Care Home: Summer Court Hall Residential Home

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What the care home does well People are supported with their personal care in a way that reflects their individual personalities showing them as different people with choices in their daily lives. People are able to have their family and friends visit them in the home, with this being at times that they chose. This helps to maintain relationships that are important to people. People are supported by a staff team that on the whole they appear to have positive relationships with and were the interactions are appropriate. People are supported through systems in the home that help them, if they wish to raise a concern or complaint, and were these systems enable these to be dealt with appropriately ensuring that people are confident that their views will be heard. What has improved since the last inspection? The acting manager has undertaken a large amount of work to improve the quality of the record keeping and standard of care for the people who live in the home. Consequently the Statutory Requirement Notices which were issued to the service have now been met and further legal action in relation to these Statutory Requirement Notices is not being considered. There are now assessments and care plans in place that reflect the needs of people who live in the home and how these needs are to be met. With clear instructions for the staff team on the actions that they should take to support people. The care plans now include detailed risk assessments that identify if people are at risk, for example with moving and handling. The risk assessments include instructions for the staff team, with these details being reviewed on a monthly basis to ensure that the staff are aware of the latest needs/risks to people and how these are to be met. People now receive good support to maintain their personal hygiene and this was reflected in people`s appearances. People`s assessments now include the details of the leisure activities that they enjoy and some of these activities are now provided to help in the meeting of these needs. Additionally assessments now include details of when people require support with particular behaviours and how this support is to be offered by the staff team. The medication systems have now improved in the home and the records for this reflect that the systems are now kept up to date. Consequently people now receive their medication in a timely manner and medication is not allowed to run out of stock. People now live in a home that is more comfortable and homely. Some of the carpets and furniture has been replaced, with additional lighting installed. Areas of the home have been decorated and the home is clean throughout , this is positive for the people who live in the home and makes it more comfortable. Staff have undertaken some training and development to support people in the home. This includes some mandatory training and training on how to support people with needs relating to behaviours. This helps to ensure that people`s needs are fully met. What the care home could do better: People who have needs relating to dementia should be supported by staff who have received training in this. This will help to ensure that their needs are fully understood by the staff and that these are fully met. Additionally the staff should be deployed in a way that ensures that people who live in the dementia unit receive the correct support at mealtimes and the meeting of their nutritional needs, and that leisure activities are organised so that these needs are met. People`s care plans should be consistently completed to ensure that staff are aware of the latest and correct information relating to them and their needs, reducing the possibility for confusion or error. The assessments that show that people have a specific need, that might normally require the support of specialist equipment, but on this occasion do not need this support, should be clearly recorded in their plan of care, showing how this person`s needs are met without this support and how this decision was made. Key inspection report Care homes for older people Name: Address: Summer Court Hall Residential Home Football Green Hornsea East Yorkshire HU18 1RA     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: Sarah Rodmell     Date: 2 8 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 31 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 31 Information about the care home Name of care home: Address: Summer Court Hall Residential Home Football Green Hornsea East Yorkshire HU18 1RA 01964532042 01964532042 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hexon Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The Home may admit up to 37 service users when the building works are completed and a Certificate of Completion issued under the Building Act 1984 Building Regulations Date of last inspection Brief description of the care home Summer Court Hall is located in the seaside town of Hornsea on the coast of the East Riding of Yorkshire, close to all local amenities. It has parking facilities for several vehicles. The home is registered for thirty-seven older people, a maximum of twelve may have dementia and are cared for in a separate area of the home. The home does not provide nursing care. Currently the service is without a manager. Care Homes for Older People Page 4 of 31 Over 65 12 25 0 0 2 3 0 2 2 0 1 0 Brief description of the care home The bedrooms are arranged on both the ground and first floor, with a lift and stairs providing access for residents. The home has a lounge with a conservatory, and a separate dining room in the main part, and a connecting lounge and conservatory in the dementia care unit. There are bathrooms and toilets on each of the floors. The current fees for residents range from £369.99 to £450 a week and are primarily based on their assessed needs. This was correct at the time of the visit and was confirmed to us by the manager of the service. Information is available in the statement of purpose and service users guide. Care Homes for Older People Page 5 of 31 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 quality rating for this service is one star. This means that the people who use this service experience adequate quality outcomes. The inspection report is based on information received by the Care Quality Commission (CQC) since the last key inspection on 23rd February 2010, including information gathered during a site visit to the home. The unannounced visit was undertaken by two inspectors and a pharmacy inspector and lasted 7 hours. On the day of the visit the inspectors spoke with the people who live in the home, visitors, staff and the manager. Inspection of the premises and a close examination of documentation including 5 care plans was also undertaken. At the end of the visit feedback was given to the manager and owner of the home of our findings, including any requirements and recommendations that may be in the key Care Homes for Older People Page 6 of 31 inspection. We have reviewed out practice when making requirements to improve national consistency. Some of the requirements form previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at significant risk of harm. in future if a requirement is repeated, it is likely that enforcement actions will be taken. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? The acting manager has undertaken a large amount of work to improve the quality of the record keeping and standard of care for the people who live in the home. Consequently the Statutory Requirement Notices which were issued to the service have now been met and further legal action in relation to these Statutory Requirement Notices is not being considered. There are now assessments and care plans in place that reflect the needs of people who live in the home and how these needs are to be met. With clear instructions for the staff team on the actions that they should take to support people. The care plans now include detailed risk assessments that identify if people are at risk, for example with moving and handling. The risk assessments include instructions for the staff team, with these details being reviewed on a monthly basis to ensure that the staff are aware of the latest needs/risks to people and how these are to be met. People now receive good support to maintain their personal hygiene and this was reflected in peoples appearances. Peoples assessments now include the details of the leisure activities that they enjoy and some of these activities are now provided to help in the meeting of these needs. Additionally assessments now include details of when people require support with particular behaviours and how this support is to be offered by the staff team. The medication systems have now improved in the home and the records for this reflect that the systems are now kept up to date. Consequently people now receive their medication in a timely manner and medication is not allowed to run out of stock. People now live in a home that is more comfortable and homely. Some of the carpets and furniture has been replaced, with additional lighting installed. Areas of the home have been decorated and the home is clean throughout , this is positive for the people who live in the home and makes it more comfortable. Staff have undertaken some training and development to support people in the home. This includes some mandatory training and training on how to support people with Care Homes for Older People Page 8 of 31 needs relating to behaviours. This helps to ensure that peoples needs are fully met. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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. We looked at standards 3 & 6. Peoples needs are assessed prior to them entering the home to ensure that they can be met once residing there. Evidence: We looked at the files for 5 of the people who live in the home. All of these files contained an assessment of need that identified each persons needs and how these were to be met. This included peoples needs relating to personal care, health and social needs. We saw that one file contained a letter from the manager of the home to the person confirming that following their assessment the home was able to meet their needs. We saw that one persons files also contained a copy of the Local Authority care plan Care Homes for Older People Page 11 of 31 Evidence: and that the details in here matched those of the care plan produced by the service. The manager confirmed to us that the home does not provide intermediate care and consequently standard 6 does not apply. Care Homes for Older People Page 12 of 31 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. We looked at standards 7, 8, 9 & 10. Record keeping has improved and now offers better support to people with the meeting of their needs. Although some inconsistencies remain and these should be addressed for people to receive good support with the meeting of their needs. People now receive good support in the meeting of their health and medication needs. Evidence: We looked at the plans of care for five of the people who live in the home. We saw that where possible people had signed to confirm the content of their care plan. We saw that there are now plans of care that identify the support that people need to live their lives. This includes the level of support that they require with their personal care. We observed that peoples appearances reflect their individuality and that support is provided with this. We noted that records are kept of the support given with personal care and that these records are up to date. One persons care plan included Care Homes for Older People Page 13 of 31 Evidence: information that they require a specialist cream to maintain their skin condition. Details of when the cream is to be applied are recorded in the care plan. The plans of care also included an assessment of the person with regard to their ability to make decisions and the Mental Capacity Act. This had been completed by the manager to determine if people are able to make decisions in the home. We saw that on one occasion the information recorded in here was not consistent as it identified that a person was no longer able to make a decision yet later in their file it recorded that they gave their permission for their medication to be administered by the home. Peoples files included a variety of assessments. These included an assessment to determine the risk of someone developing a pressure sore and the actions that should be taken to help prevent this. Further assessment was undertaken on peoples nutritional risk and if identified as a need people were referred to a dietitian to assist with this. A record is then kept of the individual weight to help identify if there are changes to this that require further assistance from health professionals. Peoples moving and handling needs are also assessed and this included the risk of people falling. However, one person had been identified as at high risk with their moving and handling and when being transfered, yet at low risk of falls. This does not reflect clearly the needs of the individual service user and should be amended. Plans to support people with their behaviours are in place in peoples files. These include some of the details of the triggers for behaviours and how staff are to support people with this. These could be developed further to be more comprehensive. It had been decided that one person would not use a bed rail, yet there was no written assessment for this. The manager was advised that this should be assessed through a formal system with the details of how the decision was reached to be clearly recorded. Risk assessments are also now in place and these include for when people may display behaviours that may place themselves or others at risk. The assessments include some of the details of things that may trigger these behaviours and how staff may deal with this to try to protect people. Other risk assessments included the risk of using steradent and the risk from hot substances. We saw that the assessments were up to date and reviewed by the manager on a monthly basis. Care Homes for Older People Page 14 of 31 Evidence: Daily notes are kept of the lives of the people in the home. The notes reflect the level of support that someone has required and any changes in their lives. It also records when someone has been visited by a health professional or when the home has contacted the health professional on behalf of the individual service user. We saw that on one occasion the notes from the professional were recorded with their visit and not transferred to the care plan, as should be the case. If someone is unwell staff record these symptoms and request that other staff monitor this. There were no recordings made for when the person becomes well again and no longer needs monitoring. This should be recorded to ensure that full support is offered to the individual and monitoring of conditions can easily take place. The manager has completed a large amount of work to improve the care plans in the home and this reflects in the detail held for the service users. The care plans now only require minor amendments to ensure continuity. This includes to ensure that all relevant sections are dated and signed with clear review dates. For example, it is good practice to assess whether an individual has a preference to the gender of the person who will support them and this had been completed in one case but not all and should be completed consistently. A pharmacist inspector spent two hours in the home assessing compliance against a medication statutory requirement notice issued at a previous inspection. This involved looking at the medication administration, ordering, storage, and disposal arrangements, examining medication administration record charts (MARs) and speaking to the manager and staff about medicines management arrangements in the home. We found the systems for medication ordering, receipt, storage and record keeping to be good and all previously issued medication requirements were found to be met at the time of this inspection. We examined the 21 current MARs for accuracy and completeness and found no gaps in the records. This indicates that people living in the home can expect to receive their medicines correctly. Medication ordering, receipt, storage and disposal arrangements in the home are good, and the GP prescriptions are checked by staff each month when the medicines are delivered. This good practice helps to make sure that the home is aware of any prescription changes and that staff will know that sufficient quantities of everyones medicines have been prescribed each month. Records of temperature checks of the medication storage areas, including refrigerators, are now made regularly. This helps to show that all medicines are kept at temperatures recommended by the manufacturer. Staff have begun to record information about peoples individual medicine-taking preferences in care files. This good practice will help to reduce the number of times essential medicines are refused or not given. Care Homes for Older People Page 15 of 31 Evidence: Although medicines management processes in the home have greatly improved since the last inspection, the homes medication policy documents should be updated and reviewed in line with current professional guidance. This will help to make sure that all staff understand exactly what is expected of them when looking after and giving medicines to people living in the home. We observed that peoples appearances reflected their individuality and that staff and service user interactions in the residential area of the home were positive and respectful. Although in the dementia area of the home, we saw a staff member move someone in their wheelchair without informing this person of what they were doing. Additionally the support for people with their meals in the dementia unit does not respect their dignity. We further saw in the dementia unit that there are records for when people had taken a shower. However, these records were fastened to the bathroom wall and on display. This was also found at the last visit to the home and at the time the manager removed these from the wall. These records should not be on display as they are not appropriate and do not respect the dignity and privacy of the individuals concerned. Care Homes for Older People Page 16 of 31 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. We looked at standards 12, 13, 14 & 15. On the whole people are supported to have their social, leisure and dietary needs met. However, this is not the case for people in the dementia care area of the home. Evidence: Peoples plans of care include their choices and preferences relating to their social needs and any activities that they enjoy. We saw in peoples daily diary notes that they take part in activities that include, snakes and ladders, listening to music, motivation, gardening and spending 1:1 time with staff. There was little evidence of community based activities. We saw on the day of the visit that staff and service user interactions were on the whole relaxed and positive. We saw that people were able to have visitors as they chose and when we spoke with the visitors they were happy with the support provided in the home. We observed the people in the dementia unit and found that there was little activity taking place. Staff were at times extremely busy and appeared to require direction with their roles. The TV was switched on, but few people were watching it. This was Care Homes for Older People Page 17 of 31 Evidence: also noted at the last visit to the service and must be addressed. We observed breakfast and lunch in the dementia unit. At breakfast time people were given their food, but then left with no support to eat it. We saw that when this had not been eaten it was simply removed. At lunchtime staff required direction from the area manager with their role and we saw that people were provided with food but again left without cutlery. One person commenced eating their lunch with their hands, another was passed some cutlery from a visitor and another person began throwing their food out of the door. There appeared to be no consistent approach to supporting people with their meals, as we also saw that staff tried to support more than one person at a time with the eating of their meals. Overall people in the dementia care unit have rushed mealtimes with little support. However, we saw that in the residential side of the home, the mealtime was quiet and relaxed, making mealtime a social occasion. We saw that there are menus held within the home that offer a choice of meals for people and that these have been completed to cover a 4 week period. Care Homes for Older People Page 18 of 31 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. We looked at standards 16 & 18. People are supported to be able to raise concerns and are protected from harm. Evidence: At the last visit to the service we saw that there was a complaints policy and procedure held in the home. There have been no complaints to the service since the last visit to the home. At the last visit to the service we saw that there were systems in place for the handling of any allegations of harm.We examined the records of incidents that had occurred in the home and the notifications that had been forwarded to the CQC and found that these appeared correct. We saw that there are records kept regarding peoples monies and that these appeared correct and up to date. Care Homes for Older People Page 19 of 31 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. We looked at standards 19, 20, 22, 24, 25 & 26. People now live in a home that is clean, comfortable and well maintained. Evidence: The home comprises of a large property that has been extended to provide accommodation for people who require support with dementia care. The ground floor includes the main residential lounge, dining room, conservatory, some bedrooms, the offices and kitchen. The dementia unit is all on the ground floor and offers a lounge/dining area, conservatory and bathrooms, with the laundry for the service also attached to this part of the building. Upstairs there are further bedrooms and bathroom facilities. Since the last visit to the home there have been a number of improvements made. The owner told us that this included the purchasing of new carpets and furniture. We completed a tour of the premises and found that it was clean and comfortable throughout with new lighting and carpets, there were no unpleasant odours. The lounge in the main part of the home is clean and comfortable with a new carpet. The lift area is adjacent to this, and this area also now has a new carpet, and been redecorated making this a lighter and brighter area for people. Care Homes for Older People Page 20 of 31 Evidence: We saw that the main area of the dementia unit, although clean continues to be sparse. When we looked in some peoples bedrooms we saw that new furniture had been bought and that the old wardrobes had been replaced. People are able to personalise their rooms, making them more homely. We saw that rooms are no longer used for storage and that bedroom windows now all have opening restrictors to reduce the risk of someone falling or injuring themselves. One bathroom window did not have a window opening restrictor and the manager was advised as to this at the time of the visit. The owner told us that thermostatic valves had been fitted to the hot water outlets and we found that the water supply was close to 43 degrees. One outlet provided water that exceeded this temperature, this was rectified at the time of the visit. We saw that the locks to the bedroom doors that could have prevented people from leaving their room as they chose have now been removed. The manager has liaised with the Health and Safety representative from the local authority and ensured that specialist equipment, in particular bed rails, is used through a risk assessment basis and that is is reviewed daily to ensure that it doesnt pose a risk to the people who live in the home. We saw that the home was clean throughout and that there is a separate laundry room. The floor for this is not covered and action must be taken to ensure that this is not permeable which could compromise the control of infection within the home. The kitchen was found to be clean and tidy. Food was stored correctly, being covered. We did not look at the fire systems in the home at this inspection, these were addressed at the inspection in February 2010 and will be addressed again at the next inspection. Care Homes for Older People Page 21 of 31 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. We looked at standards 27, 28, 29 & 30. People are supported by staff who overall are well recruited and receive training. However some gaps with staff training means that there are still areas that can be improved upon. Evidence: We looked at the staff files for three of the people who had recently commenced employment in the home. All three of these had completed an application form as part of their recruitment. However, one persons form was incomplete and for example, did not include all the details of their previous employment. This does not ensure that there is a clear employment history, reflecting that the persons suitable to work in this role. All three staff members had provided references which help to verify that the person is suitable to work with vulnerable people. One reference was entitled To whom it may concern. It is recommended that new references are sought direct from peoples referees to ensure the authenticity of references. Also that once received the reference is verified as authentic with the referee, this helps to ensure that the details are correct and from the referee. Care Homes for Older People Page 22 of 31 Evidence: Criminal Records Bureau checks (CRBs) had been received for all three people, these help to identify that no-one has a criminal conviction that may prevent them from working with vulnerable people. The manager told us how staff who commence work with only an ISA first check and not a CRB do so only under supervision, as is recommended practice. However there were no written records confirming this and it s recommended that this is undertaken. We saw that staff complete an induction when they commence in their role in the home. We looked at the training records held in the home. Some of these are yet to be updated and the manager has written to people asking for confirmation and copies of training certificates. This will clearly evidence both the training that they have attained and any further training that may be required. We saw evidence in one persons file that this year they had undertaken training on Challenging Behaviour and Dementia, Health and Safety, Manual handling, Mental Health and Food Hygiene. From the staff training matrix we saw that 7 of the 13 staff have achieved a National Vocational Qualification (NVQ). The majority of the staff still require First Aid training and that there are gaps that reflect a number of staff still require training in Mental Health Awareness, Fire and Food Hygiene. No training has been undertaken regarding dignity and as this was also recommended at the last visit to the service it is recommended that this training is undertaken in the near future. On the day of the visit there were staff available in both areas of the home with the general manager assisting in the dementia unit of the home. Despite this we observed that peoples needs were not met as fully as possible and that staff needed to be deployed and guided further in their roles. For example, staff placed meals in front of people and then rushed off without giving people cutlery. Consequently one person started to eat their food with their fingers and a relative intervened and gave another person some cutlery. Throughout the day staff seemed unsure in their roles and this was discussed with both the manager and owner of the home. Both agreed that peoples roles in the dementia section of the home require further development to ensure a full and consistent service to people. Care Homes for Older People Page 23 of 31 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. We looked at standards 31, 33, 35, 36, 37 & 38. People now live in a service were the paperwork and administration has improved in order to help ensure that their needs are met. However, the acting manager continues to be unregistered with the CQC. Evidence: The acting manager has now worked in the service since January 2010. They have yet to apply to be registered with the CQC and have not commenced with the process, with an application for a CRB. Since the last visit to the service the acting manager has undertaken a large amount of work to improve the care planning for the people who live in the service. Consequently a number of the previous requirements and the Statutory Requirement Notices have been met. The owner of the home has continued to undertake Regulation 26 visits to the service, with records being kept of these visits. Additionally the area manager presently visits Care Homes for Older People Page 24 of 31 Evidence: the home every day to assist the manager and staff. We looked at the quality assurance system in the home. The system includes a calendar and plans for staff appraisals and consultations with the people who live in the home, as well as visiting professionals. It did not include evidence of a summary report or plans for actions to be taken with any identified shortfalls. We looked at the supervision records for the staff and saw that these take place on a monthly basis. They discuss the work routines and the needs of the service users that the staff are key workers for. We looked at the maintenance certificates held in the service. These showed that maintenance checks had taken place on the emergency lighting, gas systems and portable appliances in recent months and that these checks were up to date. The systems for monitoring and assessing the use of bed rails has been revised following guidance from the Health and Safety officer of the Local Authority. At the previous inspection there was a large amount of outstanding requirements and work that needed to be undertaken in the home, the majority of these have been met. Care Homes for Older People Page 25 of 31 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 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Information about people, 30/08/2010 recorded in risk assessments should be clear and consistent. This will help to ensure that these are correct for use and fully support people. 2 8 13 Clear records should be kept 30/08/2010 for people, of any assessment undertaken to decide upon the need for specialist equipment or support in the safely meeting of their needs. This will help with the safe meeting of needs and allow for a baseline for review to be able to meet ongoing and changing needs. 3 8 13 People should have clear 30/08/2010 records kept of when they require additional monitoring/support with their health needs and when this need has ceased. Page 27 of 31 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will help to ensure that peoples health is accurately monitored and supported. 4 10 12 Peoples dignity must be maintained at all times. This will help to ensure that their needs are well met. 5 12 16 People who have specific needs relating to dementia should have social and leisure activities provided that will help in the meeting of these needs. This will help to ensure that their needs are fully met. 6 15 16 People who reside in the dementia care area of the home must receive adequate and appropriate support with their food and fluid intake. This will help to ensure that their nutritional needs are fully met 7 27 18 People should be supported 30/08/2010 by a staff team who are correctly deployed within the home to ensure that their dementia care needs are met through the correct level of support. 30/08/2010 30/08/2010 30/08/2010 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will help to ensure that their needs are fully met. 8 29 19 People should be supported by staff who have been correctly recruited. This would include that the recruitment practices in the home must ensure that full and complete information is received about the prospective employee. This will help to ensure that the employer is assured that they have the correct experience and skills to support fully the needs of the people who live in the home. 9 30 18 Staff should be trained in all 15/09/2010 mandatory training including First Aid. This will help to ensure that peoples needs are fully met. 10 30 18 People should be supported by staff who are trained in dementia care. This will help to ensure that thier needs are understood and fully met. 11 30 18 People should be supported by staff who are trained in Dignity. 15/09/2010 30/08/2010 30/08/2010 Care Homes for Older People Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will help to ensure that peoples needs are fully met in a dignified way. 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 A weekly or monthly at a glance log would alert staff to those people that had not participated in anything so that this could be addressed. Records kept relating to people should be signed and dated, with clear dates for review and monitoring. Medication policies should be up to date in line with current professional guidance. Community based activities should be further developed and include to provide for the people who live in the dementia area of the home. The lounge in the dementia care unit should be made a more homely and stimulating environment for people. Records should be kept that show that when staff commence employment with only an ISA first check, that they are supervised and how this is undertaken. The manager should be registered with the CQC. Action plans should be produced to address any shortfalls highlighted in surveys and audits, and a report compiled from the results of surveys. 2 3 4 8 9 13 5 6 20 27 7 8 31 33 Care Homes for Older People Page 30 of 31 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 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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