Care Home: The Gables

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What the care home does well It is evident through us talking to members of staff that the emotional health of the residents is of a high priority to the home and that staff are pro-active in maintaining and supporting residents with their emotional needs in order to maintain their quality of life in accordance to their plan of care. Staff demonstrate their commitment to achieving best outcomes for residents. Staff stated they expressed job satisfaction and confidence in the management of the home. Residents who spoke to us confirmed in their own words that they receive a good quality of care from staff who are courteous, respectful, communicate well, are experienced and deliver care in a individualised and professional manner. What has improved since the last inspection? It was evident through the inspection process that the home is taking steps to improve the standards of care. Namely, First aid training has been provided for staff working on each shift. Other areas within the report also show improvement from the previous inspection. What the care home could do better: The inspection identified several areas that were in need of being addressed. The main areas that were identified were :The home is currently subject to major re-building works with the addition of a new extended lounge and a additional wing with new bedrooms with en suite facilities. Once finished and registered this has the potential to significantly improve the environment and the experiences of the residents living within the home. A requirement was made at the previous inspection that this would be completed by 30th November 2008. The works have yet to be completed. The provider is aware of the slippage and has supplied to us a undertaking that such works internally and externally will be completed within six months the timescale of the statutory requirement stated in this report. Failure to meet this deadline without serious due cause could result in formal legal enforcement action. Individual and group staff training needs had been identified. From documentary evidence seen the standard of staff training was adequate overall with the majority of staff completing basic courses. However shortfall were noted with regard to basic courses. Namely induction, health and safety, and infection control. It was requested that staff additionally receive training in dying and bereavement. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Gables Gravesend Road Wrotham Kent TN15 7QD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Robert Pettiford     Date: 2 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 30 Information about the care home Name of care home: Address: The Gables Gravesend Road Wrotham Kent TN15 7QD 02086609953 01732822758 thegablesnursinghome@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Stargate Partnership Ltd care home 25 Number of places (if applicable): Under 65 Over 65 25 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 25. 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 to the home are within the following categories: Old age, not falling within any other category - (OP) Date of last inspection Brief description of the care home The Gables is a large detached property set in extensive grounds. The home is registered to provide nursing care to 25 older people. There are 6-shared bedrooms and 13 single bedrooms, 10 of which have en-suite toilet facilities. Many of the rooms registered for shared use are being used as singles and the number of double rooms are being reduced, to provide larger single bedrooms for residents. Most of the bedrooms are overlooking the Kent countryside. The home has a small lounge and dining room. The home is situated in a rural location close to the A20 and M20, public transport links are some distance, there is ample off road parking in the grounds of the home. The nearest shops are in Wrotham or Meopham, both are a couple of miles away. Care Homes for Older People Page 4 of 30 Brief description of the care home The home has recently been taken over by Stargate partnership Ltd, and the responsible individual and the new manager plan to extend, refurbish and redecorate the property in the future. Many of the bedrooms have already been refurbished. The current fees range from £459.56 to £568.02 per week, newspapers hairdressing and chiropody not included in the fees. Care Homes for Older People Page 5 of 30 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: The inspection took place at 8:10AM on 29th April 2009 We agreed and explained the inspection process with the manager. The focus of the inspection was to assess the home in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Older Persons. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. We used a varied method of gathering evidence to complete this inspection, pre inspection information such as the previous report and discussion and correspondence Care Homes for Older People Page 6 of 30 with the registered provider/manager was used in the planning process. This was to support us to explore any issues of concern and verify practise and service provision. The home had completed an annual quality assurance assessment questionnaire (AQAA). This provided us with information relating to What the home considers it does well, What we could do better, What has improved within the last 12 months and plans for improvement. The judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable the Commission to be able to make an informed decision about outcome areas. Further information can be found on the Commissions website with regards to information on KLORAs and AQAAs. Documentation and records were read. Time was spent reading a sample of written policies and procedures, reviewing care plans and records kept within the home. Other areas viewed included risk assessments, pre-admission assessments, rotas, and training records. In addition an environmental tour took place. We identified a sample of residents for case tracking (a review of the level of care and support needed, and if it is being provided in a way that treats them with respect and dignity). What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 30 Care Homes for Older People Page 9 of 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can feel confident that the care home can support them. This is because there is an 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. Evidence: Residents can be confident that the care home can meet their needs, as an offer of accommodation would only be given if this were possible. This is because they, or people close to them, have been able to visit the home where possible and have got full, clear, accurate and up to date information about the home. The AQAA states potential clients can visit at any time to view the home and dont have to make an appointment. there is a brochure, and information sheet to give them general information about the home. Also available in the entrance hall is a copy of the statement of purpose which explains the aims, philosophy of care, and what range of Care Homes for Older People Page 11 of 30 Evidence: facilities and standard of lifestyle the residents can expect. There is also a copy of the inspection report for them to read if they wish. Potential service users are invited to come and view the home but often their frail condition makes this difficult so the manager takes a brochure with her when she does the pre-assessment. The home offers the chance for the potential resident or their relatives to ask questions and clarify that the home will suit them and shows them around the home. Records held showed that residents have an assessment, which identifies their individual needs prior to or on admission to the home. The residents, their families and health provide the information / social care professionals. The assessment focuses on achieving positive outcomes for people and this includes ensuring that the facilities, staffing and specialist services provided by the home meet needs of the individual. The Commission reviewed a sample of assessments to gather evidence and spoke to a relative about the assessment process. The AQAA states all residents are encouraged to follow their own religious beliefs and they have residents and staff from several religious backgrounds. All staff are instructed during their induction and NVQ programmes to respect all the residents whatever their religious belief, race, gender identity, disability and sexual orientation. However the manager was recommended to review the homes policy on equality and diversity to ensure that it follows current guidance and policy. Care Homes for Older People Page 12 of 30 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. Residents benefit from having individual plans that identify their physical and medical needs. They are regularly updated and reviewed and followed the principal of person centred care, in that they detailed the residents health and social needs. Residents can feel fully confident that they are fully supported with their healthcare needs and that there wellbeing will be protected by the homes policy and procedures with regard to the handling and administration of medication. Residents can be confident that they will be treated with respect and dignity and their rights to make decisions about their lives and are respected as they wish or their capacity allows. Evidence: We viewed and discussed with the manager the care records relating to three residents at the home. The home is registered currently for 25 but has 12 at present due to ongoing building works. In the care plans viewed there was sufficient detail and Care Homes for Older People Page 13 of 30 Evidence: guidelines in respect of the support needed to meet their needs. All the care plans viewed were regularly updated. However daily notes did not follow guidance issued by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting in that they were not signed on some examples seen, with the signature printed alongside the first entry and not include gaps. It was recommended that this guidance is followed. Evidence was available that residents or relatives where possible were involved in drawing up personal care plans in the documentation and that they are consulted in reviewing and amending such care plans as their capacity allows. Some of the care plans viewed were signed by a resident or a representative. The inspector viewed a sample of care records and specific health care records relating to several residents. Records viewed confirmed that residents had access to a range of health care inputs as and when required and part of regular health checks. The home also ensures residents have access to Dentists and Opticians etc. The home also ensures that residents have access to their chosen Doctor for medication reviews and health check ups (if possible), in addition to identified specialist health care input. The Commission at the time of the inspection had the opportunity to discuss the level of care offered at the home with a visiting Doctor. He stated that he found the quality of care offered to be of a good standard and did not express any concerns and supported the nursing staff by visiting the home on a regular basis. The inspector visited the home at 8:10AM. During the inspection we noted that residents were seen making choices about their lives and were seen to be part of the decision process where possible. A relaxed atmosphere was noted with the residents interacting with staff. We also had the opportunity to speak with many residents who expressed satisfaction with the care offered and given. All spoken with expressed satisfaction of living within the home and the respect and dignity they were treated with. The AQAA states to assist with residents mental health they now have a pet rabbit and a visiting dog which the residents find extremely soothing to pet, and are stimulated by taking part in his care if they wish to. Evidence showed that care plans and other confidential information is now kept securely in the office. This now ensures that a requirement from the last report is met. The Commission viewed the storage arrangements and some records including Medication Administration Record (MAR) sheets, and the protocols for the administration of PRN/s Required Medication. The home has one clinical / medication room on the fist floor. Medication cabinets and Care Homes for Older People Page 14 of 30 Evidence: a trolley were evident. The medication record sheets observed were completed correctly. However PRN medication was not written up on the back of the sheet and it was unclear in some instances whether some PRN medication was being used as a regular medication. PRN protocols were not written up for each PRN. Such guidance provides Nurses with an agreed protocol / guidance to ensure that any clinical decisions to give PRN is done in a consistent manner. The Manager was requested to review some of the residents medication with their Doctor to ensure that PRN guidance is in place. The disposal of medication brought to the Commission some concerns on how the throughput of medication could be audited to a high standard. It was the view of the Commission that the current system could be open to abuse. We commented on the homes drug disposal policy and asked the manager to review to ensure it meets with current guidance to ensure that it complies with The Royal Pharmaceutical Society of Great Britain (RPSGB) 2007. The Handling of Medicines in Social Care, this provides professional pharmaceutical guidance for staff working in every area of social care to improve the safety and quality of medicines. No requirement has been made at this time, as the Commission is confident that the shortfalls would be addressed. Care Homes for Older People Page 15 of 30 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 social and recreational interest and needs are provided for with a range of activities organised and are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. Residents nutritional needs are met by a home that sees food as something to be enjoyed and required to maintain good health. Evidence: The AQAA states residents are encouraged to participate in all activities, and go out with their families whenever they wish to. The home provides a range of activities to suit as many people as possible, and it is their choice whether they attend or not, the carers do inform every resident of the activities of the day, and they are promoted on the notice boards. The AQAA states the home has sought the views of residents and considered their varied interests and abilities when arranging activities. The activities and plans are resident focussed, regularly reviewed. Care Homes for Older People Page 16 of 30 Evidence: Residents are actively encouraged to keep in contact with family and friends living in the community. Visitors are welcome at any time and facilities are available for them to have a drink or a meal. Residents can choose to entertain visitors in their own rooms or lounge. At present there is limited opportunities to entertain visitors in the garden due to the current ongoing building works. This will dramatically improve once these works are finished. The AQAA showed that mealtimes are very important to residents and they are encouraged to socialise and sit with friends. There are some residents who like to eat in their own rooms and this is accommodated. There are regular meetings with the residents where possible. They enjoy celebration meals either in the dining room or with relations and friends. Residents can plan to have relatives for meals on any day. The food provided for the residents was found to be varied and nutritious and of a good quality. During the inspection food storage areas were viewed along with quantity and quality of food. A good variety of food was found including meat, vegetables tins and fresh fruit. The kitchen and storage areas were seen to be well organised and clean. Care Homes for Older People Page 17 of 30 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 a effective complaints system in place and residents and families are aware of its contents. Some amendments were seen to be needed to ensure that it shows a residents rights to complain to other agencies at any time should they so wish. Residents are protected by adult protection policies and procedures. Evidence: The home had a written complaints procedure, which was seen in the foyer. Residents spoken with felt free to voice their concerns. The home has received 8 complaints in the last 12 months. 60 of these were resolved within 28 days. From evidence seen within the complaints procedure some amendments were seen to be needed to ensure that it shows a residents rights to complain to other agencies at any time. Following a review of complaints received from the last inspection the manager confirmed that the home ensures complaints are taken seriously and dealt with in an appropriate manner. The AQAA states the complaints procedure is in place in the hall, and in the service user guide so residents and relatives are informed of clear pathways to follow in order to voice their grievances and complaints. The Manager actively seeks their opinions in less formal ways also, and is happy that residents and relatives would be happy to approach her at anytime if they had concerns, and would be confident that she would Care Homes for Older People Page 18 of 30 Evidence: deal with them appropriately. The Commission viewed and discussed copies of the Homes Policy for the Protection of Residents and staff whistle blowing procedure. These include procedures for the reporting of suspicion or evidence of abuse with a format for the recording of any allegations and action to be taken. Full training has been provided for staff. More courses are planned to ensure all staff receive the training required to protect residents from abuse. One referral was made within the last 12 months with regard to the protection of vulnerable adults which is now closed and managed appropriately. Criminal Record Bureau Checks (CRB) have been obtained for all staff. The Manager is aware of her obligations with regard to ensuring the safety of Residents and protecting them from abuse. Care Homes for Older People Page 19 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do not benefit at present from living in a home that provides for a homely environment, which provides access to comfortable indoor and outdoor communal areas. The standards of internal and external decoration were found to be of a variable quality with limited facilities for all residents to have access to all of the home and grounds. Residents health is protected by the homes infection control procedures. Evidence: The home is currently subject to major re-building works with the addition of a new extended lounge and a additional wing with new bedrooms with en suite facilities. Once finished and registered this has the potential to significantly improve the environment and the experiences of the residents living within the home. A requirement was made at the previous inspection that this would be completed by 30th November 2008. The works have yet to be completed. The provider is aware of the slippage and has supplied to us a undertaking that such works internally and externally will be completed within six months the timescale of the statutory requirement stated in this report. Failure to meet this deadline without serious due cause could result in formal legal enforcement action. Care Homes for Older People Page 20 of 30 Evidence: Whist it is accepted that the manager is doing her best to limit the effects of the building works on the residents it is evident that the quality of care is affected. We would expect that the existing residents within rooms that require re-decoration are offered rooms within the new wing to facilitate re decoration of the older parts of the home. The management and staff encourage residents to see the home as their own home. Personal items were found in many of the residents rooms to make them feel more at home. It provides a very well maintained, safe, comfortable home. As well as a good selection of general aids such as hoists, the home also ensures that equipment is individualised for each residents and all staff members are trained in the safe use of aids and equipment. All residents are assessed for their need to have equipment or aids before they move into the home and these are provided to them on admission. The home uses slings for the hoists in different sizes. Each resident does not have his or her own sling. For reason of infection control and the risk of cross contamination the manager was requested to consult with current guidance and the Infection Control Nurse to ensure that the home is following best practice. The home was found to be is well lit, clean and smell fresh at the time of inspection which was commendable in view of the ongoing building works. Staff wear protective clothing (gloves and aprons) when providing personal care or handling soiled linen. Laundry facilities are comprehensive and meet the needs of residents and current guidance. Care Homes for Older People Page 21 of 30 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. Residents can feel confident that their care, social and emotional needs are promoted by the employment of care staff in sufficient numbers to meet their needs and recruitment practices are sound. However staff induction, core training and access to National Vocational Qualifications needs to be improved to ensure staff are supported by training to carry out their role. Residents are protected by the recruitment procedures within the home. Evidence: The ratios of care staff to residents are determined according to the assessed needs of residents. Following discussions with the manager, a review of the rota and observations made during the inspection. The Commission is of the opinion that sufficient care staff were on duty to support residents with their needs. At present the home has only 12 residents. The manager stated that staffing would be reviewed once the previously building works are complete. The AQAA states the manager ensures a appropriate ratio of trained and untrained staff are on duty in line with the number of, and needs of the residents. The duty rota is a true reflection of whose on duty 24 hours a day. It further states the home has not used agency staff and uses bank staff so residents receive a consistent level of care. Care Homes for Older People Page 22 of 30 Evidence: All staff are CRB checked and references are obtained prior to them starting work, and only after these checks are satisfactory. The staff are then subject to ongoing training and development. The home employs a number of ancillary staff who work as cleaners, laundry, maintenance staff. Thus allowing care staff the time to meet the needs of residents. The staff training records indicated undertaken training. Individual and group staff training needs had been identified. From documentary evidence seen the standard of staff training was adequate overall with the majority of staff completing basic courses. However shortfall were noted with regard to basic courses. Namely induction, health and safety, and infection control. The training matrix shows 12 members of staff have had Dementia training. However further training is needed in this areas to ensure all care staff have a good understanding of how dementia effects people. It was requested that staff additionally receive training in dying and bereavement. Evidence also confirmed that the home does not currently meet with the required standards with regard to achieving an NVQ National Vocational Qualification Level 2 or above care qualification. The manager was able to confirm that the home has a development programme for all new staff, which meets Sector Skills Councils workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of residents, and that all members of staff receive induction training to specification. However evidence seen confirms all staff have not had the benefit of such training. The manager confirmed that sufficient staff with a first aid qualification are now working within the home on each shift. This meets a previous requirments made. A requirement has been made relating to training to ensure residents are supported with fully trained staff. The home showed that it undertakes a recruitment practice including submission of an application form detailing all previous work history, requests proof of identity and copies of qualification certificates, seeks two written references, and confirms work status. The homes recruitment files observed were seen to include all the information as required under schedule 2 of the Care Home Regulations 2001. Care Homes for Older People Page 23 of 30 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. Residents and or their relatives can be confident that their views and opinions effect how the home is run and the manager put the welfare of the residents first. However continued failure to comply with requirements with regard to the environment set at previous inspections within agreed timescales compromises the quality of care and improvements in the homes quality assurance systems are needed. Residents can feel overall confident that their health and safety is protected. Evidence: The AQAA states the Manager has gained two years experience at management level and has completed her registered managers award. There is also a Deputy Manager in post. Feedback and evidence from discussions with residents, relatives, and other healthcare professionals show that the management of the home has improved and residents health and social needs are met. Care Homes for Older People Page 24 of 30 Evidence: The AQAA states the Manager has good communication skills, and promotes an open, inclusive atmosphere by holding regular staff meetings, and completing staff satisfaction questionnaires. Staff opinion is actively sought and they are encouraged to participate in decisions regarding the residents and the home. Staff have informed the Manager that they feel able and happy to come to the office to discuss any issues which may affect them and feel confident that appropriate action will be taken if required. Company policies and guidelines are accessible to staff for their use at any time. The AQAA shows the Manager keeps records regarding petty cash, supplier invoices and other finances in an efficient manner. Service users are able to choose to keep money with them or put it in safekeeping. Transactions of all monies are recorded and kept. Records are kept of any valuables both kept with the service user and handed in for safekeeping. The Manager ensures all staff have regular supervision and appraisals. All records are kept secure and are maintained and used in accordance with data protection act. Staff are trained in confidentiality. Service users records are assessable to them, and they are encouraged to participate where appropriate. Quality assurance was discussed and the views and opinions of many of the residents relatives sought. They confirmed satisfaction in living within the home and felt confident that their views and opinions were valued by the staff and management. The manager confirmed that the home does undertake quality assurance by means of asking residents, relatives to complete questionnaires in addition to healthcare professionals. This enables the home to ensure it is meeting the goals that are set out in the Statement of Purpose. The registered provider of the home does visit the home regularly and complete what is known as a Regulation 26 visit (Statutory documented visits by the provider to monitor standards within the home). This requires the owner / provider to assess the quality of care within the home and ensure that it is meeting with the required National Minimum Standards. It was recommended that such visits need to focus more on outcomes for residents with regard to staffing, adult protection, audits of policies and procedures, staff training, Activities, Health and Safety etc. along with speaking to staff and residents. The managers present at the inspection were requested to speak with the provider to ensure that such documented visits also monitor if requirements from previous Care Homes for Older People Page 25 of 30 Evidence: inspections are met. This is due to failure to comply with requirements set at previous inspections within agreed timescales. The building is currently undergoing major re-building works. The fire risk assessment was out of date as it predated the start of the works. The home was requested to review such assessment and ensure that it meets with current guidance and law. The inspector viewed records relating to Health and Safety Procedures, maintenance and servicing, and risk assessments. The inspector viewed the Fire Log book, which was up-to-date. The Commission was able to evidence that checks and servicing of fire safety equipment / emergency lighting had been undertaken at the required frequency. Care Homes for Older People Page 26 of 30 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 19 23 (2) The registered person shall ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally, in that The major refurbishment planned be commenced. Repeated from the last inspection. 30/05/2008 Care Homes for Older People Page 27 of 30 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 19 23 The registered person shall ensure that the premises to be used as the care home is of sound construction and kept in a good state of repair externally and internally to meet the needs of the residents. Major rebuilding works currently in progress to be completed within the extended timescale given. Failure to meet this deadline without serious due cause could result in formal legal enforcement action. To ensure residents live in a well maintained home which provides facilities to meet their needs. 29/10/2009 2 26 18 The registered person 29/10/2009 ensures that the homes staff team is trained to Sector Skills Councils workforce training targets and ensures that staff fulfil the aims of Care Homes for Older People Page 28 of 30 the home and meets the changing needs of residents. The home has a trained staff team who meet the needs of the residents. 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 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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