is a suitable place for them. The admission procedures ensured that senior staff visited people prior to a decision Care Homes for Older People Page 12 of 32 Evidence: being made about whether or not the home could meet their needs, and that staff completed a brief pre admission assessment. People were also given the opportunity of visiting Stamford House to give them a chance to see what the home is like. More detailed assessments were undertaken on and after admission. Social work assessments were obtained to assist the staff to develop their own assessments and care plans. Assessments of risks associated with some aspects of everyday life and support needed were undertaken but these did not always lead to accurate details about the specific risks to individuals or include detailed instructions to staff on how to eliminate or reduce the risk (see next section). Also although the home is currently registered to provide care to people who are dependent because of problems associated with old age, a number of people have been admitted with problems and needs other than those associated with old age. Though there was documentation to show what these problems were there was no evidence to indicate that the home was equipped in terms of staffing expertise and facilities to fully meet these needs. For one person whose records were viewed there was no detailed plan that indicated the specific support needed or any long term aims and objectives (see next section). It was therefore unclear whether or not the home was the correct place for this person, and discussions with those involved indicated that this person was not yet receiving support that maximised their independence. For an older person whose records were viewed there was insufficient information about their social interests and hobbies and about the risk of falling out of bed (see next section). Detailed and accurate information about peoples needs is necessary to help staff understand the needs so that the right care and support can be planned. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All residents had written care plans that helped staff understand what care to provide, but some care plans did not include sufficient information on all matters of health, risks and personal care. Some medication systems and procedures need to be improved to make sure that all medication is given correctly. Evidence: All residents had care plans with some information about what and how care and support should be provided. These care plans were easy to follow and had some useful information to guide staff. One care plan that we looked at had the guidance to staff to help prevent pressure sores. There was also evidence that the care needs of people were being reviewed and the care plans updated as necessary. However some parts of the care plan were not completed in sufficient detail. On one care plan viewed of a younger person there was insufficient information about how staff should support them in one important aspect of their lives, what support was needed for bathing and also what action they should take in the event of an epileptic seizure. In addition there were no long term goals for this person. In another care plan there was insufficient information about what support was needed to ensure the resident had the food they Care Homes for Older People Page 14 of 32 Evidence: liked and that the food was presented in the right way to encourage them to eat. There was also insufficient information about what support was needed in terms of leisure activities and religious observation. Whilst there was no evidence that people were in general not getting the care and support they needed, some examples were highlighted in discussion of where more written information and guidance to staff could have been useful in ensuring there was greater understanding of peoples wishes. In addition some of the risks associated with activities were not always fully and accurately assessed such as the use of bed rails and smoking in the bedrooms. This resulted in staff having insufficient written guidance about what to do to protect people and potentially left people at risk. The care plans and the assessments of risks were discussed fully with the manager and she agreed to make the necessary improvements. We were subsequently provided with information that demonstrated that some matters referred to above had been addressed, such as, preferences for food were now written on the care plan in question, individual risk assessments for protecting people from falling out of bed and for smoking in bed rooms had been developed as had written guidance for staff on how to support an individual in the event of an epileptic seizure. Records and talking to the manager showed that residents received the medical care they needed, including visits to the hospital as necessary and contact with the community services. District nurses were involved as required, such as with pressure areas, and the chiropodist visited the home regularly. There were satisfactory written policies and procedures covering most aspects of medicines handling and that should provide useful guidance to staff. One or two procedures were outstanding and the manager agreed to develop these. Since the previous inspection in 2008 the storage of Controlled Drugs (CDs) had been improved and a CD cabinet had been installed. We were also told that since a complaint was made last year about the administration of medicines in the home all staff who administered medication had completed training and that the deputy manager had assessed them as competent (see below). Through checking the medication and the records of 2 residents it appeared that medication in the monitored dosage system had been generally given as prescribed. However there was one example of a persons medication not being given, though it had been signed as given. This means that the Medication Administration Records was incorrectly signed and indicated that it was not signed at the time of administration. This is poor practice and may result in false records and medication not being given correctly. There were a number of other Care Homes for Older People Page 15 of 32 Evidence: matters for improvement that were identified. The recording of medication received into the home was noted on the MARs but the amount carried over onto the next MAR was not recorded accurately, or the date received or the date carried over, so there was not an easy clear audit trail to determine whether all the medication was being given as prescribed. The application of prescription creams was not being recorded. This means that staff would not know whether or not these creams had been applied and may result in them being used incorrectly. There was also insufficient information about what they were required for, and how often they should be applied. In addition there were several other examples of confusion and lack of clarity about whether or not medication, such as pain relief and bowel medication, should be given as when required and in what dose. There were no instructions from the General Practitioner about this and no written information about what the medication was for. Instructions from the prescriber about whether or not medicines should be administered when required and written guidance about when and why these medicines should be given, is necessary so that people receive the correct dose at the right time. We were told that the competence of staff was assessed before they were allowed to adminsiter medication, but there was no records of this. Formal assessment of competence, with written records, is necessary so that the assessor checks all the areas of competence required and that there is a record of the results which is a reference point and a baseline for development and improvement. Medication must also be formally audited regularly by a competent person so that any errors and poor practice are identified and dealt with. These matters were fully discussed with the manager at the time of the site visit and we were subsequently informed that action had been taken on some matters, such as the development of further procedures, the developing of competency assessments and auditing systems and seeking advice from the community pharmacist about some of the sytems. There was evidence through observation on the site visit and talking to people that peoples rights to privacy and dignity were respected. People said that staff treated them properly, that they were well looked after and that staff carried out personal care in the right way. However not all the bedroom doors had appropriate locks, or bedrooms a lockable facilty to store things privately and securely. We were told that those who wanted these could have them, but there was no written evidence to support this. This is necessary to demonstrate that peoples right to privacy is being respected. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were some suitable activities, and the programme was being developed according to peoples interests. The food served was wholesome and varied and suited most residents tastes and preferences. Evidence: Routines appeared flexible enough to suit peoples preferences. People had choices in what to eat and whether or not to stay in their rooms and some people were able to go out with or without staff support. We were told that there a member of the care staff was employed as an activities coordinator half a day per week to assist in the development of suitable activities according to individuals interests and wishes. However their was still insufficient written information about this, though we were told that social profiles were being developed to help staff understand peoples past lives and interests and hobbies. Exisiting activities included a visiting organist, quizzes, fund raising tea party and birthday parties. We were also told that there were plans to organise more trips out and another residents holiday. People could and did go out with relatives on a regular basis. A Newsletter was being developed to inform people of what was going on and to encourage people to become involved. People spoken with seemed satisfied with the Care Homes for Older People Page 17 of 32 Evidence: routines and activities in the home. Church ministers visited the home, but there was little information on the care plans about peoples spiritual needs, so it was not clear whether or not their spiritual needs were being met. Two visitors to the home were spoken with at the time of the site visit. One told us that they felt welcome in the home, could visit at any reasonable time, and that staff were friendly and approachable. They also said that communication between the staff and themselves was good and that they were kept informed of health matters and changes in peoples condition. One relative told us that there were some matters of concern that she wished to discuss with the manager and these were discussed and resolved at the time. To assess the food served we spoke to residents, looked at the menus and observed the lunch time meal served. Menus showed that each day there was a choice of 2 hot meals at lunch time and choices of a lighter meal at tea time. The main hot meals served on the day of the site visit appeared tasty and wholesome. The menus viewed showed a good variation of traditional dishes. We were told that these had recently been revised and changed according to residents wishes and views. The lunch time meal served on the day of the site visit appeared appetising and of suitable proportions and meal time was relaxed and unhurried. People spoken with said that they enjoyed the food, though one person stated that she didnt always get what she wanted at tea time. This was discussed with the manager and we were told that the matter would be resolved. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and recording of complaints was not satisfactory with insufficient records to indicate how the complaints had been investigated and resolved. The procedures and the training available for the Protection of Vulnerable Adults should help staff take the right course of action to protect people living in the home. Evidence: The home had a complaints procedure that appeared to be accessible to people, but that needed up dating and developing in a number of respects so that people had accurate information and guidance. Residents spoken with said that they would speak to the manager or another member of staff about matters of concern, and at the time of the site visit a resident and a relative raised matters with both the inspector and the manager who said she would deal with them (see previous section). However there were no records in the home of a recent complaint made to the commission and passed to the previous owner to investigate. Another previous and related complaint had not been recorded properly and there was no date to indicate when this had taken place. This meant there was no information about how the complaints had been investigated, the outcome and any action that had been taken to resolve matters. We were subsequently informed by the manager that a new system had been set up for the recording of complaints which may help staff to make the appropriate records of the investigations and outcomes. The information provided by the home prior to the site visit stated that two complaints Care Homes for Older People Page 19 of 32 Evidence: had been made to the home in the last 12 months. The records we looked at and discussion with the manager indicated that the complaints referred to were Safeguarding of Vulnerable Adults incidents. These had been correctly reported to Social Services and there was some records kept that explained the incidents and the outcome of the investigations. The matters had been resolved satisfactorily. The home had the local authority safeguarding information and procedures, and people spoken with knew what to do in the event of a suspicion or allegation of abuse. In addition we were told that most staff had undertaken suitable training in Protection of Adults from Abuse, with the local authority, and that new staff completed inhouse training whilst waiting for suitable outside training. This should help staff understand these issues and help them take the correct action to protect people. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided clean and comfortable accommodation for the residents and which was of a satisfactory standard of decorating and furbishment. However the smoking arrangements in the home were unsatisfactory. Evidence: A tour of the premises was undertaken which showed that in general the home was satisfactorily decorated, maintained and furnished, and confirmed that there had been a number of recent refurbishments, such as carpets, curtains and new TVs. Most inside areas were light and bright. We were told that further improvements were planned, such as to the outside and the redecorating of bedrooms according to the wishes and tastes of the incoming residents. We were also told that the new owners had a more progressive attitude to the home and were committed to improving the environment. This should ensure that the matters for improvement discussed with the manager, such as a few bedrooms, some outside areas, and a carpet area near the office that was a trip hazard, would be dealt with in the near future. The fire equipment in the home had been serviced within the last 12 months and in general the homes other safety measures were satisfactory. The radiators were covered and the hot water supply at the outlets that were tested at random was of a safe temperature. This meant that people were not at risk from water that was too hot or hot surface temperatures. However we saw that one low opening bedroom window Care Homes for Older People Page 21 of 32 Evidence: on the first floor did not have a window restrictor and could pose a risk of a resident falling out. There was no written assesssment of risk to demonstrate that the current resident was not at risk. The manager agreed to take action on this and we were subsequently informed that a window restrictor had been fitted to this window to ensure the safety of the occupants. Also we were concerned that the home did not have a safe smoking/no smoking policy and procedures that complied with current legislation. There was an inside smoking area at the back of the house which meant that smoke drifted into the communal corridor. This could affect the health of residents who didnt smoke. To try to stop this practice some residents were allowed to smoke in their rooms, but there was no satisfactory written assessment of the risks or guidance to staff to ensure that this was safe. We were told that the new owners were committed to changing this arrangement and practices. The manager agreed to immediately review the arrangements with the owners and we were subsequently informed that action was being taken to provide an alternative smoking area in accordance with the current legislation All areas of the home viewed were of a satisfactory standard of cleanliness and there were no unpleasant odours in the communal areas. Staff had undertaken suitable training in infection control to help ensure satisfactory standards of hygiene and cleanliness. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff appeared to be on duty in sufficient numbers and with the right skills and experience to meet the physical needs of the residents. Staff recruitment procedures need to be more thorough to help ensure that unsuitable people did not work in the home. Evidence: There appeared to be sufficient members of staff on duty at the time of the site visit to ensure that the physical needs of the residents were being met. It was also evident that staff continuity was good as most staff had worked in the home for a number of years. The manager and the deputy manager worked in the home most days and provided management and support for the staff. A cook and cleaner were working in the home and this helped to ensure that good standards of food and cleanliness were maintained. A high number of care staff had gained National Vocational Qualifications in care. We were informed that, when 4 people had completed the NVQ course they were studying, all the care staff would be qualified to at least NVQ level two. Records and discussion with the manager showed staff took additional training in the core areas of moving and handling, fire safety, food hygiene, infection control and first aid. This training was undertaken both in house, through training package DVDs, and external with outside trainers, such as for moving and handling, fire safety and Protection of Care Homes for Older People Page 23 of 32 Evidence: Vulnerable Adults. Some members of staff had also completed training in caring for people with dementia and we were told that new members of staff who required a more in depth induction, completed one that was compatible with Governement guidance on this. This should help ensure that new members of staff had the right skills and knowledge to commence work. One member of staff spoken with confirmed the training that she had completed and said that she felt well supported by the management and the new owners. However staff did not underatake relevant training to help them understand and support some of the specific needs of some of the people living in the home (see Choice of Home). Whilst there was no evidence that in general peoples needs were not being met because of lack of staff training, the right knowledge expertise and skills are needed to ensure that people receive the right understanding and support for their specific situation. With respect to staff recruitment we were told that there there had been no recently recruited care staff. In addition to the staff records referred to above regarding staff training and complaints, we looked at a member of staffs recruitment records. This showed that this person had commenced work about 2 months before the Criminal Records Bureau check had been received and even though it was known that this person had relevant convictions. There was no written evidence to show that any risks associated with this appointment and the convictions had been fully assessed, or whether or not any monitoring measures were needed. Whilst there was no evidence that this person had posed a risk to residents, not following thorough procedures and assessments of risks could mean that unsuitable people are employed in the home. The manager subsequently informed us that different procedures would be followed in the future and that people would not be employed without suitable checks being made and recorded. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a qualified and experienced manager, who is registered with the commission. The home was generally a safe place for people to live in and work. Evidence: The manager had been in post for about 7 years, was registered with the commission and had all the necessary qualifications for someone managing a care home. She felt that she had sufficient management hours to manage the home effectively. At the end of last year new owners purchased the home, and the people spoken to at this site visit were optimistic and positive about these developments and for the future of the home. We were told that unannounced monitoring visits under Regulation 26 of the Care Homes Regulations were being undertaken by the nominated responsible individual. However the reports of these visits were not in the home; we were told they were kept at head office. Some copies were faxed to the home before the end of the site visit but they did not include sufficient detail on all matters as recommended in the commissions guidance, and did not identify any of the matters highlighted at this inspection. Care Homes for Older People Page 25 of 32 Evidence: We were told that the homes own quality monitoring systems included the use of resident and relative questionnaires. However the results of the recent surveys were not in the home so there was no evidence that the home was developing according to the views of the residents. We were told that the previous owner had taken this information and that because of this another survey was to be undertaken in the near future. Staff meetings and residents meetings were held and the new owners had ensured that they had met with both staff and residents to communicate the changes etc. Residents finances appeared to be managed safely. Spot checks on 2 residents spending money that was kept in the home showed that the cash remaining balanced with the amount shown in the records. The records were clear and up to date and receipts for items purchased were kept. The home appeared to be generally a safe place for people to live and work. The information provided by the home prior to the inspection, stated that the equipment and installations had been serviced and maintained appropriately. However the electrical portable applicances tests were overdue. We were told that this would be rectified in the near future. Staff had undertaken health and safety related training, such as moving and handling and fire safety. The fire precautions were viewed and were satisfactory. Records showed the equipment was tested, and fire drills were held, with sufficient frequency. The fire risk assessment had been developed with the involvement of an expert in this field, and was therefore presumed to be a suitable basis for the fire precautions in the home. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 4 14 The home must ensure that 09/07/2010 people are only admitted to the home when all the needs are clearly identified and understood and that it is clear if and how these needs are to be met. So that only people whose needs can be met are admitted to the home and to ensure that people receive the right kind of care and support. 2 9 13 The newly developed 09/07/2010 systems for the formal and written assessments of carers competence in the administration of medication and regular audits must be implemented without delay. To ensure that all carers are competent and confident in the administration of medication and to identify Care Homes for Older People Page 28 of 32 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 and prevent mistakes being made. 3 9 13 Medication must always be 09/07/2010 given as prescribed unless there is an acceptable explained reason for not doing so and the MARs must be signed correctly and accurately and at the time of administration, including the recording of the application of prescription creams. To ensure that people receive the correct medication for their health and well being and to ensure that accurate records are kept that show exactly what medicines have or have not been taken. 4 16 17 A record of all the complaints made to the home and the investigations and actions must be made and kept in the home. So that there is accurate information about complaints that is used to develop the service, and that provides evidence and information about what action has been taken. 5 19 23 The home must comply with the smoking/antismoking legislation. 16/07/2010 09/07/2010 Care Homes for Older People Page 29 of 32 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 To ensure that residents and staff live and work in a smoke free environment and safe environment 6 29 19 Staff recruitment procedures 09/07/2010 must be sufficiently thorough and in accordance with the Regulations to ensure that all checks are undertaken before people commnce work in the care home To help ensure that unsuitable people do not work in the home. 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 statement of purpose and service user guide should be updated with respect to the changes of ownership of the home and should give accurate information about the facilities and the range of needs that the home can meet. The assessment should include sufficient details on all aspects of personal, health and social care, including social interests and hobbies and personal safety and risks. The care plans should include sufficient details on all matters relating to health, personal and social care and the protection of people from risk so that staff have the enough guidance to understand and provide the right care and support and keep people safe. There should be clear records on the MARs of the number of tablets carried over and of the date the medicines were received. Page 30 of 32 2 3 3 7 4 9 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 5 9 There should be written information from the doctor about whether or not medicines can be give as when required and if so there should be written guidance to staff about what the medicines are for, when they should be given and in what dose. Suitable locks should be provided on bedroom doors and bedrooms should have a lockable facilty unless there is clear evidence that this is not suitable or wanted. Activities should be developed according to individuals interests, hobbies and capabilities and these interests, hobbies and preferences should be recorded in the care plans. The complaints procedure should include accurate information about the organisations involved in the investigating of complaints. All parts of the home should be well maintained, safe and furnished including improvements to the carpet near the office. Staff training should be developed to include training on the specific conditions for which people admitted to Stamford House. The Regulation 26 visits and reports should be in sufficient detail in all areas of the home to be monitored and should identify any areas for improvement and development The results of the homes quality monitoring systems involving the residents and relatives should be analysed and used to develop the home. The homes portable appliances should be tested according to the homes stated timescale. 6 10 7 12 8 16 9 20 10 30 11 31 12 33 13 38 Care Homes for Older People Page 31 of 32 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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