Care Home: Tadworth Grove

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What the care home does well People have detailed individual care plans which they are involved in making and the service has implemented a "Resident of the Day" system . People receive well balanced and presented meals which meet with their preferences and they are provided with choices and alternatives. People told us that they enjoyed their meals. comments included, "Good meals" and "good range of choices choices ". Comments received from people and their representatives included, "Brilliant, would recommend it and good communication with staff". Relatives surveyed said,"The staff are friendly and kind"; "My relative`s care has been very good indeed, they are being greatly nursed and I am happy with my relative`s care"; "This is a happy home and one large family". The expert also spoke with some people`s relatives and friends who also expressed satisfaction with their relative`s care. People`s choices were respected. During this visit the Expert observed in the residential dementia unit, staff speak to residents carefully and thoughtfully to help them make choices relating to their preferred refreshments and meals What has improved since the last inspection? Since the previous inspection the service has implemented systems to ensure that people and /or their representative are consulted about their plan of care . At the time of this visit we observed that people`s privacy and dignity was respected,which was also confirmed through discussions with people. During this visit we observed people being able to make choices in their daily lives . The service has ensured that the Commission has has been informed of incidents and events that they are required to notify us about required by the legislation . What the care home could do better: The registered person must ensure that the application for a manager is to be register with the Commission is to be completed. The service needs to consider the times of the day that activities are provided for people and increase their opportunities in community participation. Key inspection report Care homes for older people Name: Address: Tadworth Grove The Avenue Tadworth Surrey KT20 5AT     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: Lisa Johnson     Date: 1 1 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Tadworth Grove The Avenue Tadworth Surrey KT20 5AT 01737813695 01737813285 deanef@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 71 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 to be accommodated is 71. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE). Date of last inspection Brief description of the care home Tadworth Grove is a large property situated in a quiet residential road on the outskirts of Tadworth in Surrey and is managed by BUPA. Accommodation is provided in two separate buildings that are linked by a ground floor Care Homes for Older People Page 4 of 30 Over 65 0 71 71 0 Brief description of the care home corridor. Nursing care is offered in the three-storey building and residential dementia care, in the smaller two-storey building. Both buildings are fitted with shaft lifts that give access to all floors. The grounds are spacious and attractively landscaped to provide seating and shade for the service users. Ample car parking spaces are available. The current fees per week range from £700 for residential care and £800 for nursing care per week. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 site visit was part of a key inspection. The visit was unannounced. We arrived at 9:00am and left at 5:30pm Information was provided to us by the service prior to this visit in the Annual Quality Assurance Assessment. (AQAA). This is a self-assessment that focuses on how well outcomes are being met for people using the service. We received the AQAA by the expected date, which provided us with all the information we asked for. Reference is made to this assessment throughout this report. As part of this key inspection we were accompanied by an expert by experience. An expert by experience is a person who because of their shared experiences of using services and/or ways of communicating helped us to get a picture of what it is like to live in the home and their observations are included in this report. Care Homes for Older People Page 6 of 30 During this visit the expert by experience spent four hours in the service and explored how people are able to make choices in their daily lives, looked at the arrangements for meals, looked at activities, explored resident and relative involvement and the environment in the residential units. The expert by experience provided feedback to the inspector and the manager. The expert by experience provided a written report to us of their findings, which are incorporated in this report. Throughout this report they will be referred to as the Expert. Other methods used to inform our judgments made in this report included discussion with people, their representatives and members of staff. We received surveys from three peoples representatives and five surveys were returned to us from members of staff. During this visit we sampled staff recruitment, and training records, care plans, risk assessments, menus, complaint, accident/ incident records, quality assurance systems, medication administration policies, health and safety records and policies and procedures We also reviewed other information that we have received since our previous including notifications. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 8 of 30 order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed prior to admission to the home ensuring that the service can meet their needs. The service does not support people for intermediate care. Evidence: The service continues to operate a clear pre admission procedure, which includes an assessment process,which involves gathering information from the person their representatives, care management assessments and any relevant health professionals. During this visit we looked at four peoples pre admission assessments, which were detailed and covered their health,personal, emotional, communication, social, cultural and religious needs. People considering the home as a place to live are able to visit, stay for lunch and the service is able to accommodate short term trial stays. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs are set out in an individual plan of care, which people and their representatives are consulted about Peoples health and personal care needs are met and their privacy and dignity is respected. The home supports people with medication in a safe way. Evidence: Each person has a care plan in place,which is based on an assessment tool called QUEST. Information supplied in the AQAA stated that people and their representatives are encouraged to attend care reviews and that they are involved in personal care planning. During this visit we sampled four peoples care plans that had been signed by their representatives confirming their involvement. The service is currently implementing a Resident of the Day,system, therefore once a month care plans are reviewed and relatives are invited to participate with the persons permission. The person will meets with the manager or deputy, chef and activities coordinator to discuss any issues or preferences for the following month. Information seen in the care plans demonstrated that these are regularly reviewed Care Homes for Older People Page 12 of 30 Evidence: and audited. Information seen demonstrated that a range of risk assessments are completed including, tissue viability, moving and handling and use of bed rails. The service is ensuring that staff complete wound care documentation where this is required. We saw two peoples plans, which contained wound care assessments and we also saw where a person may have a wound a pain assessment chart had been implemented. Where people were identified at risk of falls risk assessments were completed and where people were identified a risk of developing pressure areas appropriate equipment such as pressure relieving mattresses had been provided. Peoples weight is regularly monitored and their nutritional needs are assessed using a recognised nutritional assessment tool. The AQAA states that the service has links to regional and national specialists that are available for consultation. Records were maintained of all health consultations that people receive such as chiropody and they are registered with a General Practitioner of their choice. During this visit we looked at four members of staff training records, which demonstrated that they receive a range specialist training, which included dementia, palliative care and risk assessment A quality audit was carried out earlier in the year, which highlighted that wound care training needed to be carried out and updated, which has been taking place and catheterisation. Information supplied in the AQAA states that the service has nominated a dementia Champion who will attend additional training and attend local and national conferences and training programme to improve the service provided to people with dementia . During this visit we observed staff respecting peoples privacy by keeping bedroom doors shut when carrying out personal care. Information seen in peoples care plans recorded their preferred name of address and demonstrated that people had been consulted about their preferred gender of staff to support them with their personal care. Staff were observed to be attentive and spoke to people respectfully. At the time of this visit people were seen to be appropriately dressed and clean. At the time of this visit a relative spoke positively about the care that their relative received Brilliant, would recommend it and good communication with staff. Relatives surveyed said,The staff are friendly and kind; My relatives care has been very good Care Homes for Older People Page 13 of 30 Evidence: indeed, they are being greatly nursed and I am happy with my relatives care; This is a happy home and one large family. A person surveyed spoke positively about a supervisor in the residential unit When this person is working there is a very positive and happy atmosphere. One relative surveyed said, I think staff could pay a little more attention to detail, that is-small comforts, sitting properly in the wheelchair and perhaps talking to the residents a little more. During this visit we looked at the medication administration practises in the service. Each unit has their own medication trolley and clinic room. During this visit we viewed the medication on one of the nursing units in Willow. Medication was stored appropriately in the clinic room. Medication is obtained from a local chemist using the monitored dose system (MDS). Records were maintained for the receipt and disposal of medication Systems were in place for the safe storage of controlled medication and we viewed the register, which was appropriately maintained Medication administration records sampled were maintained and recorded. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with activities that meet with their social, cultural and religious needs, although further improvement is needed to provide more personal involving activities and to consider the times that they are provided.People maintain contact with their family and friends, although further opportunities for people to maintain contact with the local community needs further improvement. People are enabled to make choices and they are are provided with varied and well balanced meals. Evidence: There is activities programme in place, which also includes the provision of some activities at the weekends. The programme was seen on display in the service and information supplied in the AQAA states that the programme is sent out a month ahead. The range of activities included, movement and music, Pets therapy, film shows, sing a longs, painting, indoor games card, tea in the garden, games and external entertainers. Peoples religious needs are respected and three local churches visit the home every third Sunday where people can enjoy a short service.The home provides a large hairdressing salon and we were informed that there are volunteers who visit. A map of life is incorporated in to each persons care plan, which provides information Care Homes for Older People Page 15 of 30 Evidence: about the persons individual interests and hobbies. A care plan in respect of social activities for a person living in the residential unit provided detailed and comprehensive information. Information supplied in the AQAA states that the service could improve by promoting the link for residents with common interests to form small interest groups. Occasional outings take place, although the manager has identified that they would like to improve community integration. During this visit a person told the Expert that they would like to undertake some personal clothing items shopping. The manager acknowledged to the expert that the matter of external visits to the shops and library had been noted following a residents request and they were actively seeking out a local organisation that might undertake these visits and they are exploring external day services. The managers plan is to hold Managers coffee sessions to which residents and relatives would be invited to jointly bring concerns and suggestions. The manager is also planning to provide an in house trolley from which small items could be personally purchased by residents. A member of staff surveyed said, The home could improve by providing more outings for people and having their own vehicle. The expert visited the dementia unit in the residential service.There were six people seated while country and western music was being played. It was quite loud and cheerful and two residents and a staff member were clapping with the music, although the expert noticed that during the whole time of their visit some music continued in the background. The expert observed two people who were talking to each other although one person appeared to be asleep for the whole morning. The expert observed staff moving around the room talking in turn to each person and assisting them to get up and walk about if the person indicated. The care staff spoke to residents carefully and thoughtfully to help them make choices relating to coffee, tea, sugar and biscuits. The expert observed the thoughtfulness and attention given by one particular carer in the dementia unit was excellent. The other residents on this floor had chosen to stay in their rooms. The expert was invited by a person to sit with them in their room who said, We all get on alright together, we sort things out together. The expert visited downstairs in the residential unit after 11a.m. and observed that people remained in their own rooms for much of the time or visited other people in their rooms on a one to one basis. As there was only one member of staff designated downstairs and activities were said to be offered by carers in the morning they would Care Homes for Older People Page 16 of 30 Evidence: be inevitably be busy attending to their other designated duties. People were able to exercise choice by staying or not staying in their rooms, but after that there was little stimulation apparently available. The expert spoke to one person who was unhappy about their placement and that due to resident changes there was no one that they could really talk to.This was brought to the attention of the manager. It was observed that the main activities only take place in the afternoon. We were told that a number of people get up later in the morning. This was addressed with the manager as some people were quite tired after lunch with some people declining group activities.The service should consider the time that activities are provided When the inspector visited the main lounge in the afternoon the activities coordinator was undertaking activities with residents, which they appeared to be enjoying. The service employs an open visiting policy taking in to account peoples wishes. Relatives and friends are invited to attend social events.Three relatives told us that they are always made to feel very welcome and that the service receive visitors well. The expert observed that there were a number a relatives and friends who were waiting to see their resident after the meal time was over. On being asked they expressed satisfaction with their relatives care in sometimes challenging situations. People are able to bring their own possessions into the home and the manager has instigated a new system of consultation meetings with people and their representatives. Regular communications and news letters are produced to keep people and their relatives informed of choices and developments in the home. The home provides a four weekly rotating menu, which is changed seasonally. The menu was varied and well balanced and consisted of choices and alternatives. The service provides a night bite menu, which ensures that food is available for twenty four hours. Meals are provided to meet different dietary and cultural needs. Since our previous visit the service has now provided menus on the tables to make these more accessible to people During this visit we observed the lunch time meal served in both the nursing wing and the residential unit.The dining room provided a pleasant and comfortable environment for people to have their meals. Where people required support with their meals staff were seated and provided good interaction and sensitive support. Meals provided in the residential unit and on the nursing floor were served from a heated trolley.The expert observed that the chef managed most efficiently to present Care Homes for Older People Page 17 of 30 Evidence: appropriate, attractive meals to a number of dining rooms. The expert observed that the meals were brought rather slowly to the table from the large, heated trolley. The meals were hot and the chosen content was attractively presented. When one person saw their meal which was fish with sauce they were very unhappy and said No. The carer talked to this person nicely and realised that the sauce was the problem, they removed the plate and went to see the chef. A new piece of fish was cooked and the chef appeared shortly after wards and was welcomed by all in the dining room. During this visit refreshments were provided through the day with home made biscuits and cakes. People and two relatives spoken to during this visit expressed their satisfaction with the meals. Comments included, Good meals, choices available and the meals are pretty good. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience 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 and their representatives concerns and complaints are listened to and they are protected from abuse . Evidence: We looked at information provided to people, which tells them about how they can make complaints.The complaints procedure is displayed and is also provided in the service user guide. The home also has a suggestions box and information supplied in the AQAA states that a comments book on the residential unit for people who wish to comment or raise issues. Some people spoken with said that would speak to the nurse or the manager if they had any concerns or complaints. During this visit the expert also spoke with several residents who were aware if they were worried about anything they would seek help from a carer or the manager. Three people surveyed also confirmed that they know how to make a complaint. In the last year the service has received ten complaints. Two of these complaints had been brought to the attention of the Commission, which were referred to the provider to investigate, which they completed. The service maintains a complaints register, which we sampled. During this visit we sampled some of the complaints that had been raised. Clear and detailed records were maintained of all the complaints and the concerns received and the action that has been taken to resolve them. Care Homes for Older People Page 19 of 30 Evidence: The service has safeguarding vulnerable adults from abuse and whistle blowing procedures in place.The service provides safeguarding training for staff and discussion with staff and training records sampled confirmed this. Two members of staff spoken with during this visit told us that they were aware of the procedures, that they had attended training and were clear about their responsibilities should they witness or be made aware of any incident where the safety of a person is compromised. Over the last year six safeguarding referrals have been made following the local authority safeguarding vulnerable adults from abuse procedures, which have resulted in two matters being accepted by the local authority. These pertained to a service user to service user incident and a care practise and staff training issue. These have now been completed and currently there are no open safeguarding matters. Some practise issues not accepted by the local authority have resulted in further investigation by the organisation and a quality audit being conducted. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live an environment that is in the main safe, maintained, comfortable and clean, although this could be enhanced with further redecoration. Evidence: The service is situated in a pleasant residential area in Tadworth and is set in well maintained gardens. There are two main buildings, Willow that provides support to people who require nursing care and Pine Lodge which provides residential care with the second floor being appointed to support people with dementia. There is a continuous refurbishment plan in place. Since our previous visit some improvements have been made in the second floor in Pine lodge including replacement of flooring. The Expert observed that the downstairs in lounge provided no cheerfulness or flowers and had an old bar, which had unused optics. The inspector also noted that this room also had a musty smell and a hoist was seen stored there. This was addressed with the manager who told us that there are plans to redecorate and refurbish this room and other communal areas throughout the building. There are also plans to replace carpets and some soft furnishings. At the time of this visit the second floor in Willow unit was closed due to redecoration and some people have moved into vacant rooms on the ground floor. The manager told us that people have been consulted about this work and the AQAA states that the Care Homes for Older People Page 21 of 30 Evidence: service intends to continue to involve people and their families in suggesting improvements in the home. The expert spoke with some residents in the residential unit who were aware that building improvements were taking place in the other building and commented, Its about time our part had an uplift. A relative surveyed said, I feel that some of the rooms could do with refurbishing and laundry could be more carefully monitored. The expert walked through several dining areas as they were set up in both buildings. They were attractively and spaciously arranged with table cloths, serviettes and flowers. There were vases of flowers around the building in parts that were in regular use making a welcome focus. During this visit the home was observed to be accessible for people using wheelchairs and a lift is provided to access the second floor. Grab rails were provided throughout and assisted bathrooms are available. People are provided with call bells and we observed that these had been placed where people could access them. The homes signage has been audited to ensure that is accessible for wheelchair dependent people. We were invited by some people to visit their rooms, which were personalised with their belongings. The bedrooms which were seen by the expert were compact, but in cases there was sufficient space for a book case or cabinet of precious , memorable items and in some cases there was a chair for a visitor. There were on the doors of several of the rooms upstairs in Pine Lodge bright, large painted names of people although one person asked the expert what it was on their door, but at least some effort to personalise the rooms had been made. In some of the bedrooms downstairs the expert observed there was no chair available for a guest to sit on. At the time of this visit the service was observed to be clean and hygienic Information supplied in the AQAA states that that the service have continued to monitor the quality of housekeeping and ensure that the correct staffing levels are in place.Infection control procedures are in place.Staff records sampled indicates that they receive infection control training and hand sanitizers were in place. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels in the main meet the needs of people living in the service, although they need to be kept under continuous review. Staff are supported to attend training and development to ensure that they are able to meet the needs of people and they are protected by robust recruitment procedures. Evidence: At the time of this visit the service thirty people were in residence.The home is currently under half occupied . The second floor nursing unit was also closed due to redecoration. At the time of this visit there was a registered general nurse and three carers on duty in Willow nursing unit and a further care member of staff was supplied to support three people who are currently residing on the ground floor. In pine lodge residential unit three carers were provided on the second floor and one member of staff was available on the ground floor supporting five people.Pine lodge also has a manager. Three members of staff surveyed said that there is usually enough staff and one person said sometimes. Two members of staff felt that staffing levels could be improved in the nursing unit due to the dependency needs of people living there. This was discussed with the manager who informed us that a deputy manager is in post who also provides floating support and that staffing levels are kept under review. Care Homes for Older People Page 23 of 30 Evidence: The service is also supported by catering, activity coordinators, laundry, domestic, maintenance and administrative staff. New staff receive induction, which follows the Skills for Care core induction standards. Discussion with staff confirmed that they received induction , which was also recorded in their training file.The service employs thirty care members of staff, thirteen of these have acquired National Vocational Qualifications (Level 2) or above. Information supplied in the AQAA stated that the organisation (BUPA) has obtained Investors in People accreditation for staff training and development. The service maintains a staff training schedule in place. During this visit we sampled four members of staff training records, which demonstrated that they receive statutory and specialist training.There is ongoing training in Customer service, tissue viability and Mental Capacity Act. During this visit a member of staff said, There is lots of training. Four members of staff surveyed said that they feel they always or usually have enough support, experience and knowledge to meet the needs of people living in the home. Comments included, The service provides the necessary and required staff training Staff recruitment is based on equal opportunities and the current staff are of mixed gender and ethnicity. Four members of staff personnel files were sampled during this visit, that contained all the documentation, which is required including fully completed application forms, two written references and enhanced criminal record bureau checks CRB Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a manager in post who needs to register with the Commission. Quality assurance systems are in place and peoples safety and welfare is promoted. Evidence: Since the last inspection there has continued to be some changes of managers. A manager was appointed, who commenced in December 2009 who only stayed short term. Since February 2010 a manager who had previously worked at this home for a short period from within the organisation (BUPA) has now been appointed as the permanent manager. The service has not had a registered manager in place for a year. The manager needs to submit their application to the Commission to register with us, which must be completed. Shortly after this visit the manager has contacted us to confirm that they have submitted their enhanced criminal records bureau check application to us. Prior to the appointment of the current manager information had come to the attention of the Commission in respect of some practice concerns. This was addressed Care Homes for Older People Page 25 of 30 Evidence: with the registered provider(BUPA) earlier this year. The organisation has carried out a quality audit of the service, which resulted in an action plan being implemented, which highlighted areas for improvement.This was also provided to the Commission. The organisation is demonstrating that this action plan is being regularly monitored and reviewed. During this visit we noted that there has been some areas of improvement such as the appointment of a permanent manager, staff training and improved care planning. While there have been improvements made their are still some areas of the service that need to be improved such as enhancing further activities for people and refurbishment of areas within the home. The Annual Quality Assurance Assessment (AQQA) also provided to us by the manager contained clear information about areas that have improved and they have identified areas where further improvement needs to be made. Some positive comments were received from people living in the service about the new manager including, The manager is accessible, listens and Takes action and a relative surveyed said, We have a new manager, staff are to be retrained, this is good. Some members of staff spoken with at the time of this visit spoke positively about the appointment of the new manager . Comments included, The home seems more settled and there have been improvements in care; The morale has improved and The manager is approachable. A majority of the staff said that were happy working in the home, although one member of staff commented that further improvement is needed in respect of relationships with the team. Staff also told us that regular team meetings take place and some staff told us that they receive regular, formal supervision. Monthly unannounced quality monitoring visits are conducted by the registered provider, which were available for viewing.In addition a range of regular quality audits are conducted such as care plans, and medication. The organisation also obtains internal and external feedback from people living in the service and their representatives including annual quality assurance feedback surveys that have been carried out to gain the views of people and their representatives. The outcomes are analyzed and action plans are implemented. Since the appointment of the new manager meetings with people living in the service Care Homes for Older People Page 26 of 30 Evidence: and their representatives have been resumed. Policies and procedures are in place for the safe handling of peoples monies.People handle their own affairs or by their representatives. The service provides an invoicing system for the payment of items such as hairdressing. The service has a range of health and safety procedures in place. Monthly health and safety audits care carried out and water temperature monitoring is conducted. Staff training records sampled demonstrated that they receive statutory training including first aid, moving and handling, food hygiene and health and safety. Information supplied in the AQAA and from records sampled during this visit confirms that regular servicing and maintenance of equipment takes place. Accident and incident records were maintained and the service has provided notifications to us about events that we must be informed about required by the legislation. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 9 The registered person must make arrangements to ensure tha a completed application is made to the Commission to register a manager This is to ensure that the service is run by a person fit to do so 11/08/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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