Care Home: The Alders

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What the care home does well The manager is leading the continued development of the home, both in the environment, and in the way care is provided at the home. People living at the home are given choices, and are helped to maintain their usual daily routines as much as possible. Assessments of need and care plans provide person-centred information for staff, enabling them to know how best to look after each individual. Daily records made by staff give a good picture of the life of each resident in the home. The resident`s surveys returned to us told us that they usually received the care and support they needed. A relative commented, `Premises are always clean. Sufficient staff are always present and they are kind and knowledgeable`, and a resident stated, `The Alders meets all my needs`. Staff we spoke to had a good understanding of residents` needs, and we saw good interaction between the staff and the residents living at the home. Staff attend various training courses, and 50% of them hold NVQ qualifications. The home has a relaxed and friendly atmosphere, and the furnishings are very homely and comfortable. Bedrooms are attractive, and the addition of personal belongings makes them all individual. We saw activities planned for the residents, and they told us about playing lounge darts and skittles, and about trips they had been on to Blackpool illuminations and Blackpool zoo. Staff told us about the sing a longs enjoyed by residents, and the specialised trainer who called to provide exercise sessions. A dedicated cook plans and prepares meals, and all of the residents told us they enjoyed the food at the home. Meetings with residents are held to discuss different meals they would enjoy. The manager told us that the approach in the home is open, and she tries to encourage staff to discuss issues, and residents to chat freely and express opinions. All of the residents we spoke to were generally satisfied with the way they were looked after. `Keeps everyone together like a family` said one resident. What has improved since the last inspection? The manager has been registered with the Care Quality Commission. A system is now in place to show that prospective residents have participated in their assessment and decisions on their care needs. The manager has addressed the overcomplex recording systems and structured them to prompt staff more easily on where and when they should make records. The organised files make it easy to audit information. The manager has tried to further develop the activities provided in the home, in consultation with residents. She is aware this area can still be further developed. Staff training now includes dementia awareness. Staff one to one supervision sessions have been organised, and the manager is trying to ensure these are carried out regularly. She has also addressed the need for staff meetings. The quality assurance systems in the home are developing, with resident meetings and detailed surveys providing feedback and liaison to aid in improving the service. What the care home could do better: The manager and staff have worked hard to develop the systems used in the home to provide a good standard of care to residents. We discussed some areas of further good practice with the manager in order to build on these developments. It could be made clearer that the resident has participated with the assessment of their needs by completing the systems in place fully. This entails making sure there is always the resident`s, or their representative`s, signature and the date of the assessment. When staff complete care records, they could make sure the individual records within each file cross check, such as the body map and the medical record, or the assessment of need and the personal care record, so that they provide clear information about the care provided. Body maps could give up to date information and link to written records. It could be made clearer that mental capacity assessments are carried out for all residents, to identify the level of decision making ability people have about their lives. Medication Administration Records (MAR) could hold a photograph of the resident they refer to, so as to minimise any mistakes of administering medication to the wrong person. Any MAR handwritten by staff could be checked and signed for accuracy by a second member of staff. The medication declaration signed by some residents, stating that they take full responsibility for their own medication, could be developed to include a statement and a residents signature if they agree to the home taking responsibility for their medication, where this occurs. The medication returns book could be signed and dated when stock is returned to the pharmacy, for auditing purposes. Medication audits that are carried out could be more carefully done, so that errors are not missed. A menu board could be in view of the residents to inform them of the meals of the day, and so remind them of what they have chosen. Any more minor concerns could also be centrally recorded, so that any patterns from the overview could be addressed as part of the quality assurance system.The contact details of the appropriate authority to contact regarding any complaints could be amended in the complaints procedure. It could be made clearer who the referees are for new carers, by clearly naming them on the reference and not depending on the signature only. Key inspection report Care homes for older people Name: Address: The Alders 1 Arnside Crescent Morecambe Lancashire LA4 5PP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jennifer Hughes     Date: 1 2 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Alders 1 Arnside Crescent Morecambe Lancashire LA4 5PP 01524832198 F/P01524832198 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Calderdean Ltd Name of registered manager (if applicable) Mrs Sharon Edwards Morris Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies 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 The maximum number of service users who can be accommodated is: 32 Date of last inspection Brief description of the care home The Alders is situated in a residential area of Morecambe, close to shops and local amenities. There are two separate dining rooms and three lounges that are used for a variety of purposes and provide residents with a choice of where to sit and who to sit with. Residents rooms are all single and have ensuite facilities. There are two stair lifts in the home. In the centre of the home is an attractive courtyard that is used by residents in the warmer months. Residents are encouraged to retain links with the families and friends and contacts in the local community. The Alders is a no smoking Care Homes for Older People Page 4 of 31 Over 65 32 0 2 0 1 1 2 0 0 8 Brief description of the care home home. The current range of fees are from £386.50 to £435.00 per week for residential accommodation, and respite fees vary. Further details about fees can be obtained from the manager of 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit to the home, in that neither the company or the manager were aware that it was to take place. The site visit was part of the key inspection of the home. A key inspection takes place over a period of time, and involves gathering and analysing written information, as well as visiting the home. The length of the visit was for 6 and a half hours. Every year the registered persons are asked to provide us (Commission for Quality Care, CQC) with written information about the quality of the service they provide. We use this information, in part, to focus our assessment activity. This document is called the Annual Quality Assurance Assessment (AQAA). Surveys were sent and received from residents and staff of the home. Some responses were received from relatives of residents. Care Homes for Older People Page 6 of 31 During the site visit staff records and resident care records were viewed, alongside policies and procedures of the home. The manager, residents, and care staff were spoken to, and their responses are reflected in the body of this report. A tour of the home was made, viewing lounges, dining rooms, bedrooms and bathrooms. Everyone was friendly and cooperative during the visit. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? The manager has been registered with the Care Quality Commission. A system is now in place to show that prospective residents have participated in their assessment and decisions on their care needs. The manager has addressed the overcomplex recording systems and structured them to prompt staff more easily on where and when they should make records. The organised files make it easy to audit information. The manager has tried to further develop the activities provided in the home, in Care Homes for Older People Page 8 of 31 consultation with residents. She is aware this area can still be further developed. Staff training now includes dementia awareness. Staff one to one supervision sessions have been organised, and the manager is trying to ensure these are carried out regularly. She has also addressed the need for staff meetings. The quality assurance systems in the home are developing, with resident meetings and detailed surveys providing feedback and liaison to aid in improving the service. What they could do better: The manager and staff have worked hard to develop the systems used in the home to provide a good standard of care to residents. We discussed some areas of further good practice with the manager in order to build on these developments. It could be made clearer that the resident has participated with the assessment of their needs by completing the systems in place fully. This entails making sure there is always the residents, or their representatives, signature and the date of the assessment. When staff complete care records, they could make sure the individual records within each file cross check, such as the body map and the medical record, or the assessment of need and the personal care record, so that they provide clear information about the care provided. Body maps could give up to date information and link to written records. It could be made clearer that mental capacity assessments are carried out for all residents, to identify the level of decision making ability people have about their lives. Medication Administration Records (MAR) could hold a photograph of the resident they refer to, so as to minimise any mistakes of administering medication to the wrong person. Any MAR handwritten by staff could be checked and signed for accuracy by a second member of staff. The medication declaration signed by some residents, stating that they take full responsibility for their own medication, could be developed to include a statement and a residents signature if they agree to the home taking responsibility for their medication, where this occurs. The medication returns book could be signed and dated when stock is returned to the pharmacy, for auditing purposes. Medication audits that are carried out could be more carefully done, so that errors are not missed. A menu board could be in view of the residents to inform them of the meals of the day, and so remind them of what they have chosen. Any more minor concerns could also be centrally recorded, so that any patterns from the overview could be addressed as part of the quality assurance system. Care Homes for Older People Page 9 of 31 The contact details of the appropriate authority to contact regarding any complaints could be amended in the complaints procedure. It could be made clearer who the referees are for new carers, by clearly naming them on the reference and not depending on the signature only. 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 10 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 11 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. Clear information is provided, which enables people to make an informed decision about the home. The assessment that is carried out for all residents means that a service is provided that is tailored to an individuals needs and preferences. Evidence: The home provides very clear information about the service it provides in the form of a Statement of Purpose and Service User Guide that clearly details who owns and manages the home, and what services the home provides. There is detail on what people who live there can expect from the day to day running of the home, and the staff who will look after them. The information is easy to read and contains photographs of some of the rooms in the home so that prospective residents have a good picture of where they may be living. They also have the opportunity of visiting the home, and staying for a meal, or a short respite stay, to help them decide if it is the right place for them. Care Homes for Older People Page 12 of 31 Evidence: We viewed the individual records of three residents we randomly selected. There is a set procedure for admitting someone to the home, and all of the files held preadmission assessments carried out by one of the management team. We found that the assessments held information about all aspects of the physical, social and psychological care of the individuals. The assessments made sure that the individual needs were identified, and the home could meet those needs. The home also held information from other sources, such as social work assessments, Primary Care Trust (PCT) assessments, or information from the Community Mental Health Team (CMHT). The home have good systems in place to show the prospective residents have participated in the assessments, and agree with the care plans, and we advised they should ensure these documents are always signed and dated by staff and the resident as the form indicates. Staff told us that they are always given up to date information about the care needs of people they support, and are able to view the assessments the management team has made for more information. They were able to tell us about the needs of residents, and how to meet those needs. Care Homes for Older People Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents are well met in this home. Evidence: We viewed the care plans of three randomly selected residents at the home. We found that there was a standard format for the care plans, covering areas that clearly identified the needs of each individual and informing staff on the best way to look after people. We saw that the home had worked hard at the format and content of the care plans since our last visit, and the manager told us that she continues to try and make them as effective as possible. Some staff have attended courses in care planning, and there are plans to provide them with formal training in record keeping. The system used provides a comprehensive set of plans in each area of daily living for staff to monitor for each person, and a care plan agreement, for the resident to sign and date, to show they have agreed with the care to be provided. Care Homes for Older People Page 14 of 31 Evidence: Occasionally the content of an individual area, such as personal hygiene, did not clearly reflect what was happening, and the manager commented that the recording system was still being adjusted to address this. For example one care plan record stated that a resident needed full assistance, and the personal hygiene record showed assistance with personal washing had been carried out once a week, making them contradictory. We noted that district nurses visiting the home were satisfied with the way staff were providing pressure care for a resident, and skin assessments were carried out for all residents. The records include the use of a body map, identifying any marks on the skin needing attention. Some of the information on the body map was several weeks old, and staff should ensure that these are kept up to date, and clearly link with written records to show the outcomes of any findings. We saw that risk assessments were carried out on the needs of each resident, and the tasks to be carried out. These were up to date, and signed by each member of staff as read and understood. We saw that reviews of the care needed were carried out very regularly, and the care records showed good liaison with health professionals, social work staff, and the Community Mental Health Team. Since our last visit the home has made referrals to social services under the Deprivation of Liberty Safeguards (DOLS), and the manager was able to discuss the requirements of the Mental Capacity Act 2005 with us. We found a Mental Capacity Assessment on one of the files we viewed, and advised these should be carried out for all residents to identify whether they are able to make their own decisions on how they want to be looked after, and their daily lives. Staff surveys and staff spoken to indicated that they were kept up to date with the needs of the people living at the home. A daily record is made by staff for each resident, with good detail of any event noted. A staff member told us We give support in the best way we can. Staff care for people with diverse needs, for example there are residents from different cultural and social backgrounds. Records hold information about the differing needs, and in speaking to staff they were aware of how they should care for the individuals. We saw and heard staff chatting with residents, who clearly felt able to say how they felt and what they wanted. Care Homes for Older People Page 15 of 31 Evidence: Residents can choose to go where they wish in the home, and may see visitors in the lounges or dining room, or in their own room. Some residents preferred to stay in their own room, where staff were seen to knock and wait for an answer before entering. We viewed the medication administration records (MAR), and medication storage and stock. Medication is stored securely and appropriately, with a seperate controlled drugs cabinet (medication open to abuse), and a dedicated fridge for medication that requires it. We advised that each MAR should hold a photograph of the resident they referred to, to minimise errors. We found that generally medication records were correct and up to date. We viewed several residents records, and found one residents medication had been signed for by staff but not given. This can occur due to copy-cat signing by staff. We also noted that some specialised nutritious drinks held in the fridge were out of date. We found that staff usually dated medication when it was opened, although one tube of opthalmic ointment had not been dated, and staff must ensure this is always done due to its limited life. One MAR had been handwritten by a staff member, and good practice would be for this to be checked and signed by a second member of staff. We saw that the manager carried out full audits of the medication every month, and no issues had been found by her over recent months. We advised the manager to ensure the good practice they have of monthly audits is carefully carried out so that no errors are missed. We saw that there was a good system in place for returning unused medication to the pharmacy, and advised that staff should ensure the returns record is signed and dated when stock is returned, to allow for correct auditing. Any resident who self administers medication signs to agree that they are taking responsibility for their own medication. We advised that the home also provide a declaration for residents to sign that states they agree to the home taking responsibility for their medication, where this happens. Staff administering medication have attended Safe Handling of Medication training. Care Homes for Older People Page 16 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. Residents daily lives and social activities are generally catered for, and people benefit from living in a home that tries to continually develop to provide people with opportunities to live lives that are fulfilled. Evidence: The individual records we saw included information on each persons life history, their religious needs, and what hobbies and activities they preferred. The home have developed the provision of activities since our last visit. One of the staff has been named as Activities Coordinator, and they have spoken with residents and their families and friends regarding suggestions for activities. We saw a record of some of the activities taking place. One relative told us The home tries to involve visitors in activities. We saw the mailbox provided for residents in the home, so that they could post their own letters and cards, giving a community feel to their lives. The manager told us that they try to provide organised entertainment once or twice a week, and have other activities ongoing as people wish. There may be a planned fashion show, exercise session for the elderly, or a visit from a musical entertainer, while staff may provide one to one time with residents, or group games such as Care Homes for Older People Page 17 of 31 Evidence: lounge skittles or darts, or a sing a long afternoon. The home have also arranged trips to Blackpool illuminations, a trip to Blackpool Zoo, a trip to the Lake District, held birthday parties for residents and held a Summer Fayre. Surveys returned to us from residents told us that the home usually arranges activities they can join in with, although one suggested they could have entertainment coming in more, eg singers, games, crafts. We spoke to some residents who told us that they preferred to stay in their own rooms, reading or watching their televisions. Staff surveys said We provide a warm and friendly and homely environment for all residents, family and visitors. The meal choices and quality are excellent. There is a range of activities. Staff spoken to said they tried to provide one to one support when they could, although often providing for the care needs of people meant they had little time left to do this. The manager told us the activities provision is an area that she is continually addressing, and plans to hold more regular social events, and provide activities that would encourage more residents to participate. There are also plans for staff to attend training on activities for the elderly. We sampled both choices on offer as the main meal on the day of the visit. These were either cheese and ham omelette and chips, or gammon and pineapple with mashed potatoes and creamed leeks. Lemon tart or strawberry gateau followed. Both meals were nicely cooked and tasty, and well presented. The dining rooms were clean and tidy, with nicely set tables. During the lunch period drinks were readily available for residents, and staff made sure everyone had had their fill. Residents told us that if they did not like or want something, staff would always see what else they could make for them. As they finished their lunch, one resident said That was really good. We saw staff gently assist where necessary. Some residents choose to eat in their own room, and one told us that staff were Very good at making sure Ive got everything. The food is always hot. We spoke to the cook, who showed us the four week menu plan she generally followed for all the meals though the day. Residents are able to choose from the choice of meals on offer each day, and we advised that the meals of the day are advertised on a board for all to see, so that residents are clear on what their meal is to be. A couple of the residents told us Whatever it is, itll be good. The cook follows the good practice of reviewing the meals every month with each Care Homes for Older People Page 18 of 31 Evidence: resident, and we saw records of the outcomes of these reviews, which included suggestions for meals. She told us about courses she had attended, which provided information about appropriate meals and nutrition. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit by being supported and protected. Evidence: There is a complaints procedure in place, and a file in which to record any complaints which come to the owners attention. There are copies of this available in the entrance of the home, and in information about the home given to residents. We did advise the manager to ensure the contact details for social services are included in the complaints procedure information within the guide, and also to update the address and contact details for the Care Quality Commission, which has recently changed. There have been no complaints received about the home since our last visit. A concern had been raised with us regarding low staffing levels causing staff being unable to always meet residents needs. We found that staffing levels had been adjusted to address the numbers and needs of the residents in the home. All of the residents we spoke to said that they knew how to make a complaint, and what they would do. Id tell any of the staff here if I didnt like something, said one resident. A relative told us in a survey They (the home) communicate with their clients. They do ring if there is a problem, or sort it if I have a problem. The manager told us that any minor concerns from residents or their relatives are recorded in their individual file. She told us they try to address any problems from the Care Homes for Older People Page 20 of 31 Evidence: outset so as to prevent minor, easily solvable, problems from becoming more significant. We advised that a central record be held of these to give an overview. This would give a picture of events in the home, and any patterns emerging may be areas needing improvement or development. This would form part of the homes quality assurance system. We saw that staff had attended training about safeguarding procedures. These are procedures all homes must have in place that must be followed if it is suspected that a resident has been the victim of any kind of abuse. We spoke to staff on duty, and found they had a good understanding of the procedures. The home had made two safeguarding referrals to social services since our last visit. We saw that the home dealt appropriately with the referrals, in full liaison with the social work team. The manager told us they plan to continue to ensure our residents are listened to. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a well maintained environment, which provides aids and equipment to meet the care needs of the residents. It is a pleasant, safe and homely place to live. Evidence: The home has a well kept exterior, with an enclosed central courtyard with seating providing residents with an outside garden area to use when they wish. One resident was enjoying a daily stroll around this space when we visited. We toured the home, and saw that all of the home was clean, tidy and fresh. The home was kept comfortably warm. Domestic staff have set routines to follow to keep the home to a good standard of hygiene. Surveys returned from residents told us that the home is always fresh and clean. The lounges we saw were homely, comfortable and clean. There is plenty of communal space, with a large lounge and dining areas in the main part of the home, and smaller lounges in other parts. People can choose where they want to be, and were seen moving from one place to another as they wished. There is equal access to all areas of the home for residents and visitors with mobility problems, in that there are ramps and a stair lift in place. Aids and adaptations are also in place to help with toiletting and bathing needs. Care Homes for Older People Page 22 of 31 Evidence: The bedrooms we saw were personalised with residents own belongings, such as pictures, ornaments, and small pieces of furniture. All of the residents said that they were happy with their rooms, and that they were kept clean. One resident told us I like to stay in my room. Ive made friends with people who go past my window and we wave and smile at each other. Ive got all my family pictures here, and the staff always pop in to see Im alright. We saw a maintenance record, where staff could record any maintenance needs around the home. This was signed and dated as the work was completed by the maintenance person. A decorator was present at the time of our visit, painting and refreshing parts of the home. We saw that carpet in part of the corridor was showing some wear, and the manager told us that these were items that were addressed during the continual maintenance assessments. The laundry room was clean and tidy. A clear system is used to collect laundry, and distribute clean laundry, with each item being logged in and out. Staff were aware of infection control procedures. The home provides a small smoking area for residents. A risk assessment is in place, as the area is reached by passing through the laundry area and going down two large steps, meaning that staff need to always accompany residents. Care Homes for Older People Page 23 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. The home is properly staffed, which means that the residents are supported by sufficient numbers of trained staff. Evidence: We viewed three staff files, and noted that careful recruitment procedures had been followed, ensuring the protection of residents. References had been obtained prior to employment, and Criminal Records Bureau (CRB) disclosures were available. We advised the manager to ensure it is clear who the references are returned from, as often the signature was difficult to read. We found that often staff were starting work prior to the CRB disclosures being returned, but never before the check on the Protection of Vulnerable Adults list (POVA 1st) had been received. We reiterated that this should only occur in very exceptional circumstances, and the staff member should be closely monitored until the receipt of a satisfactory CRB. The manager confirmed that staff are supervised in these circumstances. All new staff have induction training, and sign to agree that they have understood it. The manager told us that new staff shadow experienced staff, until they are confident and the manager feels they are competent. A staff survey confirmed that induction and ongoing training was provided. We viewed staff rotas, and found the home was appropriately staffed for the residents Care Homes for Older People Page 24 of 31 Evidence: in the home at the time, with two care staff and the manager on duty each day, and two staff on waking watch each night. Some residents told us They have a shortage of staff sometimes, and Shortage of staff means you have to wait for things, and They could have more staff on duty. When you need quite a bit of help you feel bad pressing the buzzer knowing they are staff down. Staff commented that sometimes during busy periods such as meal-times, or mornings, it was difficult to address peoples wishes as quickly as they would like, and also the geography of the building meant that it could take some time to get from one end to the other. The manager confirmed that she constantly monitors staff workload, and was aware of the need to also monitor the level of provision each resident required, so as to ensure the appropriate numbers of staff were available. A relative told us Sufficient staff are always present and they are kind and knowledgeable. Staff told us about training they have received, finding it relevant to their role, and helping them to understand and meet the individual needs of people. The manager told us in information sent to us that 50 of staff have obtained National Vocational Qualifications (NVQ). Examples of training include communication, confidentiality, fire safety, National Vocational Qualification levels 2 and 3, health and safety, pressure care, medication, moving and handling, palliative care, Parkinsons disease awareness, dementia care and first aid. Residents said the staff usually listened to them, and were usually available and gave the care they needed. Staff told us that they felt well supported with regular contact with the manager. We work well as a team, its a friendly environment said a staff member. The manager told us that formal staff meetings take place about every two months, and that minutes were taken. We were unable to access these at this visit. Staff suggested more meetings would help them give more feedback that may develop the service further. Care Homes for Older People Page 25 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. The manager leads a team of staff who work to make sure people who live at the home are as safe and comfortable as possible. Their aim is to improve services and so provide a good quality of life for residents. Evidence: The manager has been registered with CQC since our last visit, and is presently attending a training course to gain a management qualification. The management team has settled into a clear structure, with an assistant manager and two senior care staff supporting the manager. The staff team have stabilised, allowing minimal use of agency staff, and training programmes to develop. The manager has worked hard to ensure the systems used in the home are more structured and easy to use, with a person centred focus. We found records were up to date and easy to audit. Care Homes for Older People Page 26 of 31 Evidence: The management approach is open and inclusive. We saw residents and staff regularly call at the office with queries, or just to chat, and all were welcomed. We found that the manager has a plan for regular one to one supervision of staff, and we saw that most of these had been carried out. The quality assurance systems in the home are also being developed. The home have ISO (International Standards Organisation) 9001-2008, an external independent body, assuring their quality systems. The manager regularly audits the records to identify any errors, and has started using a survey for residents. We saw that this asked specific questions of residents to identify exactly what they wanted, or needed to know about the service. The collated responses were positive. The manager confirmed that residents finances continue to be safeguarded by the procedures in place. She confirmed that all equipment in the home has been serviced as required. Every year we request a self assessment document from each care service, the Annual Quality Assurance Assessment (AQAA). This provides us with information on how the service operates and how it plans to develop. It also gives us some numerical information about the service, such as staff and client numbers.The AQAA we received from the agency held basic information about the operation of the service, and how the systems worked. We discussed the content with the general manager, and the need to develop this information to more clearly describe how the homes systems work in each area. The general manager confirmed this would be addressed in the agencys next AQAA. 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 It should always be made clear that the resident has participated with the assessment of their needs with their, or their representatives, signature and the date of the assessment. Where body maps are used, they should give up to date information and link to written records. It should be made clear that mental capacity assessments are carried out for all residents, to identify the level of decision making ability people have about their lives. The individual records within each file should cross check so that they provide clear information about the care provided. Each Medication Administration Record should hold a photograph of the resident they refer to so as to minimise mistakes. Any MAR handwritten by staff should be checked and signed for accuracy by a second member of staff. The Medication Declaration should be developed to include a residents signature in agreement to the home taking responsibility for their medication, where this occurs. 2 3 8 8 4 8 5 9 6 9 Care Homes for Older People Page 29 of 31 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 7 9 The medication returns book should be signed and dated when stock is returned to the pharmacy, for auditing purposes. Medication audits that are carried out should be carefully done so that errors are not missed. A menu board should be in view of the residents to inform them of the meals of the day. The contact details of the appropriate authority to contact re complaints should be amended in the complaints procedure. Any concerns should be centrally recorded so that any patterns could be addressed as part of the QA system. It should be made clear who the referee is for applicants by ensuring the name is stated on returned references 8 9 10 9 15 16 11 12 16 29 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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