Care Home: Tapton Court Nursing Home

What the care home does well People were offered appropriate access to community health services to ensure their health needs were properly identified and met. People were supported to maintain close links with their families and friends. This helped them to have regular social contact with people close to them. People told us they were treated with respect by the staff and their right to privacy was respected. People had opportunities to meet their social, cultural and recreational needs. People who lived at the home were encouraged to eat a healthy and varied diet. Some areas of the home were nicely decorated and furnished, which made these areas of the environment feel homely. What has improved since the last inspection? At the previous inspection four immediate requirements and fourteen requirements were issued and these had all been fully actioned. The action taken included: People`s opportunities for appropriate exercise and physical activity were not restricted. New support chairs had been purchased, which helped people to sit upright and be comfortable without restricting their movement. Staffing numbers and skill mix of qualified/unqualified staff were appropriate to the assessed needs of people, the size, layout and purpose of the home. Substances that could be hazardous to health were being safely stored, so that people`s safety was maintained. People did not move into the home without having their needs assessed, so that the staff could be assured that they could meet people`s individual care and support needs. People`s care plans set out in detail the action which needed to be taken by staff to ensure all aspects of their health, personal and social needs were met. People were given opportunities for stimulation through leisure and recreational activities in and outside the home which suited their needs, preferences and capabilities. All staff had completed basic adult safeguarding training and some staff were booked in to complete more in depth training in the near future, so that people were protected from harm. Staff were aware of their responsibilities in reporting any allegations of abuse to the local safeguarding team, so that this could be responded to and investigated where necessary.Risk assessments had been completed so that any risks to people could be reduced or eliminated, which helped to keep people safe. What the care home could do better: Over the last year the home had not been managed effectively. Staff had not been offered adequate leadership and support and the providers had not adequately monitored the management of the service to ensure that people were being offered good levels of safe care and support. This had placed people who lived at the home at risk of harm. So that people are protected from being harmed or suffering abuse, senior managers` must continue to work with other health professionals to ensure that people are not put at risk. From this any actions that need to be taken must be completed in a timely manner. Further work was necessary to ensure that accurate medication records were maintained. So that people`s health, safety and welfare were not put at risk. Where a medication has not been taken the reason for this should be recorded. More care should be taken to make table settings look more appealing and make the mealtime a more enjoyable occasion. Some areas of the home including some bathrooms, toilets and some communal lounges needed to be refurbished as the decor was scuffed and stained in some areas. Key inspection report Care homes for older people Name: Address: Tapton Court Nursing Home 63 Tapton Crescent Road Crosspool Sheffield South Yorkshire S10 5DB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sue Turner     Date: 1 8 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 31 Information about the care home Name of care home: Address: Tapton Court Nursing Home 63 Tapton Crescent Road Crosspool Sheffield South Yorkshire S10 5DB 01142660648 01142661345 care@amocura.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Amocura Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 69 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The service can admit service users between the age of 60-65 years provided that their care needs can be met. Date of last inspection Brief description of the care home Tapton Court is a purpose built home situated in the Crosspool area of Sheffield, which was first registered in 1996. Nursing and residential care is provided for up to 69 older people of both sexes with mental health problems. The home is a two-storey building with a passenger lift, and is fully accessible. Communal lounges and dining rooms are situated on each floor. All of the bedrooms are single, and all are provided with ensuite toilet facilities. Sufficient bathing facilities are in place. A central commercial type kitchen and laundry serve the home. A car park is available. There is easy access to local facilities, such as shopping centres, public houses and bus routes. Information about the home is provided to people. Copies of the most recent Care Quality Care Homes for Older People Page 4 of 31 Over 65 69 0 1 2 0 2 2 0 1 0 Brief description of the care home Commission (CQC) inspection report, and statement of purpose, are available from the home. The scale of charges ranges from £377.00 per week to £556.30 per week. Further information about fees can be obtained by contacting the manager at the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means that people who use the service experience adequate quality outcomes. Sue Turner, Regulation Inspector, carried out this unannounced visit to the service over one day and the total time spent on site was 7 hours. The acting manager, Jackie Spiro and managing director, Maureen French were at the home during the site visit. In the report we make reference to `us and `we. When we do this we are referring to the inspector and the Care Quality Commission. We used a variety of information as well as our findings from the visit to assess the quality of service offered to people who lived at this home. Some time was spent with six people who lived in the home and three relatives that Care Homes for Older People Page 6 of 31 were visiting the home. These peoples views have been reflected in this report. Five staff attended interviews with us. Their comments and feedback have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check the homes policies and procedures. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection in February 2010. The progress made has been reported on under the relevant standard in this report. At the end of the site visit the acting manager and managing director were given feedback. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? At the previous inspection four immediate requirements and fourteen requirements were issued and these had all been fully actioned. The action taken included: Peoples opportunities for appropriate exercise and physical activity were not restricted. New support chairs had been purchased, which helped people to sit upright and be comfortable without restricting their movement. Staffing numbers and skill mix of qualified/unqualified staff were appropriate to the assessed needs of people, the size, layout and purpose of the home. Substances that could be hazardous to health were being safely stored, so that peoples safety was maintained. People did not move into the home without having their needs assessed, so that the staff could be assured that they could meet peoples individual care and support needs. Peoples care plans set out in detail the action which needed to be taken by staff to ensure all aspects of their health, personal and social needs were met. People were given opportunities for stimulation through leisure and recreational activities in and outside the home which suited their needs, preferences and capabilities. All staff had completed basic adult safeguarding training and some staff were booked in to complete more in depth training in the near future, so that people were protected from harm. Staff were aware of their responsibilities in reporting any allegations of abuse to the local safeguarding team, so that this could be responded to and investigated where necessary. Care Homes for Older People Page 8 of 31 Risk assessments had been completed so that any risks to people could be reduced or eliminated, which helped to keep people safe. 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 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who were considering moving into the home had their initial needs assessed, by managers from the home, before they were admitted. This helped to ensure that peoples individual needs were fully identified so they could be adequately met. Evidence: We looked at the care plans for three people. We saw that people had a preassessment form completed before they were offered a place at the home. The assessment included information about mental capacity and deprivation of liberties. This assessment then formed the basis of the initial care plan. The manager said that the issues that had arisen previously were because people had not been re-assessed when they had been admitted to hospital and were due to return to the home. She showed us the assessment report that would be used when staff re-assessed people before they were admitted back into the home. She also said that the senior staff had a very clear procedure to follow. When a person was returning to the home for end of life care, a multi disciplinary meeting was held so that all health professionals involved Care Homes for Older People Page 11 of 31 Evidence: in the persons care were aware of the persons current needs. This would ensure that the homes managers were satisfied that they would be able to continue to meet peoples individual and changing needs. Following the last inspection the provider had agreed to temporarily stop people being admitted to the home so that issues raised, that were of a safeguarding nature could be resolved. This embargo had been lifted on 21st April 2010. There had been one recent admission to the home, since the voluntary embargo had been lifted. We saw that for this person full and accurate pre admission information had been collated. We asked the manager if there were any people whose current needs could not be met at the home. The manager did not have any concerns that anyone living in the home was inappropriately placed. We asked staff if they believed that people living in the home were appropriately placed and if peoples individuals needs and preferences were being met. Staff said that they were able to provide appropriate care and support to everyone living in the home and there was no one they thought was wrongly placed. This was confirmed to us during our observations of people throughout the day. The manager told us the home does not provide intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs were being adequately reflected in care plans. People were not being fully protected by the homes medication policies, procedures and practises, which could place people at risk. Evidence: The manager said that since the last inspection all care plan documentation had been revised. We checked three care plans and we found that each persons health, personal and social care needs were set out in an individual plan of care. There was evidence to show that peoples changing needs had been monitored and reflected in their care plan. Signatures, dates of entry and monthly review dates were clear to see. Care plans and dependency levels were reviewed each month and then action was taken so that peoples care and support needs continued to be met. Care plan training for all staff had commenced in February and was continuing to be rolled out until all staff were competent. We asked three people who lived at the home and three relatives, if they knew about their (or their relatives) care plan and they told us they had recently been offered the Care Homes for Older People Page 13 of 31 Evidence: opportunity to see or contribute to the care plans or the reviews. People said they had welcomed this. The care plans we checked showed evidence that people had the opportunity to see their G.P as required and were also supported by other specialist community health teams such as district nurses, opticians, dentists and social workers. This helped to promote peoples health. We checked to see whether people had risk assessments in place to protect their health and welfare. We found detailed risk assessments in place that helped staff to ensure that any identified risks to people were reduced or eliminated. Since the last inspection new posture chairs had been purchased. These chairs provided comfort to people who were unable to move around the home. They enabled people to sit upright in a supported and comfortable position. Staff said that people were benefiting from being able to look around and see what was going on around them. We saw that peoples wellbeing was enhanced. At meal times people were able to eat and digest their food much better due to the different positions the chair allowed them to be in. We observed the homes storage and handling arrangements for medicines. Information detailing peoples allergies to medicines had been completed. This information is required to maintain peoples safety. We also observed medicines being given to people after their breakfast. Pots were used to hand medication to the person and water was offered to help with the taking of medicines. Time was spent with each person and encouragement given to help them take their medication. We saw that two inhalers had been left on the dining room table, after being used. The trained nurse, responsible for medication administration said that they had been given to people, to take when they chose. This was reported to the manager as an unsafe practice. If the service has taken responsibility for a persons medication administration then they must ensure that they administer all medications according to the homes policies and procedures. If a person is able to self administer then a risk assessment of this should be in place and precautions taken to ensure that the medication is stored safely so that other people would not be at risk of taking someone elses medication. There were a small number of unexplained gaps within the medication administration record (MAR) charts. These gaps were not for medication that was given on a regular basis, but for medications given when required. In most cases staff had entered a Care Homes for Older People Page 14 of 31 Evidence: code that meant the medication was not required, however a small number of gaps were left. This presented a risk, as staff would not always be aware if a person had required the medication. This also meant that medication audits would be difficult to complete. We spoke to the manager and managing director about this. They said that a recent medication audit had been carried out, however this had involved sampling and not all MAR sheets had been checked. They agreed that in future MAR sheets would be checked in full, each week. The manager said she would meet with all staff who administered medications and if necessary further training would be provided for them. We were told that no people were currently administering their own medication. We observed staff interactions with people and at all times saw how people were treated with positive regard. Staff were professional yet informal and friendly with people who used the service. This was very good to see and people we spoke to told us they were treated well by staff. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had opportunities to meet their social, cultural and recreational needs. People who lived at the home were encouraged to eat a healthy and varied diet. Evidence: The home employed an activities coordinator who worked 16 hours per week. We spoke to the activities worker and found that she was very enthusiastic and motivated. She had only recently been employed and had many ideas and plans for forthcoming events. We saw evidence on the communal notice boards in the home that there were daily activities available to people. These included cake decoration, photography and gardening. We saw that people had been involved in art work, which was displayed around the home. A reminiscence room was being set up which people said brought back memories. The manager had recently discussed increasing the activities workers hours as it was clear to see that her input was promoting peoples well being. People told us: Ive started a gardening project, Im busy with it, its great. I enjoy knitting and sewing, which staff help me to do. Care Homes for Older People Page 16 of 31 Evidence: I love classical music, the staff make sure they put it on for me. I choose not to be involved, its not for me. We asked the staff what they thought of the activities in place for people and they said, The activities worker has made a huge difference to peoples social lives. Most people would like to go out more, which we are hoping to do in the nicer weather . We are all enjoying being involved in projects and activities. People we spoke to told us they were able to keep in contact with families and friends and that visitors were made to feel welcome and could call at any time. This helped to support people to maintain important relationships. We asked three people who lived at the home whether they were helped to exercise choice and control over their lives. This is what they told us, Well we do have some choices, we can do activities if we want. We can choose when we get up and go to bed. Staff are always asking us what we want to eat and if we want a drink. These examples showed that people were offered basic choices and opportunities to control their lives. We asked people who lived at the home about the meals offered to them and this is what they told us, Breakfasts are good they made me porridge and scrambled eggs this morning. The food is good. We get fresh vegetables and fruit each day. We get asked what we want and if we dont like the choices we can have something Care Homes for Older People Page 17 of 31 Evidence: different. We also observed breakfast and lunch being served at the home and saw that people were offered a wholesome meal in pleasant surroundings. People were offered a choice of food and drinks. Staff were seen offering assistance and encouragement to people where necessary. Peoples personal likes and dislikes were documented and known by staff. Special diets were available as needed. At breakfast time cereals, toast and drinks were placed on a side table and handed to people as they came in the dining room. Very little attention was given to presentation. Tables were not set with cutlery and crockery, some table cloths were creased, which made the table settings look very unappealing. We discussed this with the manager and managing director, who agreed to look at this and make improvements so that peoples experience at meal times was enhanced. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints procedures were being used effectively, which helped to protect peoples rights. A number of adult safeguarding concerns were being investigated, so that people would not be harmed or suffer abuse. Evidence: We wanted to check if people who lived at the home and their relatives and friends were confident that their complaints would be listened to, taken seriously and acted upon and this is what we found. We saw that the service had a complaints policy and procedure, which was on display in the entrance hall. Since the last inspection the home had received one complaint. This had been resolved by the managing director. We spoke to three relatives to see if they knew the complaints procedure and would feel confident to use it. They said they had never needed to complain, but were aware of the complaints procedure and felt able to use this if necessary. They said any issues or concerns they had were quickly resolved by the staff or manager. This showed that peoples rights were promoted and protected and their concerns were adequately addressed. There was clear evidence that since the acting manager had been in place, staff, relatives and people felt more confident in raising any issues. People said, Care Homes for Older People Page 19 of 31 Evidence: If I had any concerns or worries I would speak to the staff. My family would sort out any problems for me. Im very happy here, theres nothing to complain about. Relatives said, The staff are very good and always ask us if things are OK, so if we had a problem wed go to them. I did raise a concern quite a while ago and it was sorted straight away. Since the last inspection there had been no adult safeguarding referrals or concerns raised with the home. However there remained three outstanding safeguarding investigations, one which had been referred to the coroner. Issues that are of an adult safeguarding nature were continuing to be monitored via strategy meetings, where all professionals come together with relevant information. From this the provider had been issued with a number of actions that they must take to ensure that people were kept safe. We saw that the manager had taken the action necessary and in a timely manner. We asked five staff if they had completed safeguarding adults training, they all told us they had. Staff said the manager had held a staff meeting which had totally focused on adult safeguarding. The staff training matrix confirmed to us that all staff had either completed training in safeguarding or were booked onto a refresher course in the near future. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people lived in a warm and comfortable environment. Some areas were in need of refurbishment and redecoration. Evidence: We wanted to see if people lived in a safe and well maintained environment and this is what we found. People told us they thought the home was nice, clean and met their needs. People said they were happy with their bedrooms. Some people had brought in small pieces of furniture and other pictures and ornaments from their previous home. At the last inspection we identified a number of bedrooms that had a spartan appearance. Some people had not been supported to personalise their bedrooms so they could be surrounded by personal possessions and enjoy a homely setting. During this site visit we saw that staff had made efforts to make peoples rooms more homely. Pictures, photographs and art work were on the walls. Rooms were clean and tidy. The routine for making sure peoples rooms were comfortable had been changed. This allowed staff more time to make/change beds and tidy up. The manager acknowledged that more work was needed to further improve the homes appearance. She said she had visited other services that provided care to people with dementia, to gather ideas about further improvements. Care Homes for Older People Page 21 of 31 Evidence: People had access to communal lounges, dining areas, quiet rooms and were free to use their own personal bedrooms at any time. The building was adequately maintained, however, areas of the home were in need of redecoration. Communal rooms had scuffed paintwork. Corridors had been recently re decorated and looked more welcoming. We looked at the communal bathroom and toilet facilities on the ground and first floors and found that most were in need of redecoration and some needed refurbishment. Bathrooms and toilets were bare and unappealing. These rooms were not homely, they were institutional and stark. This did not provide people with a homely environment. The home had a laundry area on the ground floor of the building. Equipment was provided to ensure clothing and other laundry was washed adequately, however the room was in need of updating and painting. The manager showed us a building and maintenance annual development plan. This showed that refurbishment of the home was ongoing. Clear timescales had been set for completion of the refurbishment. We checked to see if the home had effective hygiene and infection control measures in place. Staff said they had completed training in infection control, which meant they had the skills and knowledge to carry out infection control practises safely. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were not appointed until full and complete checks were carried out and recruitment documentation had been received, so that people were not put at risk. Evidence: We wanted to check if the people who lived in the home had their needs met by the numbers and skill mix of staff. This is what we found. On the day of the inspection there were 40 people living in the home. There were 2 trained nurse and 6 carers working during the day. Considering the dependency of the people in the home this was sufficient. Laundry, domestic and catering staff were also on duty. The manager, administrator and managing director were also present. We saw that people were given the time and attention necessary. Staff spent time with people on a one to one basis, caring and supporting them and assisting them to eat. We noted there was an atmosphere of mutual respect; their conversations were relaxed and friendly. The staff group were well motivated and enthusiastic about their work. People said, The staff are great, they always help me when I need it. I like all the staff, I have no problems. Care Homes for Older People Page 23 of 31 Evidence: Relatives said, Staff are welcoming and polite, they keep us informed about our relative. The staff always go out of their way to speak and ask if things are OK. Of the 23 care staff only seven had completed the National Vocational Qualification (NVQ) Level 2 award. A further 5 staff were undertaking the qualification. This meant that only 30 per cent of the staff team were NVQ trained and this did not ensure that staff had been assessed as having the appropriate skills and knowledge to support peoples needs. The staff training matrix showed us that there was a rolling programme of mandatory training provided to staff. Staff were able to confirm a number of dates booked for them to complete training in specialist topics such as, dementia, challenging behaviour and end of life care. Staff said they talked in supervisions about any additional training they would like to complete. The manager would then try to arrange this. Staff said when they started work they were given an induction. Following the induction they then worked with a senior member of staff, shadowing them under their supervision. They said this had been very beneficial and had given them the confidence to eventually work alone. At the last inspection issues were raised about the homes recruitment process. We checked to see if improvements to the process had been made. We looked at the recruitment files for three members of staff that had been recently employed. We found that two references for each person had been received, one of which was from the persons previous employer. We saw that each person had completed an enhanced Independent Safeguarding Authority (ISA) check. Full and complete employment records had been recorded on each persons application form. Where necessary the manager had added additional information to the file, for example, information stating that references had been verified with the referees. This would help to ensure that people were not placed at risk. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate monitoring and quality audit checks had been completed at the service. The health, welfare and safety of people was promoted and protected. Evidence: We checked to see whether the home was being run and managed by a person who was fit to be in charge, of good character and able to discharge their responsibilities fully. This is what we found. In February 2010 the registered manager left the service. Since then the provider had asked the area manager to be acting manager at the home, until a permanent manager was recruited. On the day of the inspection the manager and managing director were carrying out interviews for the manager position. The acting manager was qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. She had worked hard to action the previous requirements made at the last inspection. She said that she would continue Care Homes for Older People Page 25 of 31 Evidence: to manage the home until a permanent manager was in place and all the issues that had been raised through adult safeguarding and serious concern meetings were resolved. We asked people living in the home, staff and relatives, what they thought about the current acting manager. People said, Shes very nice, although I dont really know her very well yet. She seems OK, no problem at all. Relatives said, I havent had much contact with her, but Im starting to notice that things are getting much better. We have no problems, we could go to her if we had any issues. Staff said, Things are so much better now, shes approachable and always willing to listen. Shes fabulous, very understanding and very fair. Improvements are already starting to happen. We wanted to see if the home was run in the best interests of the people who lived there and this is what we found, Prior to the inspection we had requested that the provider send to us the Regulation 26 reports. These are monthly reports completed by the provider, or their designated person, to ensure they are monitoring the quality of the service appropriately. These were being completed each month and had highlighted the changes that needed to be made to improve the quality of the service. The manager told us that they had recently sent out surveys to people and relatives to gather their views about the quality of the service. There had been a very poor response to this. Only two relatives had returned surveys. We saw these and they were very positive, stating that they were satisfied with all aspects of the service. We saw that a notice had been put up telling people that further quality assurance Care Homes for Older People Page 26 of 31 Evidence: surveys would be sent out later in the year so that people had another opportunity to give the home some feedback. Recent resident and relative meetings had not taken place, due to the lack of attendance. Staff were looking at other ways in which they could involve people in decision making. We saw that the manager/administrator handled money on behalf of some people. These were sampled. We saw that account sheets with receipts were being kept. A second person witnessed each transaction. This helped to ensure that peoples financial interests were being safeguarded. At the last inspection substances that could be hazardous to peoples health were seen in en-suite toilets. We saw that cupboards had been fitted with safety locks so that substances were kept out of peoples reach. As part of the site visit we examined some of the maintenance and servicing records. All were up to date and these included, an electrical circuit check certificate and a gas safety certificate. The fire detection and fighting equipment had been checked. Fire drills had been undertaken and fire alarms had weekly tests undertaken. These checks helped to ensure peoples safety and welfare was protected. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Staff that administer medication must make sure that they stay with people until their medication has been administered. Medication must then be locked away out of peoples reach. To protect peoples health, safety and welfare. 07/06/2010 2 9 13 Accurate medication records must be maintained, where a medication has not been taken the reason for this must be recorded To protect peoples health, safety and welfare. 07/06/2010 3 18 13 Senior managers must continue to work with other health professionals to ensure that people are not put at risk. From this any identified actions need to be taken in a timely manner. 07/06/2010 Care Homes for Older People Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that people are protected from being harmed or suffering abuse. 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 9 Medication audits should include a complete and thorough check of MAR sheets. Where there are gaps found, action should be taken to prevent a recurrence of this. More care should be taken to make table settings look more appealing, which would enhance peoples dining room experience. The planned redecoration and refurbishment programme, which included all areas of the home, should be completed. This will ensure that people are living in a well maintained and comfortable environment. The planned programme of staff training should continue. 2 15 3 19 4 30 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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