Care Home: The Grange

What the care home does well People have clear, relevant written information about the services provided. People`s healthcare needs are being met and people are treated with dignity and respect. People are consulted about matters affecting their daily routines and the care they receive. Staff work well with relatives, carers and healthcare professionals in order to meet people`s needs. There is a high standard of food and people are able to take part in a variety of social activities as they wish There is a clear complaints procedure The service has a warm, friendly and welcoming atmosphere. The building is safe, wellmaintained clean, comfortable and homely. The service is well staffed. People using the service speak positively about the staff and the way in which they carry out their duties. What has improved since the last inspection? Improvements have been made to the assessments people have before they move to the service. People can be confident the service has all the relevant information about their health and personal care needs. Care plans and risk assessments provide staff with the information they need to support people safely and meet their health and personal care needs. Improvements have been made to medications procedures so people can be confident their medications are managed safely. Staff training is being monitored so people can be confident that the staff who work with them have up to date training in medications, protection of vulnerable adults and health and safety. People can be confident that regular checks are being done on the quality of their service. This includes asking people who use the service for their opinions and using them to improve the service. What the care home could do better: Staff should be clear about a person`s needs as soon as they arrive at the service, before a care plan is set up. This involves clarifying information from outside agencies and ensuring staff have a good hand over. This will ensure people`s needs are met from the start.The service should consider, as part of personalising people`s support, recording information about people`s likes, dislikes and social interests at an early stage. This will make sure that people have access to personal support, social activity and occupation that is of their choice. The service should make sure that information about decisions that are made are clearly recorded, in particular treatment or rehabilitation decisions and decisions about leaving the service. This will ensure decisions are made in the person`s best interests and with reference to the Mental Capacity Act. The service should consider labelling and dating boxes of medications and recording quantities on recording sheets. This will make auditing easier for staff and easy to see where mistakes have been made. The service should consider installing a second sink for staff to wash their hands in the laundry, so it is separate from where clothes are washed by hand. The service should make sure that induction and specialist training is provided for staff so that they are confident in providing appropriate support for an intermediate care and rehabilitation service. This will ensure that people`s specialist needs are met and their independence promoted. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Grange 162 Sutton Park Road Kidderminster Worcestershire DY11 6LF     The quality rating for this care home is:   two star good 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: Emily White     Date: 2 4 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 33 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 33 Information about the care home Name of care home: Address: The Grange 162 Sutton Park Road Kidderminster Worcestershire DY11 6LF 01562756820 01562756822 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) : Worcestershire County Council Home Care Services care home 34 Number of places (if applicable): Under 65 Over 65 0 34 dementia old age, not falling within any other category Additional conditions: 34 0 The maximum number of service users who can be accommodated is: 34 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 34 Dementia (DE) 34 Date of last inspection Brief description of the care home The Grange is a large, detached purpose built establishment that is operating as a resource centre. The premises are located in a pleasant residential area of Kidderminster close to shops and other amenities. The centre is owned and operated by Worcestershire County Council and is registered to provide care and accommodation for a maximum of 35 older people. The premises including the garden and patio areas are accessible to people using wheelchairs. The accommodation is provided on two floors. A passenger lift is installed to enable Care Homes for Older People Page 4 of 33 Brief description of the care home people to have easier access to the facilities on the first floor. There are thirty-four bedrooms. One of the bedrooms can be used as a double bedroom. Two of the bedrooms have an en-suite facility. There are a variety of communal lounges and dining areas and kitchen facilities are provided to enable people to make their own drinks and snacks. The centre has an assessment unit with a total of ten places including seven places for assessment, two places for respite care and two places for transitional care. The centre also provides a rehabilitation service with thirteen places and a further eleven places for respite care. This forms the intermediate care service. The centre also provides a day-care service which did not form part of the inspection. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before we visited the service we looked at all the information we had received about the service since the last key inspection in 2007. The service sent us an Annual Quality Assurance Assessment which tells us about what they are doing well, improvements that are being made to the service and some statistics about policies, staff and people who use the service. We also received some surveys from people who have used the service and staff who told us their opinions. We visited on a weekday and met the deputy manager and several staff members. We also met several people using the service and observed daily life in the house. We also looked at records including care and support files and records to do with the management of the service. Care Homes for Older People Page 6 of 33 Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Staff should be clear about a persons needs as soon as they arrive at the service, before a care plan is set up. This involves clarifying information from outside agencies and ensuring staff have a good hand over. This will ensure peoples needs are met from the start. Care Homes for Older People Page 8 of 33 The service should consider, as part of personalising peoples support, recording information about peoples likes, dislikes and social interests at an early stage. This will make sure that people have access to personal support, social activity and occupation that is of their choice. The service should make sure that information about decisions that are made are clearly recorded, in particular treatment or rehabilitation decisions and decisions about leaving the service. This will ensure decisions are made in the persons best interests and with reference to the Mental Capacity Act. The service should consider labelling and dating boxes of medications and recording quantities on recording sheets. This will make auditing easier for staff and easy to see where mistakes have been made. The service should consider installing a second sink for staff to wash their hands in the laundry, so it is separate from where clothes are washed by hand. The service should make sure that induction and specialist training is provided for staff so that they are confident in providing appropriate support for an intermediate care and rehabilitation service. This will ensure that peoples specialist needs are met and their independence promoted. 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 9 of 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with comprehensive and relevant information about the service and they are given a contract that contains clear details about the service they will receive. People in receipt of the intermediate care service are helped to maximise their independence and return home. Evidence: We received five surveys from people who have used this service. They all said they had information before moving, for example, A social worker told me about it and the doctor thought it would be good for me, I am so glad I came here. People we met during our inspection told us that someone had been to see them before they came, but many people could not remember what information they had. We saw guides to the service placed in peoples rooms. Care Homes for Older People Page 11 of 33 Evidence: The Annual Quality Assurance Assessment tells us that a new brochure and information is being developed to give more easily accessible information on the service to people being assessed. Following the last key inspection a requirement was made that people have their needs fully assessed, looking at all the areas of personal care covered by the National Minimum Standards. People who are thinking of coming to the service are assessed by Intermediate Care Assessors or by senior staff if they are coming for respite. We followed the experiences of two people using the service, one staying in the assessment unit and one staying in the rehabilitation unit. People have detailed assessments of their needs and goals before they come to the service. Information about their health and personal care needs is taken, to make sure the service can meet those needs. Assessments from social workers and other professionals are also used so the service has a good picture of that person. We saw that the discharge information from the hospital is often unclear with abbreviated words which are difficult to understand. It would be good practice for the service to make sure they understand all the information about a person before that person moves in. We also note that the assessment information looks mainly at health and physical needs, and does not include detail about peoples likes and dislikes, and social interests. As staff use the assessment for information until the care plan is set up, it is important that the service is aware of peoples preferences as soon as possible so that they can be sure they are meeting their needs as soon as they arrive at the service. The Grange is an intermediate care centre. The rehabilitation unit looks at peoples mobility and activities of daily living and the assessment centre looks at their future support needs. Most people aim to go home, but some people move on to long term care. The service employs occupational therapy and physiotherapy staff and has support from the local district nurse team. Care staff have a role in supporting people to achieve their goals for independence. The centre has good facilities to help them do this, such as kitchens and a therapy room. One person told us she had asked to come to this service as she had been before. Other people we met made comments such as: Very useful occupational therapy. I have been at The Grange for six weeks now and am leaving tomorrow morning. I am feeling so much better, and after all the good caring people have put me back to health I am so very grateful. The Annual Quality Assurance Assessment tells us that the service could improve by Care Homes for Older People Page 12 of 33 Evidence: ensuring that the multidisciplinary team are all active in the Intermediate Care Plan within the shortest time possible after admission. This will ensure the earliest discharge and most effective outcome for the person. Staff tell us that how soon someone is seen is dependent on how they are when they arrive, to give them the best chance to succeed. Care Homes for Older People Page 13 of 33 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. The support provided is responsive to the individual needs of people who are helped to be independent and to take responsibility for their personal care. Peoples privacy and dignity is respected. More attention needs to be given to personalising the support that people receive. Evidence: We received five surveys from people who have used the service who say they always receive the care and medical support needed. Comments include: Always a very high standard of care at The Grange When I came to The Grange I was a very depressed person, but on arrival here I met the most wonderful carers who made me feel that I was not alone any more, each day I began to feel better. People using the service tell us they are treated with respect. During our visit we observed staff and daily life at the service and saw that all staff are respectful of peoples dignity and privacy. Staff knock on peoples doors, use their preferred names and are discreet about personal care. Following the last key inspection two requirements were made that more detail must Care Homes for Older People Page 14 of 33 Evidence: be included in peoples care plans and risks around nutrition, pressure care and moving and handling must be assessed. The Annual Quality Assurance Assessment tells us that Care planning continues to be a work in progress, we continue to train all staff to add to care plans appropriately so that all relevant information is recorded to ensure the best outcome. We looked in detail at the experiences of two of the people using the service, which included speaking to them, speaking to staff who work with them, and looking at care files and records. People have key workers who are the staff responsible for coordinating the care plan, for monitoring its progress and for staying in regular contact with everyone involved. Staff say that they aim to set up the care plan within 72 hours but this is dependent on the persons ability to be involved, for example one person we met did not have a plan set up for six days. As the plan is set up with the person and signed by them, sometimes staff wait until they are well enough to contribute. The service understands the importance of involving people in setting up their care plan, for example one comment from staff reads: Discussed care plan with client. Unsure if she retained information given. Client willing to sign, will get family to read also. One person who had arrived at the service the day before our inspection did not have a care plan in place. Staff use the information from the assessment until the care plan is set up. We spoke to staff who had supported this person that morning, who had not seen any care records for this person. They were aware of her medical needs and background from the handover they had received from the night staff. However they were not sure about her goals, reason for being there or her personal support needs. It would be good practice for the service to consider improving ways of passing on information when a person first comes to the service, such as through the assessment or the handover process. Peoples care plans provide detail about their activities of daily living, their current situation, what they expect or their goals, and what support interventions are needed by staff. The care plans cover all areas of health care required by the National Minimum Standards, but some improvement could be made to make the plans more personal to people using the service and to ensure that information and decisions are clearly recorded. Care plans use the word client rather than the persons name. While there are clear details on peoples needs, there is little detail on peoples individual preferences, for example: Client is able to do own grooming but needs prompting to do so; Enable client to maintain personal standards as they prefer. Care Homes for Older People Page 15 of 33 Evidence: One person we met and observed needed assistance with getting up and sitting down. This had been identified by the occupational therapist at the service. A risk assessment for moving and handling was completed two weeks after this person arrived at the service which contains detailed information about sitting and standing. However this persons care plan did not make detailed reference to the help needed in this area. From staff daily notes and our observations we saw that the person was getting the correct help, but it is important for staff to make sure that all details are recorded in a persons care plan so that everyone involved knows how to support that person. We saw from the diary and care files that peoples plans are regularly reviewed. Staff tell us that reviews include goal setting, planning for home or residential care if needed, and opportunity to voice concerns. People invited include the person, their family, carers, senior staff, and social worker as necessary. We could see from records that people are having regular reviews of their support, and staff tell us that review and assessment is ongoing. However there are some areas where decisions are not always clearly recorded. For example, one person had been seen by the occupational therapist who had referred to the physiotherapist. There was no record of what happened after this, although the physiotherapist was able to tell us about it. This person was also described by staff as having some cognitive impairment and assessed by the occupational therapist as having some communication difficulties. Staff told us they were thinking about moving to residential care although the person told us they would like to go home. It is very important that the service document decisions that are made by people using the service and decisions made on their behalf, with reference to the persons best interests and the Mental Capacity Act. For those people whose care plans we saw, staff show a good understanding and knowledge of the needs of the people they support. Care plans show that staff observe peoples abilities in mobility, management of hygiene and activities of daily living and record on an assessment sheet. Daily notes are very detailed and record peoples development and changes in ability. Staff also show a good understanding of their role to support rehabilitation, and say they are comfortable with basic nursing skills such as management of colostomy bags. However not all staff have had training in intermediate care skills, and no staff have had any training in diabetes care. This presents some risk to people with diabetes using the service, as diabetes management may feature in their plan for rehabilitation. Records show that there is a high level of involvement of health professionals in peoples support. People have good access to GPs and district nurses who manage skin care amongst other health needs. A GP told us that the service is very good, he is always called out promptly and appropriately. Meetings are held every week to discuss the development of everyone using the service, which are attended by therapists, Care Homes for Older People Page 16 of 33 Evidence: social workers, assessors, senior on duty, and the unit coordinator. Care plans are read by all staff, and staff say that communication is good, there are handover books, and daily notes are recorded three times per day. Following the last key inspection report requirements were made to make sure medications were administered correctly and staff had appropriate training. The Annual Quality Assurance Assessment tells us that medication training has been undertaken by care staff, and a recent pharmacy audit did not identify any major concerns. We looked at medications for someone who had very recently moved to the service and someone who had been there for some weeks, and observed medications being given. Medications practices and procedures are being followed for safe storage and administration. We were not able to see the revised medications policy during our visit but were told it had been completed. We found medications difficult to audit as staff do not write the dates of opening on boxes or record the numbers of medications at the start of a new recording sheet. The deputy manager explained their system of auditing which is acceptable however agreed that a system of using the recording sheets would make auditing medications quicker. If someone wishes to take their own medications staff will observe them for a few days before signing them off as able to manage. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to maintain their autonomy while staying at the centre. There are social and lesiure opportunities and the food is good. More attention should be paid to personalising the support people receive. Evidence: We received five surveys from people who have used the service, who tell us that there are always activities to take part in. One person comments: There are relaxation classes, games such as scrabble and bingo, exercise classes, painting, crafts, all the above is done by the activities coordinator We also met people using the service during our visit who all told us there are a wide range of things to do. Comments include: Its very entertaining They look after us all Im very happy here The Annual Quality Assurance Assessment tells us that the service has a dedicated activities organiser who consults with people to ensure recreational activities meet their needs and wishes. This may involve one to one with people or doing a group activity such as craft activities, bingo, or cooking. We observed the activities coordinator playing bingo with a group of people during the morning. We spoke to the Care Homes for Older People Page 18 of 33 Evidence: activities coordinator who told us about her role. She understands the importance of working one to one with people and that social activity could be chatting, going for a walk or reading the paper. She has also attended a one day training course in dementia care. Individual activities are not recorded due to limited time. The coordinator says that staff are good at identifying who likes what. However one persons care plan states under social activities, to ensure client is able to live as full a life as possible while residing at The Grange. This does not provide enough detail about that person. It would be good practice, as part of personalising peoples support, if information about peoples likes, dislikes and social interests are recorded at an early stage. People are supported to keep up community contacts as far as possible. People attend church services, and the activities coordinator is able to go for walks and escort people to town if they need assistance. Visitors are able to come at any time, and can join in with mealtimes if requested. People we met during our visit told us they are able to make choices regarding daily routines and the matters that affected their care, for example where they ate their meals and when they get up and go to bed. The Annual Quality Assurance Assessment tells us that People attend their own reviews to lead decisions about their own future care. If advocacy services are needed we can access these or show them how to do this themselves. We asked people using the service what they thought about the food. Comments include: More fresh veg, not frozen and more roast dinners on a Friday I would like more fish and less gammon especially as I attend day care on a Friday When I came into The Grange I had no appetite at all as I had not eaten for some weeks, after 24 hours I started to eat again and to enjoy food The food is good The food is marvellous There is a lot of choice People who returned surveys said they always or usually like the meals at the service. We observed a lunch time and saw friendly chatting, a calm atmosphere, food which looks and smells appetising, and staff offering choices of food and drinks. The Annual Quality Assurance Assessment tells us: We continue to offer special dietary needs for individuals such as appetising soft diets, diabetic choices. We ensure the kitchen is given a dietary checklist for everyone on admission which gives their preferences or any special requirements. We devise a four weekly seasonal menu. This is all home cooked food and mostly fresh vegetables. All cakes are baked on the premises. Our catering is very highly thought of as shown in our feedback questionnaires. We have again been awarded an Excellent rating by the District Council in their Food Hygiene Ratings. We met the kitchen staff and observed Care Homes for Older People Page 19 of 33 Evidence: practices which confirmed this. Care Homes for Older People Page 20 of 33 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 resource centre has a clear complaints procedure and other relevant policies and procedures to help ensure that people are protected from abuse. People feel confident about making a complaint and also that any concerns will be dealt with quickly and appropriately. Evidence: No complaints have been received by us since the last review of the service. Five surveys returned by people who use the service say that they always know who to speak to if they are not happy and they know who to speak to to make a complaint. We spoke to staff and people using the service who are all aware of the complaints procedure. The complaints procedure is included in the information pack that given to people when they move to the service. There is a folder with cards and letters of thanks, as well as minor complaints and suggestions from people using the service. The service also monitors formal complaints which are dealt with by the local authority Customer Services Unit. Following the last key inspection a requirement was made that the senior staff must undertake training in the protection of vulnerable adults from abuse and all the care staff must receive training in basic awareness of abuse. A further requirement was made that a procedure should be introduced regarding peoples money and financial affairs. The Annual Quality Assurance Assessment tells us that protection of vulnerable Care Homes for Older People Page 21 of 33 Evidence: adults training has been undertaken for all groups of staff. The training schedule for the service shows that the majority of staff have had this training in the past 12 months. The deputy manager also tells us that training on the Mental Capacity Act and Deprivation of Liberty is planned. We spoke to staff who all show an understanding of safeguarding vulnerable adults. One staff member who is new to the service had not yet had protection of vulnerable adults training and did not appear on the training list. This was raised with the manager. Care Homes for Older People Page 22 of 33 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 are accommodated in safe, well-maintained surroundings. Evidence: Surveys returned by people who have used the service and people we met all said that the house is always fresh and clean. One person commented: The home is very clean and the cleaning ladies work hard keeping it spic and span every day. The service has an ongoing maintenance and decoration plan. We observed that peoples rooms and the communal areas are clean, homely and welcoming. People have good quality furniture in their rooms which meets their mobility needs. Bedrooms have photos of the key workers and an information guide to the service. There is access to patio areas in the gardens. We asked staff about hygiene and prevention of spread of infections and sickness and diarrhea. Staff are aware of how to take the right precautions and what do if someone becomes unwell. There are plenty of facilities for staff to wash their hands. Toilets and bathrooms are clean and equipment is regularly checked for maintenance. The training schedule shows that staff have had training in infection control. There has been recent improvement work done in the laundry, including raising the washing machines on plinths. There is one sink in the laundry which is used for hand washing some clothes. Care Homes for Older People Page 23 of 33 Evidence: The service should consider installing a second sink for staff to wash their hands. Care Homes for Older People Page 24 of 33 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. The staff are experienced, trained and employed in sufficient numbers to fulfil the aims of the centre and to meet the changing needs of people using the service. Evidence: Surveys returned by five people who use the service say that staff always listen and act on what is said, and staff are always available when needed. Comments include: They sometimes need reminding but only because theyre busy The staff are available at all times, night and day, they are so well trained and always pleasant and so helpful During our visit we observed staff throughout the day, talking to people using the service and making sure their needs were met. There appeared to be enough staff working on that day. Rotas confirm the level of staffing is consistent. In addition to care and support staff and therapy staff and there are two senior staff on duty during the day. After 5pm this is reduced to one senior and one senior at weekends. The Annual Quality Assurance Assessment tells us that the service acts quickly to fill any staff vacancies that occur and the service has a good team of dedicated relief staff. We met several staff who all say that there are enough staff and they have the time to do their jobs. The Annual Quality Assurance Assessment also tells us that There are only five care staff currently without NVQ2 but these have been nominated to start as soon as Care Homes for Older People Page 25 of 33 Evidence: possible. A further six staff have been nominated to undertake NVQ Level 3. We also have two senior assistants currently undertaking their Level 4 in care. The training schedule operated by the service shows that well over half of the staff have NVQ2 or above. We looked at staff files to check that recruitment practices are safe. Staff files contain a photograph, an application form, two written references, evidence of an enhanced CRB disclosure check, proof of identity and a copy of a staff contract. Staff said that they had had all the appropriate background checks done before they started work. The service has a training schedule which they use to keep up to date with staff training. This is monitored by a senior member of staff. Medications, infection control, equality, food hygiene, hazardous substances, health and safety, moving and handling, fire and abuse are all treated as mandatory and updated annually. From speaking to staff and looking at the training schedule we note that some of this training has not been updated annually for some staff, however we could also see that the majority of this training has been booked for staff to attend this year. We received some staff surveys which said that the induction covered everything they needed to know partly or very well; that staff feel they usually or sometimes have the right support experience and knowledge to do their jobs; and that they always have relevant and up to date training. Some comments include: Dementia care training, learning disability or other complex needs, mental health, understanding the needs of individuals with these problems are a concern, as well as nursing problems, diabetes, hypotension, and leg ulcers, we need to know more information in order to promote health Staffing depends on individuals needs and if something happens to warrant extra staff. If individuals have complex needs for example nursing, physiotherapy or mobility these can cause problems or concerns This service is an intermediate care service and offers rehabilitation. For this reason it is important that staff have additional specialist training and a thorough induction so that they can enable people to reach their goals for independence. Although the occupational therapist delivers training on daily living skills, we note that there is little or no training on basic nursing skills, diabetes and other specialist areas. Some staff members have attended module C training or ADP which provide training in intermediate care skills, but not all staff have done this. The deputy manager confirms that the new staff follow an induction with the home care team, which meets Skills for Care criteria. We were not able to see evidence of this as folders are not kept at the service. The Annual Quality Assurance Assessment tells us that there service is currently Care Homes for Older People Page 26 of 33 Evidence: reviewing the facilities for the suitability of people with dementia, and have started in depth diploma training for managers and senior team. All staff have had access to dementia training and will be having training on the Mental Capacity Act and Deprivation of Liberty. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a safe and well-managed service. However it does not have a registered manager and arrangements must be made for a suitable manager to be recruited quickly. Evidence: The service is being managed by the deputy and operations managers following the recent resignation of the registered manager. Staff tell us that the systems in place at the service are continuing to run well and the disruptions in management have not affected their day to day work very much. Staff also returned surveys to us which said they usually have up to date information, have regular meetings with the management, they know what to do when they have concerns and information is usually shared well. Senior staff members have additional responsibility for management tasks such as auditing staff files, supervising staff, monitoring training, and responsibility for health and safety. Care Homes for Older People Page 28 of 33 Evidence: Staff tell us that they have supervision every three months, by a senior member of staff with the opportunity to be supervised by the manager every six months if they want. There are also staff meetings every two months. One staff member who had joined the service within the last six months told us she had not had supervision since she started. This was raised with the deputy manager. Following the last key inspection a requirement was made that a quality monitoring system must be set up which includes the views of people using the service and others involved in their support. The service uses a series of audits based on the National Minimum Standards to check on the quality of the service. The Annual Quality Assurance Assessment also tells us that: We ask everyone who use our services to complete Having Your Say questionnaires to enable us to get feedback and make adjustments as needed. During the next 12 months we will be improving and expanding our strategy to look at involvement within our services, this is following on from our successful Customer Service Excellence assessment. Following the last inspection requirements were made to make sure staff had the mandatory health and safety training and that accident procedures were being followed. The training schedule shows that staff are receiving updated training and where gaps are identified training is being planned. The Annual Quality Assurance Assessment tells us that: We log any accidents on an online reporting system which is County Council policy. Reports are sent by our Health and Safety officer at County hall when they are required. We complete Regulation 37 forms (to CQC) when needed. A random check of maintenance and health and safety files shows that checks are being carried out. Environmental risk assessments are kept for each unit which are kept up to date and in good order. The Annual Quality Assurance Assessment tells us that We keep only small amounts of money for people who request us to do this. The money is kept in individual envelopes with cards which are double signed when money is taken out or put in. People moving to the service are encouraged to use the safekeeping facilities for their money and sign to agree to this when they arrive. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 It would be good practice for the service to make sure they understand all the information about a person before that person moves in. This includes being clear about medical terminology and abbreviations. It is important that the service is aware of peoples likes, dislikes and social interests as soon as possible so that they can be sure they are meeting that persons preferences as soon as they arrive at the service. It would be good practice for the service to consider improving ways of passing on information when a person first comes to the service, such as through the assessment or the handover process. This will make sure the person gets the support they need before their care plan has been set up. The service should make sure that all details are recorded in a persons care plan so that everyone involved knows how to support that person. This includes improving information about the persons personal preferences, likes and dislikes. The service should make sure that information about decisions that are made are clearly recorded, in particular treatment or rehabilitation decisions and decisions about Page 31 of 33 2 3 3 7 4 7 5 8 Care Homes for Older People leaving the service. This will ensure decisions are made in the persons best interests and with reference to the Mental Capacity Act. 6 9 The service should consider labelling and dating boxes of medications and recording quantities on recording sheets. This will make auditing easier for staff and easy to see where mistakes have been made. The service should consider, as part of personalising peoples support, recording information about peoples likes, dislikes and social interests at an early stage. This will make sure that people have access to social activity and occupation that is of their choice. The service should consider installing a second sink for staff to wash their hands in the laundry, so it is separate from where clothes are washed by hand. 7 12 8 26 Care Homes for Older People Page 32 of 33 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. 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