Care Home: The Elizabeth Anne Nursing Home

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What the care home does well Residents say they enjoy living at the home and are very happy there. Comments they made included "I would be much worse off if it was not for the people here" and "I could not want for a better place". Residents` needs are being met with good liaison with other health care professionals. Staff are good at helping new residents to settle in. There is encouragement for residents to partake in activities suited to their preferences and capabilities. Residents enjoy the meals which are of good quality. Visitors tell us they always find there to be a friendly atmosphere at the home. The standard of general cleanliness around the home has improved since our last visit. Robust recruitment processes are followed to help ensure the home employs only appropriate staff. What has improved since the last inspection? Improvements are being made to the care plans so they are more specific in detail of how people`s needs are to be met and important information is more readily accessible to staff. Parts of the home have been redecorated. Some furnishings have been replaced. What the care home could do better: The home has failed to meet two of the Requirements made as a result of our last inspection. These were for better infection control. Since our visit, the home has sent us a detailed action plan with timescales. Accordingly, we will not be issuing Statutory Notices at this moment. Statutory Notices will be served if the home fails to fully meet the Requirements within the timescales stated in the action plan. As a result of this inspection, we have made three additional Requirements. These are for improvements in the completion of Medication Administration Records and staff training, including safeguarding. These will better promote residents needs and safety. Some staff members do not interact with residents when giving assistance. Examples being, when assisting residents to eat their meals and assisting residents in transferring with a lifting hoist. Improved interaction would better promote residents` dignity and make some situations less stressful for them. Shortcomings we observed in some staff practices and non compliance with the recommendations of a recent infection control audit would be picked up by more robust checks and day to day management of the home. The complaints procedure is to be updated to include up to date information and contact details for other agencies. It should also be made available in a format that people with cognitive difficulties may understand more easily. A business plan for the redecoration and refurbishment of the home should be made available, with priority being given to peoples` safety and privacy. The use of shared bedrooms should be reviewed in view of the mental and physical frailty of the residents and their associated behaviours and care needs. Those who share bedrooms may not be able to make a positive choice to share with full understanding of the implications. Key inspection report Care homes for older people Name: Address: The Elizabeth Anne Nursing Home 64 Edgar Road Cliftonville Margate Kent CT9 2EQ     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: Gary Bartlett     Date: 2 7 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 Elizabeth Anne Nursing Home 64 Edgar Road Cliftonville Margate Kent CT9 2EQ 01843221375 01843225054 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cliftonville Nursing Homes Ltd care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 30. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home The Elizabeth Anne Nursing Home is a large detached premises, with 24 single and 3 double bedrooms. It provides 24 hour residential care with nursing for up to 30 older people with dementia or a mental disorder. Accommodation is on three floors and there are two shaft lifts. The homes stated aim is to provide an environment and programme of care to residents which will reinforce normal acceptable behaviour, aiming to diminish Care Homes for Older People Page 4 of 32 1 6 0 9 2 0 0 9 30 30 Over 65 0 0 Brief description of the care home confusion and encourage residents to move from dependency to independence through clear guidelines for their care. The home is located close to the seafront, local shops and bus route in Cliftonville. There is an external grassed area to one side of the property. The current fees range from £325 to £2,359 per week. Full details of these and of any additional costs can be obtained from the Manager. 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 key unannounced inspection was conducted by Gary Bartlett and Sandra Crosby, Regulatory Inspectors, who were in The Elizabeth Anne Nursing Home on Wednesday, 27th January 2010 from 8.00 a.m. until 3.30 pm. During that time the Inspectors spoke with some residents, two visitors, a visiting healthcare professional and some staff. Parts of the home and some records were inspected and care practices observed. The Manager was not able to be at the inspection. Feedback was given to the proprietor, Mr. Yilmaz, after the inspection. The Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for Older People refer to people who use the service as service users. People living at The Elizabeth Anne Nursing Home prefer to be referred to as residents. Accordingly this shall be done in the text of this report. Care Homes for Older People Page 6 of 32 The Inspectors would like to thank everyone involved for their contribution to the inspection. 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: The home has failed to meet two of the Requirements made as a result of our last inspection. These were for better infection control. Since our visit, the home has sent us a detailed action plan with timescales. Accordingly, we will not be issuing Statutory Notices at this moment. Statutory Notices will be served if the home fails to fully meet the Requirements within the timescales stated in the action plan. As a result of this inspection, we have made three additional Requirements. These are for improvements in the completion of Medication Administration Records and staff training, including safeguarding. These will better promote residents needs and safety. Some staff members do not interact with residents when giving assistance. Examples being, when assisting residents to eat their meals and assisting residents in transferring with a lifting hoist. Improved interaction would better promote residents dignity and make some situations less stressful for them. Shortcomings we observed in some staff practices and non compliance with the recommendations of a recent infection control audit would be picked up by more robust checks and day to day management of the home. Care Homes for Older People Page 8 of 32 The complaints procedure is to be updated to include up to date information and contact details for other agencies. It should also be made available in a format that people with cognitive difficulties may understand more easily. A business plan for the redecoration and refurbishment of the home should be made available, with priority being given to peoples safety and privacy. The use of shared bedrooms should be reviewed in view of the mental and physical frailty of the residents and their associated behaviours and care needs. Those who share bedrooms may not be able to make a positive choice to share with full understanding of the implications. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home undertakes pre admission assessments of prospective residents to help ensure it is the right place for them. Residents can not be assured that the staff has the skills to meet all of their needs. Evidence: The organisation has policies and procedures for their home managers to follow when assessing and admitting a resident to the home. The Deputy Manager said they prefer to visit the prospective resident in their home or hospital to help ensure they obtain information that is up to date and accurate. A pro forma is used for this and is the starting point for the individuals care plan. It is very important to collect this information to obtain a complete understanding of prospective residents needs and to be able to assess if the home is able to meet them in the way in which individuals prefer. Residents, their families and advocates, and relevant health care professionals are involved in the assessment process. Care Homes for Older People Page 11 of 32 Evidence: Residents said they or their families had been able to visit the home before moving in. Two relatives who were visiting confirmed this and said staff are very helpful in assisting new residents to settle in. At our last inspection of 16th September 2009, we identified that the training matrix was not up to date. It was consequently difficult for the home to readily show that all members of staff had the necessary training for them to have the skills to meet residents needs and to comply with current legislation and good practice guidelines. The training records still show that key staff members have still not had some mandatory training or required updates. It is important for staff to be able to understand the residents conditions and know how best to promote their welfare. 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. Residents personal and health needs are promoted with good liaison with other health care professionals. Improved medication recording would better safeguard people. Residents dignity is not consistently promoted. Evidence: Each resident has a care plan and three were inspected in detail. Since our last inspection, the home has been improving the care plans so they are more specific in detail and make important information readily accessible to staff. We saw that improved systems of nutritional screening have been introduced. A Dietician from the Primary Care Trust was at the home during our inspection and she told us staff members are very good at seeking her advice and at implementing her suggestions. The care plans show residents have ready access to health care professionals such as GPs, Psychiatrists, dentists, chiropodists etc. It is evident the care plans are regularly reviewed and are updated when there are changes in residents health and welfare. Care Homes for Older People Page 13 of 32 Evidence: The standard of daily records is generally good and informative. The staff must be more consistent in ensuring information in the daily records is transposed to the relevant parts of the care plan to avoid it getting lost. For example, we saw a record of how the gender mix of staff was to be considered when giving personal support to an individual but this was not reflected in the care plan itself. Further work also needs to be done in reporting residents emotional states, positive activities and things individuals have enjoyed doing to gives a comprehensive picture of the persons lifestyle. This will help staff when it comes to reviewing the care plans. Two visiting relatives we spoke with, said the home is very good at keeping them informed of residents health and welfare. Risk assessments are being written and reviewed in response to accidents and incidents or changes in residents welfare to help safeguard those concerned. Records show that staff administering medications have been trained and signed off as being competent to do so. Medicines were seen to be given in accordance with good practice guidelines, although the morning medicine round was still progressing at 9.45. It is recommended the home looks at ways of shortening the time taken to do this to help ensure medicines are given at the prescribed intervals. Not all of the Medication Record Administration Record (MAR) sheets we inspected had been completed appropriately. We were told that one persons medication had been stopped for that week, but there was not a written instruction about this on the MAR sheet. Other records contained crosses or ticks, so there was not a clear accountability of the person administering that medication. We inspected the Controlled Drugs Book and found those records to be in order. The temperature of the medication room was not being monitored to check that medicines are being stored at an appropriate temperature. The home had addressed this issue before the end of our inspection visit. We advised that the sharps boxes should contain dates of starting use and closing and that needles should not be resheathed. The home agreed to address this immediately. We observed some poor practice in regard to how some staff members interact with residents when giving assistance. We saw that a member of staff providing 1 to 1 support care just stand around and was not interacting in anyway for at least ten minutes before we brought this to the attention of a senior staff member who then spoke with the carer. The carer then proceeded to sit on the arm of the residents chair with her back to the person sitting next to them and partially blocking that Care Homes for Older People Page 14 of 32 Evidence: persons view. At one time there were six carers were assisting individual residents to eat their breakfast. Three were doing this in an appropriate and respectful way, and three staff members were not. There was no attempt on their part to enter into conversation with the residents, describe what they were doing or ask after the residents wishes. Likewise, we saw two staff members assisting a resident in transferring with a hoist without communicating with the person to make the process easier and less stressful. This poor practice is demeaning to the residents and had the Deputy Manager not agreed to take action straight away, we would have issued an Immediate Requirement Notice. Other staff members were seen to speak with residents in a friendly and respectful way. Care Homes for Older People Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to exercise choice and control over their daily lives as far as is practicable and to maintain links with friends and relatives. They would benefit from more consistent commitment to the promotion of their dignity by some staff members. Residents enjoy the meals which are of good quality. Evidence: The members of staff spoken with are aware of the need to enable residents to have choice in daily routines and activities. They understand that individual preferences differ and must be supported as far as is practicable. For example, some residents like to participate in activities such as music for health, other prefer to watch the television in the smoking room. Staff members recognise that some residents prefer their own company and are conscious of the need to monitor the risk of social isolation. However, we observed that some staff need training in how their lack of interaction with residents can have a negative impact on individuals and the need for inclusive social engagement. Care Homes for Older People Page 16 of 32 Evidence: The residents tell us they are able to participate in the activities of their choice and within their capabilities. In accordance with their preferences, the home mostly arranges for visiting entertainers in addition to their Activities Coordinator who works three days per week. During our inspection, the hairdresser was in attendance for her weekly visit and music for health was in the main lounge. The latter could have been been better enjoyed by residents nearby if the staff had thought of switching off the sound system playing in the reception area. Some residents like to go to the town for shopping or go to the local public house. One resident regularly goes to a local cafe for lunch. For group outings, the home has access to a minibus owned by one of the organisations other homes. The Manager is still hoping to get funding for the home to have its own minibus. It is again recommended this be done to increase opportunities for more spontaneous outside activities. The home understands the importance of supporting residents wishes in respect of any religious and cultural observances. These are ascertained at the time of admission. If residents have strong spiritual beliefs the home supports them in meeting these. One resident regularly attends church with assistance from a staff member. A religious minister visits the home to conduct a service each week. Visitors tell us they always find there to be a friendly atmosphere at the home and they are made welcome at any reasonable time. The visitors book records regular visits by families, friends and others. The design of the home provides seating areas within the communal areas where residents can entertain their visitors, in addition to the privacy of their own room. Residents are encouraged to personalise their rooms with their own possessions if they wish. Some residents have brought items of furniture and personal effects with them. The cook, of whom residents and staff spoke very highly, provides good quality meals that meet the dietary needs of the residents. The meals seen were well presented, looked appetising and the portions were appropriate to individuals preferences. Hot and cold drinks are served through out the day, as well as snacks. A significant number of people at the home need assistance with eating. As detailed earlier in this report, some staff members do not give the necessary help in a way that upholds the residents dignity. In a subsequent telephone conversation, the Manager has assured us that he is addressing this as a matter of urgency through supervision and meetings. Care Homes for Older People Page 17 of 32 Evidence: 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their visitors are confident their concerns will be listened to. The complaints procedure needs to be updated to include the correct details of the Commission. There are systems to protect clients from abuse. These will be more effective when more staff have had the training necessary to help safeguard people. Evidence: The home tells us that all residents are informed of the complaints procedure upon arrival and there is a copy in each bedroom. We saw two different versions being used. One has an incorrect address for our office and the other includes the previous title of the Commission as well as the current one. Since our inspection, the Manager has told us that he is correcting this to avoid confusion. At our last inspection, the Manager had said he was intending to provide the procedure in a format that people with cognitive difficulties may understand more easily. This has still to be done and we again recommended this is done as soon as possible. Residents and visitors we spoke with said there is an open door policy at the home and they are confident they are listened to and any necessary action is taken. A visiting relative made the comment They always take time to listen to you. The Commission has not directly received any information regarding complaints about the home since the last inspection. Care Homes for Older People Page 19 of 32 Evidence: There has been one Safeguarding Vulnerable Adults (SVA) alert in the last twelve months. The home has procedures for responding to suspicion or evidence of abuse or neglect. The homes training matrix shows that, of the forty seven staff members listed, fourteen have not had SVA training, one last had training in 2005 and four last had SVA training in 2007. These people must receive training as soon as possible so they are fully conversant with the changes that have taken place in safeguarding procedures. The Training matrix shows nineteen staff members have not had training in challenging behaviour since working at the home. It is recommended this be done, especially taking account of the clients cognitive frailties and the challenging behaviours sometimes associated with them. The home understands the need to promote the residents ability to exercise their legal rights should they so choose. A senior staff member stated all residents are on the electoral roll. She said some use postal votes and others use a local polling station. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples quality of life and safety would be enhanced by improvements to the environment in which they live. Evidence: Residents tell us they like living at The Elizabeth Anne Nursing Home and find it comfortable. The home is a large detached premises located close to the seafront and to the local shopping area with all its amenities. Accommodation is on three floors and there are two shaft lifts. The upper floors are on split levels accessed by small flights of stairs. Consequently people with mobility difficulties are dependant on both lifts being serviceable at all times, to be able to have access to all parts of the home. It is an older building and, despite ongoing redecoration, some parts look shabby. Some ceilings continue to be stained from water leaks and some rooms have worn or damaged surfaces, wallpaper and paintwork. In high infection risk areas such as sluices, bathrooms and toilets, this compromises the health of people at the home. At our last inspection, we made a Requirement that these areas must be improved to better promote infection control. This has not been fully addressed. Infection control is further compromised by using sluice rooms as storage areas for cleaners equipment such as dusters and for tools and equipment being used for building works. Care Homes for Older People Page 21 of 32 Evidence: An infection control audit of the home was conducted on 11th November 2009 at their request. A Health Protection Nurse and a Health Protection Nurse Specialist undertook the visit. Their report highlights several deficits in infection control. Some of these relate to improvements needed in the environment, such as the sluices, laundry and medicines room. Other recommendations are in regard to practices such as cleaning and the storage of equipment. We saw little evidence that the recommendations have been acted on. For example, mops and their buckets are still being stored in an inappropriate way. This places people at risk through poor infection control. The standard of general cleanliness around the home has improved since our last visit. The laundry, however, required cleaning. The layout does not allow for a clear separation of clean and soiled laundry. Laundered items are being stored over the washing machines. This means that clean items can become contaminated. The laundry is readily accessible and the door can not be locked. Again, we recommend that an assessment should be done as to whether this places some people at risk. Some damaged easy chairs have been replaced as have the commodes with rusted frames. Other damaged furniture should likewise be replaced. When the home is full, three of the bedrooms can be used for shared occupancy. The use of shared bedrooms should be reviewed in view of the mental and physical frailty of the residents and their associated behaviours and care needs. Those who share bedrooms are not able to make a positive choice to share with full understanding of the implications. At our last inspection, the Manager had undertaken to ensure there was adequate provision of privacy screening in all of the shared bedrooms so all aspects of the occupants personal care could be given in private. This had not been done. We have since been advised that this is now being addressed. The Manager had also agreed to arrange for the door to a communal toilet on the third floor to be made lockable. This also had not been done. Mr. Yilmaz tells us the door has been fitted with a lock since our visit. Some bedroom doors do not have locks. Mr Yilmaz undertook to have them fitted where necessary. If a lock is not to be fitted because of a risk to the resident, this is to be clearly recorded in their care plan. The two bedroom doors that we saw that would not close properly are to be adjusted. Mr Yilmaz tells us a fire door at the top of some stairs has already been adjusted so it closes properly. Care Homes for Older People Page 22 of 32 Evidence: These deficits, with others we observed , should be picked up by the environmental checks that we are told are done regularly. It is again recommended the checks be more robust and improvements initiated more quickly to better ensure peoples safety and comfort. There is a small, well maintained garden area that residents like to use in clement weather. Care Homes for Older People Page 23 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. Residents consider the staff to be caring, but the home can not show they all have the necessary skills to meet peoples needs. Evidence: Residents and their relatives speak highly of the staff and of the care given. There had been a stable staff group at the home until some changes recently amongst the qualified nurses and care staff. This, and staff sickness, had led to some problems in maintaining adequate staffing levels. We are told this has now been resolved and the number of qualified staff employed at the home has been increased. People applying to work at the home have to complete an application form, attend an interview and provide satisfactory references, Independent Safeguarding Authority (ISA) checks and Criminal Record Bureau (CRB) checks. We looked at the files of four staff members and these showed that appropriate recruitment processes were followed prior to them commencing duties. New staff are required to undertake an induction program and the AQAA indicates NVQ training is encouraged. Staff members speak of regular training and there are some certificates on their files. However, the training matrix shows substantial gaps in mandatory training. Consequently, it is not evident that all members of staff have had Care Homes for Older People Page 24 of 32 Evidence: the necessary training for them to have the skills to meet residents needs and to comply with current legislation and good practice guidelines. Residents say there is enough staff available when needed. The staff rosters seen indicate staffing levels are geared to peak times of activity. Care Homes for Older People Page 25 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. Residents interests would be better promoted by more robust day to day management and quality assurance arrangements for the safe and efficient running of the home. Evidence: Mr John Moffatt was registered as Manager of The Elizabeth Anne Nursing Home in June 2008, having worked there since 2002. He has worked as a mental health nurse since 1971 and is a moving and handling trainer and NVQ D32/D33 Assessor. He was not able to be at the home at the time of our inspection. Residents, their relatives and staff find the Manager approachable and supporting. Acknowledging there have been some unexpected problems in staffing since our last inspection, it is disappointing that some simple improvements have not been implemented as agreed. The deficits we observed in some staff practices and non compliance with the recommendations of a recent infection control audit would be Care Homes for Older People Page 26 of 32 Evidence: picked up by more robust checks and daily supervision. Formal supervision also needs to be more consistent. A staff member told us she had been working at the home for several years but had never had a formal supervision or appraisal. At our last inspection, the Manager had explained that residents views are sought in various ways to check their experience of living in the home is a positive one and to help improve the service they receive. It was intended to include health care professionals and Care Managers in future surveys but as none have been distributed since we visited the Home in August 2009, this could not be assessed. It is a legal requirement for the provider to arrange for the home to be visited at least once a month to evaluate the quality of service and for a report to be written. We had sight of the most recent report dated 18th November 2009. Senior staff members confirmed there have not been any further visits. The provider must ensure the visits are done on his behalf monthly and reports produced. We understand that he has recently appointed an Area Manager and it will be part of their role to do these. A staff member told us it is planned to implement some improvements to the kitchen but they were not sure when. The need for the improvements was evidenced by a damaged refrigerator door and some ceiling tiles that were coming away from their frames. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 26 13 The registered person shall 18/12/2009 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. The registered person has a legal responsibility to prevent infection, toxic conditions and the spread of infection at the care home. The sluice rooms must be made good to promote infection control and maintain adequate hygiene standards. To be completed by the given timescale and maintained thereafter. 2 26 13 The registered person shall 27/11/2009 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. The registered person has a legal responsibility to prevent infection, toxic conditions and the spread of infection at the care home. All equipment, aids and adaptations that have damaged or rusted surfaces must be made good or replaced. To be completed by the given timescale and maintained thereafter. 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 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. It is a legal requirement for the registered person to make arrangements, safe administration of medicines. Medication Administration Records must be completed in compliance with current good practice guidelines. To be completed by the given timescale, if not sooner, and maintained thereafter. 19/03/2010 2 18 13 The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. 30/04/2010 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 The registered person has a legal responsibility to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The home must be able to provide evidence that all staff members are fully aware of what constitutes abuse, how to recognise abuse and how to report it. To be completed by the given timescale, if not sooner, and maintained thereafter. 3 30 18 The registered person shall, 16/04/2010 having regard to the size of the care home, the statement of purpose and numbers and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training. It is a legal responsibility to ensure the home has a staff group with the necessary knowledge and skills to meet service users needs. The 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 home must arrange for all staff to have undertaken induction training and arrange for the necessary training courses to be booked with appropriately accredited trainers by the given timescale if not sooner. 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 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). 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