Care Home: Tanfield Care Centre

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What the care home does well Tanfield creates a comfortable, fresh, clean and homely environment for the people who live there, and for those people who require further support midway between hospital discharge and returning home. The home has a staff team who are committed to meeting the needs of the residents and keeping those residents safe. Staff treat residents with dignity and respect at all times. Staff receive the necessary training they require to meet the needs of the residents and to keep them safe, whilst promoting residents choice. Residents and their representatives know how to complain and who to speak to if they are not happy, and management within the home listens and acts upon any concerns or complaints that are raised. What has improved since the last inspection? In January 2009 the manager became the registered manager of the service. The home has recently recruited permanent senior staff, and care staff. This has reduced, and will continue to reduce the amount of care hours covered by agency care staff that will improve continuity of care. A new nurse call system has been installed and new laundry system that promotes infection control has been installed. Two of the homes assisted bathrooms have been updated with walk in showers. What the care home could do better: Tanfield Care Centre meets the personal, health and social care needs of the people who live there. Some of the documentation used within the dementia care unit to record how those needs are met does not fully identify the assessed and changing needs of the person. The home should as part of their own quality assurance review improve documentation in the following areas: The service should ensure residents needs assessment are reviewed at least annually by those health and social care professionals involved. Any changes from the reviewed assessment should in part, be used in agreement with the resident and/or the residents representative to update the persons care plan; other records of monitoring should be used to inform the persons care plan. The service must ensure documents that monitor a resident`s weight, food and fluid intake are monitored to identify any change that should be referred to health care professionals, and/or to update the persons care plan. This is to make sure the persons nutritional and health care needs are fully monitored and met. The service should where appropriate use information received from health care professionals to inform and update the person`s care plan. Training records of all staff should be kept within the home to make sure the manager and senior staff are full informed of staff training attended to date, so as to identify training and refresher training requirements of staff. Staff records should have proof of identity that includes a recent photograph. Inspections under regulation 26 of the Care Homes Regulation must be undertaken regularly as part of the quality assurance monitoring of the home. Key inspection report Care homes for older people Name: Address: Tanfield Care Centre 2 Hexham Road Whitley Wood Reading Berks RG2 7UG     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: Yvonne Souden     Date: 1 5 0 7 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 28 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 28 Information about the care home Name of care home: Address: Tanfield Care Centre 2 Hexham Road Whitley Wood Reading Berks RG2 7UG 01189015355 01189015356 james.skelt@reading.gov.uk www.reading.gov.uk Reading Borough Council Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr James Andrew Skelt Type of registration: Number of places registered: care home 31 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 31 The registered person may provide the following categories of service : Care home only-(PC) to service users of the following gender : Either Whose primary care needs on admission ot the service are within the following categories : Dementia (DE) Physical Disability (PD) Old age , not falling within any other category (OP) Date of last inspection Brief description of the care home Tanfield Care Centre is a Reading Borough Council care home. It is purpose built and situated in Whitley, a suburb of Reading, close to the shopping and recreational amenities that Reading has to offer. Public transport is available to the service, and the home has parking for several vehicles. Care Homes for Older People Page 4 of 28 Over 65 0 31 31 0 Brief description of the care home The home is registered to provide personal care and accommodation for up to thirty one older people, providing intermediate care and dementia care. People who require intermediate care receive a short programme of intensive therapy in order to recover and regain their independence following an injury or illness. This period of rehabilitation gives the person discharged from hospital, extra time to recover in the home whilst receiving 24 hour care and support. Up to eight people with dementia live permanently in the home that is separate unit from the intermediate care section, people who live on the dementia unit receive 24 hour care and support from a dedicated staff team Care Homes for Older People Page 5 of 28 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: Date of last key inspection 30/05/2007 Date of Last Annual Service Review 15/05/08 The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The manager completed an Annual Quality Assurance Assessment (AQAA), which is a legal document provided, by the commission. The AQAA was used by the manager and provider to review their service and inform the commission of their findings. The AQAA was used as part of the evidence to inform this report. Other evidence used to inform the report included a 9 hour site visit to the service by one inspector. This enabled the inspector to observe care practices and speak to people Care Homes for Older People Page 6 of 28 who use the service, staff and management of the home. The Care Quality Commission received completed questionnaires from people who use the service and from health and social care professionals who have regular contact with the people who live in the home; their views of the service provided have been used to inform the report. Other evidence used to inform this report was documentation viewed by the inspector during the site visit. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Tanfield Care Centre meets the personal, health and social care needs of the people who live there. Some of the documentation used within the dementia care unit to record how those needs are met does not fully identify the assessed and changing needs of the person. The home should as part of their own quality assurance review improve documentation in the following areas: The service should ensure residents needs assessment are reviewed at least annually by those health and social care professionals involved. Any changes from the reviewed assessment should in part, be used in agreement with the resident and/or the residents representative to update the persons care plan; other records of monitoring should be used to inform the persons care plan. The service must ensure documents that monitor a residents weight, food and fluid intake are monitored to identify any change that should be referred to health care professionals, and/or to update the persons care plan. This is to make sure the persons nutritional and health care needs are fully monitored and met. The service should where appropriate use information received from health care professionals to inform and update the persons care plan. Training records of all staff should be kept within the home to make sure the manager and senior staff are full informed of staff training attended to date, so as to identify training and refresher training requirements of staff. Staff records should have proof of Care Homes for Older People Page 8 of 28 identity that includes a recent photograph. Inspections under regulation 26 of the Care Homes Regulation must be undertaken regularly as part of the quality assurance monitoring of the home. 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 28 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 28 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. Clients who receive intermediate care have their needs fully assessed prior to admission with continual review throughout their period of rehabilitation. Prospective residents who live on the dementia unit have their health and social care needs assessed prior to admission. There is a potential risk that the resident needs are not fully reviewed to inform their plan of care. Evidence: The majority of people who use the service at Tanfield Care Centre are admitted for a short programme of intensive therapy in order to recover and regain their independence following an injury or illness. This period of rehabilitation gives the person discharged from hospital, extra time to recover whilst receiving 24 hour care and support. After a period of four weeks the person is reassessed by the nurse manager to determine whether the person would be able by the end of a six week period to return home either fully independent or with additional support; the nurse Care Homes for Older People Page 11 of 28 Evidence: manager said that most people are able to move on prior to completion of a six week rehabilitation programme. The service also provides a permanent home for up to eight people whose primary care need are dementia. We looked at the records of three residents who live on the dementia care unit. There was no evidence of an initial needs assessment by the home or by health or social care professionals, or review of a needs assessment. A needs assessment would give an account of the residents physical, mental and social care needs and is used to inform and update the persons plan of care. The manager said that initial assessments were complete, and that health and social care professionals are invited to attend individual residents care plan review. Records show that care plans are regularly reviewed by senior staff within the home. There was no evidence to support that information used to inform the plan of care was in agreement from a formal health and social care review of the persons assessed needs. Care Homes for Older People Page 12 of 28 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 who use the service have their health and personal care needs met by a caring and respectful staff team, but those needs are not always fully outlined within their plan of care. Evidence: A multi disciplinary team meeting is held each week for residents receiving intermediate care, care plans are discussed and updated as necessary to ensure residents health, personal and social care needs are met. Residents receiving intermediate care are supported by the care staff team, and by an occupational therapist and physiotherapist employed by health. A brief handover takes place each morning between the nurse manager, staff nurse and care staff to discuss residents receiving intermediate care, and a handover takes place between senior staff and care staff at the start of each shift on the dementia care unit. The intermediate service is currently reviewing the format of residents care plans and records as recommended from a recent medical and safeguarding review. We looked at the care plans of three residents who live on the dementia care unit. Care Homes for Older People Page 13 of 28 Evidence: Care plans are formatted in a style that is user friendly, describing the residents individual needs and identifying associated risks that are further described within a risk assessment. However, care plans of the people we case tracked did not detail health care needs that were identified within other records viewed despite regular review of the residents care plan by senior staff. For example, information recorded on weight, food and fluid monitoring charts gave conflicting information to that recorded on the persons care plan, information from a health care professional detailing how a particular health care need was to be managed was not included in a persons care plan, and how staff are to monitor and support a person with diabetes was not fully detailed in the persons care plan. This potentially poses a risk, as important information of monitoring was not used to inform and update the residents individual plan of care and risk assessment. Health care professionals said within surveys sent by the Commission that Tanfield meets the health care needs of the people who live there. One health care professional said, Tanfield is one of the best centres I have contact with, they are very caring of their residents and I have seen several examples of them going the extra mile... Residents said within surveys that they receive the care and support and medical care they need, and that staff are available when they need them. During our observations several staff were observed to treat residents with dignity and respect. We witnessed staff chatting, laughing with, and assisting residents in a relaxed and respectful manner. Residents we spoke with during the visit stated that the staff were kind and caring. Records kept by the home show that health care professions visit residents within the home, and that residents are supported to attend external health care appointment. We observed pressure area equipment used, and records that demonstrate plans in place for all staff to receive training specific to pressure damage prevention and nutrition. Regular visits by a community psychiatric nurse takes place and behaviour guidelines are in place for those residents who present challenging behaviour. All staff have either attended dementia awareness training or are scheduled to attend. Medication policies and procedures are in place and only trained staff administers residents medication. Medication was observed to be stored securely. On the day of this key inspection we observed staff attend in-house medication training as delivered by a pharmacist on the monitored dosage system used by the home. Care Homes for Older People Page 14 of 28 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 who use the service are given the opportunity to participate within the activities and lifestyle they prefer, but this is not always detailed fully within their care plan. Evidence: Residents said within surveys sent by the Commission that Tanfield Care Centre mostly arrange activities that they can take part in. A comment within one survey about the home was, brilliant, caring staff, it gives you the impression that the organisation has been thought about. The service has a vacant activity coordinator post and employs a part time activity organiser on the dementia unit. The activity organiser said she has worked within the home for twenty-three years, and now works 10 hours a week as an activity organiser and 10 hours as a night carer. The activity organiser was observed to have patience and understanding of the residents needs and spoke of various activities provided within the home, for example, ball and board games, cards, painting and one to one sessions with residents. Daily records did not fully evidence activities or social events undertaken by individual Care Homes for Older People Page 15 of 28 Evidence: residents, and care plans had limited information of the persons interests and hobbies. improvements should be made within this area of care planning. The home does not have their own transport, but they do access transport to support and enable residents to access the community and to go out on recreational day trips. Holy Communion is given in the home on a monthly basis, the mobile library visits regularly and a hairdresser visits the home weekly. Community groups are encouraged to visit the home. Visiting time is limited to 2:30pm to 4:30pm and 6:00pm to 9:30pm with open visiting at weekends. This is to accommodate the rehabilitation programme of those residents receiving intermediate care, and to adopt a quite relaxed atmosphere at meal times for those residents on the dementia unit. We discussed the restriction of visiting times with the manager who agreed that there was good reason to have restrictive visiting times in the morning for intermediate care residents who have various appointments and treatments, and agreed that this did not necessarily fall in with the routine of the residents who live on the dementia unit, who may be more open to visitors in the morning. The manager said that they would review visiting times and update the Service Users Guide to include the separate visiting times within each area of care. The home tries to adopt an atmosphere that people within intermediate care would experience when they return home and so discourage those residents from using the main lounge. We observed residents, using the main lounge to watch television at various times throughout the day. Most of the residents within the intermediate care section have their meal served within their flat as they would if they were in their own home. Residents who live on the dementia unit have their own dining area, and we observed staff assist residents with their meal in an unhurried and relaxed atmosphere. The main kitchen was observed to be clean and fresh with food stock appropriately stored and date labelled. An assistant cook who has been in post two months cooked the main meal on the day of the inspection and this was observed to be enjoyed by all on the dementia unit. The assistant cook said that she received a full induction and training within food handling. Residents are able to choose their meal from a set menu plan that will vary to accommodate requests, preferences and dietary needs. A resident on the dementia said, We had chicken supreme for lunch. The resident said she came to Tanfield because she had no where else to go, adding, They are very kind to you, and on the whole pretty good. Care Homes for Older People Page 16 of 28 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. Management and staff within the home listen to the people who used the service and their representatives. Complaints are taken seriously, and action is taken to protect the people who use the service from abuse. Evidence: a resident said within a survey sent by the Commission that they know how to make a complaint and that there is someone they can speak to informally if they were not happy. Health and social care professionals said within surveys sent by the commission that the home always responds appropriately if a person who uses the service has raised any concerns. Staff said that they receive regular safeguarding adult training; training records viewed confirmed this. Staff described what they would do if anyone was at risk of abuse, and were knowledgeable of up-to-date safeguarding policy and procedures kept within the home. Staff said they would not hesitate to protect the people in their care. Since the last inspection there has been one safeguarding adult investigations managed by the local authority safeguarding team. There have been no referrals made to the protection of vulnerable adults list (POVA). Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service benefit from living in a home which is pleasant, comfortable and safe. Evidence: The home was observed to be clean, fresh and comfortably furnished with sufficient domestic staff to maintain a fresh and clean environment throughout. The homes garden is nicely landscaped and has tables and chairs for residents to enjoy the garden under the shade of mature trees in the warmer months. The rooms within the dementia unit have large white plaques detailing the residents name and the frame of the doors are painted blue. This was to improve the residents ability to recognise their own room. As all bedroom doors are the same with exception to the persons name the manager could take further advice from specialists within dementia care, for example, Alzheimers society, for examples on ways that will enable residents with dementia to identify their own room with something that is unique to them. Toilets and bathrooms on the dementia unit have a yellow plaque with yellow frames for recognition. A new nursing call bell system has been fitted in all bedrooms, bathrooms and communal areas of the home. Care Homes for Older People Page 18 of 28 Evidence: Two assisted bathrooms have a large side opening parka bath and both have recently been upgraded with a large walk in assisted shower. Three other assisted bathrooms are fitted with a bath chair hoist, one was out of order. These baths are low, and the bath hoist chair is limited to the level that it can be lowered. This was discussed further with the manager who will revisit the moving and handling risk assessment for those assisted bathrooms to ensure the safety of residents and staff. Safety procedures, for example, Containment of Substances Hazardous to Health (COSHH) are followed by staff, and maintenance of the home is undertaken to ensure the home remains well maintained. Fire checks are complete and staff receive fire safety training. The laundry room has a new Otex Laundry System that kills viruses and super bugs in laundry, and is eco-friendly by using mainly cold water. Infection control policies and procedures are in place. Staff have received infection control training. Protective clothing and alcohol gel was observed to be used by staff throughout the home to promote infection control. Care Homes for Older People Page 19 of 28 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 number and skill mix of staff who have been appropriately recruited and trained contribute to positive outcomes for the people who use the service. Evidence: The home has recently recruited two senior staff to full time posts and recruited five new staff into care assistant posts. This should improve continuity of care within the home on completion of new staffs induction as use of agency staff will be reduced to cover only staff annual leave, training and sickness absence. Inspections under regulation 26 of the Care Homes Regulation must be undertaken regularly as part of the quality assurance monitoring of the home. On the day of this unannounced inspection there appeared to be adequate staffing levels to meet the needs of the residents. There is always a minimum of six care staff on duty from 7:30am until 10pm and three waking night staff. In addition there is a team of housekeeping, laundry, catering and maintenance staff. There is a separate healthcare team working in the home employed by the Primary Care Trust to meet the needs of the residents receiving intermediate care. Staff were observed to be unhurried in their work attending to residents needs with dignity, respect, and with a caring attentive attitude. Health and Social care Care Homes for Older People Page 20 of 28 Evidence: professionals said in surveys sent by the commission that they are satisfied with the service provided. Staff showed awareness of health and safety. Records identified that staff have received mandatory health and safety training and have had training updated as necessary, for example, moving and handling, infection control, health and safety, basic food hygiene and fire safety. Staff also attend specialist training, for example, dementia awareness. Some training arranged by the home as opposed to the training manager within the local authority has not been recorded on staff training records. The manager reports that recent discussions with the training manager should ensure a record of staff training is retained by the home and training department. A staff member said, We have refresher courses regularly within emergency first aid, fire safety and manual handling, and receive regular one to one meetings with our line manager to support us in the work we do. A new carer who was very positive about her new role said she has had a good induction to date, confirming training within safeguarding, and cognitive dementia awareness. A carer who has been working in the home for thirty years said, This is a very caring home, I wouldnt go anywhere else to work. Only a small percentage of care staff has an NVQ, although existing and new staff are currently being supported by the home to gain an NVQ qualification. We reviewed the recruitment files of five staff. All necessary pre employment checks had been undertaken including two references, employment history and CRB clearance obtained. The manager had advised the Commission at the last key inspection that a recent photograph would be placed on staff files this has not taken place. Staff records should have proof of identity that includes a recent photograph. Care Homes for Older People Page 21 of 28 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 who use the service benefit from living in a home that is well managed, but this is at risk if areas of monitoring are not improved by management. Evidence: The manager has managed the service since 2007 and had been the an Assistant Unit Manager within the service prior to this. The manager was registered with the commission as the registered manager in January 2009, and has recently completed a Level 4 National Vocational Qualification in care. In discussion with staff on duty it was felt that the home is well managed and run in the best interests of the residents. Staff on duty said that they enjoyed working at the home and felt well supported by the manager and felt their views were listened to and taken into consideration. Residents who were able to express an opinion were positive about the care that they receive. Surveys sent by the commission and completed by health and social care professionals and residents detailed positive comments of the service provided, and the home has receipt of many thank you cards from people who Care Homes for Older People Page 22 of 28 Evidence: have used the intermediate care service and from relatives of people who had lived in the home, expressing their satisfaction of the care provided. A senior staff communication book and minutes of staff meetings show clear line of communication is practised amongst staff to ensure the needs of the residents are met. A sample of records relating to health, safety and welfare were examined and found to be up to date and well maintained. A Portacabin placed on the grounds of Tanfield Care Centre is used as an office for health and social workers who are the single point of access for intermediate care in the community, and for health care professionals who work within the intermediate care section of the home, for example the nurse manager and occupational therapists. Staff have to enter through Tanfield Care Centres front door to access the Portacabin. The manager reports that this does not impact on the residents, particularly the permanent residents within the dementia unit as they live on the 1st floor. Staff who use the Porto cabin spoke of overcrowding and of how this affects staff stress levels that was evident. The manager confirmed that plans are in place to reduce the amount of staff who use the Portacabin by August 2009. The service has experienced difficult times in the recruitment and retention of staff since the last inspection in May 2007. This has recently improved by the recruitment of two senior staff and five care staff. Vacant staff hours had been filled by agency staff, and areas of monitoring records for the purpose of review had not been fully carried out by senior staff on those residents who live on the dementia care unit. This potentially puts the residents at risk. See Choice of Home and Health and Personal Care section of this report. The Assistant Unit Manager reports that the care manager of each resident is invited to the residents care plan review and would mostly attend annually unless significant change is reported. The assistant manager said that the home completes the minutes of review, and that no updated copy of a needs assessment is received from the residents care manager. The assistant manager showed the inspector hand written minutes of a senior staff meeting held the day before this inspection that detailed areas that the senior team recognise as requiring improvement within record keeping and monitoring. The manager stated that he is aware that records need to improve, and said he is committed and confident that improvements will be take place to safeguard and fully detail the needs of the people who use the service now that the service has a full compliment of permanent staff. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 33 26 That a written report is 31/07/2007 available in the home, following an unannounced visit to the home by a provider representative, each month. Care Homes for Older People Page 24 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person must make sure that the needs assessments of the people who use the service are reviewed at least annually and are available to inform staff, and for the purpose of inspection. 28/09/2009 This is to make sure people who use the service have their needs fully assessed to inform and update their plan of care. 2 7 15 The registered person must make sure that the care plans of the people who use the service are brought up to date following review of the residents needs assessment, from recognised changes through continual monitoring of the persons health care needs, and from information received from health care 17/08/2009 Care Homes for Older People Page 25 of 28 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 professions that would contribute to meeting the health care needs of the person. This is because there is a potential for things to go wrong if care plans of people who use the service do not reflect changes that are detailed in records of monitoring, and information received from health care professionals. 3 29 19 Staff records should have proof of identity that includes a recent photograph, as detailed within Schedule 2 of the Care Homes Regulations. This is to protect people who use the service 4 33 26 The service must have a written report within the home following an unannounced visit to the home by a provider representative each month. 24/08/2009 14/08/2009 This is to promote quality monitoring of the service on behalf of the people who live there. Care Homes for Older People Page 26 of 28 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 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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