Care Home: The Beeches

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well Care plans have been produced for all people who use the service and service users spoken to on the day of the visit said, "the staff work very hard and we are all looked after very well". Comments received in returned surveys include, "the home gives excellent care in a friendly homely environment" and "everyone is happy". One comment received under the section "what the home could do better states,"better organization" but does not elaborate on this. The staff spoken to are knowledgeable about service users` care needs and preferences. There is a motivated and established staff team who respond to service users in a respectful and appropriate manner. Service users spoken to on the day of the visit said that staff are "so helpful and help me with anything" and "they are lovely here and they work very hard". The home provides a homely environment in which people can live. Four returned surveys all made comment about the environment and felt that this was an area the home could improve upon. Individuals are encouraged to personalize their own rooms with their own furniture and personal belongings. Communication between people who use the service and staff was observed to be positive and open. The provision of meals and mealtimes are of a good standard. We joined residents for lunch and they said, "the food is lovely and I always have a choice" and "you can`t fault the food here. Its always very good". The evidence seen and comments received indicate that this service meets the diverse needs e.g. religious, racial, cultural, disability of individuals within the limits of its Statement of Purpose. What has improved since the last inspection? The home now completes a needs assessment for all potential service users. Care plans now include evidence of regular reviews. Procedures for the control and safe administration of medicines have improved, to ensure service users receive their medicines in a safe manner. A records of complaints is now maintained in the home and these include a summary of the outcome of the investigation. The staff recruitment practices in the home have improved to ensure all the necessary employment checks are completed before staff commence employment. What the care home could do better: People using this service must be assessed, by a person trained to do so, to identify those individuals at risk of developing pressure sores. Appropriate records must be kept in the care plans of all actions staff are required to take and the assessment must be reviewed on a continuing basis. The home must seek appropriate advice, so that nutritional assessments, including body mass index (BMI), are undertaken for individuals living at the home. The home must make sure that there systems are in place to weigh people who have mobility needs. A moving and handling assessment must be completed, by a person trained to do so, for people with mobility needs. Risk assessments must be completed for the prevention of falls, where service users have been identified at risk. The organisation must submit the application to register the manager with The Care Quality Commission. The home must contact and take advice from the local fire authority about suitable ways in which bedroom doors can be left open without compromising fire safety. All care staff must receive up-to date mandatory training. This includes moving and handling, first aid, fire and infection control. Key inspection report Care homes for older people Name: Address: The Beeches 16 Lakes Lane Newport Pagnell Bucks MK16 8HP     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: Barbara Mulligan     Date: 2 3 1 0 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 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) 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 32 Information about the care home Name of care home: Address: The Beeches 16 Lakes Lane Newport Pagnell Bucks MK16 8HP 01908210650 01908217971 thebeeches@brancastercarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Brancaster Care Homes Ltd Name of registered manager (if applicable) 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 maximum number of service users to be accommodated is 32 The registered person may provide the following category of service only: Care home only to service users of the following gneder: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The Beeches is a two-storey residential care home and recent building work to the home has seen the home reduce in numbers from thirty two to seventeen beds. The home is comprised of both old and modern buildings and access to the upper floor is via stair lifts. The Beeches is located close to the town centre of Newport Pagnell, which offers a Care Homes for Older People Page 4 of 32 Over 65 32 0 2 8 1 0 2 0 0 8 Brief description of the care home variety of shops, restaurants pubs and other amenities. Service users are able to use taxis and the dial a ride service to access the town centre. Fees range from £500 per week to £545 per week. Additional charges are made for hairdressing and chiropody. 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 unannounced key inspection was conducted over the course of a day and covered all the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the home for completion. This was returned to the Commission by the day it was due but information was limited and did not always give us the information we needed. A total of twenty two surveys were sent to people who use the service, advocates, healthcare professionals and care staff to complete. Seven of these have been received by the Care Quality Commission. Information received by the Care Quality Commission since the last inspection was also taken into account. The regulation inspector was Barbara Mulligan. The inspection consisted of discussion with the acting manager, discussion with other staff, opportunities to meet with some people who use the service, examination of some of the homes required records, observation of practice and a tour of the premises. Care Homes for Older People Page 6 of 32 A key theme of the visit was how effectively the service meets needs arising from equality and diversity. As a result of the inspection the home has received eight statutory requirements. Feedback on the inspection findings and areas needing improvement was given to the acting manager of the home at the end of the inspection. The staff team and the service users are thanked for their cooperation and hospitality during this unannounced visit. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: People using this service must be assessed, by a person trained to do so, to identify those individuals at risk of developing pressure sores. Appropriate records must be kept in the care plans of all actions staff are required to take and the assessment must be reviewed on a continuing basis. The home must seek appropriate advice, so that nutritional assessments, including body mass index (BMI), are undertaken for individuals living at the home. Care Homes for Older People Page 8 of 32 The home must make sure that there systems are in place to weigh people who have mobility needs. A moving and handling assessment must be completed, by a person trained to do so, for people with mobility needs. Risk assessments must be completed for the prevention of falls, where service users have been identified at risk. The organisation must submit the application to register the manager with The Care Quality Commission. The home must contact and take advice from the local fire authority about suitable ways in which bedroom doors can be left open without compromising fire safety. All care staff must receive up-to date mandatory training. This includes moving and handling, first aid, fire and infection control. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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 10 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. A needs assessment is completed for prospective service users, which ensures that individual needs are identified and that the home is able to meet these needs. Evidence: At the previous inspection it was identified that a record of the assessment for the person most recently admitted to the home could not be located at the time of the inspection visit. A requirement was issued for the home to conducts an assessment of a persons needs before offering a place in the home and evidence of this assessment must be retained on file. Needs assessments were examined for five people using the service, including those most newly admitted to the home and for one person who had been receiving respite care. Staff will visit a potential service user either in the hospital or in their own home to Care Homes for Older People Page 11 of 32 Evidence: undertake the initial assessment of needs, and information is also obtained from any referring social services or health care professionals. The assessment covers mobility, mental state, personal safety, personal care, continence, dietary needs, communication, sleeping, hobbies and interests and family involvement and other social contacts and social interests. The admission documentation in all files examined was fully completed, detailed and demonstrated that prospective service users, family members or representatives are included in the assessment process if this is appropriate. The home does not admit service users for intermediate care so this standard was not assessed during the inspection. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have a good understanding of service users care needs, but the health, personal and social care needs of people who use the service and identified risks to service users, are not adequately identified in the care plans, preventing the home from meeting all the needs of the individual. Improvements to medication practices in the home ensure service users receive medication in a safe and consistent manner. Evidence: The care of five service users was case tracked and their care plans examined. The care plans reflect the changing needs of the individual. Care needs are identified in service user plans, but the action plans are very vague and require further detail, setting out guidelines detailing how staff will meet those needs. For example, in one file examined under bathing and showering the action plan states, has two baths a week and has the assistance of one carer and in another file under the section for Care Homes for Older People Page 13 of 32 Evidence: personal hygiene it states,needs help with this from two carers and in a further file, under the sections for personal hygiene, choosing clothes, dressing, bathing, using the toilet and brushing teeth, the action plan records the same instruction of one carer assists X in this activity. These statements are very vague and require more detail which sets out guidance for staff to follow to inform them how specific needs will be met. The organisation should address this. Care plan reviews are kept in the service user files and those seen were reviewed within the last twelve months. Visual observations of people using this service showed that people were smartly dressed including jewelery, make up and nail varnish and people were seen to be wearing the aids needed, for example hearing aids and clean glasses. One service user spoken to on the day of the visit said, the staff work very hard and we are all looked after very well. Comments received in returned surveys include, the home gives excellent care in a friendly homely environment and everyone is happy. One comment received under the section what the home could do better states,better organisation but does not elaborate on this. The staff spoken to are knowledgeable about service users care needs and preferences. People using this service are registered with two local GP Practices. All residents have access to local NHS Services. There were no tissue viability assessments in place for service users whose care was being case tracked, even though some care plans have made reference to the risk of pressure sores. For example,in one file it states that the individual must have cream applied to prevent pressure sores. In another file a service user was being cared for in bed and the file made reference to the fact the individual should be encouraged to sit in a chair once a day to prevent pressure sores and in a third file it indicates that the individual has a poor appetite and is not fully mobile which potentially puts the service user at risk of developing a pressure sore. A requirement is issued for service users to be assessed, by a person trained to do so, to identify those individuals at risk of developing pressure sores. Appropriate intervention must be recorded in the care plans and the assessment must be reviewed on a continuing basis. In the five files examined there is no evidence that nutritional screening is undertaken on admission and on a continuing basis there after. The home must seek appropriate advice so that nutritional assessments, including body mass index (BMI), are Care Homes for Older People Page 14 of 32 Evidence: undertaken for individuals living at the home who have not been assessed. The nutritional assessments will show who is in need of clinical advice, and care plans can be developed where necessary, so that identified needs can be addressed. This is a requirement of the report. In one file examined an individual has lost the ability to feed themselves, has a poor appetite and is unable to weight bear. They have not been weighed since 30th August 2007. In a further file a service user with identified nutritional needs has not been weighed since 07/06/09 and before that 09/01/08. The home must ensure systems are in place to weigh people who have mobility needs. This will be a requirement of the report. In the files examined there were no moving and handling assessments and there were no risk assessments in place regarding the prevention of falls. A requirement is issued for these to be completed and available in service user files. At the previous inspection it was identified that there were two policies governing the control and administration of medicines in the home. Neither of these appeared to have been written for this service. One, last reviewed in 2004, included repeated references to nurses (this is not a nursing home) and a reference to the Regulation of Care (Scotland) Act 2001, legislation which applies to Scotland and not England and Wales. The other again mentioned nursing and references to the UKCC, a body which ceased to exist on 1st April 2002. A requirement was issued for appropriate medication policies and procedures for the control and administration of medicines to be in place which do not place service users at risk.The AQAA tells us the medication policy was last reviewed and updated in February 2009. At this visit we looked at the medication administration record (MAR) charts, medication supplies and care plans for the five people whose care was being looked at as part of this inspection, and at the MAR charts for the remaining people using this service. At the time of the inspection there were no service users who were able to self-administer their medication. The medication administration records (MAR) show there are no gaps or omissions. Handwritten entries seen on MAR charts are dated and signed by two care staff. During the previous inspection it was identified that one person was receiving some medicine crushed in food because it was said the person was unlikely to take it otherwise. Without the persons permission this practice amounts to the covert administration of medicine. A requirement was issued for an appropriate balance to be maintained between measures to ensure the safety and welfare of residents and others and the need to maintain the privacy and dignity of individuals. During this visit it was noted that this practice has ceased and in one file it is recorded that one Care Homes for Older People Page 15 of 32 Evidence: individual refuses to take their medication. This is subject to regular reviews with the service users general practitioner. Care Homes for Older People Page 16 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. Service users have varied activities available to them, they are provided with nourishing meals and enabled to keep in contact with family, friends and the community to maintain important social links. Evidence: Care plans show individual routines of daily living and these include bathing, rising and retiring times. As part of the admission process, the home complete a life story when they are able to, which gives staff information about previous leisure pursuits, hobbies and other interests. The acting manager said there is a range of activities organised in the home which include quizzes, exercise sessions, movie days, visits by a local pat-a-dog scheme and invites musical entertainers to perform on a regular basis. Activities only take place in the afternoons and there were no activities advertised in the home. The acting manager said activities are decided upon on a daily basis depending what service users wish to do. Involvement by local community groups includes the local church, the local school and regular visits by the hairdressers and various visiting entertainers. Comments received Care Homes for Older People Page 17 of 32 Evidence: about the variety of activities available were mixed. Two people who responded to the surveys said, there is enough to do, I go shopping sometimes and I like to get my hair done and I enjoy the quizzes. Two people spoken to on the day of the visit said about the range of activities, we dont have anything much to do. We usually go to our rooms or watch TV and a comment received in a returned survey, under the section what the home could could do better, said,entertainment and outings. There were no activities advertised in the home and the acting manager said these are decided upon on a daily basis depending what service users wish to do. Service users are offered three meals a day. The menu is rotated on a three week cycle. The inspector had the opportunity to join service users for a lunchtime meal in the dining room where eight people were having their lunch. The meal was relaxed, unrushed and well organised. People were well supported by staff and the food was attractively presented. Some people chose to take their meals in their rooms on the day of the visit. Comments made about the food include, the food is lovely and I always have a choice and you cant fault the food here. Its always very good. Care Homes for Older People Page 18 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 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 able to effectively manage complaints and safeguard service users ensuring service users are listened to and kept safe from harm and abuse. Evidence: During the previous inspection it was identified that the homes complaint procedure informed the complainant that they could only refer their complaint to the homes inspectorate if the complaint fails to result in an outcome and a requirement was issued for the complaints procedure to refer the complainant to the Commission at any stage in the process. The Annual Quality Assurance Assessment tells us the complaints procedure was last reviewed in February 2009. The complaints procedure is clear and accessible to service users and a complaints and suggestion leaflet has now been made available in each persons bedroom. The acting manager said that prior to her commencement complaints had not been well managed. She has however, kept a written record of all complaints received since she took up post in January 2008. During the previous inspection it was identified that the investigation and outcome for all complaints was not always recorded and a requirement was issued for improvement in this area. The Annual Quality Assurance Assessment tells us that the home has received four complaints in the last twelve months and one of these was resolved within 28 days. The complaints log shows that the four complaints have been Care Homes for Older People Page 19 of 32 Evidence: well recorded and resolved to the satisfaction of the complainant. Procedures are in place for safeguarding vulnerable adults (SOVA) and staff have access to a whistle blowing policy. The home has a copy of the local authority SOVA policy. During the previous inspection details of staff training on Safeguarding adults were not available. A requirement was issued to ensure that all staff are aware of the current arrangements for safeguarding adults. Training records examined during this inspection demonstrate that seven of the eleven care staff completed Safeguarding training with Milton Keynes Council and the home are awaiting allocated places for the remaining four care staff to attend. The Annual Quality Assurance Assessment (AQAA) tells us that there have not been any safeguarding referrals in the previous twelve months. However there has been one referral since the return of the AQAA and this was still being investigated at the time of the visit. Care Homes for Older People Page 20 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. Overall the accommodation is good providing people who use the service with an attractive and homely place to live. Evidence: The Beeches is a two-storey residential care home and recent building work has seen the home reduce in numbers from 32 to 17. The home is comprised of both old and modern buildings and access to the upper floor is via stair lifts. Some areas of the home are dated and shabby and would benefit from redecoration. Part of the home has been turned into five self contained flats pending a change of use. Fourteen bedrooms were occupied on the day of the inspection visit. The main accommodation consists of an entrance hall, two living rooms and one dining room. These are homely and have many personal touches such as pictures, books and many ornaments. The dining room was sufficient in size to accommodate those taking meals there. The main kitchen was in good order, tidy and clean. It is noted that the kitchen was awarded four stars out of a possible five, for standards of hygiene and housekeeping when inspected by an environmental health officer in July 2008. During the previous inspection it was noted that in the small staff kitchen the Care Homes for Older People Page 21 of 32 Evidence: dishwasher door obstructed the kitchen door when in the open position and some open foodstuffs in the fridge had not been labeled when opened. A requirement was issued for improvement and it is pleasing to see that this has been complied with. During the previous inspection it was identified that a ground floor bathroom presented a rather dated and shabby appearance.The box covering of some pipework was broken, the bath edging appeared to have mold in some areas, the shower/hair wash hose was kinking and needed replacing, no less than four bottles of hand wash were in use, and the area was used to store a supply of bathroom rolls. A requirement was issued for improvement and it was noted that this has been completed. There are accessible toilets available for service users throughout the home and several are close to the lounges and dining area. Bathrooms and toilet areas have the appropriate aids and adaptations to meet the needs of individuals and to promote independence. It was noted that Latex gloves were in the bathroom which could pose a possible risk to service users. The home must decide whether it is safer to lock Latex gloves away or if it is safe to keep these in bathrooms. This must be supported by a risk assessment and t he home must address this. Laundry facilities are sited so that soiled articles,clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. The laundry floor finishes are impermeable and these and the wall finishes are readily cleanable. The home has an infection control policy and the AQAA tells us that eight staff have received training in prevention and control of infection. Four returned surveys all made comment about the environment and felt that this was an area the home could improve upon. Care Homes for Older People Page 22 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. The staffing numbers and skill mix is presently satisfactory to meet the needs of people using this service. Staff training needs to be strengthened and improved upon to ensure that people who use the service benefit from staff who are trained and competent to do their job. Evidence: At the time of the visit there were fourteen older people living in the home. Staffing levels at the time of this inspection provided for two care staff in the morning, two in the afternoon and two at night. The acting manager is extra to these numbers. The staff rotas show that there is always a team leader on duty. The care team are also supported by full time housekeeping laundry and catering teams. Service users spoken to on the day of the visit said that staff are so helpful and help me with anything, and they are lovely here and they work very hard. Staff turnover is low and the acting manager said that no new staff have been employed since 2007. The Annual Quality Assurance Assessment tells us that seven of the eleven care staff have acquired NVQ at Level 2 or above. During the previous inspection it was noted that there were several shortfalls in the recruitment process and a requirement was issued for improvement. The recruitment Care Homes for Older People Page 23 of 32 Evidence: files for five staff were examined during this visit. All files looked at contain the necessary documentation, except for an up to date photograph for three of the five files examined. The organisation should address this. All staff complete an induction programme and this is completed in-house. The acting manager undertakes some in-house training for care staff. Staff training files examined show that some updating needs to be completed by care staff for fire training, infection control and moving and handling. 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. The home aims to provide a safe and consistent service but previous poor management of the home and a lack of a registered manager could put people using the service at risk. Evidence: The home has had an acting manager in post since January 2008 and the Care Quality Commission has written to the Registered Provider for the home, to complete the application to register the manager. This will be a requirement of the report with a timescale for completion. The present acting manager has worked in the home for twelve years and is currently undertaking the Registered Managers Award. The have also achieved a National Vocational Qualification level 3 in care. The organisation and the home has a clear and accountable management structure and the acting manager is supported by the organisation. The inspector noted good teamwork in progress and staff spoken to had a good working knowledge of the individual residents and their care needs. Care Homes for Older People Page 25 of 32 Evidence: The Annual Quality Assurance Assessment (AQAA) was returned to us by the date it was requested,however the information was limited and did not always give us the information we needed. The acting manager said that service satisfaction questionnaires are sent out six monthly to people using the service. However these were not available on the day of the inspection and the AQAA does not provide us with any information about when these were last sent out. The inspector was informed that team leaders meet with people using the service every two months and carry out oneto-one meetings to ascertain peoples views of the home. Suggestion sheets have been placed in each persons bedroom so relatives or service users can make suggestions or give input about the service being provided. Copies of regulation 26 report visits are carried out by the Business Development Manager and the acting manager said she completes part of this, which is discussions with the service users. Regulation 26 for older people states that visits must be undertaken by an employee who is not directly concerned with the conduct of the care home and therefore the registered manager should not be completing Regulation 26 visits. The organisation should address this. The home does not look after money on behalf of people living in the home. There is a lockable facility in each persons bedroom to store money and valuables. People are required to make their own arrangements, either with their family or another representative. There is a health and safety policy in place. At the previous inspection it was identified that one bedroom door had its lock removed. The hole which was left in the door could compromise fire safety and the door of the dishwasher in the small kitchen on the ground floor posed an obstruction to opening or closing the door. A requirement was issued for the home to ensure that the fire safety of bedroom doors is not compromised by maintenance work. During this inspection it was observed that one persons bedroom door was wedged open by a small foot stool. The home must consult with, and take advice from, the local fire authority on this matter and this will be a requirement of the report. Records were seen for fire safety. These cover the homes fire procedures, fire prevention, fire alarm testing and emergency lighting testing. Testing of the homes fire alarm system is undertaken on a weekly basis and evidence was seen of this. There is a fire based risk assessment and this was dated 16/02/2008. This must be reviewed annually and the home should address this. The Annual Quality Assurance Assessment informs us that Portable Appliance Testing was last undertaken June 2009, Gas Appliances were checked in July 2009 and the homes electrical circuits (fixed wiring) was last checked in May 2008. Care Homes for Older People Page 26 of 32 Evidence: Staff training records show that not all mandatory training, including first aid, moving and handling, fire and infection control is up to date for all staff. This will be a requirement of the report. 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 8 13 The registered person must complete a risk assessment for the prevention of falls, where service users have been identified at risk. To ensure unnecessary risks to the safety of service users are identified and so far as possible eliminated. 30/12/2009 2 8 13 The registered person must ensure systems are in place to weigh people who have mobility needs. To ensure the health and welfare of service users is not compromised. 30/11/2009 3 8 13 A moving and handling assessment must be completed, by a person trained to do so, for people with mobility needs. 30/11/2009 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 To ensure suitable arrangements are in place to provide a safe system for moving and handling. 4 8 13 People using this service 30/12/2009 must be assessed, by a person trained to do so, to identify those individuals at risk of developing pressure sores. Appropriate intervention must be recorded in the care plans and the assessment must be reviewed on a continuing basis. To ensure the health and welfare of people using this service is promoted and maintained. 5 8 13 The registered person must 30/12/2009 seek appropriate advice so that nutritional assessments, including body mass index (BMI), are undertaken for individuals living at the home. To ensure the nutritional needs of service users are met. 6 31 8 The organisation must submit the application to register the manager with The Care Quality Commission. 03/12/2009 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 To ensure service users receive a consistent, well managed and planned service. 7 38 23 The registered person is required to contact and take advice from the local fire authority about suitable ways in which bedroom doors can be left open without compromising fire safety. To ensure the health and safety of people using this service is not compromised. 8 38 18 All care staff must receive and complete mandatory training. This includes moving and handling, first aid, fire and infection control. To ensure staff are trained to undertake their jobs safely. 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 30/12/2009 28/02/2010 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. 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. 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!