Care Home: Stoke Knoll Rest Home

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• St Vincents
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• Winton House
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What the care home does well Good preadmission processes ensure that people who move into the Stoke Knoll are confident that their needs can be met by the service. Effective care planning means that people have care and support delivered in the manner they prefer. Good medication practices protect the welfare of those living at the service. People living at the home are able to receive their visitors when they want to. One relative stated that they are very happy with the care provided, the food is good and the staff are very caring. What has improved since the last inspection? The service has employed a cook. What the care home could do better: Residents would like more activities, and records need to be kept. Externally the service appears shabby, a window pane was broken and paint chipped/stained. Most windows need restictors fitted to ensure resident`s and visitors safety. Some carpets need replacing as they are worn and stained and some bathroom suite facilities need refurbishing so they can be used. The provider must ensure there are adequate sluice and hand washing facilities. The provider must ensure staff are fully trained and records of training received are kept. All staff must receive regular supervision and annual appraisal. Receipts should be kept when residents have paid for hairdresser and chiropodist. Provider visits need to be more effective in identifying and rectifying maintenance issues. Residents and staff need an opportunity to have their views and opinions known. The registered manager should make sure the improvements are appropriately planned. This will help to ensure they happen. Key inspection report Care homes for older people Name: Address: Stoke Knoll Rest Home 142 Church Road Bishopstoke Hampshire SO50 6DS     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: Tracey Horne     Date: 2 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 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 30 Information about the care home Name of care home: Address: Stoke Knoll Rest Home 142 Church Road Bishopstoke Hampshire SO50 6DS 02380612402 02380666867 stokeknoll@northovergroup.co.uk www.northovergroup.co.uk Mrs Heather Northover,Mr Roy Northover Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Mary Law Johansson Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Mental Disorder, excluding learning disability or dementia - MD Date of last inspection 0 0 0 Over 65 25 25 25 Care Homes for Older People Page 4 of 30 Brief description of the care home Stoke Knoll is a rest home providing care and support to twenty five elderly men and women with age related conditions such as dementia and mental illness. Mr & Mrs Northover who are the providers, own the service. The building is an old Victorian house built over three floors with an adjoining two-bedroom cottage and large enclosed garden. The service is situated in the locality of Bishopstoke on the outskirts of Eastleigh shopping centre and train station. The area offers pleasant walks, public houses, local shops and small rivers. Care Homes for Older People Page 5 of 30 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 purpose of the inspection was to assess how well the service is doing in meeting the key National Minimum Standards (NMS) and Regulations. The findings of this report are based on several different sources of evidence. These included: We considered information received about the service since the last Key Inspection (KI) 28/02/08 and Annual Service Review (ASR) 16/01/09. We looked at what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. A visit to the service by a Regulatory Inspector and a Regulatory Manager. This took place on the 21 January 2010 between 09:30 and 16:30. Care Homes for Older People Page 6 of 30 We looked at documentation relating to four residents and six staff. We spoke with the registered manager, six staff members, one social care professional, three residents and one person who was visiting their relative. We also spent time in communal areas observing interactions between staff and residents. We spent time looking at records such as pre admission assessments, care plans, medication records, staff recruitment and training files and records of complaints and compliments. Care Homes for Older People Page 7 of 30 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. Care Homes for Older People Page 8 of 30 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given accurate information about the service and their needs are known before they move in. This helps them make a choice about whether the service will be suitable for them. People can be as sure as possible that the service will be able to meet their needs. The service provides intermediate care when it has capacity Evidence: We looked at the assessment records of four residents who had been admitted recently. They all showed that comprehensive assessments had been completed prior to admission by the registered manager and or her deputy manager. The individuals relatives or representatives were involved in the process to gather as much information about the person as possible. Such as individuals preferred routines, religion/spirituality, interests and dietary requirements. The assessments also identified any potential risks, such as a history of falls, and what steps would need to be taken to minimise them on admission, such as specialist equipment or the need for Care Homes for Older People Page 11 of 30 Evidence: two staff to provide support when transferring. We spoke to a social worker who was visiting a resident, she said she has placed several residents at Stoke Knoll. She confirmed that a member of staff assesses all prospective new admissions and arrangements are made for them to visit the service as many times as needed prior to making the decision to move in. The social worker did say that recently there has been an improvement in how proactive the service is at providing care of residents, and that staff take heed of advice given from professionals who visit. Health and social care professionals are fully involved in resident assessments, and contribute to the initial care plan. We spoke to three members of staff, all agreed to being given information about peoples needs, which enables them to provide the care the person needs. One relative recalled receiving a contract and information about the service before their relative moved in which enabled them to decide if it was the right place for them. We spoke with one relative who confirmed that they felt that the service meets the needs of all the residents, as they have observed during their visits, which are almost every day. The manager confirmed the service would only provide intermediate care if there was accommodation, equipment and staff available to meet the short term needs of an individual. Care Homes for Older People Page 12 of 30 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. Residents who are able are involved in the development and review of their care plans. Records show that residents personal and health care needs are being met. The services processes for storing and handling medication protect residents. Residents privacy and dignity is respected. Evidence: We looked at the care plan records of four residents, they included information about their personal hygiene, mobility, medication, body mapping record which is used to monitor the condition of the skin, weight and nutritional needs. We spoke to three residents, none of whom appeared to be aware that they had a care plan or contributed to it. Staff who are not always directly involved in care planning, stated that they would refer to individual care plans to ensure that residents needs are met. We spoke to three recently admitted residents who all stated that they had settled in well, and were happy with the routine and the general level of care given. All three individually agreed that staff would listen to their needs and take steps to ensure that they were met. Call bells were always answered in a reasonable time. A visiting social worker stated that the staff are prompt in referring residents to appropriate health Care Homes for Older People Page 13 of 30 Evidence: and social services. Daily records showed that residents had access to health care services such as Doctor, District nurse, chiropodists and dentists. G.Ps visit the service regularly to see anyone with minor health issues. One relative confirmed residents can see the doctor whenever they wished. The managers office and medication storage cupboard was accessed through the staff room, none of the doors could be locked. It was noted that the temperature gauge on the drug fridge was broken. We were advised that arrangements had been made to replace this fridge. The metal filing cabinet housing both resident and personnel information is not kept locked. Steps are not routinely taken to ensure that confidential information is held securely. All staff we talked to agreed they receive training that gives them enough knowledge about health care and medication. All medication is administered by staff who have received additional training in medication administration. Medication records are regularly reviewed by by a senior member of staff to ensure they are completed correctly. Two residents we spoke with said they were happy with how they received their medication. We looked at some medication administration records (MAR) sheets, which had been completed correctly. At the time of this inspection no resident manages their own medication. We saw many interactions between staff and residents. All of which were appropriate and valuing of the resident. Care was given in a discreet way and the assistance we saw at lunch time was given in an unobtrusive manner. Staff ensured that residents were treated individually and were given time to make their own choices such as what drink and eat. We could see that staff always knocked on residents bedroom doors prior to entry and spoke in a respectful manner to residents. There were no fixed curtaining around the beds of shared rooms but we could see portable screens were available. Staff stated that these were always used to promote the privacy and dignity of residents. It was noted that there was a clearly visible list of resident names attached to the door of a cupboard in a main corridor highlighting the names of each resident who used incontinence pads. Care Homes for Older People Page 14 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service would benefit from the opportunity to take part in more meaningful activities. Residents are able to exercise choice and control over their life, and benefit from a varied and healthy diet. Evidence: There was a dedicated notice board holding largely outdated local information and advertising various past activities that may have occurred. However, there was no current activities time table or planned program and no evidence of what was or had been recently available for residents. The service did not employ an activities coordinator but generally relied on staff availability and willingness to arrange activities. Several residents stated that they wished there was more to do other than watching the television or listening to background music. Up until lunch time on the day of our visit, most residents were sat in the lounge. The television was on and staff were seen making the occasional conversation with a few residents. Staff stated that external entertainers came to the service several times a month. During the afternoon of our visit, a male singer had arrived to offer organised entertainment which the majority of residents were engaged in and enjoying. Those who did not want to join in were able to spend the time quietly in their rooms. A minister from a local church visited fortnightly and staff reported that other denominations would be contacted to Care Homes for Older People Page 15 of 30 Evidence: visit should the need arise. Staff said that residents were not able to access the local community due to lack of staffing and transport. Three residents stated that they would like to go out occasionally but that only those who had visiting friends and relatives willing and able to take them out had that opportunity. There were three care staff on long term sick leave or on maternity leave. There was a weekend cook vacancy. Staffing levels have been regularly supplemented with agency staff, although steps have been taken, where possible, to use agency staff that were already familiar with Stoke Knoll. However staff stated that this limited time available to arrange activities particularly at weekend and that there was a reliance on the limited external entertainers to occupy the residents. Residents and staff said that visitors are welcome in the service at any reasonable time. This was supported by entries in the visitors book held in the entrance hall, and a relative confirmed they are made to feel welcome whenever they visit. There was a large dining room with sufficient space for all residents to eat their meals together. Staff were seen to be assisting those who required it, both to get to the table and to eat their meals. There was ample food available. Staff stated that menus are planned on a rolling monthly program and that residents are not involved in choosing menu options. However, it was stated that the staff knew what the residents liked and disliked and that these would be accommodated, and residents were asked their choice between two main meals for the following day. One resident who required a special diet stated that she only ate the part of the meal that she was allowed and that there was not always a substitute available for her. Fruit could be requested at any time to supplement the diet. There was a full time cook employed weekdays only and all food was freshly cooked on the premises. At the time of the inspection the registered manager stated that she was trying to recruit a weekend cook as at present care staff had to prepare and cook all meals on Saturdays and Sundays. We could see that there were sufficient quantities of fresh fruit and vegetables in the kitchen and an appropriate range of dried and tinned foods in storage. Care Homes for Older People Page 16 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live and visit the service would benefit from an accessible complaints procedure. Residents would be fully protected if the staff team has a good understanding about safeguarding procedures. Evidence: There was an appropriate complaints policy in place but it was not readily available to residents and visitors to the service in an accessible format. We spoke to two residents, both stated that they would make verbal complaints to staff where necessary and sometimes changes were made as a result. Feedback was not generally provided by staff following a verbal complaint and was not routinely recorded in a log. The registered manager said any concerns made are usually recorded in the file of the resident it relates to. There were no resident meetings arranged and no formal processes in place for residents to contribute to or comment on the running of the service. We spoke to a total of five members of staff, all said they would pass on any verbal complaints made by residents in an informal manner. There was a whistle blowing policy in place and all stated that they would readily report any instances of poor care practice to a senior member of staff and feel confident that appropriate actions would be taken. Four members staff said that they had not undertaken safeguarding training and were unfamiliar with the services policy or the reporting arrangements through established local social service department channels. Care Homes for Older People Page 17 of 30 Evidence: A requirement was made in the staffing section of this report, under standard 27 Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are needed to ensure residents live in a safe and comfortable environment, which is suitably maintained Evidence: Situated in a rural location, access to Stoke knoll using local public transport is limited, but there are good local roads and nearly motorways. Stoke Knoll has a sloping drive which is readily accessible by wheel chair users. There is limited car parking on the front drive supplemented by local road side parking. It was observed on approach to the service that one window pane on the first floor was broken and boarded up and another window was propped open with a toiletry container. The front drive to one side required the sweeping up of accumulated debris. The external decor was in need of redecoration in multiple places. The yellow clinical waste hopper did not have a lockable facility. There is good access to a large garden mainly laid to lawn with a patio. We could see that there were a range of significant and unacceptable environmental risks and hazards observed inside the service and there were multiple instances where the general decor required remedial work such as chipped paint and woodwork. The service lacked a comprehensive maintenance plan. Regular provider visits were made to Stoke Knoll, in line with regulation 26 of the Care Standards Act 2000, and a tick box form completed which repeatedly neglected to identify long term and arising environmental concerns and did not acknowledge the need for remedial works to be undertaken. We could see that the last three reports recorded inspected Care Homes for Older People Page 19 of 30 Evidence: and found to be satisfactory against all areas. The service was seen to be clean and tidy and adequately furnished throughout. We looked around the building and could see that there were a range of single and shared resident bedrooms, with the majority lacking en suite facilities. These rooms were generally personalised. Commodes were available in most rooms and were routinely used by residents during the night. Several rooms smelt strongly of urine. There was no static curtain screening around the beds in single or shared rooms but portable screens were available in shared rooms. Staff stated that these were always used to ensure the privacy and dignity of residents. In one bedroom it was noted that a radiator which was too hot to touch did not have a cover on it. The residents bed had been place against this radiator. It was in this room that one small window pane had been broken and had been roughly boarded up. Jagged pieces of glass could be seen on the external window ledge below. Staff advised that this window had been broken since October 2009. The window on the other side of the room was seen to be propped open with a toiletry container to prevent it from slamming shut. We were assured that the radiator would be covered and the glass would be replaced as a matter of urgency. Although a minority of windows had been recently replaced the majority remained in a hazardous state. Many could only remain open if propped in some way and several were observed to be kept open with toiletry containers or a toilet roll wedged underneath. The windows were heavy and presented a danger of slamming down. There were few protective window restrictors. We were assured that all windows that did not have sufficient restrictors would be replaced. There were multiple areas of soiled carpeting. We made a requirement for the building to be in a good state of repair inside, and out. In another shared bedroom we observed an exposed wire where an overhead wall light had been. The manager was asked to check whether this wire was live. Assurance was later given that it was not. A toilet which the manager stated was actually designated for resident use was situated on the lower ground floor accessed by a flight of steps which were protected by a stair gate. Staff lockers were in evidence in the lobby outside. This toilet was observed to be in a poor environmental state and we were advised by the manager that it had needed significant remedial work for a long time. There was a hoist in the main general bathroom on the first floor that could not be used with that particular bath. The registered manager said it was there because there was no where else to store it. The registered manager said that a shower room on the first floor doubled as the sluice, and was used for emptying commodes. The sink was not appropriate for this use and the storage cupboards below were missing. There were no hand wash facilities and there was a communal hand towel which could harbor germs. We made a requirement for the provider to ensure there are adequate sluicing and hand washing facilities for staff to use. A larger general bathroom on the ground floor had good access. Beside this bathroom Care Homes for Older People Page 20 of 30 Evidence: was a large cupboard used to store incontinence pads. Hanging on the door was a list of names of residents (clearly visible to everyone) who required incontinence padding. The registered manager said it would be removed. A large dining room, next to the lounge is where residents can gather both at meal times and for recreation purposes. The laundry room has good facilities, care staff carry out laundry work as part of their duties. A cellar accessed from the main corridor is protected by a lockable door. However the key hangs visibly on a hook beside the door. The cellar is accessed by a narrow flight of stone steps which were covered in fine debris and dust. On one side was a large walk in store of hazardous cleaning fluids. On the other side was a similar sized walk in room used for the storage of dry and tinned foods. The lobby between these store cupboards smelt strongly of damp and the external wall observed to be very moist. Staff stated that in heavy rain the entire cellar area becomes flooded. Care Homes for Older People Page 21 of 30 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. Training is not sufficient to ensure staff receive the knowledge and skills needed, to provide care and support to residents safely. Residents need to be confident that the quality of care provided is continually being reviewed. Recruitment practices ensure residents safety. Evidence: The manager said that there were three members of staff on long term sick or absence leave. Steps are taken to ensure that the same agency staff who are already familiar to the service and the residents are used in preference. Several staff stated that they consistently worked more than ten hours a week over their full time contracted hours. Staff we spoke with expressed a loyalty to the service and the residents and said that there was a good team spirit. Most staff members had worked consistently at the service for long periods of time. We looked at the files of six members of staff, and we spoke with four staff. We could see that a range of training had taken place in the last year, such as moving and handling, dementia care and fire training. However, not all staff have been able to access these training opportunities. There was evidence of a comprehensive induction program in place though not all had been completed. There are insufficient numbers of staff who have completed first aid training to ensure that a nominated first aider is on duty for each shift. There are adequate numbers of staff who have completed or are Care Homes for Older People Page 22 of 30 Evidence: currently completing NVQ level training. None of the staff we spoke with had been provided with safeguarding training. All staff expressed their confidence in being able to raise issues of poor practice with the manager and that such issues would be readily addressed. However, none of these staff had been provided with safeguarding training and were very vague in their knowledge about local external safeguarding reporting arrangements or their responsibilities for reporting. A requirement was made for staff to receive first aid and safeguarding adult training. Staff said they are supported to gain their NVQs in Care (National Vocational Qualification). This means that they have an increased skill and knowledge base which may mean they are able to deliver an increased quality of care. All files seen had a completed application form with full employment history, terms and conditions of employment and evidence of Criminal Records Bureau (CRB) and POVA (Protection of Vulnerable Adults) checks having been undertaken. Only some files held a photograph of the member of staff and other evidence of identification. Three of the personnel files did not hold two appropriate references. There is an appraisal system in place but there was no evidence seen of appraisal activity in the last three years. The service lacked a robust supervision framework and there was limited evidence of supervision notes seen, and none more recent than two years ago. None of the staff we spoke with could remember when they had had an appraisal or updated personal development plan. A requirement was made to ensure all staff receive regular supervision and annual appraisal. None could remember the last time they had received supervision. All staff stated that there was a shortage of staff due to long term sickness and a reliance on agency staff to fill in. Steps were currently being taken according to the manager to recruit a weekend cook. Regular staff meetings are not taking place. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a service that is not managed effectively in seeing the views of those using the service to influence its development. Robust procedures ensure that the finances of people using the service are protected. Resident and staff records are not stored securely. Health and safety practices need to improve to protect all people at the service. Evidence: There is a registered manager and deputy manager in place who have been in post for a long period of time and offer stable management to the service. The manager stated that she is only counted as part of the core staff in the early mornings but is generally supernumerary. She stated that she uses this time daily to talk on an individual basis to residents to ensure that they are happy with their care and life within the service. Two members of staff have been on long term sick leave which has put pressure on the core staff to provide a good and consistent standard of care to the residents. The staff rota showed that there is a dependency on agency staffing to supplement staff numbers, but all shifts have been adequately covered. The manager stated that she Care Homes for Older People Page 24 of 30 Evidence: takes steps to ensure that the same agency was always used and that agency staff who were already familiar to the service were used in preference. Currently the manager is taking steps to recruit a weekend cook. The manager acknowledged that there had been some slippage recently in undertaking appraisals, personal development plans and providing supervision. Though there are no regular staff meetings the manager stated that she was always available to staff to discuss arising issues and there was a message book for use when she was not available. A range of training had been made available to some staff but the manager should ensure that all staff are provided with the full and appropriate range of mandatory and update training opportunities with the time for staff to access them. The manager confirmed that residents expenses are paid for by the service and an invoice is sent to the residents relative or representative. Records of all transactions are kept. We looked at the records for three residents, receipts were not available for residents that had paid for having their hair done and for seeing the chiropodist. The registered manager said receipts will be given from now on. This will provide a clearer audit trail of residents money. As mentioned throughout this report, we have concerns that confidential information is not being stored securely. We made a requirement to ensure that this is rectified, to safeguard residents and staff. A maintenance coordinator ensures all equipment and utilities are regularly serviced. Weekly tests were completed for fire alarms and fire doors. Fire drills are carried out at least monthly. The health and safety of services users and staff are not always maintained due to the environmental risks detailed earlier in this report. Environmental risk assessments including the Regulation 26 visits failed to highlight all obvious risk and steps have not always been taken in a timely fashion to ensure that remedial works are undertaken. There are no resident meetings and limited evidence as to established mechanisms in place to ensure that their voices are heard and that they are able to positively influence their lives. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 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 16 22 The provider must ensure 23/03/2010 service users and any person acting on their behalf have access to the complaints procedure. To make sure everyone is aware of how to make a complaint. 2 19 23 The provider must ensure the service is in good state of repair, internally and externally. To provide people living there with a safe, comfortable environment. 23/03/2010 3 21 23 The provider must ensure appropriate sluicing facilities are available, separate from residents toilet and bathing facilities. 23/03/2010 Care Homes for Older People Page 27 of 30 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 waste can be disposed of appropriately, without risk of cross contamination. 4 27 13 The provider must ensure all 23/03/2010 staff receive training in first aid and safeguarding adults. To ensure the health, welfare and safety of residents and staff. The registered person must ensure that all care staff receive supervision at least every three months and have their standard of practice appraised annually. To review and monitor the quality of care being delivered to residents. 6 33 24 The provider must ensure there is an effective quality monitoring system. To ensure residents and staffs views of the conduct of the service are sought The provider must ensure records relating to residents and staff are kept securely. 23/03/2010 23/03/2010 5 30 18 7 35 17 23/03/2010 So that confidential information about people is safeguarded. Care Homes for Older People Page 28 of 30 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 Care Homes for Older People Page 29 of 30 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 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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