Care Home: Tandy Court

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What the care home does well Information about the home is available for people and their representatives to look at before coming into the home. This helps people decide if the home will suit them. This information is also available in people`s flats if they decide to stay this helps some people remember what services the home provides. People said about the home `They care for me,` `I enjoy being here,` ` Does everything well, there are no complaints.` Six people spoken to said that the service provided is good and the staff are friendly and caring. Information about a person`s needs is collected and is used by the staff to plan how the person can be assisted day to day. Care plans are written and these show how people`s needs should be met. People have access to health professionals when needed such as GPs chiropodist opticians and so on; this helps to ensure people keep well. One relative said `the staff were very quick to deal with my relative when they were taken ill. They notified me immediately that they had called for an ambulance to get them into hospital for medical attention.` People had their personal hygiene needs met and records showed that staff repeatedly tried if sometimes people refused. People in the home have the opportunity to join in activities. People and their representatives commented. `The home does well in cooking and general activities.` `Valentines day beautifully done even the queen wouldn`t have been disappointed.` ` Good events calendar.` People were happy with the food provided they said ` the food is lovely` `they make me breakfast every morning.` There was a good choice of food and snacks were available throughout the day. People felt comfortable to tell staff if they were unhappy with the service they received. They thought that it would be put right quickly. Staff are well trained with a large number of staff having the National Vocational Qualification level 2 in care. This is recognised training qualification for care workers and staff have specific training in some of the health conditions people have such as dementia. There is excellent recruitment practices and this helps to keep people safe. People`s money is managed well, there are good records kept and this ensures people`s money is safe. There are good records of health safety checks within the building and this helps to minimise risks to people. The home is managed well with managers that are committed to improvement in the servicec and who have a knowledge about the people they provide a service for. What has improved since the last inspection? The managers have put in place systems to check the records such as care plans and risk assessments so that gaps can be identified and rectified. Medication has improved and is administered properly and this helps to keep people well. Two people`s flats had showers installed and four people`s flats had baths replaced with showers. This helps to keep people independent for as long as possible. What the care home could do better: One person`s information gathered in the assessment was some months old before they were admitted. There was no record to show that the information had been checked to see if it was still correct. This could mean that a new need may not be met. There could be more detail recorded when a person who often refuses personal care accepts. This may help the home plan how to deliver personal care in the way the person will accept morre often. Clearer records of activities need to be collected to show how people`s social activity plan is met. Some people wanted to go out more. The home was cold on the day of the inspection. We received two comments about this one said the home could be improved by `more heating` another expressed a hope that there would be more heating in her room that night. Although the engineer was called on the day one comment was from a written survey completed some before the inspection. We are aware the boilers are to be replaced shortly plans must be made to check all areas of the home and ensure it is all adequately heated. People living in the home enjoy sitting together in one lounge on the ground floor and this is no longer big enough to meet the demand. Some people need to be monitored routinely to ensure their safety and they are better being on the ground floor. Other options need to be explored to ensure their is adequate seating in the right place. Some improvements in the home were needed to help people remember where they are in the building and to make doors easier to get through when using a walking aid. We were aware that staff were covering staff shortfalls. Five people thought they waited for care because there was not enough staff. Some people thought staff were tired from working extra hours. Staffing levels need to be reviewed to take account of the number of people that need more frequent checks and prompts. Key inspection report Care homes for older people Name: Address: Tandy Court Tandy Drive Kings Heath Birmingham West Midlands B14 5DE     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: Jill Brown     Date: 2 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Tandy Court Tandy Drive Kings Heath Birmingham West Midlands B14 5DE 01214308366 01214307581 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.anchor.org.uk Anchor Trust care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category 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 (OP) 40 Mental disorder, excluding learning disability or dementia (MD) 40 Physical disability - over 65 years of age (PD(E)) 40 Dementia over 65 years of age (DE(E)) 40 Date of last inspection 1 2 0 3 2 0 0 9 0 40 0 0 Over 65 40 0 40 40 Care Homes for Older People Page 4 of 29 Brief description of the care home Tandy Court is a well maintained two-storey purpose built Home, which opened in 1985 and is situated in a quiet cul-de-sac in the South of Birmingham. The Home is situated close to shops, a public house, post office and public transport. It provides accommodation for 40 residents over the age of 65 years for reasons of old age, dementia, physical disability or mental disorder. All flats are for single occupancy and have an en suite toilet and kitchen facility. There is a bath or shower in thirty-seven of the en suite facilities. However the baths within the flats have low-level access and may not be suitable for all residents. In addition, there are communal assisted bathing facilities situated throughout the Home, which are suitable for all residents to use and a portable bath seat that may be used in the low-level access baths. Aids and adaptations are available to assist residents with physical disabilities and handrails are provided throughout the Home. Communal areas consist of a dining room on the ground floor, which leads out onto a patio area and secure well maintained garden which is also suitable for wheelchair users. There are three comfortable lounges providing a choice of sitting area for residents. There is adequate off road parking to the front of the Home. Notice boards display any forthcoming events, CQC reports, newsletters and other information of interest to residents and visitors. The weekly fees to live at Tandy Court are dependent on whether person has dementia and who is funding. Items excluded from the fee include private chiropody, hairdressing and personal toiletries. Care Homes for Older People Page 5 of 29 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: We visited the home unannounced on a day in December 2009. We completed a key inspection which means we inspected the homes performance against most of the National Minimum Standards. During the inspection a pharmacist inspector visited and inspected the administration of medication. The home gave us information in an Annual Quality Assurance Assessment before the inspection. The AQAA shows how the home rates their performance in the areas set out in this report and what improvements to the service they intend to make. During this inspection an expert by experience Mavis Morris accompanied us. An expert by experience is a person who, because of their shared experience of using services and/or ways of communicating, visits a service with inspectors to help them get a picture of what is like to live in or use the service. During this inspection she spoke to eight people that live in the home and one member of staff. Care Homes for Older People Page 6 of 29 During the inspection we case tracked three peoples care. This means we looked at all the homes records about the person, their medication, any money held on their behalf and their bedrooms. We looked around parts of the building. We also looked at other records about the safety of the building, complaints, accidents and so on. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The managers have put in place systems to check the records such as care plans and Care Homes for Older People Page 8 of 29 risk assessments so that gaps can be identified and rectified. Medication has improved and is administered properly and this helps to keep people well. Two peoples flats had showers installed and four peoples flats had baths replaced with showers. This helps to keep people independent for as long as possible. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have enough information in order to decide whether they would like to live in the home. Detailed information is collected about peoples needs and this means that care can be planned in an individual way. Evidence: The organisation provides good information for people and their representatives to help them consider Tandy Court as a place to live. People have contracts to cover their stay and this helps to protect their rights. We received six surveys from people living in the home some of them did not remember whether they had received information. We found that information was available in service user guides which were in the flats we sampled. We looked at details of two peoples admission to the home. People were visited by management of the home before they were admitted and details of their health and social care needs were collected. This included information about the persons health Care Homes for Older People Page 11 of 29 Evidence: conditions, medication, ability to undertake daily living tasks such as washing and dressing, life history and interests. This information helps to ensure that the person receives the right care. For one person this collection of information took place several months before admission and there was no record that the information had been checked to see if it remained the same. There were no record in the care files sampled of people coming for a visit to the home before admission, although the manager stated this was available. People visiting the home over a a few hours can help the home find out what difficulties the person has especially if the person has dementia. Shortly after the person is admitted a baseline assessment is undertaken. This includes more detailed information. Some of this information has been collected after observing how the person has managed in the home since their admission. This information helps care plans be more individual to meet the persons needs. Care Homes for Older People Page 12 of 29 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. People living in the home can be assured that are detailed enough for staff to meet their needs. Systems are in place to ensure that peoples health is monitored. The medicine management was good. Robust systems had been put in place to ensure that the medicines are administered as prescribed. Evidence: Care plans are generally completed within days of people being admitted and there was a good amount of information available to inform staff how to care for people. There had been improvements in ensuring that all the essential information available was in either the care plans or the risk assessments. It was clear that the management were checking care plans for quality and where there were gaps instructing staff to rectify this. A further check that these gaps had been filled was needed in some instances. We looked at the daily records of three people and the senior staff handover records. We found that when concerns were raised about for example red areas on skin, pain, Care Homes for Older People Page 13 of 29 Evidence: or chesty coughs appropriate action was taken to get appropriate health professionals opinion. People had access to health services such as district nurses, GPs, chiropody, opticians and so on as appropriate. One relative survey said They were very quick to deal with my husband when he was taken ill. They notified me immediately that they had called for an ambulance to get him into hospital for medical attention. People appeared to have their personal hygiene needs met but this was challenging for some people. Where people refused assistance with bathing or showering, or washing and dressing we were able to see that staff approached a number of times until this was achieved. Details should be kept of what method gained the persons agreement to see if this improves the number of times they succeed with individual people. The pharmacist inspection lasted three hours. Six peoples medicines were looked at together with their Medicine Administration Record (MAR) chart and care plans. One care assistant, who had recently taken over the responsibility of medicine management in the home was spoken with. All the requirements left at the last inspection had been fully met and this was commended. The medicines were stored in two medicine trolleys used to transport the medicines to the people in the home. Surplus medicines kept in locked cupboards. A separate cream trolley was used and staff recorded their application on separate cream charts. Controlled Drugs were stored in a metal cabinet. Medicines requiring refrigeration were stored in a designated medicine refrigerator at the correct temperature. Nutritional supplements were kept in a locked cupboard and their administration recorded on the MAR chart so it was possible to see when they had been administered. The home has a good system to check the prescriptions prior to dispensing and to check the medicines and MAR chart received into the home. The quantities of medicines received together with any balances carried over from previous cycles were recorded enabling audits to take place. Audits indicated that the medicines had been administered as prescribed and records reflected practice. Protocols for medicines prescribed to be used on a when required basis had recently been written and were awaiting the doctor to confirm their accuracy. The home has a good system installed to check all new medicines received into the home. The dose of one medicine was unclear and staff sought further clarification Care Homes for Older People Page 14 of 29 Evidence: before the medicine was administered. This was commended. The care assistant spoken to had a good knowledge of the medicines she handled and had collated medical information of all the prescribed medicines on the premise for staff to read if necessary. A robust quality assurance system was in use to assess staff competence in the handling of medicines. This had help to raise the standard of medicine management seen. The care plans listed the underlying clinical conditions of the people in the home and recorded all external health care professional visits. It was possible to track why a medicine had been prescribed or why a dose had been changed. All controlled drug balances were correct and record reflected practice. The expert by experience spoke to eight people living in the home six said that the service provided was good and that the staff were caring and friendly. One person one said that some staff were insensitive to their needs and thought this was staff personalities. From the six surveys people told us I think they do everything they can I enjoy being here. Does everything well, there are no complaints. They care for me. Care Homes for Older People Page 15 of 29 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 living in the home are offered activities that are meaningful to them. People are assisted to make choices about activities and food and this enhances their life. Evidence: We looked at the records about activities provided and the expert by experience spoke to people about their activities and spoke to the activities co-ordinator. The activities co-ordinator works part time in the home. The records of activities only show only what activities the coordinator has undertaken and not any provided by other staff. When she is on holiday it does not detail if activities take place. The records do not indicate who has joined in the activity so it is difficult to determine if all people have the opportunity to join in. People have activity plans which say what peoples interests are but it is difficult to see whether they have taken part in them. However, it was clear that any festive occasion was celebrated such as Harvest festival where a trip had been arranged to a school, halloween, bonfire night and Christmas. There was a good range of activities recorded such as food preparation and cooking and gardening as well bingo, board games and gentle exercise. A number of people prefer to arrange their leisure time in their flats watching TV, one person sampled had knitting, a computer and reading material available. Five people Care Homes for Older People Page 16 of 29 Evidence: spoken to said that they spent the majority of their time watching television. Three of five said they joined in activities arranged in the home. One prefers to read books and newspapers. Although trips are arranged these are usually for small numbers of people and people spoken to wanted more opportunities to go out. A survey said The home does well in cooking and general activities. We did not speak to relatives at the time of the inspection however we looked at the complaints and compliments records and received nine surveys from relatives and representatives. (Please Complaints and Protection section). They told us The home has a friendly atmosphere, approachable staff, good food and good events calendar. they look after my relative with caring compassion. my (relative) is happy an contented which means everything is well done. allows my client choices and to live their own chosen lifestyle. overall excellent level of care and real concern for the welfare of the residents. Two out of the nine responses thought more could be done to ensure good communication between the home and the representatives. People were not observed to be unduly restricted. Where it had been necessary to restrict peoples liberties independent Best Interest Assessments had been undertaken and this helps to preserve peoples rights. We looked at the homes menus and found that people were offered a cooked breakfast three times per week plus cereals and toast and cereals and toast on other days on other days. There is a light lunch available which consists of a hot options such as jacket potatoes, soups or corned beef hash or sandwiches or salad and there is sweet trolley available. On Sunday there is a traditional Sunday roast. On an evening the main meal of the day is served and this includes a choice of hot meal and a hot pudding. Seven people were asked about meals they said that they liked them and there was variety of food available including fresh fruits. People said they were offered a choice of food. The expert by experience joined people for lunch and saw people being offered soup and buttered bread or sandwiches with a salad. There was a choice of puddings. One person said they would like more fish dishes and really enjoyed the salmon and prawn dishes the home had served as part of the christmas festivities. People were observed to be offered snacks throughout the day. However on this occasion were observed not to provide a plate for the snack which could cause difficulty for some people. One relative thought there was too much junk food between meals. However for the peoples care sampled weight increases were not an issue. Care Homes for Older People Page 17 of 29 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. Policies and procedures are in place to ensure that complaints are listened to and people are safeguarded. These measures help to ensure peoples health and wellbeing. Evidence: Records are kept of both minor concerns as well as complaints and there are records of compliments the service has received. This assists the home in determining how they can improve. We have received no complaints about the service in the last year. Complaint procedures and safeguarding procedures are displayed. Concerns raised were generally not of a serious nature and appeared to be isolated quality issues of food, noise, communication cleanliness and missing items. Compliments raised included food, communication, cleanliness, health care and the number of events. The expert by experience asked residents about concerns and complaints. One said they would raise concerns with the manager, four said they would raise them with a carer, and three people said they would talk to a relative. People thought their issues and concerns would be resolved quickly. Although people were not sure of the formal complaint procedure they did not appear to have any concerns or worries about voicing their concerns. In the last year a safeguarding referral was made by the home because of errors in medication administration. These errors were taken seriously and investigated. Care Homes for Older People Page 18 of 29 Evidence: Medication administration has improved and is now good. Staff are recruited well and have training in safeguarding and this helps to ensure the safety of people living in the home. Care Homes for Older People Page 19 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home have an environment that generally meets their needs. However some of the planned improvements need to happen as soon as possible to ensure peoples needs are met consistently well. Evidence: The home is purpose-built and is on two floors, there is a passenger lift as well as stairs to access the upper floor. People living in the home have the benefit of having a small flat that includes a bed sitting room with kitchenette facilities and separate bathroom. The home has assisted bathing and showering facilities available for people that cannot access the facilities in their flat independently. There is a wheelchair accessible garden. People living in the home told us the cleaning is done very well but we need more heating. I hope they put more heat in my room tonight. We found on inspection that areas on the ground floor were cold, work was being in the reception area that could have influenced this. However one staff toilet could not deliver hot water which indicated that one of the two boilers was not working properly. We received assurances that engineers had been called out and there was some secondary heating available. We were told that there are plans to replace the boilers at the end of March as they were becoming unreliable. The time table for this should Care Homes for Older People Page 20 of 29 Evidence: be reviewed. Relatives and representatives said about the home:- They need extra seating on the ground floor as everyone seems to congregate there. There is a relaxed atmosphere. Good environment The building is about 25 years old and showing signs of wear and tear loose handles and hinges..there needs to be a safer alternative than the door springs so people can open fire doors with a zimmer frame. The dining room is noisy and disruptive. We found that there was insufficient seating on the ground floor for the numbers of people that wanted to be in the lounge area. Although there are other seating areas on the first floor people did not want to sit there. As the home has a number of people that walk a lot this may increase the number of people on the ground floor. The atmosphere in the home is good with people choosing to mix with other people resident in the home. This could be lost if people feel there isnt room for them in a social setting such as the lounge. We found that the peoples flats that we looked at were well decorated and had evidence of being furnished the way people wished. Some people having lots of belongings and ornaments displayed others having not a lot. Finding your way around the home like a number of care homes was not easy. Flats had numbers on them these may not be recognisable to all the people in the home and more signage may assist in this. The service was looking at how the home could be easier for people with dementia to find their way around. One person was found to have difficulty with the lock on the flat bathroom door and did not understand the workings of their flats front door lock. It is suggested that a check on how each person manages their environment is undertaken so solutions to these difficulties can be found to enable peoples independence. Improvements were being made to the environment these have included showers being installed in two flats that did not have baths and four flats have had the baths replaced with showers. These are more easy for people to use independently. We were also told that the passenger lift is to be shortly. The home was clean and fresh in all areas looked at. Care Homes for Older People Page 21 of 29 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. People in this home can be assured that they will receive help from well recruited and trained staff. People feel that there are not enough staff to meet their needs quickly. Evidence: Five people told the expert by experience that there was not an adequate staffing level and this meant that they had to wait unreasonable time for assistance. Overall people felt that the shortage of staff was worse during the day in comparison to the night. People living in the home and we were aware that there had been some staffing difficulties recently. This has meant that staff were covering extra shifts. A person said that due to the shortage of staff, the girls (carers) were working longer hours and appeared to be tired. We looked at 4 weeks rota for care staff and this clearly showed that day staff were being used to cover nights. Staff have been doing overtime, some bank staff have been used. We found that at the weekends that the staffing levels were not as good. We were told that there are to be some improvements being made to staffing numbers at night with a team leader being added to the numbers at night. Some people that the service care for have high supervision needs and require numerous prompts and checks through the day. They are unlikely to request assistance and are more visible if they are encouraged to be with other people on the ground floor. The increasing needs of people admitted has impacted both on the Care Homes for Older People Page 22 of 29 Evidence: lounge facilities and the deployment of the staff. care staff are supported by a management team, housekeeping, maintenance and catering staff. Records indicated that about 78 percent of care staff have reached at least the National Vocational Qualification level 2 in care or equivalent. This is the qualification recognised by us as demonstrating that staff have had appropriate care training and this exceeds the standard of 50 per cent. We looked at the recruitment records for two staff and found that all the staff had completed an application form, and had checks including with Criminal Records Bureau and Protection of Vulnerable adult lists and references. We found that recruitment of staff was thorough with staff having a formal written test before selection to ensure that they had the skills and understanding to carry out their required duties. We looked at the training matrix for staff and found that there was a clear method to ensure that staff have the training that they require. The staff surveys received indicated that staff were proud of the service they provided and that they received appropriate training. Care Homes for Older People Page 23 of 29 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. People living in this home can be assured that it is being run in their best interests. The service needs to respond to changes in the resident population. Evidence: The Registered Manager is called the business manager in the home and she has achieved the Registered Managers Award which is the recognised qualification for people managing a care home. She is supported by care manager both have had many years experience working within a managerial role in a care environment and they hold appropriate qualifications in care. The home supplied us with the Annual Quality Assurance Assessment (AQAA) and this was completed in a timely manner. This AQAA told us that Anchors quality procedures are in place. The service has monthly quality indicators that are looked at and analysed. Visits are undertaken on a monthly basis by external Senior Managers who write reports on their findings. We looked at the staff meeting minutes and found that staff meet with managers regularly to discuss areas of care practice and areas where Care Homes for Older People Page 24 of 29 Evidence: improvements can be made. There are resident meetings records of these do not indicate whether suggestions made at previous meetings have been acted upon. We discussed with the manager various ways views of the service can be gained from people with dementia. We looked at the management of peoples money and found that the system was safe. Peoples money is paid into a residents bank account and an electronic record is kept. A small float of money is kept at the home if people want some cash and this is then taken off their electronic account. Services such hairdressing and chiropody are paid for and then the amount is taken off the individuals record. We were able to see receipts for any money that the home spent and people that bring in money were also given a receipt. Most people living in the home do not hold any money themselves. There was one person living in the home that was subject to a Deprivation of Liberty authorisation under the Mental Capacity Act at the time of the inspection. This person had a Best Interest Assessment and it was determined that the person did not have the capacity to make the decision needed. Plans were in place to act in the persons best interests. The Best Interest Assessment reviewed in a timely way. We looked at a number of health and safety records for gas, fire and water safety and found that these were in place. A check on lifting equipment was taking place at the time of the inspection. Care Homes for Older People Page 25 of 29 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 29 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 25 23 2(b)(p) Frequent monioring 09/02/2010 of the temperature of the home must be taken throughout the day and night. Where this is found not to be sufficent arrangements must be made without delay. This is to ensure peoples comfort and safety. 2 27 18 (1)(a) 12(1)(a) 26/02/2010 A review of staffing should be undertaken levels against the profile of the needs people have including supervision and prompting. This is to ensure that there is sufficient staff to provide the care and support people need. Care Homes for Older People Page 27 of 29 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 3 Where pre assessment has taken place months before admission a record should be kept of the checks made to ensure the care needs remain the same. On the occasions where people who normally refuse accept care a review of what worked should be done to see if the success can be repeated. A better record needs to be kept of how activities people have been involved in meet their social activity care plan. The seating arrangements for people living in the home should be considered to take account of the numbers of people that wish to sit together. Seating levels may need to consider the number of people where it is advisable to have oversight of where they are. Further signage should be obtained to assist people find their way around the building. An assessment of peoples difficulties with the doors in the building especially if they are using walking aids needs to be undertaken and solutions found. 2 8 3 4 12 20 5 6 22 22 Care Homes for Older People Page 28 of 29 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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