Care Home: Sunrise Operations Beaconsfield Limited (Assisted Living)

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What the care home does well Prospective service users are assessed thoroughly before they move in, to make sure their care needs have been identified and that the service is confident that it can meet needs. There is good information available about the service in its statement of purpose and service users` guide to provide people with the details they need. People`s health care and personal care needs are being well met. There are care plans in place to outline their needs and these are in good detail to ensure continuity of care. Risk assessments are in place to identify any risks and minimise them and these are being kept up to date. People have access to health care professionals when they need them and their medication is managed safely to keep them well. The service places importance on providing meaningful activities for people using the service and has a range of stimulating events on offer. Nutritional needs are being well met through individual nutritional screening and provision of a varied and wholesome range of meals served in pleasant surroundings. There is access to hot and cold drinks and snacks 24 hours a day from a bistro. There are procedures in place for responding to any complaints people may have about their care and people knew how to raise concerns informally and formally if need be. There are procedures for responding to safeguarding (adult protection) issues. Staff receive training in safeguarding and there was evidence that the service responded appropriately when an issue arose. The environment is designed to a high specification and provides comfortable accommodation for people. The premises are kept clean, hygienic and free from odour and are suitable for the needs of service users. Staff induction and training systems work well to make sure carers have the right skills and competencies to meet people`s needs and staffing levels are in line with assessed dependency levels. Feedback from people using the service was positive. The service has an experienced registered manager and clinical nurse lead. The provider has systems in place to regularly assess quality of care and there are forums such as the Residents` Council, dining committee and activities committee to feedback views. Health and safety was being well managed to prevent accidental injury or harm. What has improved since the last inspection? This was the first inspection of the service since registration. What the care home could do better: Advice has been given in the report to obtain a copy of the local authority inter agency safeguarding guidance in order that this is available for reference purposes. The Commission did not receive a notification about an incident that occurred although there was a record of a completed notification form at the service. The manager is advised to fax any future safeguarding notifications to us to make sure that we receive them and to follow this up with a posted hard copy. Details of a complaint were difficult for staff to locate although records were seen which provided sufficient evidence that action had been taken in response to the complaint. The manager is advised to make use of the complaints log that has been set up in order that there is a clear audit trail of complaints investigation readily available at the service. One of the staff recruitment files examined showed that the person required a via to work in the country but there was no evidence on the file that this had been checked and was satisfactory. A requirement has been made to address this. Health and safety, although good overall, could be enhanced through making sure there is a risk assessment of the premises, identifying any risks and putting in place measures to address these, to keep people safe. A requirement has been made to this effect. Key inspection report Care homes for older people Name: Address: Sunrise Operations Beaconsfield Limited (Assisted Living) 30 Station Road Beaconsfield Bucks HP9 1AB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Chris Schwarz     Date: 0 8 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Sunrise Operations Beaconsfield Limited (Assisted Living) 30 Station Road Beaconsfield Bucks HP9 1AB 01494739600 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sunrise Operations Beaconsfield Ltd Name of registered manager (if applicable) Mrs Susan Amanda Mitchell Type of registration: Number of places registered: care home 57 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: (1) The registered person may provide the following category/ies of service only: Care home only with nursing (N) to service users of the following gender: Either whose primary needs on admission to the home are within the following categories : Old age, not falling within any other category (OP) (2) The maximum number of service users to be accommodated is: 57 Date of last inspection Brief description of the care home The service is located close to the centre of Beaconsfield and provides accommodation for up to 57 people with nursing care needs. The building is set in well maintained grounds and has ample parking. Accommodation is spread across two floors with lift access for people with mobility difficulties. The standard of accommodation is high with plenty of communal space and different sized bedroom suites. Adapted bathrooms and Care Homes for Older People Page 4 of 31 0 Over 65 57 Brief description of the care home toilets have been installed to meet the needs of older people and corridors and doorways are wide to accommodate wheelchairs and hoisting equipment. There is a concierge service from 8 am until 8 pm to assist service users and visitors. Fees for the service are assessed according to the type of room, currently from £770 to £1295 per week, and level of staff support required, currently £20 to £50 per day plus a one off payment (community fee) calculated at the daily room fee rate multiplied by 45 (£4950 to £8325). 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted on 8 June 2009 from 9.10 am until 7:00 pm and covered all of the key National Minimum Standards for older people. It was the services first inspection since registration five months ago. Prior to the visit, a detailed self-assessment questionnaire, the Annual Quality Assurance Assessment, was sent to the manager for completion and returned in good time. It provided a good standard of information about the service and statistical information needed to plan the visit and assess standards of care being provided. Surveys were sent to a selection of people living at the service, staff and visiting professionals. Three staff surveys were returned plus seven from users and one from a healthcare professional; these have helped to form judgements about the service. Information received by the Commission since it was registered was also taken into account. The inspection consisted of discussion with the executive director, area manager, clinical nurse lead and other staff, opportunities to meet with people using the service, Care Homes for Older People Page 6 of 31 examination of some of the required records, observation of practice and a tour of the premises. The registered manager was on annual leave at the time of this visit. Feedback on the inspection findings and areas needing improvement was given to the area manager at the end of the inspection. Managers, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Advice has been given in the report to obtain a copy of the local authority inter agency safeguarding guidance in order that this is available for reference purposes. The Commission did not receive a notification about an incident that occurred although there was a record of a completed notification form at the service. The manager is advised to fax any future safeguarding notifications to us to make sure that we receive them and to follow this up with a posted hard copy. Details of a complaint were difficult for staff to locate although records were seen Care Homes for Older People Page 8 of 31 which provided sufficient evidence that action had been taken in response to the complaint. The manager is advised to make use of the complaints log that has been set up in order that there is a clear audit trail of complaints investigation readily available at the service. One of the staff recruitment files examined showed that the person required a via to work in the country but there was no evidence on the file that this had been checked and was satisfactory. A requirement has been made to address this. Health and safety, although good overall, could be enhanced through making sure there is a risk assessment of the premises, identifying any risks and putting in place measures to address these, to keep people safe. A requirement has been made to this effect. 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. People using the service are thoroughly assessed prior to admission and are given opportunity to visit beforehand to ensure it meets their needs. They have a good range of information to refer to, to help them make a decision about whether the service is right for them. Evidence: Information provided in the Annual Quality Assurance Assessment showed that people are assessed before they move in and have opportunity to visit before deciding to try the service. It said that care needs are assessed to determine the level of care people require and their doctor is asked to provide a medical report. Information provided said that prospective users and their family are fully involved in the process. A statement of purpose and service users guide were in place outlining what the service provided and giving people a good range of information to help them make a decision about whether to move in. Both were detailed and well written. Copies of the Care Homes for Older People Page 11 of 31 Evidence: service users guide were seen in peoples rooms to refer to. Three pre-admission assessments were looked at and found to be in good order with information recorded about areas such as mobility, cognitive pattern, mood and behaviour, skin integrity and risk of developing pressure damage, personal hygiene requirements, home situation, service level evaluation and problems identified. Each was signed and dated and provided comprehensive information about care needs and determined the amount and type of support that each person needed. People using the service said in surveys that they had received enough information about the service before making a decision to move in and had received a contract outlining terms and conditions. A relative commented that her mothers care charges seemed inflexible and added this is very unsettling. A member of staff from the sales team explained how charges are evaluated (according to amount of care support required as well as type of room) and advised that a couple of what had been additional charges were now being incorporated into costs of care packages. At the time of this inspection, no one needed specific nursing input or intermediate care. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the service are well met, promoting health, well-being, taking into account their preferences and religious or cultural requirements and ensuring that they receive medication in a safe and consistent manner. Evidence: Information in the Annual Quality Assurance Assessment showed that care plans are in place outlining peoples needs. It said these are reviewed monthly and risk assessments are in place. Medication training was being provided for staff and those people who manage their own medication had individual medication cabinets in their rooms. It said that peoples privacy and dignity were always upheld by staff and that people using the service have access to health care professionals to meet their medical needs. A doctor returned a survey. He said the services assessment arrangements usually ensure that accurate information is gathered about people in order for the right service to be planned. He considered that peoples health care needs were usually Care Homes for Older People Page 13 of 31 Evidence: properly monitored, reviewed and met by the care team and that staff always seek and act on advice to help improve or better manage peoples social and health care needs. He considered that people are always supported to manage their own medication or the service manages it correctly where this is not possible. He said peoples privacy and dignity were usually respected and that needs arising from diversity were usually responded to. People using the service said in surveys that they usually receive the support they need and that the service always makes sure they receive the medical support they need. One person said generally I am happy and feel well looked after here. Care plans were in place for each person and a sample of four were read in detail. Three provided a comprehensive assessment of care needs, one was for a person who receives accommodation only and manages daily living tasks unaided. Peoples religious, cultural and preferred lifestyle choices were noted. The level of detail was good where particular needs were identified, such as showering or bathing, and included the need to report on to senior staff any concerns such as signs of skin breakdown or marks. The way these had been written provided a good standard of information to ensure consistency of approach by staff. The need to support people to retain their independence and do as much as they could for themselves was reflected. Where one person required turning regularly and use of specialist equipment to prevent pressure damage, charts in her room showed that staff were turning her regularly, noting fluid and food intake and that the right equipment was in place. Her relative said the care she received was very good. Each file contained evidence of regular reviewing of care needs. Service users and/or a relative had signed care plans as well as key staff at the service such as the clinical nurse lead and designated care worker. Peoples baseline observations were noted on admission and checked regularly afterwards. Records were being maintained of any medical interventions and visits by health care professionals. Staff had policies and guidance to refer to on health care topics such as falls prevention, continence management, wound management and pressure sore prevention. Risk assessments were in place for moving and handling and risk of falls, nutritional assessments were completed and malnutrition universal screening tools had been used. Each person had been assessed for risk of developing pressure damage and medication risk assessments were in place where people managed their own medication. These assessments had been regularly reviewed. There was a comprehensive policy on medication. A communal homely remedies Care Homes for Older People Page 14 of 31 Evidence: protocol had been signed by a doctor. The clinical nurse lead had already identified that it would be better practice for individual protocols to be in place for each service user and said she would be addressing this with the doctor/s. Where people cannot manage their own medication, this was being done by staff after receiving training. Competency assessments had been completed for staff to make sure they are safe to handle medicines. Storage and administration of medicines was well managed. Photographs of users were in place to readily identify them and specimen staff signatures had been noted. Controlled drugs were stored in a separate and specific cabinet and all items in storage tallied with the controlled drugs register. Some people were managing their own medication. One person showed the inspector his cabinet and although regular, recorded checks are made to ensure safe storage and that people are taking their prescribed medicines, he was keeping his medicines outside of the locked cabinet. The clinical nurse lead agreed to monitor this. There was good regard for peoples privacy and dignity. People had been supported to look well groomed and smart, with good care taken of their clothing. Any care that was required was carried out in private areas of the building. People were spoken with appropriately and gently by staff and information that had been recorded in care plans reflected a dignified approach to people, such as using different flannels for top and bottom halves of the body when carrying out personal care. A look at the staff induction format showed that carers cover privacy, dignity and respect during their induction period. Care Homes for Older People Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met and respecting peoples preferences and religious or cultural requirements. Evidence: The Annual Quality Assurance Assessment said that peoples interests are identified as part of the care planning process. It described a monthly activities calendar displayed around the building and in peoples rooms and said that dietary needs are catered for. Open visiting times were described and that church services were provided. People were said to be encouraged to bring well behaved pets with them and it said a hairdressing service was provided. People using the service said in surveys that there are always/usually activities that they can choose to take part in. One person said the person who runs the book club, is marvellous. She prepares all the lectures thoroughly and leaves books, notes and visual aids for perusal between lectures. Her visits are the highlight of my week. Another person said they would like more activities such as table tennis and more Care Homes for Older People Page 16 of 31 Evidence: quizzes. Would like to have dances also. More outings in the mini van to local villages, pubs etc, walking trips to the local shops and enable relatives to have better feedback as to the activities residents have participated in. Senior staff described a generous budget for activities and there were sixty hours available for a full time co-ordinator and part time assistant. The co-ordinator post was vacant at the time of visiting. The services activities assistant was met as part of the inspection. She described a comprehensive choice of activities provided for people such as a book club, flower arranging, monthly church service, yoga, quiz nights, bingo, computer interactive bowling, exercises, computer skills and weekly visiting entertainers. A minimum of five activities are provided each day and notices of these are displayed around the building. A notice in the bistro advised people there was a word search, community shop, hospice lottery, social get together, book club and film night on the day of this visit. There is also a minibus to take people out on trips and people using the service can access local shops either unassisted or with staff support. The garden was well maintained and contained seats for people to enjoy some fresh air. Several people were seen around the building reading newspapers. The care plans that were read contained information about peoples interests, hobbies and former occupations. A tick list had been completed in each case to show the things they enjoy taking part in. One person was being supported to keep a cat and his care plan and daily notes reflected that staff were doing this, such as changing the litter tray. Visitors were seen to be made welcome and can eat with their relative if they wish. One relative who was met is enabled to spend each day with his wife and has space in her room to work from. The service has a large, well presented dining room and tables were attractively set. The menu was displayed and at lunchtime the two main choices were seen to be displayed to help people decide what to have. Food had been attractively presented. The chef manager was being supported by a team of staff and considered the budget for food was sufficient to provide the varied range of meals on offer. People are offered a glass of wine with their meal and can purchase more if desired. Occasionally sherry is served. A bistro with self service cold drinks and tea and coffee is available twenty four hours a day. Fresh fruit and biscuits were also available. In the kitchen there were notices to advise of particular service users needs, with a photograph to readily identify them. Service users said in surveys that they usually liked the meals provided for them. A relative said the food is usually good but sometimes a letdown. A service user said the food could be better. The casseroles are uninteresting and all Care Homes for Older People Page 17 of 31 Evidence: seem to taste the same. The vegetables are usually overcooked. 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. Safeguarding is effectively managed to protect people using the service from risk of harm. Recording of complaints investigations could be improved to provide better audit trails. Evidence: A complaints procedure was in place to respond to any views of people using the service or their representatives. It was clear and reflected prompt response to any issues raised. A policy was also seen on residents rights. A complaint identified in the Annual Quality Assurance Assessment was difficult for staff to locate to show how it had been responded to. A file set up to store complaints was empty. Records on the users file reflected that the matter had been responded to and took into account the persons mental capacity although better recording in a formal complaints log or register would be expected to show the full investigative process. The manager is advised to address this for future complaints, to make sure that clear audit trails are in place. The executive director was dealing with a complaint made after the Annual Quality Assurance Assessment was submitted and had already notified the Commission to advise of action being taken, which was thorough and appropriate. People using the service said in surveys that there is someone they can speak with informally if they are not happy and they knew how to make a formal complaint. Two of the three staff who returned surveys said they knew what to do if someone raised concerns about the service. Care Homes for Older People Page 19 of 31 Evidence: The Annual Quality Assurance Assessment showed that there had been two safeguarding incidents. Notification had been made of one incident and showed detailed and thorough investigation, in line with the safeguarding policy. For the second incident, although a notification form had been completed at the service and was seen, it had not reached the Commission and may have been lost in the post. The manager is advised to fax any future safeguarding referrals to us in future and follow up with a hard copy by post. She is also advised to obtain a copy of the local authority inter agency safeguarding guidance, as a reference for the service. Staff training records showed that they receive training in safeguarding vulnerable adults. They have a whistle blowing procedure to refer to and safeguarding guidelines if they have any concerns. Care Homes for Older People Page 20 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. The premises are clean, well decorated and properly maintained, promoting a positive environment for the people who live there and which are suitable for the range of disabilities that people have. Evidence: The service is located close to the town centre of Beaconsfield. It is a detached property providing two registered services with the assisted living component on the ground and first floors. It has a large sign to identify it and there is ample parking. The statement of purpose and service users guide reflect what the service can provide and the facilities it has to offer. The service is designed to a high specification and is well maintained throughout. It provides spacious communal areas which are attractively decorated and furnished and with comfortable seating. There is a separate smoking room if needed. The bistro was popular throughout the day with service users and their visitors making use of a pleasant area in which to read, chat or watch the world go by and the option of helping themselves to drinks if desired. On the first floor there is a large activities room with a kitchen area down one end and spacious lounge area with widescreen television which was being used for the film club in the afternoon. There are fifty bedroom suites, 25 studio type suites, seven one bedded suites and Care Homes for Older People Page 21 of 31 Evidence: seven two room suites. All have kitchen areas and well designed en suite toilets and showers suitable for people with disabilities. Those suites viewed were personalised and had the occupants name on a brass plate outside. Toilets and bathrooms were spacious and easily identifiable; four spa baths with hoisting equipment were in place and all were clean and well stocked. Antibacterial hand wash was available in toilets. Bathrooms and toilets had locks to promote privacy. The building was being kept clean throughout and odours were being effectively managed. Laundry areas were tidy and alginate bags were being used for soiled items of washing. People using the service can do their own laundry; if staff wash service users clothing it is put in a machine alone to prevent cross infection from other peoples washing. Clinical waste was being managed well and bins kept emptied. The kitchen is designed with a one way entry system. The chef manager considered he had the equipment needed although storage space could be more generous for the size of the premises. People using the service said in surveys that the premises are always kept fresh and clean. One person said rooms, including bedrooms, are always kept very clean and tidy. Another relative said that asking for extra appliances for bathroom aid has been a problem. People were seen to freely move around the building and knew where their rooms were. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides staff cover to meet needs and has effective induction and training systems to make sure staff are equipped with the skills and competencies to meet needs. Some attention is needed to recruitment practice to make sure it is consistently robust to protect users from risk of harm. Evidence: The Annual Quality Assurance Assessment described corporate induction and training procedures and systems for appraisal and supervision of staff. Thorough recruitment procedures were referred to and the manager said there had been good initial recruitment and retention of staff; only two people had left since the service opened. At the time of completing the Annual Quality Assurance Assessment, seven staff had achieved National Vocational Qualification at level 2 or above. A staff rota was being maintained with the manager working supernumerary to this. The clinical nurse lead was deputising in her absence. The area manager advised that current staffing levels had been determined according to the service level assessments carried out for each service user; when further service users are admitted, staffing is planned to increase in line with their assessed needs. A doctor who completed a survey said that he considered staff usually have the right skills and experience to support peoples social and health care needs and added a Care Homes for Older People Page 23 of 31 Evidence: caring organisation. Everyone working there I have met appears to be truly caring. He considered the service could be improved through having more nursing support due to peoples high care needs. People using the service said in surveys that there are always staff available when they need them and that staff listen and act on what they say. One person said there could be better cover for holidays and sickness. The staff left are extremely busy and one does not like to detain them by chatting, which was one of the advantages when they were not so busy. Another said carers always friendly and helpful and keen to involve residents in activities - good communication between staff and residents. A relative said this new home is very well presented. All staff are polite and friendly. The trained carers seem to do a very good job helping my mother with her disabilities. They listen and are always respectful. The person added sometimes a new carer doesnt have the experience to shower my mother, but do their best. A service user said the staff are kind and helpful, another said friendly and helpful staff. Three members of staff returned surveys. They said they are usually given up to date information about peoples needs. They all said their employer had carried out checks such as a Criminal Records Bureau checks and uptake of references before they started work and that their induction had partly covered the areas they need to know about. They said they are receiving training which helps them to understand and meet individual care needs and which gives them enough knowledge about health care and medication. Two said that their moving and handling training was poor. They felt training was relevant to their role. They said they sometimes have enough support and meet with their manager to discuss ways of working. They considered information sharing systems sometimes worked well and that there were sometimes enough staff to meet individual needs. They all gave a different perspective on whether they considered they have enough support, experience and knowledge to meet the different needs of people using the service, ranging from always to sometimes. One added I think the care suffers at times due to shortage of staff. Carers are expected to serve in the dining room as well as perform housekeeping tasks such as cleaning and laundry. This makes it very difficult, for example at breakfast time, when people are trying to assist residents out of bed as well as be on dining room duty, administer medication etc. Recruitment files for five staff were looked at. Each had an application form, written references, signed job description, preliminary POVAfirst check and Criminal Records Bureau disclosure. Each of these staff had started work with preliminary POVAfirst clearance; senior managers said this was under supervision, but there was no formalised system in place to make sure that staff in these circumstances had been made aware of limitations to practice until they have full clearance, or that shift Care Homes for Older People Page 24 of 31 Evidence: leaders had been made aware. The manager is advised to address this to make sure that service users are fully protected by the services recruitment practice. One file was for a member of staff from overseas. Her passport showed that she was visa work permit dependant. No copy of the work permit was contained on the file. A requirement is made to address this to ensure that the person is entitled to work in the country legally. The statement of purpose stated that staff induction covers nine days theory and a minimum of three days of practical supervision. For nursing staff this is in addition to their clinical training. Personal development files were in place for staff members showing that they have been undertaking an induction in line with the common induction standards for care services. They also have to complete a package of training and are then assessed on their competency to translate theory into practice. Training records showed that mandatory areas were being kept up to date and some specialist courses had been attended also such as dementia care, philosophy and ethos of the organisation, infection control and activities. Care Homes for Older People Page 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the service promote continuity and quality of care for the people who live there. There is good regard for health and safety and this could be enhanced through risk assessment of the premises to make sure that people using or visiting the service are kept safe. Evidence: The manager is registered and holds nursing and management qualifications. She has worked in community health care settings and registered services and has been a registered manager previously. She is assisted by a clinical nurse lead who is also experienced in older peoples care. Details on the registration certificate were appropriate and there was no evidence that anyone had been admitted whose needs could not be met and whose care was outside of the remit of the statement of purpose. The provider is an established company with registered services in this country and Care Homes for Older People Page 26 of 31 Evidence: abroad. There has been regular monitoring of the service since it opened in January this year and the area manager advised there had been an audit in the first six weeks, although the report could not be located to verify this. Information was supplied in the Annual Quality Assurance Assessment about other auditing systems that the provider uses in its services including an annual anonymous Gallup poll and six monthly family meetings. The service has other forums for users to feedback comments about quality of care such as the Residents Council, dining committee and activities committee, all of which meet monthly. People therefore have several options to put across any views they have of their care. The service was not managing anyones finances at the time of this visit. There is a system of billing for reimbursement of costs for any individual expenditure such as hairdressing, chiropody and newspapers and there were invoices and computerised billing records to show proper accounting measures are in place. There was good regard for health and safety around the building. The building is new and all necessary certificates for installation and commissioning of equipment such as the call bell system, electrical hardwiring, emergency lighting, gas installation and boiler were seen and satisfactory during the registration site visit in January this year. There were policies and procedures on health and safety and related areas in the managers office and staff were observed to be diligent whilst going about their work, using yellow hazard bollards where floors were wet or being cleaned. Training records showed they receive input on health and safety related topics such as food handling, infection control and moving and handling. Accident reports were being completed where necessary and overseen by senior staff to see if any measures could be taken to reduce recurrence. Additionally, there is monthly clinical reporting to look at the incidence of areas such as falls and use of anti-psychotic medicines. Individual risk assessments were contained in peoples care plan files. Assessments for the premises could not be located; the manager is required to have these in place and available to make sure people using and visiting the service are kept safe. Care Homes for Older People Page 27 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 28 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 29 19 Where staff from overseas require a work permit, this is to be examined before offering employment and a copy of the permit kept on their personnel file. This is to make sure that people using the service are fully protected by robust recruitment practices and that staff are legally entitled to work in the UK. 01/08/2009 2 38 13 A risk assessment of the premises needs to be written to make sure that any hazards are identified and measures taken to minimise likelihood of injury or harm. This is to make sure that people using or visiting the service are kept safe. 01/08/2009 Care Homes for Older People Page 29 of 31 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 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. 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 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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