Care Home: The Foundation of Lady Katherine Leveson

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What the care home does well The surroundings are attractive and comfortable and are full of character and original features. All areas visited were clean and free of any unwanted odours. A neighbourhood community atmosphere was sensed. The health care needs of the people living at Lady Katherine`s are met, with recorded evidence of visits by the GP and other health care professionals. Risk assessments are in place regarding the development of pressure sores [a break in the skin due to pressure, which reduces the blood supply to the area] and moving and handling [the transferring of a person from one place to another] in order to minimise the risks involved in these areas. The home employs a part time activity coordinator who organises and arranges activity and occupation for people living there. There is a weekly programme of stimulating and varied group activity. There are good links with the local community, in particular with the church and the primary school. Visitors are made welcome, which was confirmed by people spoken with and in the surveys returned to us. People using the service have the opportunity to make choices about their life style, including when to get up and go to bed, what to eat and where to spend their time. People are cared for in a respectful manner, which was observed throughout our visit. Meals are taken in attractive surroundings and people can choose from varied and nutritious choices. When asked, people spoken with said that they always enjoyed the meals and three of the answers to this question in the surveys was "Always". However one person answered "Usually" and one "Sometimes" to this question. Residents and visitors can be confident that their concerns will be listened to and addressed appropriately. There are appropriate policies, procedures, training and practice at Lady Katherine`s to minimise the risk of abuse to the people living there. Infection control systems were in place and staff had attended relevant training. The home is sufficiently well staffed to meet the needs of the current people living at Lady Katherine`s. Staff rotas should show the capacity in which the person works, the hours to be worked and hours actually worked or a key used to show what hours the codes on the rota denote. The importance of training is recognised, with all new staff having undertaken induction training, more than 50 per cent of the staff having achieved National Vocational Qualification [NVQ] Level 2 or 3 and all mandatory training being up to date. This should ensure that the staff are able to work safely and effectively. The home is managed by a person who is registered with us, has the necessary management qualifications, and is also a registered nurse, and is committed to the home regaining its previous high regard and has worked hard through a difficult period to achieve what is in the residents best interests. She has been supported by the deputy manager and the staff in this. Due to the policies, procedures, practice and training the home is a safe place to live and work. What has improved since the last inspection? With the support of external contractors the home has developed new pre-admission assessment formats and care plan formats. Both of these allow for extensive information to be recorded but with some omissions. Care plans are reviewed monthly. The medication had improved greatly with all the associated requirements having been met at the previous random inspection in May 2009. The improvements continue and the system safeguards residents` health and welfare. What the care home could do better: The new pre-admission assessment format does not include all of the required headings, including those related to the person`s culture and the person`s family and friends contact and relationships. The new care plan format has pre-printed statements about a person`s care but these are too generic in parts and do not enable personalisation. The recording of individual aspects of the needs of the person could be overlooked. Items other than contyrolled drugs should not be stored in the controlled drug cupboard. Although every attempt has been made to safeguard the financial interests of people whose money is held for safe keeping by the home, there is a need for records and receipts to be individualised to further ensure this and also to protect the staff involved in handling any monies or related records. The management should ensure that activity and occupation available and offered are meeting the needs of people who do not choose to, or can not, join in with group activity. Key inspection report Care homes for older people Name: Address: The Foundation of Lady Katherine Leveson The Foundation of Lady Katherine Leveson Temple Balsall Solihull West Midlands B93 0AL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lesley Beadsworth     Date: 2 7 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Foundation of Lady Katherine Leveson The Foundation of Lady Katherine Leveson Temple Balsall Solihull West Midlands B93 0AL 01564772850 01564778432 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.leveson.org.uk The Foundation of Lady Katherine Leveson care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Foundation of Lady Katherine Leveson was founded in 1674 to provide almshouses for women in need. It now provides sheltered and residential care accommodation for older men and women. The foundation, which is a charity, offers accommodation for 30 residential service users and 15-sheltered accommodation places. The Court of Lady Katherine Leveson is situated in Temple Balsall, lying between Knowle and Balsall Common. It is a listed building and the majority of service users live in self-contained accommodation in the Court Yard where they have views of the mature gardens and a secure and pleasant place to walk and sit. The accommodation is mixed, all have ensuite toilet facilities, and some have a bath or shower. There are a number of suites comprising of a bedroom, small lounge, kitchen and bathroom. The Court of Lady Katherine Leveson has a Christian ethos, and although they will consider nonChristians, it is required that the people resident are sympathetic to the Christian Care Homes for Older People Page 4 of 31 Over 65 30 0 0 3 0 3 2 0 0 9 Brief description of the care home ethos. There is also a 14th Century Templar Church on the premises and people are invited to attend the service on Sundays and other Christian celebrations. The registered provider is referred to as the Master and is an Anglican priest. Fees vary and are dependent on the needs of individual people. Items not covered by the fees include toiletries, private treatments such as physiotherapy and chiropody, hairdressings and newspapers. For up to date fee information the public are advised to contact the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection included a visit to The Foundation Lady Katherine Leveson care home. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment [AQAA], which is a self assessment and a dataset that is filled in once a year by all providers. This was completed in 2008 and a further AQAA has been requested for 2009. The AQAA informs us about how providers are meeting outcomes for people using their service. Surveys were sent to service users and five were completed and returned to us. Information contained within the AQAA, in surveys, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were case tracked. This involves establishing an individuals experience of living in the care home by meeting or observing them, talking to their families, where possible, about their experiences, looking at residents care files and focusing on outcomes. Additional care records were viewed where issues relating to a residents care needed to be confirmed. Care Homes for Older People Page 6 of 31 Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 11:15 and 21:45. Care Homes for Older People Page 7 of 31 What the care home does well: The surroundings are attractive and comfortable and are full of character and original features. All areas visited were clean and free of any unwanted odours. A neighbourhood community atmosphere was sensed. The health care needs of the people living at Lady Katherines are met, with recorded evidence of visits by the GP and other health care professionals. Risk assessments are in place regarding the development of pressure sores [a break in the skin due to pressure, which reduces the blood supply to the area] and moving and handling [the transferring of a person from one place to another] in order to minimise the risks involved in these areas. The home employs a part time activity coordinator who organises and arranges activity and occupation for people living there. There is a weekly programme of stimulating and varied group activity. There are good links with the local community, in particular with the church and the primary school. Visitors are made welcome, which was confirmed by people spoken with and in the surveys returned to us. People using the service have the opportunity to make choices about their life style, including when to get up and go to bed, what to eat and where to spend their time. People are cared for in a respectful manner, which was observed throughout our visit. Meals are taken in attractive surroundings and people can choose from varied and nutritious choices. When asked, people spoken with said that they always enjoyed the meals and three of the answers to this question in the surveys was Always. However one person answered Usually and one Sometimes to this question. Residents and visitors can be confident that their concerns will be listened to and addressed appropriately. There are appropriate policies, procedures, training and practice at Lady Katherines to minimise the risk of abuse to the people living there. Infection control systems were in place and staff had attended relevant training. The home is sufficiently well staffed to meet the needs of the current people living at Lady Katherines. Staff rotas should show the capacity in which the person works, the hours to be worked and hours actually worked or a key used to show what hours the codes on the rota denote. The importance of training is recognised, with all new staff having undertaken Care Homes for Older People Page 8 of 31 induction training, more than 50 per cent of the staff having achieved National Vocational Qualification [NVQ] Level 2 or 3 and all mandatory training being up to date. This should ensure that the staff are able to work safely and effectively. The home is managed by a person who is registered with us, has the necessary management qualifications, and is also a registered nurse, and is committed to the home regaining its previous high regard and has worked hard through a difficult period to achieve what is in the residents best interests. She has been supported by the deputy manager and the staff in this. Due to the policies, procedures, practice and training the home is a safe place to live and work. 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 Care Homes for Older People Page 9 of 31 order line 0870 240 7535. Care Homes for Older People Page 10 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met with some shortfalls in the format used. Evidence: In conjunction with Friends of the Elderly acting as an external contractor, the home has developed a new pre-admission assessment format that consists of a twelve page booklet. This has a checklist to tick for each heading of assessed need and space for information additional to the checklist. There is an itemised risk assessment for dementia entitled Behaviour or Symptoms Indicative of Risk in Dementia where dementia symptoms could be recorded but no specific assessment heading for mental state and cognition. Cultural needs were also omitted from the headings, and the form asked for only limited information regarding the family involvement, other social contacts and relationships. Three care files were looked at as part of the case tracking process. Each had a preCare Homes for Older People Page 12 of 31 Evidence: admission assessment that had been carried out in order to assess if the home could meet the persons needs prior to offering them a place at the home. All medical conditions and needs were identified. Not all the appropriate headings were included in the assessment but there was sufficient detail to decide if the home could meet the persons needs or not. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place for all residents although with some shortfall in personalisation. Residents have access to health care professionals and are cared for in a respectful manner. The medication process safeguards the residents well being. Evidence: Three care files were looked as part of the case tracking process. A new care plan format had been devised with support from Friends of the Elderly using their care plan format as a base. The format has a care plan for identified needs that are to be reviewed, revised as necessary, at a minimum of monthly intervals to ensure that they are up to date. Care files included a summary of the persons life story and a medical summary from the GP in order to provide more information about the person so that needs could be more readily met. The new care plans, entitled Standardised Care Plans (SCP), include guidelines for their completion in which it states that it is well known that there are some general Care Homes for Older People Page 14 of 31 Evidence: care needs that will be applicable to all residents and those that must be personalised wherever possible. Each of the new care plans has pre-printed details said to be common to all people needing support in this area, with space for handwritten information to be added in order to personalise them. One care plan for instance had the type of hoist and sling required for a person. However the blank form looked at has some general statements that do not enable ease of personalised care information, for example the SCP for oral care include three pre-printed options of need and subsequent care, [the inappropriate ones to be crossed out] Residents with their own teeth; Residents with dentures and Advanced oral care, each with generic instructions. An example, Dentures should be cleaned night and morning and soaked overnight in a cleansing solution. Apply Vaseline to lips if required, does not consider the persons preferences or wishes, for instance in the number of times they wish their dentures to be cleaned, what type of cleaning solution, if any, they prefer or whether they would like Vaseline on their lips or not or if there is something similar that they would prefer. Personal hygiene care plans refer to as required or as appropriate or if condition permits for particular care tasks but do not tell the care staff when this would be required or be appropriate or what the persons condition needs to be to be able to carry out the task. Care plans for other needs had similar pre-printed instructions. However the care plans seen gave the information required by care staff to meet the persons needs Records of falls, pressure areas, weight and bathing nail checks, nutrition and nutritional screening were in place within the files looked at. Completed risk assessments for tissue viability in relation to the development of pressure sores [a break in the skin due to pressure, which reduces the blood supply to the area] were in place and risk assessments for moving and handling [transferring a person from one place to another] were also in place. These would help to minimise any risk in these areas. Individual risks were also assessed. Preventative measures such as pressure relieving cushions were seen in use for those people at risk of developing pressure sores. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician and chiropodist being identified in the care files looked at. One resident spoken with said, very pleased with care which is given with great devotion and love. The medication system was inspected in some measure. This had been thoroughly Care Homes for Older People Page 15 of 31 Evidence: inspected at a previous visit by one of our pharmacist inspectors when all related outstanding requirements had been met. The pharmacist supplies most of the medicines in a monitored dosage system where each medicine is dispensed in a blister pack from which to administer on a daily basis. A random audit of medication was carried out and all balances were correct in line with the Medication Administration Record [MAR] sheets. There were no inappropriate gaps and no incorrect codes used when medication had not been given in the MARS looked at. The contents of the controlled drug cabinet were audited against the controlled drug register and the quantities were correct. Storage and records were appropriate, although a member of staff had put a purse belonging to a resident in there for safe keeping. The controlled drug cupboards should not be used as storage space for anything else. Observations and discussion with staff and visitors showed that residents are cared for in a respectful manner. Their preferred name was included in the care file and heard to be used by staff. Staff were seen to knock on the door of residents accommodation and wait for permission to enter. It was apparent that this accommodation was seen by staff to be the private space of the occupant. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are occupied and stimulated. Visitors are made welcome and their needs considered. Residents have choices and control over their daily lives and enjoyed the nutritious and varied meals provided. Evidence: The home was lively and active during our visit. People living there were moving from area to area and chatting with other residents and staff in a comfortable and neighbourly way. On the same land there are other buildings, including the Church of St Marys the Virgin and Lady Katherine Leveson Primary School, which the residents are closely involved. The children visit the home regularly and under the supervision of the teaching staff spend time with the residents. Residents have the opportunity to attend the church services and the clergy from the church also give services in the home. There is a designated part time activity co-ordinator employed who organises activity and occupation for the people living there and who has attended relevant training and workshops with Help the Aged. A weekly newsletter includes a diary of events for the forthcoming week and one of these included, a table top sale and coffee morning, Care Homes for Older People Page 17 of 31 Evidence: church services, a barbeque that was open to family and friends, entertainment with children from the primary school, painting, keep fit, beauty shop [people were asked to inform the activity coordinator if they wanted a facial mask or a manicure], a school leavers service in the church, Lexicon and shopping trips. The newsletter also informed of the birthdays of residents during the week. Other events in other weeks newsletters included a poetry group, a free concert in the church, and a canal trip. There was also a general invitation for residents to attend a wedding, of a son and daughter of people known to the home, which was taking place in the church. The home encourages contact with family and friends and events tend to be open for them to join in with. Visitors are made welcome and are able to visit at any reasonable time. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat and where to spend their time. Minutes of the residents general meeting further reflected this. We joined residents for lunch in the main house. Lunch was a social event with staff offering assistance in a discreet and sensitive manner. The dining room is a pleasant area to take meals, with appropriate tableware and table linen. Staff wore protective clothing (disposable hats and aprons) in order that serving food was a hygienic procedure. However one or two of the residents said that they do not like the new headwear the staff are currently wearing. Lunch was tasty and well presented and the menus provide a varied and nutritious choice of meals throughout the day. Fresh fruit was readily available and residents said that this was always the case. All the residents spoken with about the food said that they always enjoyed the meals. The kitchen was visited and was clean and in good order. The Environmental Health report was satisfactory. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has appropriate policies and procedures regarding complaints and to safeguard residents. Evidence: A copy of the complaints procedure was displayed in the reception area. People spoken with said that they knew who to talk to if they had any concerns and in the surveys answered Yes to the questions, Is there someone you can speak to if you are not happy? and Do you know how to make a formal complaint? A complaints log was maintained by the home and this showed that complaints had been appropriately addressed and managed. This gives people the confidence that their concerns will be listened to. All staff undertake training regarding safeguarding to enable them to identify abuse and to know what to do if the witness or suspect it. The home uses the Local Authority Safeguarding policy for procedure and guidance. Those staff spoken with on the subject were familiar with safeguarding and aware of their role in this. Staff recruitment minimises the risk of the employment of unsuitable people. Money was held by the home for safekeeping for some residents. The financial interests of these people were safeguarded by the relevant practice and procedures. Care Homes for Older People Page 19 of 31 Evidence: Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers the people living there comfortable and attractive surroundings, which are clean, free of offensive odour, safe and well maintained . Evidence: The Foundation of Lady Katherine Leveson is a charity founded in the 17th century and which amongst other things provided almshouses for women in need. Part of the premises were built in the 17th century and an extension was built in the 18th Century and they are listed buildings. They retain many of the original fittings and features and offer characterful and comfortable surroundings for the people living there. These buildings now provide care home and sheltered housing accommodation for older people. On the same land there are other buildings, including the Church and Lady Katherine Leveson Primary School. The surrounding gardens are attractive and offer pleasant walking areas. The premises are divided into the main house and the courtyard apartments. The courtyard is a peaceful quadrangle garden area, is well maintained and provides a pleasant place to sit or walk and to meet other residents and staff. It is a throughway from the main house to other areas of the Foundations property. The apartments here offer self contained accommodation of lounge and/or a bedroom, kitchenette and bathroom. All private accommodation in the main house has the minimum of ensuite toilet facilities. The dining room, communal lounge areas and assisted bathroom are Care Homes for Older People Page 21 of 31 Evidence: also situated in the main house. All areas of the premises visited were clean and free of any unwanted odour. The premises are well maintained, decorated and furnished. Staff are provided with protective clothing, disposable gloves and aprons, to maintain infection control when needed. Hand washing facilities of disposable towels and soap dispensers are available in all communal areas where staff or residents are expected to wash their hands. The laundry provides appropriate equipment and practices to maintain infection control. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff available to meet the needs of the current residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. Evidence: The manager told us that the usual complement of staff when the home is full is five care staff in the morning, afternoon and evening and two during the night. Rotas made available to us showed that adjustments had been made, which the manager said was because of the current number of vacancies and that there were now usually three to four care staff during the waking day and two during the night. In addition there are adequate catering staff, domestic assistants and laundry staff each day. Evidence indicates that there are sufficient staff in the home during the day to meet the needs of the people currently living there. However once the number of residents returns to usual numbers the staff must continue to be sufficient to meet their needs. The number of night staff should be monitored to ensure that two members of staff are sufficient given the layout of the building and the need for staff to leave the main building to attend to anyone living in the courtyard accommodation. The rotas seen have a code for the shifts, for example E for an early shift, L for a late shift. The deputy managers and some of the ancillary staff rotas are only ticked on the days that the person is working in the home. There must be a key to these codes, Care Homes for Older People Page 23 of 31 Evidence: or the hours recorded on the rota, for inspection purposes and so that anyone reading the rota knows what hours the shifts cover and what hours were actually worked. The managers hours also need to be added to the rotas. There are secretaries for the home and the Foundation who are responsible for general and financial administration. Records showed us that 52 per cent of the care staff have achieved the National Vocational Qualification [NVQ] Level 2 or 3 in Care, exceeding the minimum requirement of 50 per cent, and two further staff are currently undertaking NVQ training. This qualification means that staff have been trained and assessed as competent in their role. Three staff files were looked at to assess the recruitment procedure and practice of the home. One of these contained the required Protection of Vulnerable Adults [POVA] First checks, the Criminal Records Bureau [CRB] disclosures, two written references and also evidence of application form and interview showing that there had been a formal recruitment process. The home was awaiting a CRB disclosure for two of the staff, who were shadowing an experienced member of staff and were supernumerary to the rota in the meantime, in order to minimise any risk of the employment of an unsuitable people. One of these had only one written reference and a record of a verbal reference whilst awaiting the written version from one referee. There needs to be two written references before a person commences employment in order to ensure that the recruitment practice is sufficiently robust to safeguard the people living at the home. All new staff undertake induction training that is in line with Skills for Care, in order for them to attain the knowledge and skills they need to do their job safely and effectively. The deputy manager, who is responsible for organising staff training, told us that the aim is for all staff to progress to NVQ training within three months of completing induction training. Discussion with the deputy manager and looking at records showed us that all mandatory training is up to date. Staff have also undertaken training related to specific needs of residents, including dementia, mental health awareness, nutrition, reporting and recording, challenging behaviour and continence management. Staff responsible for medication have also completed medication management training. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A person with the appropriate qualification and who has previous management experience manages the home. Monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. Health and safety training, policy and practice protect residents and staff at the home. Evidence: The registered manager has been in post since 2001. She has the appropriate qualifications for the post. The deputy manager also has appropriate training and extensive experience in the care profession. Both the manager and her deputy have worked hard to meet the requirements made at previous inspections. They have been working with outside contractors to improve the recording of the information care staff require to meet the needs of the people living at the home and to ensure that the medication system is safe and had made good progress. Care Homes for Older People Page 25 of 31 Evidence: Discussion with the manager showed her commitment to the home and her determination for the home to regain its previous good standing. She was supported in this by the deputy manager. Residents and staff spoken with spoke highly of her and showed confidence in her leadership. The home has a Quality Assurance system that includes surveys distributed to residents and their family and friends and to other professionals that visit the home in order to gain their feedback on the services provided. The responses in these surveys are correlated and actioned as appropriate. An external contractor, The Friends of the Elderly, visit the home, representing the organisation, to carry out unannounced monthly inspections, from which a report is produced for us and the manager. They also audit and monitor the care plans and medication system and feed back their findings. Monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. Some money is kept on behalf of residents, which is credited to a joint bank account which is for residents money only. There were detailed records and receipts of all transactions but these were not all individualised for each person, for example receipts for hairdressing and showed the names of everyone that had received the services at that time. Each resident for whom the organisation holds money on their behalf must have their own record, which needs to be completed at the time of the transaction, and a receipt for each payment or purchase made. Any withdrawal needs to be signed by the resident where possible or otherwise by two members of staff in order to safeguard their financial interests. Although the Bailiff (financial Manager) and finance administrator, who tend to work office hours have the responsibilty for this money, residents have access to their money at all times via a petty cash system, which is reimbursed later. The Bailiff holds financial surgeries for residents to be available for advice and for requests for larger withdrawals of money. The manager informed us that staff supervision takes place every two months and includes observation of the member of staffs practice. Records are maintained. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. A recent fire drill had taken place. The deputy manger and the maintenance person had recently undertaken refresher fire Care Homes for Older People Page 26 of 31 Evidence: warden training in order to train staff on fire safety and to be able to monitor the fire safety practice in the home. All staff training related to health and safety, including moving and handling, fire safety, food hygiene, Health and Safety, was up to date. There were no health and safety issues noted during our visit and evidence indicates that health and safety practice protects residents and staff at the home. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 People must not be employed until two written references have been received. This will safeguard residents by minimising the risk of the employment of unsuitable people. 30/10/2009 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 1 3 The pre-admission assessment format should cover all areas of need as listed in the National Minimum Standards, and all these areas should be assessed prior to admission. Care plans should be person centred and individualised to the residents needs and preferences. The activity provided and offered to people who do not want, or are unable, to join in group activity should be monitored to ensure that all people have the opportunity to be involved in activities that are in line with their wishes and preferences. Staff rotas should include all people working at the home 2 3 7 12 4 27 Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations and show the actual hours worked. 5 35 All records for money held on behalf of residents should be individualised . A receipt should be held for each purchase made. Any withdrawal from the money held on their behalf should be signed by the resident or if this is not possible or practical by two members of staff and recorded and signed for at the time of the transaction. 6 35 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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