Care Home: The Garden House

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What the care home does well Information is available to help people who are thinking about using the home to make a decision about it and their needs are appropriately assessed to ensure the service can meet these. The home has a relaxed and homely atmosphere and people are supported by staff who generally know them well. Comments from people living in the home and their relatives told us "The garden house is extremely friendly and welcoming; it feels like my mother is at home". People using the service can take part in a variety of activities to ensure they experience a lifestyle that meets their wishes and needs and a variety of healthy home cooked meals are provided to ensure their receive a nutritious diet. A relative told us "They do everything to make my mother feel at home and encourage her to join in activities". The concerns of people using the service are taken seriously and staff training is provided to ensure they can meet their needs and know how to protect them from harm. People living in the home are provided with an environment that is comfortable and well maintained and appropriate recruitment checks are made to ensure staff are safe to work with people living in the home. What has improved since the last inspection? The management team have worked well to implement requirements we previously made and a Statutory Requirement Notice to improve the medication systems had been complied with appropriately. New secure medication storage facilities had been developed with training on systems for this to ensure staff know how to administer medicines safely. Further mandatory training had been given to staff in moving and handling, infection control, first aid and safeguarding people living in the home to ensure they know how to do their jobs. The reporting of significant incidents had been improved in recent months and a new care planning system had been introduced with some staff training provided on this. Improvements to food served in the home had been developed following consultation with people using the service and further work had been carried out to upgrade the facilities with new carpeting laid to some bedrooms and a number of them redecorated with new furniture and curtains. What the care home could do better: We previously served a Statutory Requirement Notice to ensure that care plans are improved. Whilst this requirement was partly met and we will not be taking enforcement action at this stage, we will be making a further visit in the near future to check compliance against this. This is to ensure staff have up to date information about their changing needs and know how to safeguard them from potential harm. A manager must be appointed to run the service to ensure it is effectively managed in the best interests of people living in the home. Staff must receive regular professional supervision and appraisal of their skills to ensure they can do their jobs and are given clear leadership and direction. Evidence that the stand aid hoist has been appropriately serviced must be submitted to the Care Quality Commission. This is to ensure the health and safety of people living in the home is promoted and protected. The acting manager and future appointed manager should complete safeguarding training appropriate for their role. This is to ensure people living in the home are protected from potential abuse and full Criminal Records Bureau clearance should be received for all new staff before they are allowed to work to ensure they are safe to work with people living in the home.Dementia care training should be given to staff to ensure they have the right skills to enhance the general wellbeing of people using the service and enable them to feel more in control of their lives. Accurate and timely records of the use of prescribed skin care products should be maintained and care plans should include detailed information guiding staff how to use medicines prescribed to be given "when required". MAR chart dividers should display enough personal information to link photo to named MAR. The Quality Assurance systems should be further developed to include monthly audits and analysis of internal systems and events to enable the home to be monitored better. Key inspection report Care homes for older people Name: Address: The Garden House 24 Humberston Avenue Cleethorpes North East Lincs DN36 4SP The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rob Padwick Date: 0 1 0 6 2 0 1 0 This report is a review of the 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 stars – excellent • 2 stars – good • 1 star – adequate • 0 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. things that people have said are important to them: 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 They reflect the We review the quality of the service against outcomes from the National Minimum Care Homes for Older People Page 2 of 26 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Garden House 24 Humberston Avenue Cleethorpes North East Lincs DN36 4SP 01472813256 01472812337 worcestergarden@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Worcester Garden (No 2) Ltd Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Number of places (if applicable): Under 65 0 0 10 Over 65 20 44 0 care home 44 Date of last inspection: Brief description of the care home: 0 2 0 6 2 0 0 9 The Garden House is a 44-bedded care home set in an exclusive area of Humberston, near the towns of Grimsby and Cleethorpes. The main house is in the style of an old manor house and retains many of its original features. The previous owner added a sympathetically designed extension in the grounds. There is ample car parking space and a well-designed and colourful garden. The home provides care for those with problems of old age and will take permanent, respite and emergency admissions. Some rooms have en-suite facilities, but there is ample bathroom and toilet facilities positioned around the home. There are several sitting rooms and a large dining room. All areas, including the gardens are accessible for wheelchair users. Care Homes for Older People Page 4 of 26 Brief description of the care home: The home charges third party top-up fees. The amount payable is dependent upon the level of the fee paid by the responsible local authority (where applicable) and/or whether the resident occupies a shared, single or ensuite bedroom. In addition to this residents are expected to pay for hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Details of current fees payable are available from the home. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: one star adequate service Our judgement for each outcome: Choice of home Health and personal care Daily life and social activity Complaints and Protection Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: This inspection report is based on information received by the Care Quality Commission since its last visit to the home, which took place on 19/2/10 and includes information gathered during a site visit to the home. The site visit was undertaken by Mr Steve Baker, Specialist Pharmacist Inspector for The Care Quality Commission and two Regulatory Inspectors, Mr Rob Padwick and Ms Karen Westhead. The reason for the inspection visit was to check the quality of the service and compliance with two Statutory Requirement Notices that we had previously issued to improve medication systems and care planning in the home. Care Homes for Older People Page 6 of 26 As part of the inspection process, we sent out a self assessment document that the Registered Person completed and returned to us as required. This self assessment helps us know how well the home is meeting regulations and National Minimum Standards and what has been done to improve it and what still needs to be done. The self assessment was completed and information from this used as part of the inspection process. Other information used included feedback from people living in the home, their relatives and Professional people who know the service well, together with official notifications sent to us by the home. This information helps us to reach judgments about the service provided. The site visit was unannounced and lasted for 9 hours. The home owner was not told in advance when the visit would take place and as well as speaking to him, we talked the Area Manager and staff who were on duty as well as people living in the home and their relatives who were visiting. We looked around the building and shared areas of the home and inspected the records of peoples care, staff files, some health and safety documents and other records kept by the service. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: We previously served a Statutory Requirement Notice to ensure that care plans are improved. Whilst this requirement was partly met and we will not be taking enforcement action at this stage, we will be making a further visit in the near future to check compliance against this. This is to ensure staff have up to date information about their changing needs and know how to safeguard them from potential harm. A manager must be appointed to run the service to ensure it is effectively managed in the best interests of people living in the home. Staff must receive regular professional supervision and appraisal of their skills to ensure they can do their jobs and are given clear leadership and direction. Evidence that the stand aid hoist has been appropriately serviced must be submitted to the Care Quality Commission. This is to ensure the health and safety of people living in the home is promoted and protected. The acting manager and future appointed manager should complete safeguarding training appropriate for their role. This is to ensure people living in the home are protected from potential abuse and full Criminal Records Bureau clearance should be received for all new staff before they are allowed to work to ensure they are safe to work with people living in the home. Care Homes for Older People Page 8 of 26 Dementia care training should be given to staff to ensure they have the right skills to enhance the general wellbeing of people using the service and enable them to feel more in control of their lives. Accurate and timely records of the use of prescribed skin care products should be maintained and care plans should include detailed information guiding staff how to use medicines prescribed to be given when required. MAR chart dividers should display enough personal information to link photo to named MAR. The Quality Assurance systems should be further developed to include monthly audits and analysis of internal systems and events to enable the home to be monitored better. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Care Homes for Older People Page 9 of 26 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 26 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. Information is available to help people who are thinking about using the home to make a decision about it and their needs are appropriately assessed to ensure the service can meet these. Evidence: The home has developed information to help people thinking about using the service, which was displayed in the reception area of the home. The homes self assessment told us there were plans to improve and update this with more details to help people make a more informed decision about the service. We are at present looking at changing our service user guide, terms and conditions and contract to give clear guidance re: fees incurred. Case files belonging to people using the service contained evidence their needs had been appropriately assessed to ensure the service can meet their needs. Feedback from people living in the home and surveys we sent to their relatives was generally positive and one relative told us My mother chose the Garden house because she liked the atmosphere. We feel she is in excellent hands and are very happy with the service provided. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst improvements had been made to ensure the health and personal care needs of people living in the home are met, continued shortfalls in reviewing their care planning information mean that staff may not have up to date information about them which potentially places them at risk of harm. Evidence: We served statutory notices to improve care plans and medication systems following our last visit to the home in February 2010, due to failures to meet requirements we had previously made about these. Feedback in surveys from people using the service was generally positive about the home and indicated their health and personal care needs were being largely well met. A relative told us Staff are very caring, sympathetic and aware of residents dignity and privacy and Very flexible and cater to personal needs. We saw evidence of improvements with the implementation of new style care planning documentation and we were told that some of the staff had attended training on this. The reporting of significant incidents in the home to us had improved in recent months and a new pharmaceutical company had been contracted with and new arrangements made concerning administration of medicines. We looked at the care records for five people living in the home and whist there was evidence of work carried out to improve these, more work was still needed. Information in some had not been fully transferred to the new style of documentation and the use of them was not being consistently applied. We saw evidence of a failure Care Homes for Older People Page 12 of 26 Evidence: to regularly review care plans in all of the care records we inspected, together with gaps in entries where they had not been signed or dated, that could lead to possible confusion and errors. The file of one person living in the home contained care planning details on a wide range of identified issues; with good use of simple, clear language and evidence of a person centred approach. However, an associated care plan had not been updated to reflect changes identified in their daily notes and a night care plan had not been signed or reviewed since March 2010, despite it detailing this was to be reviewed every month. The case notes of two other people we inspected were awaiting transfer to the new system of care planning documentation, but we were unable to find evidence these had been reviewed, including one dating back to their time of admission which had been three years previously. Information about identified risks to people living in the home were included in their case files, however it was unclear from the assessments when these had been completed or if they had been reviewed. This continues to place people using the service at potential risk of harm, because staff may not have up to date information about their changing needs and the type of support needed. Staff involved in implementing the new care planning documentation told us that whilst they had spent time with the acting manager about these, they were Only just getting used to using the documentation. The provider told us that training on care planning had been given, but we saw evidence that only four of the seventeen permanent care staff employed had attended this. A pharmacist inspector spent nearly five hours in the home assessing compliance against medication requirements issued at previous inspections. This involved looking at the medication administration, ordering, storage, and disposal arrangements, examining medication administration record charts (MARs) and speaking to staff about medicines management arrangements in the home. The outcome is as follows. We found the systems for medication ordering, receipt, checking and record keeping to be generally good. Although most medication management processes in the home now follow best practice, some additional improvements in medication record keeping are recommended to ensure a complete record is maintained of how all medicines are used in the home. All previously issued medication requirements were found to be met at the time of this inspection. Senior staff who are authorised to give medicines to people have received update training in medication safety and further awareness training is planned for other care staff. Although the homes medication policy has been updated, we found some omissions. For example, the home lacks a list of homely remedies agreed with local GPs and there was no guidance for staff on how best to record the use of prescribed skin care products. The homes medication policy should be further expanded in line with current professional guidance so that all staff know exactly what is expected of them when managing peoples medicines. Evidence: Care Homes for Older People Page 13 of 26 We examined 32 current and previous months MARs for accuracy and completeness and found no significant gaps in the records of administration of those medicines taken by mouth. This indicates that people living in the home can expect to receive these essential medicines correctly. However, records of the use of prescribed skin care products on six MARs were unclear, meaning it is difficult to be sure people are receiving all the intended benefits of such products. Another persons GP had recently reduced the dose of one medicine so that it should only be given when required instead of regularly each day. This persons care file contained records of the GPs visits but these lacked sufficient detail. A new medication care plan for this person should be written so that all staff understand the reasons for the change and then only give the medicine according to agreed directions in the care plan. MAR chart dividers displayed recent photographs but lacked other personal identification information such as name and birthdate. Adding this information to the MAR chart divider helps to make sure staff give medicines to the correct person each Time. New hand written entries and changes to MARs were clear, detailed, complete and had been checked by a second person for accuracy. This means all staff should be able follow the changes on the MARs correctly. Where relevant, the new MARs indicated the quantities of medicines brought forward from the previous month. This information is helpful when checking that medicines are being given correctly or that sufficient medicines remain available until the next delivery is due. Medication ordering, receipt, and disposal arrangements in the home are good, and the GP prescriptions are checked by staff each month before the medicines are delivered. This good practice helps to make sure that the home is aware of any prescription changes and that staff will know that sufficient quantities of everyones medicines have been prescribed each month. The medicines storage and security arrangements in the home have greatly improved since the last inspection. This helps to minimise the risk of any loss or diversion of peoples medicines from the home. Finally, the dates of first opening should be recorded on the labels or containers of all oral liquids and all prescribed skin care products in use. This helps staff to know that these products are safe to use whenever needed. Daily life and social activities These are the outcomes that people staying in care homes should experience. Care Homes for Older People Page 14 of 26 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. Whilst people living in the home are able to take part in a variety activities to ensure they can experience a lifestyle that meets their wishes and needs, further staff interaction with them would enable their individual needs and sense of general well being to be enhanced. Evidence: Feedback in surveys from relatives and people who use the service was generally positive and we were told they can make choices about their lives to ensure they experience a lifestyle that meets their wishes and needs. A relative told us They do everything to make my mother feel at home and encourage her to join in activities. Whilst another said Staff are very caring, sympathetic and aware of residents dignity and privacy. The home has a part time activities organiser and we saw evidence of a variety of trips out and entertainments regularly put on. We observed some people taking part in various games of cards, whilst others told us about knitting and making crafts for fundraising activities. A number of people living in the home have dementia type symptoms and difficulties associated with memory impairments, whilst we saw evidence of one to one time spent with individuals and relatives told us Staff are very flexible and cater to personal needs we observed times when their interaction with people using the service could be further improved. The self assessment indicated the provider was aware of this shortfall and was considering dementia training for staff and a recommendation about this is made. The home welcomes the involvement of relatives and friends and a number were observed visiting during the period of our visit. One person told us The Garden House is extremely friendly and welcoming, it feels like my mother is at home. The self assessment told us The activities and entertainment needs to be looked at for all clientelle, so all the needs of all clients are considered and we were told of plans to Care Homes for Older People Page 15 of 26 Evidence: address this and involve volunteers and relatives To help form friendships and assist in activities within and outside the home. People using the service said they generally enjoyed their food and that the standard of meals served was of good quality. We observed a variety of home cooked meals provided and case files contained evidence of nutritional assessments and monitoring of aspects of diet to ensure nutritional needs are appropriately met. Care Homes for Older People Page 16 of 26 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 Concerns of people using the service are taken seriously and staff training provided to ensure they are protected from harm. Evidence: Comments from relatives and people living in the home were generally positive and one person told us We feel xxx is in excellent hands and (we) are very happy with the service provided. We had previously made requirements to ensure the concerns of people living in the home are appropriately followed up and there was evidence of good progress in this regard. A copy of the complaints policy was on display in the reception area of the home and the self assessment indicated that when a complaint is received, they Embrace the complaint and try to learn from it. Whilst we saw evidence of recent staff actions to record concerns that had been raised together with actions to resolve the eleven complaints received over the past year, some comments received indicated more direction and leadership was still needed to ensure appropriate action is taken to follow these up more promptly. Comments from people using the service told us they felt generally Safe and secure and policies and procedures are available to ensure they are protected from potential abuse. There had been some safeguarding incidents recently which had been referred to the Local Authority to investigate, and we saw evidence the service was working well to fully implement their recommendations about these. Most of the care staff have now received appropriate training on the Protection of Vulnerable people who are at risk of harm as previously required, however the acting manager told us she had had not yet attended training on this locally as previously agreed by the provider. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are provided with an environment that is comfortable, homely and welcoming and generally well maintained to ensure their general health, safety and welfare is promoted. Evidence: The home was comfortable and clean and we observed domestic staff working hard to keep the building tidy. The atmosphere throughout the service was warm and homely and we observed care staff interacting with people living in the home in a friendly and supportive manner. A relative told us My mother chose the Garden house because she liked the atmosphere whilst another described it as Friendly and welcoming. Access to the top floors of the home is by passenger lift and aids and adaptions are in place to maximise the independence of people who use the service. The home has three assisted baths and an assisted shower and seventeen of the bedrooms have ensuite facilities. Since the last time we visited, further ongoing work had been undertaken to improve the building, with a new medication room and office created, some bedrooms re carpeted and redecorated and new flooring laid to a front bathroom and toilet. Whilst there was evidence the building was being generally well maintained, a washing machine and dishwasher were not working properly, although the owner had taken appropriate action to remedy this. Good progress had been made with implementing recommendations from a Local Authority safeguarding investigation and staff had undertaken mandatory training in moving and handling and senior staff completed a Train the Trainer course in infection control. We were told other training on this issue was to be given to care staff in the near future and that water soluble bags were now used for soiled linen, as recommended by an infection control specialist following a previous outbreak of sickness in the home. Care Homes for Older People Page 18 of 26 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. Recruitment checks are made to ensure staff are safe to work with people living in the home and they are provided with appropriate training to enable them to do their jobs. Evidence: When we visited the home in February 2010, we found that the management of the home had worked hard to improve the availability of training to ensure staff are able to do their jobs. The service has worked closely with the Local Authority in this regard and we saw evidence that care staff had continued to attend courses on the safeguarding of vulnerable adults, moving and handling, infection control, care planning and first aid. We saw evidence of further training booked to take place in the near future. We observed staff working with people using the service in a friendly and supportive manner and comments received from them confirmed improvements made. Staff told us Training now given is to a better standard and (we) work as a team. The self assessment for the service indicated that 73.5 of the permanent care staff are trained to NVQ level 2 or above and we saw evidence of certificates for this in the staff files we inspected. Whilst staff were observed to be kept busy, appropriate staffing levels were observed with a senior, plus five care staff on duty in the mornings and four in the afternoons. A new shift pattern had recently been introduced for senior staff to enable greater continuity of leadership and we were told that following consultation, it was hoped this would be rolled out more generally for care staff throughout the service. Over the past year there has been a considerable amount of instability within the staff team, with a number of long standing staff deciding to leave. However, staff told us Things are starting to be a lot better and that things had now settled down and that use of agency staff had now ceased. Files of newly employed staff indicated appropriate recruitment procedures were being followed and all contained evidence of checks to ensure staff were safe to work with people living in the home. All of the three files we inspected contained evidence Care Homes for Older People Page 19 of 26 Evidence: however that staff had commenced work prior to full Criminal Records Bureau clearance being obtained, but we were told new staff complete their induction and shadow others before being allowed to start work on their own. The Area manager was reminded this practice should only be followed in exceptional circumstances and a recommendation is made about this. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst management systems are in place to ensure the service is run in the best interests of people who use the service, further development of monitoring and recording arrangements and staff support would enable their needs to be better met. The service needs a manager who is formally registered to manage the home to ensure good management arrangements are in place. Evidence: Good Progress had been made to implement the requirements we made previously and a fire plan was available, together with evidence of weekly checks of the fire alarm and a periodic electrical wiring certificate for the building obtained. The service had worked well with the Local Authority to implement recommendations following a safeguarding investigation, however monthly management reports identified low staff morale and that Staff are continuing to feel the pressure from the lack of leadership, guidance, and support over the past few months. Whilst these shortfalls had been identified, we were unable to find records of regular staff supervision and comments received indicated this had not formally taken place, although time had been spent time with the manager and area manager to develop the care plans as required. As previously noted, further progress was still needed with these and a requirement is made to ensure staff are given clear leadership and direction and to enable their career development to take place. Since our last visit the provider had developed quality assurance systems to ensure the home is run in the best interests of people who use the service. We saw evidence of surveys about the choice of food and consultation on this to improve the menus. Monthly reports are written by the provider to enable the service to be monitored; however as indicated above, there was evidence more work was still needed to develop Care Homes for Older People Page 21 of 26 Evidence: internal monitoring checks to ensure appropriate action is taken when needed and that any deficits identified are addressed in a timely fashion. A recommendation is made about this. The self assessment for the home was generally completed to a good standard and told us about changes made to the home and improvements where these were still needed. The acting manager had recently resigned from the service however and whilst there was evidence to comply with a statutory improvement notice about medication in the home, further work was still needed to ensure care plans are consistently maintained and routinely reviewed. The Provider has told us the Area Manager will now cover the managers post until a replacement can be appointed and that action will be taken to ensure care plans are brought up to date. The registered provider must appoint a manager for the service to ensure the service is appropriately managed. Systems were in place to ensure the health, safety and welfare of people living in the home are promoted and we saw evidence of a range of certificates and internal checks and progress with implementing recommendations from the Local Authority as previously noted. Despite evidence however of ongoing contracts for the servicing of equipment, we were unable to find official certification to confirm repairs to a hoist that was previously identified as faulty. A requirement is made about this. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes 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 8 13 The Registered Person must ensure assessments about the management of known risks to people living in the home are kept up to date and regularly reviewed. This is to ensure people using the service are kept safe from potential harm. This is a previous requirement that was not met and remains outstanding. (Previous timescales of 15/01/2010 and 21/05/2010 not met) 15/07/2010 Care Homes for Older People Page 23 of 26 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 7 15 The Registered Person must 15/07/2010 ensure that an audit of care plans is carried out to identify which care plans have not been reviewed and that action is taken to bring them up to date. This is to ensure staff have up to date information about the care people need. The Registered Provider 01/09/2010 must appoint a manager for the service. This is to ensure the service is managed effectively and ensure the service is run in the best interests of people living in the home. The Registered Person must 15/07/2010 ensure staff receive regular formal supervision and appraisal of their skills and knowledge. This is to ensure they are able to do their jobs well and are given clear leadership and direction. 2 31 9 3 36 18 Care Homes for Older People Page 24 of 26 4 38 13 The Registered Person must 15/07/2010 submit evidence that the stand aid hoist has been appropriately serviced and is operational. This is to ensure the health and safety of people living in the home. 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 2 9 9 3 4 9 14 5 18 6 29 7 33 MAR chart dividers should display enough personal information to link photo to named MAR. Care plans should include detailed information guiding staff how to use medicines prescribed to be given when required. Accurate and timely records of the use of prescribed skin care products should be maintained. Dementia care training should be provided to staff to ensure they have the right skills to enhance the sense of autonomy and general wellbeing of people living in the home and enable them to feel more in control of their lives. The Registered Person should ensure the acting manager and future appointed manager complete safeguarding training appropriate for their role. This is to ensure people living in the home are protected from potential abuse.1 Full Criminal Records Bureau clearance should be received for all new staff before they are allowed to work in the home. Only in exceptional circumstances should new staff be allowed to commence work with preliminary protection of vulnerable adults (POVA) checks. Quality assurance systems for the home should be further developed to include monthly audits and analysis of internal systems and events. Care Homes for Older People Page 25 of 26 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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