Care Home: Teme Court

What the care home does well People are given information to help them decide whether they want to move to Teme Court. Full assessments are completed to make sure the home can meet peoples needs before they move in. Care plans are completed from information gathered during assessments so that staff know how to give the care and support people need. People live in a homely environment, which is comfortable and clean. People receive support from staff in a courteous and friendly way. A range of activities are provided so that people can choose what they would like to do. People enjoy healthy, home cooked food. They can choose what they want to eat. Visitors are made welcome to the home and are able to visit at any time. Medication is being stored safely. People are given a copy of the complaints procedure and are supported to make a complaint should they need to. What has improved since the last inspection? This is the first inspection of this home under new ownership. What the care home could do better: The manager is aware of the need and plans to complete a full audit of the service which will include reviewing and updating all policies and procedures and making sure staff have access to these. A training audit is being completed and staff training is to be arranged to make sure all staff are up to date with required training to maintain their skill development. All recruitment checks must be completed for all staff employed at the home so that only suitable people are employed. A review of the service must be done so that a plan can be developed and worked to for future service improvement. The fire risk assessment must be reviewed and updated so that everyone knows how to respond in an emergency. Key inspection report Care homes for older people Name: Address: Teme Court Lower Wick Old Road Worcester WR2 4BU     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: Dianne Thompson     Date: 1 5 0 4 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 32 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 32 Information about the care home Name of care home: Address: Teme Court Lower Wick Old Road Worcester WR2 4BU 01905422195 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Teme Care Limited Name of registered manager (if applicable) Mrs Yvonne Mary Sims Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 21 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP, maximum number of places 21, Dementia - Code DE, maximum number of places 21, Physical Disability - Code PD, maximum number of places 21 Date of last inspection Brief description of the care home Teme Court is situated in a quiet residential area of Worcester within a few minutes walking distance of the river Teme. The property is a large detached residence set Care Homes for Older People Page 4 of 32 Over 65 21 21 21 0 0 0 Brief description of the care home back from the road. The property has been adapted and extended for its use as a residential care home. Teme Court is registered to provide personal care for a total of 21 older people who may also have a physical disability and or a dementia illness. People who use the service are accommodated on the ground and first floor in 15 single bedrooms and 3 double bedrooms. 9 of the single bedrooms and the 3 double bedrooms have an en suite facility. There is a passenger lift so that people can access the first floor more easily. There are two lounges and a separate dining room. There is a large lawned garden with car parking facilities to the front of the building and a small enclosed garden to the rear. The reader should contact the service for up to date fee information. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection of the service. A key inspection is where we look at a range of areas to see what life is like for the people who live there. This is the first inspection under the new ownership of the home. We looked at care records, staff records and other records and documents. We looked closely at the care of three people who use this service. This process is called case tracking. We used information from the Annual Quality Assurance Assessment completed by the service and sent to us as required. We toured the building, spent time talking with people who live at Teme Court, talking with visiting relatives and professionals, talking with staff including the newly appointed manager of the service. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 32 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 8 of 32 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. Information about the service is available to help people decide whether they want to live at Teme Court, and if Teme Court can meet their needs. A system is in place to make sure that full detailed assessments are carried out for all prospective residents that make sure the service is fully able to meet their needs before a place is offered. Evidence: We saw a copy of the statement of purpose for Teme Court that has now been updated. This means that people are now given clear and accurate information to help them make a choice about the service prior to their admission. People we spoke to said they had been given information about the home before they moved in. People say they are very happy living here. One person said they never thought they would feel like this about living in a home. One person said their mother Care Homes for Older People Page 9 of 32 Evidence: had settled in very quickly and they were very pleased with the way staff treat her. The Statement of Purpose states that Teme Court will carry out their own full assessment that takes Community Care assessments and other information into account. Information recorded on new admissions to the home show this is being done. People are invited to visit the home and follow this up with introductory visits and overnight stays to help them in making their decision about their choice of home. We saw records to show that information has been gathered from a variety of sources, such as a community care assessment, discussion with a prospective resident and their family, discussion with stakeholders or a previous home. This information is then evaluated to show that the service has considered whether or not they are fully able to meet the persons needs prior to their admission. For one recent admission the manager had provided confirmation of placement and level of care needed in a letter to the resident and family. The manager was advised to complete this process for all future residents. Care Homes for Older People Page 10 of 32 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. Improvements have been made to the level of information given in care plans about peoples identified needs, so that staff know how to give the care and support people need. Medication is stored safely and staff follow the policies and procedures for the administration of medicines to keep people safe. Evidence: We tracked the care for three people recently admitted to Teme Court. We spent time talking to people, their relatives and attended a care review meeting with a visiting social worker. This process is called case tracking and helps to see what life is like for people living at Teme Court. Worcestershire County Council has supported staff at Teme Court in providing more effective care plans for people who live at the home. We saw that care plans are now fully developed from information obtained before people move in. This includes details about the care people need and how they prefer things to be done including hair care, Care Homes for Older People Page 11 of 32 Evidence: foot care, bathing, dressing/undressing. This level of information and recording makes sure that all staff have access to up to date information so they can give care in a consistent way. We saw personal profiles giving details about people and their background, their family, their interests, and any employment history they may have. We saw where decisions in the event of death and dying have been considered and a copy of these plans signed by the resident and their relative. Consideration has also been given to the preferred choice of carer (gender) and this has been signed by the resident. Peoples health care needs are supported by records such as those which identify allergies and appointments to be maintained, such as dentist and opticians. Ongoing assessments are completed covering areas including diet, oral health, tissue viability, communications and mobility. Weight chart are being maintained. Detail on these charts should include the frequency of checks to make sure all staff know when checks are to be done. The manager was advised that people are monitored more closely such as two weekly for the first few months following admission. This allows for any significant weight loss monitoring and response. We spoke to residents to hear their views about the home. People say they are well looked after, they get all the help they need, the staff here are wonderful and so caring, nothing is too much trouble. Residents appear well, settled and well cared for. We spoke to visiting relatives. One relative said their mother had lived in the home for some years, things have really improved now and happy with her care now. We spoke to staff about the care needs for the people we case tracked. Staff said they were aware of each persons needs, and would access information in the care plans, or speak to senior staff or the manager if they were unsure about how to give care. Risk assessments have been completed and reviewed as part of individual care plans. Assessments are completed where a risk of falls is identified. We discussed the procedures in place where people have been identified at risk of falls with the manager. The manager said that people are assessed for nursing care, pressure mat, hourly observations, assessed for further support e.g. knee brace and regular monitoring. The manager was not aware of the service provided by the Community Falls Nurse and was advised to obtain information about this service. Ongoing mental health assessments are completed. Where people lack capacity Teme Care Homes for Older People Page 12 of 32 Evidence: Court needs to make sure that decisions taken about their well being are fully documented and explained. Staff need training in Deprivation Of Liberties (DOLs) and the Mental Capacity Act (MCA). At present staff work through a checklist to assess peoples ability to make decisions for themselves. The manager said that all staff need training in these areas and this will help them understand what they are assessing. We saw where a social worker recorded for one person that a MCA assessment had been completed, but a copy of this assessment not available on the individuals file. We saw that a local authority community care assessment stated that a MCA assessment was to be completed for another person. This has not been done and no copy was available at the home. The manager was advised to ask for relevant copies. Teme Court is registered with Care Quality Commission (CQC) to provide care for people with Dementia. The manager said further knowledge and skills are to be addressed through Dementia care training so that staff will know how to manage people with complex needs safely, and make sure people are not put at risk of actual harm. The manager and the proprietor are to complete a more intensive dementia care training course. Although it is reassuring that this training is planned, it would be of greater benefit to include the deputy manager and senior staff in this training to ensure that development of skills is shared with all staff as a priority. There needs to be evidence to show that learning from this training is being put into practice. This will be considered at the next inspection visit. Systems are in place to make sure that medication storage is secure and people who use the service are protected from harm. Safe systems are also in place to ensure that medication is returned when it is no longer needed and also to make sure that safe levels of medication are stored within the home. The manager said that the Primary Care Trust (PCT) pharmacist recently audited the storage of medication in the home (12/3/10) and advised the home should get an up to date BNF book. The BNF details medicines prescribed in the UK, with special reference to their uses, cautions, contraindications, side-effects and dosage. The manager should make sure that regular monthly audits of all medication in the home is completed in addition to medication and pharmacy checks. Medication records were checked and records show that these are being completed as required. We saw that details about prescribed medication had been included in the care plan for one person. This information explains why medication has been prescribed. It is good that staff can read this information and have a better understanding about the medication and what it is prescribed to treat. This information should be given for all residents. Care Homes for Older People Page 13 of 32 Evidence: We checked the records and content of the controlled drugs cabinet. All medication was correct and tallied with the records. All medication dispensed had been signed for. We saw that consent to medication forms and written risk assessments are now in place for people who wish to control their own medication. People are involved in decisions about their care where they are able. Care plans are signed by the person receiving the service or their relative. We saw evidence to show that regular planned reviews are taking place. Care Homes for Older People Page 14 of 32 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 have opportunities to take part in regular activities. Activities are being planned to make sure people are occupied in a way that provides stimulation and reflects their individual needs and preferences. People who live in Teme Court are able to maintain contact with their relatives and friends. People also enjoy good quality, home-prepared meals. Evidence: We looked at activity assessments and records of activities in care plans for three people. We saw that records show where people had taken part in activities with a photo record of activity participation : photographs show residents enjoying christmas, busy making cakes at easter, making cards, reading magasines or colouring, washing up the dishes in the refreshment area, singing songs, visits from the vicar and regular services, watering the plants, celebrating mothers day, and doing some of the chores such as washing the medicine pots. Other activities include dominoes, jigsaw puzzles, bingo, with pampering such as nails painted and routine hairdresser sessions. One lady said she has her hair done every week by the hairdresser, they are so kind here you know. I wouldnt have stayed if they werent. Care Homes for Older People Page 15 of 32 Evidence: The manager talked about the small back garden area with potting shed and washing line which has been encouraging residents to participate in activities such as potting on seedlings and hanging out the washing. Pat a pet visited the home during the morning and a game of bingo was held during the afternoon of the inspection visit. The manager and staff are currently organising further activities such as meals at the local pub, taking people on day trips to the seaside, arranging singers to come into the home, regular quiz sessions, the mobile shop visiting the home on a monthly basis, and planning other social gatherings. In the services Annual Quality Auurance Assessment (AQAA) the manager states that they are moving away from bingo and using person centred information incorporated into activities. Teme Court now employs an activities co-ordinator. People who live at Teme Court have regular visits from family and friends. Visitors said that they are made very welcome when they visit. We saw records that show support is given so people can maintain their links with their church, with clergy also visiting on a regular basis for those wishing to take part in Communion. Visitors were very positive about the care and support for their relatives. Time was spent talking to the chef. Menus are planned on a rolling basis and the chef said he speaks to everyone who uses the service every day so they can choose what they would like to eat from the menu. The chef said that there are alternative options if anyone would like something different to the main menu of the day. Lunch was taken with residents who were part of the case tracking process. Lunch on the day was home made steak and kidney pie with mashed potatoes, cabbage and cauliflower. A choice of tapioca coconut pudding or ice cream with fruit was available for desert. Alternative main meal options were made available for those not wanting steak and kidney pie. Lunch on the day of the second visit to the home was a choice of curry and rice or lamb stew with potatoes and vegetables. Home made scones and jam were available for afternoon tea, and they were delicious!! Meals are now served in the new dining area. The atmosphere was happy and people were chatting. Although the dining area is smaller it does seem that people are encouraged to talk to each other more and be more sociable. We saw that residents choose where they want to sit and no one seems to have their own chair. People said they like the home, like the food, like Matt and all the staff. Everyone said the chef is a wonderful cook and the meals are very nice. The records Care Homes for Older People Page 16 of 32 Evidence: indicate that food served is varied and nutritious and the chef confirmed that most of the food was home made. Care Homes for Older People Page 17 of 32 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. People know how to complain about the service if they wish to. Staff know to follow procedures to make sure that people are being adequately safeguarded from risks of neglect, abuse or other harm. Evidence: The manager said that copies of the complaints procedure are given to people on admission. This was confirmed by a visiting relative. The service has a complaints log book and complaints log folder. The manager was advised to use one or other and not work from both as this is confusing. We saw that no complaints had been recorded in the log book, and one complaint recorded in the complaints log folder which had been resolved. Copies of the complaints procedure were in place in the files of people we case tracked. The policies and procedures handbook available for staff needs to be updated so that staff have relevant and up to date guidance and information at all times. Staff are aware of the complaints procedure and said they would support people should they wish to make a complaint. The service has received numerous compliments. On the day of the inspection a thank you card was received in the post thanking staff for the wonderful care and kindness Care Homes for Older People Page 18 of 32 Evidence: given to their relative. There is a whistle blowing policy and a policy on Adult Protection and Prevention of Abuse using the Department of Health No Secrets guide in place. The Adult Protection and Prevention of Abuse policy includes the contact details for the Adult Protection Coordinator. Staff training in protection of adults has been completed by some members of staff, with training to be planned for the remainder of the team. Staff confirmed in surveys that they had completed the training and they would know how to respond should they have any concerns. The manager said that no allegations or suspected incidents of abuse have been reported to her or otherwise come to her attention since her appointment. Copies of Regulation 37 notices for the service were examined and notices have been completed and sent to the Care Quality Commission as required. We checked completed accident records. We saw that all accident records are kept in each persons file and a confidential log of these records is being maintained. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Teme Court enjoy a comfortable and homely living environment. The home is spacious and is kept clean and has a new dining area. Evidence: Teme Court is situated in a quiet residential area in Worcester. The property is a large, detached residence set back from the road within a few minutes walking distance from the river Teme. Teme Court is a homely environment that is clean with no offensive odours. The laundry is sited in the cellar and contains all necessary equipment including two washing machines and two dryers. The washing machines have been replaced by the new proprietor. The laundry also contains a wash hand basin and liquid soap and paper towel dispensers. People have their own furniture and personalise their rooms to their own style. People living at Teme Court said they like it here and I like my room. The corridors are free from clutter and there are signs to all the bathroom and toilet doors to help with access. Care staff no longer wear uniforms, in keeping with the principles of dementia care. There have been some changes to the layout of the home by the new proprietor. The conservatory is currently being used as a lounge/activity room and now no longer Care Homes for Older People Page 20 of 32 Evidence: used as the dining room. The conservatory needs much repair and there are plans to redevelop this area of the home to provide further bedrooms and a new conservatory. The manager said that as rooms become vacant they will be refurbished. Some carpets have been replaced, a new carpet cleaner has been purchased and there are plans to make the outside areas safer, for example, new slabs and new sheds are to be fitted. The lounge area has been painted and the manager said that consultation is ongoing with residents about the choice of new curtains to the front door area. Residents and relatives said they liked the new flooring that has been laid to the lounges, hall way and corridors. Specialist equipment is provided such as roho cushions, pressure mattresses, and pressure mats for security. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff working at Teme Court relate to people in a friendly and courteous way. Staff recruitment procedures are not always followed and this puts the safety of all residents at risk. Training is being planned to make sure staff develop their skills to support people, although continued skill development will help staff understand the needs of people with dementia type illnesses. Evidence: We looked at copies of the staff rota to show staffing arrangements for the service. The rota gives details of the management team, care and ancillary staff working hours. Three staff are shown to be on duty for each shift, currently working 7-3 and 310 shift patterns. Teme Court employes six full time and eight part time care workers with five ancillary staff. Seven staff surveys were received and all commented that there are not enough staff. Teme Court does not use agency staff. Staff say things are settling now with the new owner, things get done when needed and they feel more supported. The manager and staff say that staff morale has improved with new ownership of the home, and many of the previous staff team has been retained. Care Homes for Older People Page 22 of 32 Evidence: The deputy manager has now completed NVQ 4 and says she is due to start her Leadership and Management award in June 2010. The manager confirms in the services Annual Quality Assurance Assessment (AQAA) that seven staff are qualified to NVQ level. Staff recruitment procedures are in place. We looked at the files for three staff recently employed by the service. All information was in place to show that recruitment procedures had been followed for two care staff, including security checks to make sure suitable people are employed. The third file related to ancillary staff and contained no proof of identity or evidence to show that security checks had been completed. The manager believed this was not necessary as the person would not be directly involved with residents, but proof of identity is an important part of security checks for all staff prior to employment commencing. The manager has confirmed that action has been taken to fully complete the recruitment checks for this person following the inspection. The manager confirmed that newly appointed staff complete an induction which consists of two or three shadow shifts. The service uses an induction checklist which covers practicalities such as break times, reporting structure, call bell system, visitors and safe working practices. We saw that an induction record folder is in place but found no records of inductions having been completed since 7/4/09. Two members of care staff started in February 2010. We looked at staff training records. The manager said she is working to provide support and encourage the development of a competent staff team. The manager has completed a training matrix to identify specific training needs for all staff. The matrix does not however match to information recorded in staff files and is confusing. In the services Annual Quality Auurance Assessment (AQAA)the manager states that all staff have basic madatory training but this is not confirmed by staff records and the training matrix. For example, some staff are overdue to complete refresher training in mandatory fields. The manager said that all records need to be reviewed and updated. The aim is to implement training records, plan future training courses, arrange regular staff supervions and team meetings. This has not been possible for the manager to fully complete in the short time she has been in post. The manager was advised that skill based training relating to specific needs such as person centred planning or challenging behaviour training is not included on the training matrix and should be considered to further enhance staff skills, particularly Care Homes for Older People Page 23 of 32 Evidence: supporting people with dementia. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A manager has been appointed and registered to run the service. The manager needs to make sure that Teme Court is run safely and in the best interests of the people who use the service. Evidence: Teme Court is under new ownership since the last inspection. The manager has recently been apppointed and has been registered with CQC to manage the home. The manager Yvonne Sims, is qualified and experienced manager, having completed her Registered Managers Award and additional training to work with older people. Yvonne is to enrol for the feelings matter most dementia training. The manager is supported by a deputy manager and senior staff. The Annual Quality Assurance Assessment (AQAA) was sent to us following a reminder letter from CQC. The content of the AQAA was brief and could usefully have provided more examples of current practice and plans for development as evidence to support the assessment. This was discussed with the manager. Care Homes for Older People Page 25 of 32 Evidence: Time was spent time talking with the manager, who said that her main challenge has been to sort out the paperwork particularly care plans, risk assessments, policies, procedures and recording of information. In addition audits are to be done and a full quality assurance review of the service will be carried out. Although a staff training analysis had been completed the manager recognised that it requires further updating as discussed in the staffing section of this report. The manager said that training for staff will be organised, and the service will work to make sure staff supervision is up to date and continues on a regular planned basis. We were given a copy of the support and supervision review matrix that shows supervision dates and future planned dates. We were told that a quality assurance review of the service will be completed and a development plan will be put in place. The review will include obtaining views of people who use the service, their families and other interested parties. An audit of policies and procedures will be completed and those due to be reviewed and updated will be identified in the development plan. A report of the findings from this review should be published and made available to residents, their families and interested parties. As part of the ongoing monitoring and review of the service the proprietor must carry out regular monthly visits in accordance with Regulation 26 of the Care Standards Act 2000, and provide the manager and staff with a full written report of the findings. This will make sure that the service is regularly monitored and the manager receives regular feedback about the running of the home. The manager told us that Teme Court does not act as an agent or appointee on behalf of any of the people who use the service. No money or any personal possessions or valuables are held in safekeeping on behalf of anyone who uses the service. This was confirmed by a relative of one of the residents we spoke to and case tracked. Responsibility for protecting peoples financial interests therefore rests, appropriately, with individuals and their families. We saw health and safety policies and procedures for the service. The manager told us that work has been ongoing to update all the homes policies and procedures and not all have been completed as yet. We saw a copy of Hereford and Worcester Infection Control guidelines dated 2004 that needs to be updated. We examined records of safety checks. These showed that safety checks are being completed and include weekly fire alarm tests, monthly fire equipment, and monthly visual checks. We saw that daily food temperature checks and freezer temperature Care Homes for Older People Page 26 of 32 Evidence: checks are completed as required. Fire drill records showed that fire drills are being completed. The manager should make sure that all drill are carried out at the appropriate 6 monthly intervals. Records show that the last drill took place 21/2/10 and the previous one 2/6/09. The manager is aware that all staff training needs to be updated, including regular fire safety training. The fire risk assessment in place is dated 04/09. This needs to be updated and procedures reviewed following the change of provider. The risk assesment in place does not take into account changes to the home layout. Staff should be issued with revised, updated fire procedures. Care Homes for Older People Page 27 of 32 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 32 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 7 13 Staff training in the Mental Capacity Act and Deprovation of Liberties must be completed So that staff are able to understand when mental health assessments are needed and they are aware of procedures where people lack capacity to make decisions for themselves. 30/07/2010 2 9 12 The manager should make sure that regular monthly audits of all medication in the home is completed in addition to medication and pharmacy checks. This will make sure that medication is received, stored and administered safely. 25/06/2010 3 29 19 All recruitment checks must 11/06/2010 be carried out before people start working at Teme Court. Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will make sure that only suitable staff are employed to keep people safe. 4 33 26 As part of the ongoing 25/06/2010 monitoring and review of the service the proprietor must carry out regular monthly visits and provide a report of the outcome of the visit. This will make sure that the service is regularly monitored and the manager receives regular feedback about the running of the home. 5 33 24 A quality assurance system 27/08/2010 must be in place that reviews the service provided and includes the views of people living at Teme Court, relatives and staff. This will make sure that everyone receives the quality of service they expect and know that peoples views are listened to and acted upon. 6 38 23 The fire risk assessment 28/05/2010 must be kept up to date and reviewed regularly. Care Homes for Older People Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will make sure all fire procedures are up to date and staff know how to respond in an emergency. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 8 8 Weight check charts should specify the frequency of checks to be carried out so staff know when these are to be done. The manager is advised to contact the local Community Falls Nurse to discuss local procedures for monitoring falls. Care Homes for Older People Page 31 of 32 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. © 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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