Care Home: The Grange Residential Hotel

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What the care home does well The home undertakes a thorough assessment of peoples needs before they move in. People are given good information about the home to enable help them make a decision about where they live and the services they receive. People are given the opportunity to visit the home before they decide to move in. Each resident has a detailed care plan, which describes their needs and the way they choose and prefer to be supported. A detailed record is kept of peoples personal and health-care needs. Peoples health is closely monitored and any changes or concerns regarding a persons health is dealt with promptly. The home gathers very good information about peoples interests and important contacts. There is a full activities programme and staff support people to partake in activities in the home and in the local community. The staff listen to residents and take seriously any concerns or complaints that are raised. Staff receive training in the safeguarding of vulnerable adults and are aware of the procedures to follow if they suspect an incident of abuse has occurred, The standard of accommodation is good. Recent improvements within the environment has further ensured that people have a safe place to live. The home is staffed by workers who are well trained and competent. The manager presents a good role model for her staff and manages the home well. What has improved since the last inspection? There are better systems in place for recording the care needs of people living in the home. This information is now well organised, and can be understood and accessed by the people providing care. Arrangements have been made for a Domiciliary Dentist to visit residents who cannot leave the home for dental checks. Medication is now stored safely in a locked medication trolley. Medication requiring cold temperature storage is now stored in a separate fridge. There has been redecoration of some bedrooms and communal areas as part of the homes on-going maintenance and renewal plan. Health and Safety standards have improved in the home. The manager has worked hard to address the concerns raised by the Environmental Health Officer and last Key Inspection. The home has registered with a new training provider and all staff now have a individual training programme. A new staff member has been appointed to assist the night staff during the busy part of the evening. What the care home could do better: To improve the Fire safety arrangements the Provider must liaise with the Fire Authority regarding the entrance between the kitchen and Laundry area. Locks still need to be made available on one of the communal bathrooms shower rooms. Consideration needs to be given to the privacy and dignity of people being assisted to use the communal toilet within the main hallway of the home. Key inspection report Care homes for older people Name: Address: The Grange Residential Hotel Townsend Hill Ipplepen Newton Abbot Devon TQ12 5RT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Wendy Baines     Date: 0 8 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Grange Residential Hotel Townsend Hill Ipplepen Newton Abbot Devon TQ12 5RT 01803813656 01803813656 robin.a.sutton@gmail.com www.ogwellgrange.co.uk Ogwell Grange Ltd care home 17 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Old age, not falling within any other category (OP) maximum 17 Physical disability over 65 years of age (PD(E)) maximum 17 Date of last inspection Brief description of the care home The Grange Residential Hotel is a large, detached, grade two listed property on the edge of the Devon village of Ipplepen. Newton Abbot, a market town, and the holiday area of Torbay are a few miles away. The home is located about 150 yards from the village centre near the shops and Doctors surgery. Accommodation is arranged on two levels with a shaft lift and stair lift servicing the first floor. There are ample parking spaces at the front with level access to the front door. A large lounge on the ground floor is complemented by a large dining Care Homes for Older People Page 4 of 31 Over 65 17 17 17 0 0 0 Brief description of the care home room with a small conservatory leading to the secure, attractive garden at the rear of the home. In all there are fifteen bedrooms, five of which are on the ground floor. Three bedrooms are suited to shared / double accommodation if required. Some rooms have assisted en-suite bathing facilities. The Grange Residential Hotel caters for men and woman over the age of retirement who may have a degree of physical disability and memory problems. The home came into the possession of its present owner in August 2004 who, with his Registered Manager and team of workers have made many positive changes to the building and the culture of the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is Two Star. This means that the people who use the service experience GOOD quality outcomes. The Inspection was unannounced and took place over one full day on the 24th March 2009. The Registered Manager for the home was present throughout the inspection visit. A sample of surveys were sent out to the people who live in the home and six of these were returned. The Provider completed a Annual Quality Assurance Assessment (AQAA) prior to the visit. This provides the Commission with information we need to know about how the home is run and the people who live there. Care Homes for Older People Page 6 of 31 During the visit the Inspector was able to complete a full tour of the premises and meet with all the staff and management on duty. A sample of records relating to the running of the home and the residents were examined. These included care plans, risk assessments and health and safety records. The Inspector was able to spend time talking to residents and observing staff as they provided support. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? There are better systems in place for recording the care needs of people living in the home. This information is now well organised, and can be understood and accessed by the people providing care. Arrangements have been made for a Domiciliary Dentist to visit residents who cannot leave the home for dental checks. Medication is now stored safely in a locked medication trolley. Medication requiring cold temperature storage is now stored in a separate fridge. There has been redecoration of some bedrooms and communal areas as part of the homes on-going maintenance and renewal plan. Health and Safety standards have improved in the home. The manager has worked hard to address the concerns raised by the Environmental Health Officer and last Key Inspection. The home has registered with a new training provider and all staff now have a individual training programme. A new staff member has been appointed to assist the night staff during the busy part Care Homes for Older People Page 8 of 31 of the evening. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may be considering moving into the home are provided with good information to enable them to make an informed choice about where they live and the type of services they receive. Assessments and care planning processes ensure that people who use the service , and their relatives can be confident that care needs are fully identified and can be met by competent staff. Evidence: A good range of information is available to people who may be considering moving into the home. A Statement of Purpose and Service user guide contained information about the homes aims and objectives, the services provided including staffing arrangements and all necessary contact details. The manager confirmed that this information would be given to all new residents and anyone making inquiries about the home. Copies of these documents were also available within the main reception Care Homes for Older People Page 11 of 31 Evidence: area. The files of two residents recently admitted to the home were looked at during the inspection. The purpose of this was to determine the quality of the homes admissions procedure and the experiences of the people concerned. The manager confirmed that prior to admission she would visit the person concerned and undertake a full assessment of their needs. This may take place within the persons own home, hospital or other setting. As well as speaking to the individual information would also be gathered from family and other professionals such as a GP or District Nurse. The pre-admission assessments seen during the inspection were very detailed and contained particularly good information about peoples history, social interests and preferred choice of daily routines. Residents spoken to confirmed that before moving in they had been invited to visit the home, view their room and stay for afternoon tea. The manager said that following the initial assessment and visits to the home they would contact the individual and/or their family to advice them whether or not the home would be able to meet their needs. Arrangements would then be agreed for the new resident to move in. Staff spoken to said that they are made aware of the care needs of new residents before they move in and are not asked to care for people outside their area of expertise. They said they felt well trained and supported by the Registered Manager. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at The Grange can be assured that they will receive good personal and health-care support. Peoples health-care needs will be regularly monitored and any changes dealt with promptly. The recent review of the way peoples information is documented ensures that staff are able to understand information about peoples needs and provide care in a consistent manner. Evidence: The Inspector had access to all records during the visit. The care records of five residents were examined in greater detail. Each person living in the home had an individual plan of care. It was noted at the last inspection that this information was stored in a number of different files making it difficult to understand and track the residents plan of care. The home has now re-organized the way it document and stores this information and the inspector commended the manager on how in most Care Homes for Older People Page 13 of 31 Evidence: cases the information now clearly describes peoples needs and in all cases demonstrated how this information is monitored and reviewed. Care plans are reviewed on a monthly basis, and comments within these review notes confirmed that residents are involved in this process and and are encouraged to partake in issues concerning their care. A daily record is also kept for each resident and information regarding their needs and any important issues are passed to staff during daily shift handover meetings. Information about people living in the home is safely stored. Most of the residents care plan had good detailed information about their care needs and how they prefer to be supported. Examples of recording included details of oral care, a falls record, nutritional screening, and weight monitoring. Individual care plans stated when particular monitoring processes were in place such as fluid intake, and monitoring charts were found to be well maintained and up to date. Through discussion with the manager it was evident that some residents were requiring more support due to health and /or their age. One care plan stated that the resident required total support in the bathroom. however the care plan did not describe the type of support or how this would be delivered. It was discussed with the manager the importance of detailed information for staff to ensure that the care provided is suitable and consistent. Risk assessments were found in each care plan for different areas of care including; prevention of falls, Moving and Handling and pressure care. The plan described the risk and the arrangements in place to reduce it, such as staffing levels and use of equipment. All residents are registered with a local GP and are able to see visiting health professionals in the privacy of their own room. A Domiciliary Dentist now also provides annual visits to people who are unable to leave the home to visit a dentist. The homes systems for the administration of medication were examined. Good information is gathered about a persons medical history prior to them being admitted to the home. This information is documented along with information about particular drugs and possible side effects, for staff to refer to if necessary. Since the last inspection the home has purchased a trolley for the safe storage of medication and a separate fridge for medication cold temperature storage. Both of these facilities as well as medication recording charts were inspected and found to be well maintained and in good order. Care Homes for Older People Page 14 of 31 Evidence: The manager said that at the time of the visit all residents required support to administer medication. However, if a resident requested to do this independently a risk assessment would be completed and facilities would be available to safely store medication within the residents own room. Records showed which members of staff were able to administer medication. Staff spoken to said they would only undertake this task if they had received training and if the manager assessed that they were competent and confident enough to do so. Observations during the inspection showed that peoples dignity and privacy were respected by staff. Staff were seen knocking on peoples bedroom doors before entering. All bedrooms and most communal rooms had locks provided. However, locks were not fitted on one of the communal shower rooms. It was noted that several residents were using the toilet in the main hallway, which was within close proximity to the main front door and busy part of the home. Several of these residents required support from staff and due to the small size of the room this involved the door being opened and closed several times. Staff could also be heard providing support to residents during this time. Consideration should be given to the location of this room to ensure that the privacy and dignity of residents is maintained at all times. Feedback from residents and family regarding health and personal care support included: I feel my mother health has improved since she has moved into the home, The staff are always happy to help me make any appointments and arrange transport when required. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Grange are well supported to maintain their social interests and contacts. There is a commendable varied and interesting range of activities on offer. People are able to enjoy a well balanced diet, which is suitable to their needs within comfortable and unrushed surroundings. Evidence: Records confirmed that the home gathers really good information about peoples backgrounds, hobbies, interests and social contacts before they move in. This information is then used to help plan daily activities and social events for the individual and the home. There was a lovely atmosphere in the home when the inspector arrived. Several residents were sat together in the main sitting room talking, watching television and reading the morning papers. Some of the residents spoken to said they preferred to spend time in their rooms and were able to do so. During the afternoon of the visit one staff member sat and read to residents in the communal lounge. This seemed to be an activity which residents enjoyed. Care Homes for Older People Page 16 of 31 Evidence: A very full activities programme was advertised on the notice board, and included information about visiting entertainers, hairdresser visits and events within the local community. Staff said that the home has visits from at least 8 different entertainers including, musicians and dancers. There are also regular art and craft sessions and gentle exercises programmes. The manager said that as a result of feedback from residents the home has recently increased their staffing levels to assist residents to pursue interests and hobbies outside of the home. Residents spoken to said that there is always a range of activities to join in if they choose to do so. One resident was looking forward to a meal out with friends to celebrate a birthday and others said that during the summer months cream teas are served in the garden and the opportunity to help with potting plants in the conservatory. The Inspector was able to meet with relatives who were visiting the home during the visit. One relative said that she was always made to feel very welcome by staff and was kept well informed of any important issues. Another resident and their relative had returned from a trip out and was being served tea and biscuits by the staff. Staff were seen supporting one resident to write a letter to a relative. Private telephone lines are available in each room. There is also a private telephone booth in the main hallway. The home assists people to join activities in the local community by providing transport. On the day of the visit the cook was unwell and staff were assisting to prepare lunch. This seemed to be very well organised and residents were full of praise for the staff concerned. A very tasty, hot meal was served within the homes attractive dining area. The tables were attractively laid with fresh flowers, and quiet music was played in the background.Overall this created a relaxing, comfortable environment for people to eat their meals. Residents files contained good information about any special dietary needs and particular food preferences. This information was also available in the kitchen and included peoples preferred choice of snacks and drinks. Staff were observed serving meals on trays to residents who chose to eat in their rooms. Care Homes for Older People Page 17 of 31 Evidence: All of the residents who completed surveys stated that the food is always good. One person commented; I enjoy the food, it is always delicious. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at The Grange can feel confident that their concerns will be listened to and taken seriously. There are sufficiently robust systems in place to safeguard people from abuse. Evidence: The Grange has a written complaints procedure and policy. A copy of this information is provided to residents at the time of admission and is also available on the homes notice board. No complaints had been received by the home since the last key inspection. Questionnaires completed by residents confirmed that people were clear about who they should speak to if they had a problem. Residents and relatives spoken to said that the manager is often available and that there is a very open atmosphere in the home. During the inspection the manager was approached numerous times by residents and staff to answer questions, discuss daily arrangements or just to have a chat, and at all times responded in a sensitive and respectful manner. The homes induction and training programme includes training related to safeguarding vulnerable adults and all staff are expected to attend this training. The Registered Care Homes for Older People Page 19 of 31 Evidence: Manager is knowledgeable about the correct procedures to follow should any form of abuse or neglect be alleged or suspected. Small amounts of money are held for people living in the home. This is securely stored and records maintained of all transactions. It was discussed with the manager that any agreements made between the home and individual regarding management of their finances should be documented as part of their care plan arrangements. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Grange benefit from a homely and comfortable environment in which safety measures have continued to improve. On-going maintenance and attention to the areas of the home that have been identified will ensure that people continue to live in a home that is safe and meets their needs. Evidence: The home is located about 150 yards from the village centre near the shops and Doctors Surgery. Accommodation is arranged on two levels with a shaft and stair lift servicing the first floor. There is ample parking space at the front with level access to the front door. A large lounge on the ground floor is complemented by a large dining room with conservatory leading to the secure, attractively laid out garden at the rear of the home. In all there are fifteen bedrooms, five of which are on the ground floor. Three bedrooms are suited to shared/double accommodation if required. Several of the bedrooms were seen during the inspection and all were found to be clean, bright, attractively decorated with plenty of furnishings and personal belongings to reflect the residents personality and interests. Care Homes for Older People Page 21 of 31 Evidence: A kitchen and laundry are also sited on the ground floor. To the rear of the kitchen there is a former bedroom, which has been converted to office accommodation. Prior to the Inspection concerns were passed to the Commission from Environmental Health regarding the location of this office and the potential risk this could pose to residents who may wander through the kitchen while hot meals and drinks are being prepared. This concern was raised with the manager and records confirmed that a risk assessment had been completed for this part of the building and individual residents. As a result the kitchen door is now shut at two busy periods of the day. The risk assessment for one resident highlights the need for staff to be extra vigilant of her whereabouts and to provide her with information she needs to reduce her need to walk through the kitchen area. Concerns were also raised by Environmental Health regarding the absence of a door between the kitchen and Laundry area. The manager said that this has been discussed with a Fire officer and options are being explored. Since the last Key inspection a number of improvements to the homes environment have been made. These were identified in the Annual Quality Assurance Assessment returned by the Registered Manager and confirmed by our own observations. Examples included; - Updated and refurbished the kitchen washroom, installing a new stainless steel commercial double sink with full tiled walls. - Provided additional glove and apron dispensers on the 1st floor. - Fire resistant windows fitted in two bedrooms and staff bathroom. - Dining room and communal lounge redecorated with new light fittings and carpets. Requirements and recommendations relating to the environment identified at the last key inspection have been addressed including; - The fitting of a window restrictor on the room identified during the visit. - A potential tripping hazard between the conservatory and dining room, and at the top of the stairs between a bedroom and stair-lift have both been addressed. The Inspector noted that the Registered manager has worked hard to address the areas of concern raised at the last inspection. Discussion took place for the need to still ensure that, - A door is fitted between the kitchen and laundry area. -Locks still need to be fitted on one communal shower room. Care Homes for Older People Page 22 of 31 Evidence: The home also has some very attractive original features including a tiled floor in the main hallway and natural stone floor in the conservatory. These need to be well maintained to ensure that they do not present a potential tripping hazard for people living in the home. Risk assessments need to be in place for these parts of the home. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at The Grange will recieve care from a skilled group of staff who will be sufficient in number to meet their current and changing needs. Evidence: Staff were described by people living in the home and those visiting as very kind and caring with nothing being too much trouble. People said that they were supported promptly indicating that staff were employed in sufficient numbers to meet the needs of those living in the home. On the day of the inspection there were 14 residents living in the home. The staff team consisted of the Registered Manager a senior carer, care worker and two house keepers. The Chef was absent on the day of the visit but the staff appeared to be managing with additional tasks as well as assisting the Inspector throughout the day. The manager said that staffing levels are regularly reviewed and discussed within staff meetings and supervision. Since the last inspection some additional staffing hours have been agreed to cover the busy period during the evening and to allow staff to spend more time with residents who may want to partake in activities outside the home. Staffing at night consists of one person remaining awake in the home and a staff member who is on call after 8pm and sleeping in the staff facility, North Grange, Care Homes for Older People Page 24 of 31 Evidence: which is a separate unit attached to the main house. At the last key inspection the manager was asked to review this arrangement and has since appointed a staff member to cover the busy 8-10pm shift within the home. Throughout the visit staff were attending to chores, assisting residents with personal care needs and spending time with residents in the communal parts of the home. During the afternoon one staff member spent time reading to a group of residents, whilst another helped a resident write a letter to a relative. Staff spoken to said that they felt well supported by their colleagues and the Registered Manager. One commented that their had been several recent improvements particularly in the way that information about residents is documented and stored. The staff member felt that this change made it easier for staff to understand and access the information they needed to provide care to residents. Three staff files were examined during the inspection. The files seen contained references, evidence of identity checks, and Criminal records checks. Staff from abroad had work permits. There was also information about the interview process and Induction training. Since the last key inspection the home has registered with a new training provider and each staff member has a personal development plan. New staff were provided with Induction training to ensure they are given information about the care home and the people living there. This was evidenced in a number of staff files. Staff files confirmed that staff complete training in health and safety, and most have had this updated since the last key inspection. Staff also have the opportunity to complete training for a National Vocational Qualification, a nationally recognised qualification for which staff must demonstrate their knowledge and skills in supporting older people. One staff member spoken to during the inspection was particularly keen to complete training relavent to her role and said that her enthusiasm was encouraged and supported by the manager. In addition to the Mandatory training staff also attend a range of specialised courses relavent to their role and needs of the people they care for including Bereavement and Safeguarding of vulnerable adults. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is supported well by the staff team in providing clear leadership throughout the home with staff demonstrating an awareness of their roles and responsibilities. Improvements in recording systems and health and safety procedures will ensure that people receive good quality care within a safe environment. Evidence: The Registered Manager has a National Vocational qualification at level 3 and at level 4 in Management. She also holds an NVQ Assessors award. In addition to completing Health and Safety training she has also attended recent training in the Mental Capacity Act and Safeguarding of vulnerable adults. The Registered Manager said she is well supported by a good core team of staff who have worked in the home for many years. She meet with the Director and Proprietor Care Homes for Older People Page 26 of 31 Evidence: of the home on a weekly basis. Feedback from the staff group indicated that they felt well supported. Discussion with staff during the visit and examination of staff files confirmed that they received regular supervision. The Inspector was able to observe staff within a shift handover meeting when staff were given detailed information about the days events and anything specific to individual residents. Evidence was seen that people living in the home, relatives and other agencies were consulted about the quality of the service provided. Questionnaires are sent out to residents and their families on an annual basis and details of the findings discussed with staff and management. The homes Annual quality Assurance Assessment completed by the home prior to the inspection stated that as a result of feedback from residents the home had recruited more staff to provide support with day time activities. Health and Safety issues were examined. Staff files confirmed that since the last inspection all staff have had their health and safety training updated. Practices concerning the transfer of laundry had been reviewed and laundry was no longer being transfered through the kitchen area.To further prevent to spread of infection the home had also purchased a large laundry trolley for transferring soiled linen. The manager has worked hard to address all the issues raised at the last inspection. This has included a review of all records relating to the care needs of residents. The records are now documented separately for each resident and provide clear information for staff about current and changing needs. Most of the concerns regarding the environment have now been addressed and the manager was aware of work that still needs completing. This included the fitting of a door between the kitchen and laundry and locking facilities on communal toilets and shower room. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 The Registered Provider 09/08/2009 must seek advice from the Fire Officer regarding the need for a door between the kitchen and laundry. The Registered provider must ensure that all parts of the home to which people have access are so far as reasonably practicable free from hazards to their safety. 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 10 The home should complete their programme of fitting locks to doors. This should include the two remaining communal toilets and shower room, which do not have this facility. Consideration should be given to the location and use of the communal toilet in the main downstairs hallway. This facility should not be used by residents requiring support by staff. This would further ensure that that the privacy and dignity of residents is maintained at all times. Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 18 Any arrangements agreed between the resident and the home regarding finances should be documented and reviewed as part of the service user care plan. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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