Care Home: Sweetcroft Residential Care Home

Similar services:

• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)
• Queen Elizabeth House

What the care home does well The home has an open visiting policy and visiting is encouraged. Information regarding advocacy services is available. The meal provision is good and offers choice and variety to meet residents individual needs and preferences. The home has a complaints procedure and residents confirmed that they knew how to make a complaint. There is an ongoing programme of redecoration and refurbishment. The home provides a good standard of accommodation. The grounds are well maintained. The home is well staffed to meet the needs of the residents. NVQ training in care has been completed by the majority of staff. There are systems in place for the recruitment and vetting of new staff. Comments received include: `The home is scrupulously clean. The staff are friendly and helpful`. `Rooms are clean and secure`. `We viewed a number of care homes before choosing this one, and delighted with the choice we made`. `Staff caring and good natured`. `Residents are well supported`. `Food is good and nutritious`. What has improved since the last inspection? The Statement of Purpose and the Service User Guide have been reviewed and updated since the last inspection. Residents have been issued with updated terms and conditions of residence. We found that the home had introduced a new pre-admission assessment tool since the last inspection. However, these were not always completed in detail and have been commented upon further in the section below. Staff have received training in dementia care, however shortfalls were identified at this inspection.There has been some improvement in the completion of care plans and risk assessments however, we still found shortfalls at this inspection and they have been commented upon in the section below. There has been an improvement in the management of medications. However, some shortfalls were identified in medication management and are commented on in the section below. Staff have received training in safeguarding adults. Risk assessments have been completed on the environment. The Acting Manager has introduced the Skills for Care Common Induction Standards for all new care staff. The Registered Providers are undertaking monthly Regulation 26 Visits and are supporting the Acting Manager in developing her management skills. Residents monies are being managed by nominated staff. A system for staff supervision has been developed and implemented. There have been some improvements noted in the servicing and maintenance records. What the care home could do better: We identified areas where it was clear that work had been done following the last inspection, however shortfalls still identified show that more work is needed to bring these areas up to a good standard. Pre-admission assessments were not completed in detail and did not always assess residents dementia care needs. Whilst there has been some improvement in the implementation of the service user plans further improvements are required to ensure that care plans clearly identify the residents needs and how these are to be met. Also there must be evidence that the care plans have been formulated with the input of the resident and/or their representative. Healthcare assessments were in place however these needed to be expanded and personalised to the the individual resident. Risk of falls assessments must be in place for all residents. We identified some shortfalls with medication management. Further work must be undertaken in the areas of dignity, respect and routines of daily living. Some work has been undertaken to find out information regarding the wishes of residents in respect of their care in the event of health deterioration, however further work is needed in order to ensure all residents are offered the opportunity to express their wishes. We found little evidence that the home has a activity programme in place. Residents have little or no opportunity to undertake activities to meet their interests and hobbies. There are no specific activities for residents with dementia care needs. The Registered Providers had identified this as an area of improvement. No progress has been made with obtaining the Safeguarding policy and procedure from the London Borough of Hillingdon. Shortfalls were identified in the recording of the duty rota. Some staff were working long shifts and this is not in line with The staff have been undertaking training since the last inspection and it is essential that the knowledge learned is applied to the care of the residents. The quality assurance system must be further developed in order that it is robust and identifies and addresses shortfalls promptly. Further improvements are required in the management of records and record keeping. Shortfalls have been identified in staff undertaking fire drill training and legionella testing. Comments received include: `Make sure that my relative is in their own clothes`. `Improve on staffing and training`. `Realizing that elderly people are sometimes hard to motivate. There should be more effort to engage residents in various ways e.g singing, art, trips out.` Key inspection report Care homes for older people Name: Address: Sweetcroft Residential Care Home 53 Sweetcroft Lane Uxbridge Middx UB109LE     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: Rekha Bhardwa     Date: 1 2 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 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 33 Information about the care home Name of care home: Address: Sweetcroft Residential Care Home 53 Sweetcroft Lane Uxbridge Middx UB109LE Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ilford Homes Ltd Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is:- 20 The registered person may provide the following categories of service only Care home only - Code PC to service users of the following gender Either whose primary care needs on admission to the home are within the following categories: old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Sweetcroft is a residential home for twenty older people. It is located in a large detached house on a quiet residential road. It is within a mile of the local shops and Hillingdon underground station. The A40 and public transport links are close by. Sweetcroft was an existing home, taken over by new providers in February 2009. There is an Acting Manager in place since September 2009. There are twenty single Care Homes for Older People Page 4 of 33 Over 65 20 20 0 0 1 9 1 0 2 0 0 9 Brief description of the care home rooms, on two floors, of which thirteen have an en-suite toilet and two have en suite bathrooms. There are two additional bathrooms and a number of toilets. There is a passenger lift to the first floor. The lounge and separate dining room are on the ground floor. There are pleasant gardens, including a patio to the rear of the building, and parking to the front. There is a kitchen, laundry room and a small office. In the entrance hall, there are CCTV cameras for security. The fees range from £409 to £550 per week. The respite fee is £575. Care Homes for Older People Page 5 of 33 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: This was an unannounced inspection carried out as part of the regulatory process. A total of 20 hours was spent on the inspection process, and was carried out by 2 Inspectors. One of which was a pharmacist Inspector. The pharmacist Inspector carried out a full inspection of the medication management in the home on the first day of the inspection. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. 10 residents, 5 staff and 2 visitors were spoken with as part of the inspection process. We also met with two Social Workers from the Hillingdon Social Care Team. The Registered Providers came to the home on the second day of the inspection. The CQC Annual Quality Assurance Assessment (AQAA) document completed by the home has also been used to inform this report. Prior to this key inspection we carried out a random inspection on 19/10/09 to follow up on Statutory Enforcement Notices that had been issued at the key inspection on Care Homes for Older People Page 6 of 33 6/8/09. We have also received comments from the CQC surveys sent to the residents. It must also be acknowledged that it is not always possible to ascertain the views of people living with the experience of dementia. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: We identified areas where it was clear that work had been done following the last inspection, however shortfalls still identified show that more work is needed to bring Care Homes for Older People Page 8 of 33 these areas up to a good standard. Pre-admission assessments were not completed in detail and did not always assess residents dementia care needs. Whilst there has been some improvement in the implementation of the service user plans further improvements are required to ensure that care plans clearly identify the residents needs and how these are to be met. Also there must be evidence that the care plans have been formulated with the input of the resident and/or their representative. Healthcare assessments were in place however these needed to be expanded and personalised to the the individual resident. Risk of falls assessments must be in place for all residents. We identified some shortfalls with medication management. Further work must be undertaken in the areas of dignity, respect and routines of daily living. Some work has been undertaken to find out information regarding the wishes of residents in respect of their care in the event of health deterioration, however further work is needed in order to ensure all residents are offered the opportunity to express their wishes. We found little evidence that the home has a activity programme in place. Residents have little or no opportunity to undertake activities to meet their interests and hobbies. There are no specific activities for residents with dementia care needs. The Registered Providers had identified this as an area of improvement. No progress has been made with obtaining the Safeguarding policy and procedure from the London Borough of Hillingdon. Shortfalls were identified in the recording of the duty rota. Some staff were working long shifts and this is not in line with The staff have been undertaking training since the last inspection and it is essential that the knowledge learned is applied to the care of the residents. The quality assurance system must be further developed in order that it is robust and identifies and addresses shortfalls promptly. Further improvements are required in the management of records and record keeping. Shortfalls have been identified in staff undertaking fire drill training and legionella testing. Comments received include: Make sure that my relative is in their own clothes. Improve on staffing and training. Realizing that elderly people are sometimes hard to motivate. There should be more effort to engage residents in various ways e.g singing, art, trips out. 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 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have the information they need to make a choice as to whether the home is suitable for their needs. Prospective residents are assessed prior to admission to the home however, shortfalls in undertaking a detailed assessment could possibly lead to residents not having their needs fully met. Staff have received some training in dementia care, however shortfalls in care practice in relation to dementia care could lead to residents with dementia not having their needs fully met. Evidence: The Statement of Purpose and Service User Guide have been updated since the last inspection and provide a good picture of the services offered by the home. These documents were freely available. We were informed that an up to date contract with details of the terms and conditions of living at the home had been sent to all residents and or their representatives. Some had been returned and the Acting Manager stated that she would follow up those that had not been returned. We viewed a number of Care Homes for Older People Page 11 of 33 Evidence: pre-admission assessments that had been completed by the home. We found that information was available however this was brief and did not detail the residents needs. No specific details were available about residents dementia care needs. Assessments completed by social services were also available. We viewed some training records and their was evidence that all staff had received training in dementia care. We noted that some of the residents did display behaviour that was challenging and in our observations we found that staff found some difficulty in managing the situation. We discussed the importance of ensuring that the staff put into practice what they have learned from their dementia training. No changes have been made to the home in line with good dementia care practice. Care Homes for Older People Page 12 of 33 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. Care plan documentation does not always provide an up to date picture of each resident and their needs, and therefore the resident is at risk of not having their needs fully identified and met. Assessments are not always fully completed and the residents are at risk of not having there health needs met. Although there has been an improvement in the medication management in the home, shortfalls identified could still place residents at risk. Residents routines for daily living are not always flexible, thus residents needs and preferences are not being ascertained and met. There is some information available for end of life care, however more work is still needed in this area so that the wishes of all residents and their representatives are identified and can be respected. Evidence: The Acting Manager stated in the AQAA that We deliver a high standard of care for each service user using a comprehensive plan of care to ensure that all aspects of their health, personal and social needs are met. Care Homes for Older People Page 13 of 33 Evidence: We viewed 3 residents service user plans. Since the last inspection the Acting Manager has introduced a new care planning system. These care plans are completed on the computer and cover all activities of daily living. The care plans we viewed were very general and the information that was contained was very brief. There was evidence that the care plans had been reviewed. There was no evidence that residents and or their relatives had been involved in the formulation of the care plans. There was very little personalisation. We acknowledge that the home has been working hard to introduce the new care plans, however more work is needed in this area to bring the care plans up to a good standard. In some instances where a residents needs had changed, this had not been clearly reflected in the relevant care plan. We did find some information in the daily record, but the care plans should be updated whenever there is a change to a residents condition. For residents with dementia care needs the care plans did not contain information about meeting the dementia care needs of the residents. A new document had been introduced since the last inspection which contained some details about managing mobility risks, bathing, stairs and medication. The information contained in this document was very brief and had not been individualised. A detailed risk of falls assessment was not available. There was no evidence of any auditing of the service user plans having taken place. We were informed that the district nurse undertakes the continence assessments. Since the last inspection the home has introduced a nutritional risk assessment tool and care plan. We viewed some completed documents and in one instance found that this had not been dated or named. Again the information contained within was very brief. Detailed moving and handling assessments were not available for all residents. We found evidence within the service user plan documentation that residents had input from various healthcare professionals to include community psychiatric nurse, GP, optician, domiciliary dentist and the chiropodist. The home has four GPs who provide medical care to the residents. We carried out an inspection of medication to see if it was handled safely. We looked at storage, the recording of receipts, disposal and administration and we audited several samples of medication to see if it was given as prescribed. We looked at the MAR (Medication Administration Records) and noticed no gaps or omissions in the recording of receipts and administration. Medicines prescribed as variable doses were recorded accurately and we noticed the good practice of regularly counting tablets to check whether they were being given correctly. We counted 15 samples of medication supplied in their original boxes and were able to reconcile all but two medicines with signatures for administration. There was a discrepancy in two medicines for the same resident and it appeared that the wrong tablet had been Care Homes for Older People Page 14 of 33 Evidence: halved on one occasion. This error was verified by the Acting Manager after the inspection. If there were tablets left in the Monitored Dosage System the correct endorsement had been used to explain the reason for not giving. Several residents were prescribed warfarin and this was well managed with the result of blood results and current dose kept with the MAR, so that the right dose to be administered could always be double checked. There was evidence of medication review by the GP and hospital and the district nurse visited to administer injections and suppositories, We looked at storage and found it to be well organised and tidy. There was no excess stock in the home. Controlled drugs were inspected and balances were accurate and storage secure. We looked at the fridge and noted from records that it was maintained at the correct temperature. No medicines currently required cold storage in the home. Records of disposal were uptodate and detailed medicines returned to the pharmacist supplier at the end of the last medicines cycle. We observed a medication round at lunchtime. We noticed that the trolley door was not locked when a care worker was administering medication . Sometimes medication was also left by a residents plate without observing that it was taken. On one occasion several tablets were place in an residents hand and the resident had problems getting them to her mouth all together and dropped one. Administration of medication needs to be a dedicated task and the care worker not interrupted by opening doors etc. Overall we were satisfied that the home were making improvements in handling medication safely. However, care workers still need further training to ensure they follow the correct procedures and do not leave the trolley unattended or leave medication to be taken later. They need to be uninterrupted when they administer medication so that they do not make mistakes and can focus on each individual persons needs. We observed staff interaction with residents. Overall staff were seen to be caring and attending to the residents. However we were concerned that several aspects of the care practice within the home is based on routine, rather than individual choices and needs. An example of this was observed at the lunch time meal. Some more able residents had finished there main course and were waiting for their pudding. Residents were observed to wait for at least 25 minutes whilst the staff waited for the remaining residents to finish their main meal. Once this had happened all the residents were served with their pudding. Staff were observed assisting residents with their meal. All staff observed stood over the resident instead of sitting down with the resident. We are aware that the majority of staff have worked at the home for several years. Many practices observed are now outdated and staff must change their care practices to meet the individual needs of the residents and not the routine of the home. We discussed this with the Acting Manager and the Registered Providers on the second Care Homes for Older People Page 15 of 33 Evidence: day of the inspection. We also discussed the need for further training in respect of privacy and dignity in line with current care practice. Within the service user care plan documentation that we viewed, there was little or no information in relation to residents health deterioration. For one resident details were available of funeral arrangements. We discussed the need to discuss, record and respect the wishes of the resident and their representatives in the event of health deterioration. Care Homes for Older People Page 16 of 33 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. Residents do not have sufficient opportunities for activities to enable regular stimulation. Advocacy service information is available, thus respecting the rights of the residents to independent representation. The home has an open visiting policy and visiting is encouraged, thus ensuring residents maintain contacts with family and friends. The food provision at the home is good and provides choice and variety to meet the residents needs. Evidence: Since the last inspection there has been little progress in implementing an activity programme based on residents needs and abilities. On the first day of the inspection we did not observe any activities taking place. On the second day residents were seen in the morning undertaking some board games. We spoke with several residents and all who were able to tell us, confirmed that very few activities take place and that they would like to see more activities and outings. Two residents were able to confirm that there had been an outing to the theater before Christmas. No specific activities were available for residents with dementia care needs. We found little or no information on the residents interests and hobbies. Activities for those with dementia need to be Care Homes for Older People Page 17 of 33 Evidence: planned in short time frames and be interactive to keep their interest. The lack of activities does not promote the maintenance of good mental health. This is an important area of care particularly for those suffering dementia and impacts on residents quality of life. Observations over a period of time in the lounge confirmed that interaction between residents and staff were minimal. During this time staffs interactions were reactive they were not always interacting in a positive way. At present, only people who require Roman Catholic Communion have their needs met. No residents at the time of the inspection were going out to church. We spoke with the Registered Provider who was aware that there is a shortfall in activity provision. Plans are in place to recruit a specific member of staff for activities. We also discussed the need for staff training in this area. Further work is required in relation to the routines of the home to ensure that they are sufficiently flexible to ensure that that the daily life within the home is in line with individual residents wishes and preferences. We viewed several bedrooms during the course of the inspection. Those viewed had been personalised and residents are encouraged to bring personal possessions.The Acting Manager confirmed that residents had access to Age Concern in Hillingdon should they wish to do so. We recommended that the details of local advocacy groups be displayed. The Service User Guide states that visitors are welcome to the home at all reasonable times. We spoke with two visitors during the course of the inspection and both confirmed that they are made welcome and that refreshments are offered. We viewed the kitchen and it was clean and tidy. There was a good supply of fresh, frozen, tinned and dried foodstuffs. Food is appropriately stored and a daily record of fridge and freezer temperatures is maintained. There is a 4 week menu which provides a good variety of meals. Residents are offered a choice of meals each day, and a record of their choice option is maintained. Residents confirmed that they are offered a choice of meals and that they enjoy the meals provided at the home.The cook informed us that the evening meal is prepared by the care staff. This would include soup, sandwiches or a hot meal. Residents were seen enjoying their lunch, however we did note that staff were assisting residents who required support with their meal and standing over them. We have commented upon timings and routine under standard 10. The tables were laid out nicely. Care Homes for Older People Page 18 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure in place. The home has developed a policy and procedure on safeguarding adults, however shortfalls identified could place residents at risk. Evidence: The home has a complaints procedure in place this was on display in the main entrance and is also available in the Service User Guide. Residents and relatives were spoken to said that they felt able to raise any issues they have and staff listen to them, and CQC surveys received also confirmed this. The home has received no complaints since the last key inspection in August 2009. The home has a policy and procedure on safeguarding. We noted that this had not been dated and pages had not been numbered. The policy referred to Social Service throughout and no progress had been made in obtaining and providing information on the London Borough of Hillindon multi agency policy and procedure on safeguarding. Staff training records confirmed that staff had undertaken safeguarding training since the last inspection. Staff spoken with confirmed that they were aware of whistle blowing procedures. Care Homes for Older People Page 19 of 33 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 home is being maintained to a good standard, providing residents with a clean and homely environment to live in. Infection control procedures are in place and are followed, thus protecting residents, staff and visitors. Evidence: We carried out a tour of the home on the first day of the inspection. Overall the home was being well maintained and there was a programme of redecoration as bedrooms became empty. Plans are in place to have a new porch. The residents have access to a large garden and courtyard area. Since the last inspection the Acting Manager has carried out a risk assessment on the home and the garden area. In the AQAA the Acting Manager reports that new carpets have been fitted to five bedrooms and that all the toilets on the ground floor have had new flooring fitted. The home has laundry room which is situated on the groundfloor. Care staff undertake laundry duties. There is a industrial washing machine and tumble dryer. We did find some areas of the home which required more attention and these were highlighted to the Acting Manager. Overall the home was clean and free from any unpleasant odours. Care staff have access to gloves and aprons. Care Homes for Older People Page 20 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is appropriately staffed to meet the needs of the residents. Shortfalls in maintaining an up to date rota could place residents at risk. Systems are in place for staff vetting and recruitment, thus protecting the residents. Training is provided for staff but this should be reviewed to ensure they are aware of their roles and responsibilities. Evidence: The Acting Manager advised that there is one senior carer and three staff care staff on duty during each day between 8am and 8pm. There are two waking night staff on duty. On the first day of the inspection the home had one senior carer and 2 care staff on duty. One carer had telephoned in sick. This was not reflected on the duty rota. On duty were also the cook and one domestic for the morning and afternoon. The Acting Manager confirmed that she has supermumery hours and that she sometimes also works shifts. We viewed the duty rota and found that seven shifts in the month of December 2009 were covered by staff working a late shift and a night duty following this. In total staff were working a minimum of twenty hours for each shift. We discussed this with the Acting Manager and highlighted the issue of safety and the potential for errors when staff work such long shifts. It is also a requirement that the duty rota actually reflect the shifts that are worked by staff. It is essential that the home maintain staffing in line with the dependency needs of the residents. Care staff undertake laundry duties. We also discussed with the Acting Manager the need to Care Homes for Older People Page 21 of 33 Evidence: ensure that the staffs time whilst on shift is being used effectively. The Acting Manager confirmed that 8 staff had completed their NVQ level 2 or equivalent. Staff will be provided with opportunities to undertake further training in NVQ. A sample of staff recruitment files were viewed. These contained the information as required in Schedule 2 of the Care Homes Regulations 2001. Since the last inspection the Acting Manager has obtained a copy of the Skills for Care Induction training for care staff. We were unable to view any completed induction packs as no new staff have started work at the home. We were informed that several training courses have been arranged since the last inspection. Whilst it is recognised that staff have undertaken training in several topics it is essential that knowledge learnt is transferred into care practice. This is essential for attending to the needs of residents with dementia. Care Homes for Older People Page 22 of 33 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. The Acting Manager has the qualifications to manage the home. The systems in place for quality assurance require further work, as they do not ensure effective audit and review in all areas. Residents monies are managed and protect the residents interests. Systems for staff supervision are now in place, thus enabling staff to reflect on their practice and development. Overall health and safety is being managed at the home, however shortfalls identified could pose a risk to residents. Evidence: The Acting Manager has the qualifications to manage the home. Prior to taking up the acting position she worked in the home as a care worker. It is recognised that she is lacking managerial experience and this has also been identified by the Registered Providers. She has completed the Registered Managers Award and NVQ At Levels 2 and 3. We discussed with the Registered Providers management training for the Acting Manager to include managing people. The Acting Manager confirmed that she is now Care Homes for Older People Page 23 of 33 Evidence: better supported by the Registered Providers. Since the last inspection the Registered Providers have been undertaking monthly Regulation 26 visits. Copies of these visit reports were available for inspection. Surveys had been completed by residents and their representatives. We discussed the need to further expand these surveys to include stakeholders and other professionals who have an interest in the home. The survey results had not been collated. We suggested that these are collated and displayed. Stock checks of medications had been undertaken and were recorded on the MAR sheet. No formal medication audits were taking place. No care plan audits were in place and the need to introduce these were discussed. The quality assurance policy viewed was very brief and it was not clear whether the home had an annual development plan in place. Regulation 37 notifications were now being sent to the Commission with a copy also being maintained at the home. It is acknowledged that the management has made some progress in areas such as medication management,care planning and some aspects of quality assurance. However there are still shortfalls in key areas and although management are demonstrating some insight into this further work is required in all aspects of the running of the home. A robust quality assurance system should pick up some of the shortfalls found at the inspection. The home does handle small amounts of personal monies on behalf of residents. Individual records and receipts are maintained. Since the last inspection the Acting Manager has developed a staff supervision system. This needs to be further expanded to ensure that all aspects of development and practice are covered. We noted that there was some improvement in the management of records and record keeping. Several years of documentation was still being kept in the office. This made it difficult for the staff to access the most current records. We discussed the need to archive the records so that accessing and managing records would be easier. Further work is required in this area especially in the areas of care planning. Records must be kept up to date, signed and dated to ensure that there is a clear audit trail. We sampled the maintenance and servicing records and with the exception of the legionella testing record all those viewed were up to date. The fire risk assessment had been undertaken in June 2009 and outstanding work identified at the last inspection had been completed. Risk assessments for equipment and safe working practices had been completed. Fire drills had not been taking place. Following the inspection the Acting Manager informed us that she had undertaken a fire drill on Care Homes for Older People Page 24 of 33 Evidence: 13/01/10. The need to ensure that all staff including night staff undertake fire drill training was discussed. There was evidence of most staff undertaking training in health & safety topics and staff spoken with confirmed this. No legionella testing had been carried out since 2008 and the need to ensure that this is undertaken annually was discussed. Care Homes for Older People Page 25 of 33 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 33 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 3 14 Pre-admission assessments 28/02/2010 must be completed in detail. To ensure that the residents needs have been identified and can be met by the home. 2 4 14 That the assessment process 28/02/2010 ensures that the home has the capacity, to meet the prospective needs of residents. To protect prospective and current residents. 3 7 15 There must be evidence that 08/03/2010 residents are involved in drawing up of their service user plan, so that their needs can be discussed, recorded and a clear plan formulated to meet these needs. Where a resident is not able to or needs assistance to be involved in this process, involvement of their representative must be Page 27 of 33 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 sought, unless it is impracticable to do so. This is so the plan of care is an accurate reflection of the needs and wishes of the individual. 4 7 15 Service user plans must be up to date and accurately reflect the needs of each resident. They must be reviewed monthly and whenever there is a change in the residents needs. This is to ensure that staff have up to date and accurate information to follow. 5 8 13 All assessments must be complete and up to date, to accurately reflect each residents current condition. This is to ensure that the residents needs are safely identified and met. 6 9 13 That staff receive further training and assessments of competency. So that medication is adminstered safely. 7 9 13 That the process of safe medicines adminstration is reviewed and reinforced. 01/03/2010 01/03/2010 08/03/2010 08/03/2010 Care Homes for Older People Page 28 of 33 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 So that the risk of residents receiving the wrong medication is eliminated. 8 9 13 That the Acting Manager continues to audit medication regularly. This is to provide evidence that medication is managed safely and given as prescribed. 9 10 12 That staff receive training in 31/03/2010 privacy, dignity and respect. To ensure that residents dignity, privacy and respect is maintained and promoted. 10 10 12 That residents are encouraged to take decisions about all aspects of their day to day lives. To ensure the home meets the assessed needs of the residents. 11 11 12 Further work is needed to 31/03/2010 provide residents and their families with the opportunity to discuss the care they want in the event of health deterioration. So that their wishes are clearly identified, recorded and can be respected. 01/03/2010 09/02/2010 Care Homes for Older People Page 29 of 33 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 12 12 12 All residents must be 31/03/2010 consulted about their interests and hobbies. The activities programme must reflect this and in respect of dementia care, there needs to be more evidence of activities specifically for residents with dementia being planned for and taking place. So that the residents can have there needs fully met. 13 18 13 That a copy of the Hillingdon 02/03/2010 safeguarding policy and procedure be obtained. To safeguard the residents and for staff to have information available and understand the process og safeguarding. 14 27 17 The duty rota must be up to date and reflect the staff on duty. To ensure that sufficient staff are on duty to meet the support needs of the residents. 01/03/2010 15 30 18 Further training must be 01/03/2010 planned for staff in dementia care and this training put into practice. Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that the staff have the knowledge and skills to care and support the residents effectively. 16 33 24 The results of residents surveys must be collated and published. So that all residents are aware of the feedback obtained and any action that is to be taken in their interests. 17 33 24 There must be a robust system in place for quality assurance, to identify shortfalls swiftly. So that action can be taken to address them and protect residents. 18 38 12 That legionella testing is 28/02/2010 undertaken at the required intervals and documentation available at the home for inspection. To protect the residents and staff. 19 38 23 For there to be evidence that fire drills have been completed by all staff at the required intervals. 01/03/2010 31/03/2010 31/03/2010 Care Homes for Older People Page 31 of 33 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 is to keep their knowledge up to date and protect residents, staff and visitors. 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 2 27 31 It is strongly recommended that staff do not work 24 hour shifts as this could be potentially unsafe. That the Registered Providers ensure that the Acting Manager undertake further management training to include people management. That further improvements are made to the management of records in order that there is a clear audit trail. 3 37 Care Homes for Older People Page 32 of 33 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 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!