Care Home: The Cedars

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What the care home does well People said that the home had a, "Friendly caring atmosphere." When we visited we found that the home was relaxed and that people could follow their own routines. The accommodation provided for people is good. People are able to make themselves feel at home through having their own things about them. Communal areas are comfortable and there is pleasant outdoor space for people to enjoy. The manager always ensures that people`s needs are assessed before they move into the home to help make sure that it is the right place for them. People have the opportunity to visit the home and meet other residents before deciding to move in. People were pleased with the care and support that they receive. One person said, "They help me and look after me well." People are enjoying having more opportunities to get out and about and participate in developing activities. People were also positive about the food provided by the home feeling that it was of a very good standard, home cooked plentiful and that they were offered choice. Medication at the home is managed well and people will receive good support with this aspect of their care. Staffing at the home is stable so that people receive care from staff that they know and are used to. People felt that the management of the home was good. What has improved since the last inspection? This was the first inspection since the home was registered. What the care home could do better: So that people can feel confident that staff assisting with their support are suitable and safe, recruitment procedures need to be robust and consistent. Proper checks need to be carried out before staff start working at the home. Again to make sure that people are properly protected it is important that all staff have a good understanding of safeguarding, and what to do if they feel people`s treatment is not as it should be. Up to date information needs to be available to help people understand the actions they need to take should any incidents occur. Key inspection report Care homes for older people Name: Address: The Cedars 6 Russell Road Clacton-On-Sea Essex CO15 6BE     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: Vicky Dutton     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 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: The Cedars 6 Russell Road Clacton-On-Sea Essex CO15 6BE 01255433619 01255224431 thecedarsresidential@googlemail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): RBS Care Ltd Name of registered manager (if applicable) Miss Kim Francis Type of registration: Number of places registered: care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The registered person may provide the following categories 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 Mental Disorder, excluding learning disability or dementia Code - MD Dementia Code - DE The maximum number of service users who can be accommodated is: 13 Date of last inspection Brief description of the care home The Cedars is a privately owned and run care home. It provides accommodation and personal care and support for up to thirteen older people. People living at The Cedars Care Homes for Older People Page 4 of 28 Over 65 0 0 13 13 13 0 Brief description of the care home may have a mental health diagnosis or may suffer from dementia. The home is a large detached house located in a quiet residential area of Clacton on Sea. The home is within walking distance of the town centre, local amenities and the sea front. The Cedars is an older style property that is decorated and furnished in a homely manner. Sleeping accommodation is provided on both the ground and first floor with access provided via a shaft lift to both levels. There are eleven single rooms and one shared room. Each room has an en suite toilet. Communal bathing facilities are provided. The home has a statement of purpose and service users guide available to provide people with information about the home. Current fees at the home were advised to be £448:84 to £666:00 per week. Fees charged vary according to peoples needs and funding arrangements. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key site visit. It was our (CQC) first visit to the home since it was registered in June this year. Although newly registered The Cedars is an established home that has been open since 2004. It had re-registered in order to change ownership status and conditions. At this visit we (CQC), considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. We spent six hours at the home. We looked around the premises to see if it was pleasant and safe for people. We viewed some care records, staff records, medication records and other documentation to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to management and staff. We also spoke to a visiting professional during the site visit. Care Homes for Older People Page 6 of 28 The homes Annual Quality Assurance Assessment (AQAA) was sent in to us when we asked for it. The AQAA is a self assessment tool that providers are required by Law to complete. The AQAA tells us how management feel they are performing against the National Minimum Standards and how they can evidence this. The AQAA for The Cedars was satisfactorily completed by the manager and gave us the information that we asked for. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives, involved professionals and staff. We received responses from three residents, one relative, one visiting professional and three staff. The views expressed at the site visit and in survey responses have been incorporated into this report where appropriate. We were assisted at the site visit by the manager and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the staff team, residents, relatives and visiting professionals for their help throughout the inspection process. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can feel confident that they will be given every assistance, and be involved in the decision to move into The Cedars. Evidence: The home had a Statement of Purpose and Service Users Guide in place. We saw that the Service Users Guide needed to be updated to reflect the homes re-registration and the fact that they are now registered to provide care for people who have dementia care needs. On surveys and in discussion with people it was clear that they felt they had received enough information about the home before they moved in. The homes pre-admission assessment information documented that pre-admission visits had taken place. There was a checklist to confirm that people had been given copies of the Statement of Purpose and Service Users Guide. The AQAA told us that, We have compiled a new assessment form for potential service users. When we looked at the file of someone who had most recently moved Care Homes for Older People Page 10 of 28 Evidence: into the home we saw that a detailed pre-admission assessment had been completed by the manager. The assessment covered all aspects of needs such as mobility, oral care, foot care, social aspects and many others. The assessment went on to detail visits, and actions taken such as introducing the prospective resident to other people, showing them their potential room and information given. Other information and assessments were also available such as a ward transfer note, a Care Programme Approach Care plan, and documentation from social services. This shows that the home gather as much information as they can about the person, involve them as far as possible in the admission process, and try to ensure that a placement is appropriate. One person told us, I visited and we had a party. I could not wait to move in, another that, I saw my room before I moved in. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive care and support that reflects their individual needs and choices. Evidence: During the day people living at the home told us that they were happy with the care they received at The Cedars. On surveys and in discussion people living at the home said that they always received the care and support that they needed. People told us, They look after us well, They look after me well and take care of me, and I have been very happy with the care, attention and support here. During the day we (CQC) observed that people were given appropriate support to meet their individual needs. The AQAA said, By using person centred care plans we are able to promote individual service users choices and preferences and support each service user in maintaining their independence. Care plans are documented and followed by all care staff. It was stated that Care approaches have been re-designed to show what action care staff need to take so that all aspects of service users needs and preferences are met. We looked at two care files to see how well care and support is planned for and arranged. We wanted to see if people have a say in their care, how the home ensure that staff are made aware of peoples needs, and how they are helped to meet them in an Care Homes for Older People Page 12 of 28 Evidence: individual way. We saw that peoples care is well planned for and well documented. People are, as far as possible, very much involved in expressing their needs and how they wish these to be met. Background and historical information is recorded along with the persons description of how they like to spend their day. This leads on to reaching an understanding of the persons support needs under Support I need with.... for example, personal care, eating and drinking, communication, social interests, religious status and many other aspects of daily living. Detailed person centred care plans, relating to the support needs identified, and risk assessments followed. Peoples involvement was clear through care plan comments such as X has agreed to have a bath twice a week. We saw that people had signed their care plans. Staff told us, Because the home is small staff can spend time with service users to find out what they like and dislike. When we spoke to staff it was clear that they had a good understanding of peoples individual needs and preferred routines. We saw that care plans are reviewed on a monthly basis. In addition to this good daily records are maintained, key workers write a weekly report about how the person has been, and the manager writes a monthly report highlighting any developments, health issues, appointments attended, changes or particular events. This shows that peoples ongoing health and welfare is closely monitored. Records showed that people access appropriate health care to meet their needs. The district nursing team are very supportive, and people have regular access to chiropody, optical and dental services. A visiting professional completed one of our surveys. All the questions such as does the service respond to the diverse needs of individual people, and, are peoples social and health care needs properly monitored and reviewed by the care service were answered by the most positive response of always. They said that the home, Gave good care to all. Staff meeting minutes brought up that the district nurse had praised the home for their good care of one particular resident, which had enabled them to remain at the home. People are supported in attending appointments and reviews in relation to their ongoing mental health issues. On surveys people said that they always received the medical care that they needed. One person however said that it could sometimes be difficult to get a good response from the local doctors surgery. The manager was aware of this issue and is trying to work with the surgery to improve the service that they offer. Records of health professionals visits, hospital appointments and so on were very well maintained. We saw that crisis risk management plans were in place for each individual to manage any sudden deterioration in a persons mental health. Care plans incorporate assessments for nutrition and good nutritional records are maintained to monitor peoples diet. As far as possible peoples weight is monitored to identify any changes that might cause concern. However at the moment only stand on scales are available, so people who are unable to weight bear cannot be weighed. Care Homes for Older People Page 13 of 28 Evidence: As part of this inspection we looked at medication systems and records. Medication at the home is well managed and no errors in records or the system were identified. We saw that the system is regularly audited to ensure that correct procedures and practice are being maintained. Although the home has their own policies and procedures in place, it was advised that a copy of the Royal Pharmaceutical Guidelines on managing medicines in a social care setting were also available. These provide good practical advice and guidance to staff. Following the site visit the manager confirmed that the guidelines had been obtained. It was also advised that the temperature in the medication storage area be monitored to ensure that medicines are being stored in optimum conditions. Staff training records showed that staff administering medicines have received training. The manager confirmed that this was through a distance learning course using workbooks. However records showed that two members of staff have not completed medication training since 2005 and one since 2007. This could mean that their knowledge and practice is not up to date. The manager said that these staff would be undertaking the next course available. Observations through the day showed that staff approached residents in a calm and kind manner. Supporting people in a manner that respected their individuality was reflected in care planning. Peoples privacy was respected when they wanted to spend time alone. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a lifestyle that reflects their needs and preferences. Evidence: The manager has been working to ensure that people living at The Cedars have better opportunities for occupation and activity. An activities co-ordinator has been employed and works on three afternoons each week. One person said, Having the activities person now means that I can do more. Care staff have been encouraged to spend more one to one time with people, and residents have been encouraged to get more involved with daily living tasks. The AQAA, completed by the manager, identified that this is an area they want to continue to develop. Care plans were in place relating to peoples social needs. Activities records are maintained so it was possible to see that people are getting out and about more, and doing more in house activities if they wish to do so. Some people are able to go out independently but others need support. We saw that one person chooses to attend a local day centre. People enjoy going to the shops or into town for a coffee, going to church and socialising at the sister home to The Cedars. In house activities are still fairly basic such as bingo and ball throwing, but many residents at the home prefer their own company or spending time in the smoking room. On surveys people said that the service always arranged activities that they could take part in. People spoken with on the day seemed content. One said Care Homes for Older People Page 15 of 28 Evidence: I went to town yesterday and bought some clothes. During the day we saw that routines in the home are flexible. People got up and dressed when they wished, had drinks when they wanted them, and used the building as they wished. Visiting at the home is open, and family involvement encouraged. The AQAA said that, We actively welcome service users friends and families to visit them at the home either to visit in private or have lunch with them. At parties or celebrations friends and family are invited to attend. A member of staff said, The home has very good and open communication with families. A number of people living at The Cedars do not have any family support. The manager felt that involved professionals such as community psychiatric nurses often acted to advocate for and support residents. However information on independent advocacy services should be available to people and was not. People should know where they could go for alternative support and advice should they wish to do so. The manager undertook to make sure that this information is available. We had positive feedback on the quality of the food provided at the home. People said, Good quality food and nutrition, Good food with a professional cook. Everything home made, I Enjoy the home cooking and, Excellent home cooking. On the day of the site visit the lunchtime meal was home cooked, plentiful and looked appetising. Everyone said that they had enjoyed their meal. The home use a four weekly rotating menu, which is periodically changed. The menus showed that people have a choice of food. The manager said that if people did not want either of the choices, other alternatives would be offered. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may not be fully protected by practice and information available in the home. Evidence: The home has a clear complaints process in place that is on display for people. The AQAA said that both written and verbal information is provided to people about how to make a complaint. On surveys and in discussion people said that they would know how to raise any concerns. One person said, If I had any problems I could talk to any of the staff. No complaints had been received or recorded by the home but we saw that a process was in place for managing any that did occur. As well as the complaints procedure being on display complaints forms and a suggestions box was available in the lobby area for people to use if they wished. We (CQC) have not received any complaints about the service. We saw that the home had received a number of thank you/compliment cards. The AQAA said that POVA training is mandatory on a yearly basis. Training records viewed indicated that most staff had completed training this year. The manager said that they had done specific external training relating to safeguarding, and that six staff were due to do external training with the Essex Safeguarding Board in December this year. The manager and staff spoken with demonstrated a good understanding about safeguarding in general, and whistleblowing. However there was some concern that in the event of an incident occurring there would be little guidance available to staff about how to manage this. One member of staff said that they might not report Care Homes for Older People Page 17 of 28 Evidence: concerns if the resident said they did not want it taken further. The homes own policies and procedures did not highlight actions to be taken in terms of reporting and managing incidents in line with well established local procedures. Although the Essex safeguarding training materials and leaflets were available, local safeguarding guidelines were not. These would give staff clear guidelines of actions to be taken and forms to be completed in the event of an incident occurring. They would also provide contact details for local safeguarding teams. Following the inspection the manager confirmed that they had been in touch with the safeguarding team and that a copy of the guidelines were being sent to the home. To ensure that residents are properly protected it is important that staff recruitment is of a high standard. This inspection could not evidence this to be the case. Details of this will be given in the staffing section of this report. Everyone living at The Cedars has care needs associated with their mental health. This can affect their behaviours. We saw that care planning and risk assessments detailed the individual support required to manage these issues. Staff spoken with, and training records viewed, showed that most staff have undertaken training in managing challenging behaviour. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable home. Evidence: The Cedars provides a comfortable and homely environment for residents. The AQAA told us that in the last twelve months a number of improvements have been made to the premises. The lounge corridors and landing have been redecorated. The patio and rear garden have been landscaped to provide a safe and accessible area for residents. New carpets or hard flooring have been provided in some bedrooms. A ramp is available to provide disabled access at the front entrance. A maintenance person is available to meet the needs of the home. The home is registered to provide care for people who have dementia. Although none are accommodated at the moment, the home are preparing for this. Key pad door locks have been fitted and signage is ready to be put up to assist peoples orientation if necessary. On surveys people said that the home was always fresh and clean. When we visited the home appeared to be satisfactorily clean, and there were no unpleasant odours. When we spoke to the homes domestic staff they told us that they had received appropriate training, and that they had adequate supplies of protective clothing. The manager said that the cleaner had their own cleaning routines that ensured all areas Care Homes for Older People Page 19 of 28 Evidence: were kept clean. However there were no cleaning schedules available to show that a cyclical deep cleaning routine was in place. We noticed that a communal toilet area had a cloth hand towel rather than paper towels available. Paper towels would better support infection control. The manager said that this was because residents tended to block the toilet with paper towels. Training records showed us that staff had received training in infection control and we saw that protective clothing was available. The AQAA said that an action plan to deliver best practice in the prevention and control of infection was in place. This however was not specific to the home, but just consisted of generic infection control information. It did however include relevant contact numbers so that staff would know who to contact for advice and support. The Cedars has an adequate laundry area that was kept clean and tidy. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by caring and adequately trained staff, but may be left vulnerable through the homes recruitment practices. Evidence: On surveys people said that staff were always available when they needed them. Feedback on staff was positive and some comments made were, I like the staff, The staff are friendly and caring, and, They always help you. The previous basic staffing level of two staff from 08:00 to 22:00 has been boosted by the provision of activity co-ordinatior hours on three afternoons a week, and an addittional member of care staff on three mornings a week. The managers hours are generally supernumerary to this. The manager felt that current staffing levels were satisfactory, and that they would be flexible with extra staff being rostered if necessary to meet residents needs. On the day of the site visit staff generally seemed to be available and had time to spend with residents. Ancillary support such as domestic, catering, maintenance and administrative staff are provided to support care in the home. Staff on surveys, and those spoken with were friendly and positive about their role. Some comments made were, Good team effort. Communicates in all aspects of meeting service users needs, I have found this workplace a great environment and a good team to be in, and, All staff work together well and look after all the service users as well as they can, and all are happy. The AQAA told us that only one member of staff had stopped working at the home during the last year. This showed that staffing at the home is Care Homes for Older People Page 21 of 28 Evidence: stable, and that people have familiar staff and management to support them. Most staff have worked for the provider for a number of years either at The Cedars or its sister home. We saw from rotas that some staff work long hours. For example one member of staff regularly works from 18:00 through to 08:00 the next morning. The manager said that staff liked to do extra hours to earn more money, and that some staff might work up to 60 hours per week. This is not best practice as staff may become tired and their practice therefore be compromised. Current Standards say that at least 50 of care staff working in a home hold a National Vocational Qualification (NVQ) in care. This will enhance staffs knowledge and skills in working with people. At The Cedars all staff apart from two hold an NVQ. One of these two is currently undertaking this qualification. The home has therefore done well in achieving over the recommended 50 . To see how well people are protected by the homes recruitment procedures we looked at the files of two recently recruited staff. One member of staff had transferred from the sister home, and one was new to the organisation. For the transferred member of staff there were limited records available. The manager said that they were still at the other home. This in spite of the fact that they had been working at The Cedars since last November. Although they had started work at the sister home in May of last year their Criminal Records Bureau (CRB) check was dated 28/07/08. There was no POVA first check in evidence. There was no evidence of an identification check, or references. For the new member of staff, (employed in an ancillary role,) documentation and a confirming letter showed that they commenced work in mid July 2009. The POVA first and CRB Checks were not requested until they had been working in the home for nearly three weeks. This is very poor practice and does not ensure that residents are safeguarded. Other required documentation such as a medical questionnaires, proof of identification and references were however available in this case. On surveys staff said that their induction had covered everything they needed. The two files viewed showed that a comprehensive initial induction process was in place, and that a good level of core training such as health and safety, first aid, and POVA was undertaken when people started work at the home. Although not evidenced on the files viewed the manager showed us the induction packs incorporating the Common Induction Standards that would be used for any new care staff starting at the home. Staff surveys and staff spoken with indicated that there were good opportunities for training. A training matrix showed that as well as core training, addittional topics such Care Homes for Older People Page 22 of 28 Evidence: as palliative care, dealing with personality disorders, bereavement and MRSA have been undertaken by some staff. The home is registered to provide dementia care, although they are not doing so as yet. We saw that nearly half of staff have undertaken training in this area. the manager confirmed that remaining staff will also undertake this. The manager has been working to source good staff training in mental health issues. They have now joined a provider support programme which is a consortium of local homes. They are able to source funding to provide training so the manager is confident that this training will soon be available. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe home where their views are sought and listened to. Evidence: The Cedars has a registered manager in post. They are experienced and are currently undertaking their Leadership and Management award, which they hope to complete shortly. People spoke well of the management of the home and made comments such as, This is a very well run home, and, [The manager] is very good and always available. In discussion with the manager it was clear that they have good knowledge, high standards, and want the home to continue to improve and develop. There are strategies in pace to monitor the quality of the service. We saw that surveys are used to seek peoples opinion of the service. These had been completed by residents in October this year. Some relatives and visiting professionals had completed them in August. All responses were positive, and people are clearly happy with the service. A suggestions box is available for people to make use of. Records viewed showed that individual reviews and regular residents and relatives meetings also Care Homes for Older People Page 24 of 28 Evidence: provide opportunities for people to express their views. One person said, Regular meetings are arranged for service users and staff. This allows individuals to talk about any concerns they may have which can then be acted upon. Regulations require that standards in the home are monitored through a senior person in the organisation, or independent nominated person, undertaking a regular monthly visit to the service. The visit should include talking to people about the service. While we saw that such visits were documented, they are currently carried out by the manager at the home. This is not appropriate as they are directly concerned with the day to day conduct of the home. The provider needs to address this. Internal quality monitoring tools to monitor practice and compliance are used such as room audits and medication audits. The manager completed the AQAA this year. It was satisfactorily completed, recognised achievements, and also recognised where further improvements are needed. People can feel confident that if they or their families ask the home to help them look after their personal monies, this will be done in a way that safeguards their interests. Monies checked were correct, with receipts in place for all transactions. No major health and safety issues were noted on the day of the site visit. However the service is now registered to provide care for people who have dementia. The manager therefore needs to assess the environment to ensure that it is safe when residents with these care needs are to be admitted. For example issues that need to be considered include the storage of items such as disposable gloves and the security of potentially hazardous areas such as the kitchen and laundry. A training matrix viewed indicated that there are a number of gaps where not all staff have undertaken moving and handling or food hygiene training. however moving and handling training was being carried out on the day of the site visit. Care Homes for Older People Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 13 Robust information and practice guidance must be available to staff to ensure that any incidents are managed in a consistent manner in line with established procedures. So that residents are safeguarded. 01/12/2009 2 29 19 Staff must be properly recruited with all required checks undertaken before employment is taken up. So that residents are safeguarded. 01/12/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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