Care Home: Stinchcombe Manor

Similar services:

• Fairfields Country Rest Home
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma
• Hunters Care Centre
• Manor Lodge

What the care home does well The home has a system in place to make sure people are assessed prior to admission so they are able to provide confirmation that they can meet peoples assessed needs. The feedback we received from people during the inspection and from surveys is that they are all happy with the standard of care they receive from the staff at the home. The home offers people a range of activities that they are able to take part in if they so wish. People and staff said that they are able to express any concerns they might have with the Registered Manager as she is very approachable and supportive. The home has a continued refurbishment plan in place that will greatly improve the environment for people. People spoken with at the inspection and from the feedback we received from surveys all praised the staff saying they are friendly and helpful. People all said the food provision is very good and people said they are offered choices at each mealtime. What has improved since the last inspection? This is the first inspection for the new Registered Provider. What the care home could do better: The home has plans in place to transfer all care records onto a new format. To make sure the home meets the Care Home Regulations 2001, care plans must contain specific information for staff to follow and peoples own choices and preferences. Unsafe recruitment practices may place people who use the service at unnecessary risk. Key inspection report Care homes for older people Name: Address: Stinchcombe Manor Stinchcombe Glos GL116BQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sharon Hayward-Wright     Date: 2 5 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Stinchcombe Manor Stinchcombe Glos GL116BQ 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Stinchcombe Manor Ltd Name of registered manager (if applicable) Miss Joanne Elizabeth Howells Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users that can be accommodated is 36. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Stinchcombe Manor is registered to provide nursing care for up to 36 older people. The home is situated in the village of Stinchcombe near to Dursley and is 20 miles from Gloucester and Bristol. The accomodation is spread out over two floors and access to the upper floor is provided by 2 shaft lifts. The home has 27 rooms and several of these can be used as shared rooms. Twenty two rooms have en-suite facilities. The Registered Providers are in the process of refurbishing parts of the home to include some of the en-suites. Care Homes for Older People Page 4 of 28 Over 65 36 0 Brief description of the care home The fee ranges for this home are 452.45 pound to 715.00 pounds per week. Information about how the home manages the Funded Nursing Care contribution (FNC) is available. Additional services not included in the fees include hairdressing, chiropody and newspapers. The home makes available to people information about the services provided. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out by one inspector over two days in August 2009. Before we visited the home we sent surveys to the home in order to obtain the views of people who use the service and staff. We received four back from people who use the service and one from a member of staff. The results of these have been used in the report. We requested an Annual Quality Assurance Assessment (AQAA) prior to this inspection. We received it on time and it contained detailed information about how the home feels they are meeting the needs of people who use the service and any plans for areas they wish to improve over the next 12 months. The AQAA also contains Dataset which is numerical information. We looked at other information we have received from or about the service from other Care Homes for Older People Page 6 of 28 stakeholders. This includes where the home notifies us of any incidents that affects the well being of people who use the service. We looked at a number of systems the service has in place to include care records, activities, food provision, staff supervision and training, complaints, medication and maintenance records. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an admission procedure in place that involves providing prospective people with information about the service and undertaking an assessment of their needs to make sure their needs can be met. Evidence: This is the homes first inspection under the management of a new Registered Provider. The AQAA states that any new proposed person would receive an enquiry pack that contains a copy of their Statement of Purpose and Service Users Guide. The Registered Manager confirmed that all people who use the service have received a copy of the Service Users Guide. The Registered Provider said they are working on their website and plan to include a virtual tour of the home. The Service Users Guide contains information about how people can access additional services and how they would pay for these. The Registered People just need to add into this section that if the person was funded in part of whole by another source other than themselves how it may be any different for them to access and pay for additional services. Care Homes for Older People Page 10 of 28 Evidence: Clear information about how the home manages the Funded Nursing Care Contribution (FNC) for people eligible to obtain this is also include in the Service Users Guide. The Registered Provider said all people who use the service have been issued with new contracts and terms and conditions. We examined the pre admission assessment of a person who admitted to the home in the last couple of months. The assessment was completed by a member of staff who is trained to under this. The person was assessed at a local hospital prior to admission. The assessment contained information about this persons care needs, past medical history and list of medications. The Registered Manager said that a letter was sent to this person confirming the home could meet their needs but this was not viewed. On the day this person was admitted to the home a day profile was completed. This is brief description of this persons care needs and is to assist staff until the care plans are completed in full. This is good practice. The AQAA and Service Users Guide encourage people and their Representatives to visit the home prior to moving in. Standard 6 is not applicable to Stinchcombe Manor as they do not provide intermediate care. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs, however care records do not always contain this information. The principles of respect, privacy and dignity are put into practice. Evidence: The Registered Manager explained that they are starting the process of transferring all peoples care records on to a new format. All new people admitted to the home will now have the new format. We looked at the care of one person in detail. This includes examining care records, speaking to the person if able, speaking to staff and observing interactions between staff and this person. We also examined a number of other peoples care records. Care plans were found to be in place for peoples assessed needs, however they lacked individual care needs. The person who had their care examined in detail had recently been admitted to the home, however their care plans had not been devised for seven to eight days following admission. We would have expected to see care plans in place prior to this and changes made to the care plans as staff got to know this person. We found that a care plan had been devised for a potential problem, which is good practice. However it was written that passive Care Homes for Older People Page 12 of 28 Evidence: exercises should be used but no explanation of what this is was included. Care plans must clearly describe the care needed and any medical terms should not be used. In another care plan for this person it was written to observe for signs of infection, but again no further information about what staff should be observing for. We spoke to three other people who were able to discuss their care in detail and they were all happy with the level of care they receive from the home. One of these people was on a pressure relieving mattress that was set by their weight, but on checking their weight it was found that the mattress was set to high. The Registered Manager altered the mattress immediately. The person who had their care examined in detail also had a pressure relieving mattress on their bed and a seat cushion. We observed the staff making sure they had their seat cushion when sat in the communal lounge which is good practice. One person had a number of creams prescribed and they were able to tell us where the staff used them. However this information was not included in their care records. We spoke to a member of staff in relation to the person who had their care examined in detail and they had excellent knowledge of this persons individual care needs. Risk assessments were in place for moving and handling, falls, nutrition and pressure areas. Hand written risk assessments were also in place but it was found that some of these had not been reviewed for a number of months. People and their care records provided evidence that they have access to external professionals and these include, GPs, Continence Advisors, Chiropodists and Speech and Language Therapists. One person was attending a hospital outpatient appointment with a member of care staff on the second day of the inspection. We asked people in the surveys we sent them, do you receive the care and support you need, three people said always and one person said usually. We also asked does the home make sure you get the medical care you need, three people said always and one person said usually. One person we spoke with said they give the home 9 out of 10. We examined the medication system used by the home. Only registered nurses administer medication. The new Registered Provider has had fitted two new clinic rooms one on each floor to help with storage of medication. A trolley is used to transport the medication around the home. The ground floor clinic room is at times over the recommended manufactures temperature for the storage of medications, however an air conditioning unit is in the process of being obtained. Each person normally has a front sheet that contains a photograph and any details about any allergies. The home has a form in place that is based on some of the principles of the Mental Capacity Act 2005 for each person and this contains for example where people Care Homes for Older People Page 13 of 28 Evidence: would like their medication administered and any special requests, as one person likes to have a glass of water and a biscuit. The home had just started new Medication Administration Records (MAR) and at the top of these the staff had written checked against previous MAR. No gaps were found in the recordings of medication administered. One person has a catheter and it was recorded on their MAR the next date the catheter would need to be changed, however it was over the recommended 12 weeks and the Registered Manager checked and amended the date. Dates of opening were seen on boxed medication and creams. We found that the home has a large number of people prescribed nutritional supplements. We discussed with the Registered Manager and Provider ways to look at introducing additional calories and protein into peoples diets without always using supplements. A new homely remedy procedure is due to be introduced once it has been checked an signed by peoples GPs. Records were in place for medications received into the home, administered and a specialist contract is in place for any medications that need to be returned. The home has several people that require controlled medication and auditing of this is taking place in the home. We also checked this with the Registered Manager and the records and quantities of medication were correct. We observed part of a medication round and we observed the registered nurse using a safe procedure. A medication policy is in place but we did not examine this in detail and a medication reference book but this was dated 2007 and we would suggest a more up to date book is available for staff. As previously mentioned some care plans require more details and that was also the case for care plans for prn or as required medication. We did not examine the procedure the home has in place for people who are able to selfmedicate. We observed staff speaking to people in a respectful manner and knocking on peoples bedroom door prior to entering. We also asked people if staff respected their privacy and dignity and all people said yes. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their daily life and have access to an activities programme based on their individual expectations. Evidence: The home has an activities coordinator who works 4 days per week. She provides a range of activities that include group and one to one. Plans are in place to complete life histories on each person and this will help with staff getting to know people and when planning activities. Records are maintained of each activity undertaken and who took part. On the notice board in the lounge is a list of the weekly activities. We spoke to several people who confirmed that activities take place and one person had their nails painted and they said how much the enjoy it. People said they are able to make their own activities and are always offered the choice about whether they join in or not. On one of the the days of the inspection it was one persons birthday and the home had made a cake and people and staff were observed joining in the celebrations with this persons family. People confirmed they have access to a hairdresser and can have daily newspapers delivered. The home has arrangements in place to help meet peoples spiritualist needs. We asked people in the surveys we sent them, does the home arrange activities that you can take part it if you want, two people said usually and the other two people said they choose not take part in the activities provided. Care Homes for Older People Page 15 of 28 Evidence: Visiting to the home is not restricted and we saw visitors throughout out both days of the inspection. Visitors we spoke with said they are free to visit at anytime. The homes AQAA states that visitors are offered refreshments and can also have a meal. During the tour of the home we viewed a number of bedrooms belonging to people with their consent. We observed that some people have brought in items of furniture and smaller items of importance to them. Several people had photographs of family and friends also on display. People we spoke with said they are able to make choices about their daily lives for example where they like to spend their day, if this wish to take part in activities and where and what they would like for their meals. The AQAA states that they have information about advocacy services available. We spoke to one of the cooks and they explained that the home operates on a four weekly menu. People are able to request a cooked breakfast each day if they wish. People are offered choices at each meal and the staff ask people each day what they would like and one person confirmed this. A menu board is in place that lists the all meals for the day. The home is able to cater for people who require a therapeutic diet. Both cooks are also aware of peoples likes and dislikes. We saw evidence that health and safety checks are taking place and food records are also maintained. The kitchen has been awarded 4 stars by the local Environmental Health Department in January this year, which is excellent. Both cooks have completed training in food safety. We observed a mealtime and people are able to choose where they eat their meal. Staff serve people wearing protective clothing and all the meals are also covered. We tried the lunchtime meal on the first day of the inspection and found that it was very tasty and well cooked as the meat was very tender. We asked people about the food during the inspection and they all said it was very good. The Registered Provider and Manager also sample the meals. We were told by people and staff that the home made cakes are excellent and we also tasted one. We also felt they were delicious. We also observed that several people had alternatives to the choices provided on the menu. We found that the meals were well presented and people who required a liquidised diet had each section of the meal liquidised separately which is good practice. People are offered drinks at mealtimes and at intervals during the day. The cook said that people are able to request a snack anytime during the day. We asked people in the surveys we sent them do you like the meals at the home, two people said always and two people said usually. The AQAA states that the home is in the process of devising the menu in a picture format to help people with communication difficulties. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a complaints procedure. A system is in place to help safeguard people from possible risk of harm or abuse. Evidence: The Registered Manager said the home has not received any complaints since the new Registered Provider has taken over the running of the home. The Registered Manager operates an open door policy for people, their representatives and staff. A copy of the homes complaints procedure is displayed on the notice board in the main entrance of the home. The Registered Manager said that Representatives of people have also been sent a copy of the complaints procedure. People we spoke with said they did not have any complaints and they would speak to a member of staff or the Registered Manager if they had any concerns or complaints. We asked people in the survey we sent them, is there someone you can speak to informally if you are not happy, all four people said yes and they also know how to make a formal complaint. The home has policies and procedures in place in relation to safeguarding people and these include whistle blowing, abuse, missing persons and restraint. Staff are able to access these on computer disc or paper copies. The Registered Manager has undertaken the local County Councils enhanced safeguarding training and the Registered Provider is booked on this training. All staff have undertaken training about safeguarding using a DVD and questionnaire Care Homes for Older People Page 17 of 28 Evidence: however plans are in place to start booking staff on the local County Councils alerters guide training. The home is looking to provide in house training about the Mental Capacity Act 2005 prior to sending staff on the local County Councils training. Both the Registered Manager and Provider are booked on courses for Mental Capacity Act 2005 and Deprivation of Liberty and also 1 qualified nurse. The home have not referred any people who use the service to the Adult Protection unit at the local County Council. No staff have been referred to the Protection of Vulnerable Adults list (POVA). Staff spoken with confirmed they have undertaken training in safeguarding people and would inform the Registered Manager if they thought people were being put at risk of abuse. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. With the continued planned refurbishment of the home people will live in a comfortable and safe environment. Evidence: Stinchcombe Manor is not a purpose built nursing home but aids to assist people have been provided and these includes a shaft lift, assisted bathing facilities and hand rails. We undertook a tour of the environment with the Registered Manager and Provider. Plans are in place to refurbish a number of areas in the home. To enable people to have access to all parts of the home especially the drawing room a ramp is being removed and replaced with stairs and a fold away wheelchair lift. Some en-suites are also being refurbished and one that has been completed was viewed; it has now become a wet room and is a great improvement. Two clinic rooms one on each floor have been added to help with the storage of medications. A new staff room has also been identified. The laundry area has been upgraded and is much improved. A system is in place for staff to manage soiled linen. Redecoration of a number of areas has taken place and is also continuing which will greatly improve the environment for people. The Registered Provider said that they have also had work undertaken on the electrical systems to make sure people are not placed at risk. A new fob entrance have been installed on some doors. A chicken house has been provided outside and the home is waiting for delivery of its chickens. Plans are also in place to look at providing people with raised beds in the garden where they can grow vegetables. Care Homes for Older People Page 19 of 28 Evidence: During the tour of the home we viewed a number of bedrooms belonging to people and we saw they had their personal belongings on display. We asked a number of people if they were happy with their rooms and people said yes. The Registered Manager said that some new profiling beds have also been purchased. We found that in certain areas of the home the cleanliness was not very good, as we found visible debris on the carpets that was present for both days of the inspection. We also found that cleaning products were left unattended in one of the bathrooms on the upstairs floor whilst the domestic was downstairs hoovering. This is bad practice as it places people who use the service at risk and all cleaning products need to be stored securely at all times. We asked people in the surveys we sent them is the home fresh and clean, one person said always and three people said usually. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is confident that the numbers and skill mix of staff are meeting the needs of people who use the service. However unsafe recruitment practices places people who use the service at unnecessary risk. Evidence: The duty rotas were examined with the Registered Manager and Provider. Both feel that the numbers and skill mix of staff on duty are meeting the needs of the people who use the service. Once the numbers and dependency levels of people increase a review of the staffing will take place. Ancillary staff are available to support the care staff. Very positive comments were received from people at the inspection about the staff with people saying they are friendly and helpful. One person did comment that there has been a lot of staff changes recently but this has now stopped but it takes time to build a rapport with the new staff. The Registered Provider said they have had staff changes and now the staff are getting to know each other and working well as team. We asked people in the surveys we sent them are the staff available when you need them, three people said always and one person said usually. We also asked, do the staff listen to you and act on what you say, two said always and two said usually. Comments we received include I have been here 11 years and I am very happy with all the staff and the care they provide, I think the home provides good care, the team of staff I see regularly are very nice and The staff are very good, they help me when I want help and they are all friendly, I like to have a laugh and the Care Homes for Older People Page 21 of 28 Evidence: staff make me laugh. Staff spoken with said they enjoy working at the home and they have a good team. The home exceeds the recommended 50 percent of care staff with or working towards an NVQ 2 or above in Health and Social care, which is excellent. The recruitment records of three staff that have started work at the home since the new Registered Provider has taken over the running of the home were examined. None had a full employment history therefore any gaps in employment cannot be examined and the reasons for any gaps verified. Information regarding a statement of their health was obtained after they started work at the home for two staff members and the third member of staff had not signed or dated theirs. Two members of staff had started work at the home prior to their Protection of Vulnerable Adults check (POVAfirst) being returned, this is poor practice and places people who use the service at risk. One member of staff had not started at the home until their full Criminal Records Bureau Disclosure(CRB)had been returned which is good practice. Risk assessments need to be in place for staff that start work at the home without a full CRB being returned and they must be supervised be supervised at all times. The home should consider date stamping references when they are returned to make sure they have evidence that the home received them prior to the member of staff starting at the home. Interview records are maintained. Following the inspection the Registered Provider contacted us stating that the Registered Manager will be undertaking a training course in this area. The Registered Manager said the home uses induction booklets based on the Common Induction Standards and one booklet was examined. The Registered Manager and the registered nurses supervise new staff and this is recorded in the staff records. The Registered Manager has met with a Representative from the local County Council regarding training requirements for the staff and the home is looking to start to book places for staff on these courses. All mandatory training for example infection control, moving and handling has been provided in house but they are looking to access training from external training companies. The Care Home Support Team have provided training for nearly all care staff on dementia and person centered care. As the home has a large number of new staff training is very much ongoing. A training matrix is in place and copies of certificates are kept of any training staff have undertaken. Staff spoken with confirmed they have access to training. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of this home is undertaken by a qualified and competent manager who makes sure the home is run in the best interests of people who use the service. Evidence: The Registered Manager has been working at the home for a number of years and she is a qualified nurse and has undertaken the Registered Managers award. She has also undertaken a number of other courses relevant to the home. At the present time the Registered Manager is undertaking a course in dementia awareness. The new Registered Provider has been running the home since February 2009 and has experience of running care homes. People and staff spoken with said the Registered Manager is very supportive and approachable and they would speak to her if they had any concerns. A deputy manager is also in place and manages the home in the absence of the Registered Manager. The Registered Manager said they have not as yet sent out to people and their Care Homes for Older People Page 23 of 28 Evidence: Representatives full quality assurances questionnaires. However they have sent out a tick box survey but have had a limited response. Some auditing if taking place but the Registered Manager said they are looking to expand this area. Regulation 26 visits (where the Registered Provider undertake unannounced monthly visits to the home and completes as assessment of the service) are taking place when the Registered Provider is not spending periods of time at the home. The home purchases their policies and procedures from a specialist company and they are automatically updated. We received the Annual Quality Assurance Assessment (AQAA) on time. It contained details about what the home feels it has achieved in the time the new Registered Provider has been running the home and their plans for improvement for the next 12 months. Training in the Mental Capacity Act 2006 and Deprivation of Liberty is in the process of being planned for all staff. The home has a safe system in place for the storage and management of peoples monies. The Registered Manager has a system in place to manage staff supervision. A plan is in place for when staff are due supervision. The recommended six sessions per year is on target to be met and some staff have additional sessions. Appraisals also take place yearly. We randomly selected several staff supervision sessions and records are in place of each session signed by the member of staff. Ancillary staff also receive yearly appraisals. We would recommend that qualified nurses have some clinical supervision to make sure their skills are up to date. The AQAA contained information about the servicing of equipment and services in the home. We saw records of monthly and weekly checks that include fire equipment. We saw records of fire drills and training for staff. The fire risk assessment needs to be reviewed and an evacuation procedure for each person who uses the service needs to be devised. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 13 The registered persons must 02/10/2009 make sure that all cleaning products are stored securely at all times. This will help to reduce any risks to people who use the service. 2 29 19 The registered persons must 30/10/2009 make sure that all the required recruitment checks are undertaken prior to a new member of staff starting work at the home. This will help to make sure that people are not placed at unnecessary risk. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Medical terms should not used in care plans and if care plans require staff to observe for signs of infection for Care Homes for Older People Page 26 of 28 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 example, then specific details of what staff need to observe for should be recorded. 2 3 7 9 Care plans need to contain specific personalised information about peoples needs. The home should look at how they can introduce extra calories and protein into peoples diet without always using prescribed supplements. References should be date stamped so that the home can provide evidence that they were returned prior to the member of staff starting work at the home. Risk assessments should be in place for all staff that start work at the home without a full CRB in place. 4 29 5 29 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!