Care Home: The Limes Care Home

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What the care home does well Staff were attentive to the needs of the people that lived at the home and they had a good understanding of people`s individual needs and preferences. The interaction between staff and people that lived at the home and their visitors was observed to be friendly, caring, respectful and professional. The provision of the opportunities for people to participate in activities continued to be of a high standard and people told us that they particularly enjoyed the art activities and their art work was displayed in the home. A recently purchase mini bus, computer with internet access for the use of the people that lived at the home and a Wii games console further improved the activities which were provided. The home was clean and comfortable and there were several displays of fresh flowers in the communal areas of the home, which were attractive. What has improved since the last inspection? The home was regularly monitored in the monthly Regulation 26 visits, where people that lived at the home were provided with the opportunity of expressing their views about the service that they were provided with. People`s contracts/terms and conditions, the Statement of Purpose and the Service User`s Guide had been updated to show the details of the home`s providers and the service that people could expect of them. There were two written references in the staff recruitment records that were viewed, which showed that the appropriate checks had been undertaken to ensure that people were safeguarded. Risk assessments were in place in people`s personal records regarding manual handling and risks that were present in their daily living. The risk assessments identified the methods of minimising the risks. There were also risk assessments that had been undertaken, which identified how risks were minimised in the environment and activities that were provided both inside and outside the home. People`s care plans were in the process of being improved and they identified the support that people were to be provided with. However, they did not include details of people`s preferences and individuality, which were identified in the previous records, which were present in the home. The manager told us that the care plans were in the process of being further improved. What the care home could do better: It is recommended that the manager access training which informs them of the Mental Capacity Act and Deprivation of Liberty and how they can incorporate it into the running of the home and the service that is provided to people. The entrance to a toilet in the home was down a step and it was recommended that a risk assessment be undertaken to ensure that the risks of people falling were minimised. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Limes Care Home Earlsford Road Mellis Eye Suffolk IP23 8DY     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: Julie Small     Date: 1 0 0 7 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 32 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 32 Information about the care home Name of care home: Address: The Limes Care Home Earlsford Road Mellis Eye Suffolk IP23 8DY 01379788114 01379788201 jan.mackay@southerncaregroup.co.uk 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) : Priory Care Limited care home 26 Number of places (if applicable): Under 65 Over 65 3 26 dementia old age, not falling within any other category Additional conditions: 0 0 Within the category of DE(E) the home can provide care and accommodation only for the three named service users as listed in application V26679 Date of last inspection Brief description of the care home Priory Care Limited purchased The Limes April 2008. The Limes is a Care Home for 26 older people situated in the Village of Mellis, overlooking the village green. The village amenities include a Post Office/ Newsagent and Public House. It is 3 miles from the market town of Diss and Eye, and 9 miles from Stowmarket. There is a bus service to the surrounding towns. The Home is set in large grounds, where there are eight self-contained cottages with tenants, who attend the Home for their main meal and companionship during the daytime. The Home is not registered to provide care for the tenants living in these cottages. Care Homes for Older People Page 4 of 32 Brief description of the care home The Home has 22 single bedrooms (8 of which are located in the homes new extension) and 2-shared bedrooms. Communal day space consists of 2 small lounges, dining room, and lounge/kitchenette area leading into the new conservatory. Whilst there is no passenger shaft lift, a stair lift is provided for access to the first floor. At the time of the key inspection 10th July 2009 the manager told us that the weekly fees for the home were from £440.91 to £429.53. Care Homes for Older People Page 5 of 32 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 unannounced inspection took place Friday 10th July 2009 from 10:00 to 18:25. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The manager was present during the inspection and the requested information was provided promptly and in an open manner. During the inspection health and safety records, staff training records and the recruitment records for three staff were viewed. The care records of three people that live at the home were tracked, which included care plans and medication records. Further records viewed are detailed in the main body of this report. Observation of Care Homes for Older People Page 6 of 32 work practice was undertaken and three staff members, five visitors and six people who lived at the home were spoken with. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home and it was returned to us in the required timescales. Staff, health professional and service user surveys were sent to the home. Five staff, one health professional and nine service user surveys were returned to us before the inspection. What the care home does well: What has improved since the last inspection? What they could do better: It is recommended that the manager access training which informs them of the Mental Capacity Act and Deprivation of Liberty and how they can incorporate it into the running of the home and the service that is provided to people. The entrance to a toilet in the home was down a step and it was recommended that a risk assessment be undertaken to ensure that the risks of people falling were minimised. Care Homes for Older People Page 8 of 32 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 32 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 32 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 use the service can expect to be provided with the information that they need to make decisions about if the home is the right place for them, to be provided with written terms and conditions of the home and to have their needs assessed prior to moving in. The home does not provide an intermediate service. Evidence: People were provided with the information about the home which helped them to decide if it was the right place for them in the Statement of Purpose and the Service Users Guide. The Statement of Purpose was viewed and it was noted that since the last inspection it had been updated to reflect the current provider and management details of the home. The document also included information such as admission and assessment, how peoples needs were met, the service and facilities that were provided at the home, consultation with people, fire safety, the complaints procedure and the contact details of the homes head office and the Health Service Ombudsman. Care Homes for Older People Page 11 of 32 Evidence: The contact details of the previous inspection commission was included and this needed to be updating to show the CQC (Care Quality Commission) details, should people wish to contact us. The Service Users Guide was viewed, this had also been updated to show the current management and provider details of the home. The document included details of the service and facilities that were provided at the home, staff training, the structure of the organisation, details of the environment, the service user charter, which detailed how peoples rights and choices were respected, a satisfaction survey and the complaints procedure, which included the contact details of the homes head office, Health Service Ombudsmen and CQC. The CQC had recently changed its contact details and the Service Users Guide needed to be updated to reflect this. The AQAA stated that they ensure that a Service Users Guide is available to all prospective new service users. The service user survey asked if they had been provided with enough information about the home before they moved in so that they could decide if it was the right place for them. Seven answered yes, one answered no and one stated my (relative) did all the arranging for me as I was living in (area). Since the last key inspection people were provided with an updated written contract and terms and conditions of living at the home, which included the details of the current providers. The service user survey asked if they were provided with a contract. Eight answered yes and one answered no and stated ask (name). The care records of three people that lived at the home were viewed and each held a needs assessment which had been undertaken prior to them moving in. The assessments included details of the persons needs, abilities and well being. The AQAA stated we spend a great deal of time with prospective service users, at their homes or visiting them in hospital. Helping families feel at ease with their questions and offering advice where required and we fill in our pre-assessment forms and discuss with senior staff. We discuss with them all the things our home offers and offer continuous support to family and friends of all service users. A health professional survey said that the assessment arrangements usually ensured that accurate information was gathered and that the right service was planned for people. Care Homes for Older People Page 12 of 32 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 use this service can expect that their individual care plan shows how their health, personal and social needs are met, to be treated with respect and to be protected by the homes medication procedures. Evidence: A recommendation from the last key inspection was that peoples specific needs should be identified in their care plans. During this key inspection the manager told us that they were in the process of updating the care plans which were in line with the organisations paperwork and identified the specific support that people were provided with to meet their assessed needs. The AQAA stated that they had improved in the last twelve months by introduced a comprehensive new care plan and assessment system. The care plans of three people that lived at the home were viewed. Two of the care plans that were viewed detailed the support that people needed to meet their assessed needs on a daily basis and a twenty four hour care routine. However, it was noted that Care Homes for Older People Page 13 of 32 Evidence: the care plans were in a multiple choice format, which did not identify how people had been consulted with about the support that they were provided with and their preferences were not included. However, the previous care plans were present and they included peoples individual preferences. One of the care plans that were viewed was in the previous format and had not yet been updated. The manager was spoken with and agreed that they would consider how they would further improve the care plans to include peoples wishes, choices and views and they told us that the care plans would continue to be improved. The manager showed us the minutes from a recent care review for a person, which had included the attendance of the person and their relatives. The manager told us that the reviews would be held on a six monthly basis and that their views would be incorporated into the care plans. The care records were further improved by the inclusion of detailed risk assessments regarding issues such as nutrition, falls, manual handling and pressure areas. The risk assessments identified how the assessed risks were minimised, which ensured that people were safeguarded. Daily records were viewed and they detailed the support that people had been provided with, their well being and the choices that they had made, for example if they had chosen to participate in activities. The service user survey asked if they were provided with the care and support that they needed. Two answered always and seven answered usually. People that lived at the home told us that their needs were met and that they were looked after well at the home, this was confirmed by peoples relatives that were spoken with. The staff survey asked if they were provided with up to date information about the needs of the people that lived at the home. Three answered always, one answered usually and one stated Im a (their role) so most of the questions I feel do not apply to me. Im happy in my job but wouldnt have a problem to speak to my manager if i did have concerns regarding anything about the home, residents or my job. Five staff surveys said that the ways that they passed on information about the people who lived at the home usually worked well. The records detailed the health care that people needed and received, which included the outcomes of health care appointments that they had been provided with. During the inspection we observed health professionals, including a district nurse and physiotherapist who had visited people that lived at the home in the privacy of their bedrooms. The staff at the home were observed to discuss the outcomes of the visits with the health professionals. People that were spoken with told us that a doctor would always be called if they felt unwell. The service user survey asked if they were Care Homes for Older People Page 14 of 32 Evidence: provided with the medical support that they needed. Five answered always and four answered usually. The AQAA stated all service users are assessed and reviewed every six months by our local doctors who visit the home for the day, opticians are arranged every six months. Chiropodist every four weeks, hairdresser weekly and any other services required. We also offer exercise classes for all abilities and incontinence nurse reviews on a regular basis. District Nurses visit when required. MUST (malnutrition universal screening tool)team referrals when necessary. A health professional survey said that peoples social and health care needs were usually monitored, reviewed and met and that the service usually sought advice and acted upon it to meet peoples social and health care needs. The medication procedures were viewed and they detailed how people were safeguarded by the safe handling, administration and storage of medication. Monthly medication audit records were viewed, which showed that the medication processes, including recording, was regularly monitored and issues were identified and addressed promptly. The medication of people that chose to self medicate was monitored during the monthly audits, which ensured that people were safeguarded and checks were made which ensured that they were taking their prescribed medication appropriately. Peoples medication was stored in MDS (monitored dosage system) blister packs in a secured cabinet which was attached to a wall in their bedroom for the morning and evening medication. The lunch time and afternoon medication was stored in the homes secure medication room. The manager told us that the medication was stored in the different places due to the location of people during the day, for example they used the communal areas during the day and that they were in their bedrooms at the times of the morning and evening medication administration times. The controlled medication was stored in a secure metal cabinet which was attached to the wall in the medication room. We spoke with the manager about the current legislation regarding the storage of controlled medication and whilst the storage appeared to be appropriate the manager agreed that they would check that the storage arrangements met with the legislation. The records for the administration of controlled medication was viewed and it was noted that they were maintained in a bound book, a running total of the medication was recorded and there were the signatures of two staff members to show when the medication had been administered. The MAR (medication administration records) charts of three people were viewed and each showed when medication had been administered and the appropriate codes were used when medication had not been administered, for example if the person had Care Homes for Older People Page 15 of 32 Evidence: refused to take their medication. It was noted that the medication was accounted for. The AQAA stated our pharmacist also reviews service users medication every six months by visiting the home and well trained staff in administrating medications. Offering service users the choice to self medicate and supporting them in their decision. The AQAA said that they had improved in the last twelve months by senior night care staff now trained in administration of medications, allowing service users to take night medication as prescribed. Health care assistants now trained to apply medical creams/gels to enable these members of staff to play a larger part in the service users welfare. Staff training records that were viewed confirmed that staff that were responsible for administration of medication were trained to do so. People that lived at the home that were spoken with told us that their privacy was respected and that staff always knocked on their bedroom doors before they entered, which was confirmed with observations of staff during the day of the inspection. There was one bedroom at the home which was shared by people and it was noted that there was a screen which ensured that peoples privacy was respected. People told us that the staff treated them with respect. The interaction between staff and people that lived at the home and visitors was observed to be respectful, friendly and professional. We observed lots of light hearted banter between people and staff. It was noted that people were clean and tidy, which showed that their dignity was respected. Staff were observed to provide people with their unopened mail when it had arrived at the home. The AQAA stated we maintain service users dignity, independence and privacy. A health professional survey said that peoples privacy and dignity was always respected. Since the last key inspection a small lounge, which had previously been used as a dining room for people that lived in the bungalows had been refurbished and was available for people to entertain their visitors in. The manager showed us baskets in the laundry, which had been purchased, which were to be provided with labels with peoples names to ensure that their clean laundry was returned to the people that it belonged to. Care Homes for Older People Page 16 of 32 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 who use this service can expect to be provided with the opportunity to participate in activities which meet with their interests, to be supported to maintain their chosen contacts and to be provided with a nutritious and balanced diet. Evidence: People were provided with a good range of activities, which they could choose to participate. The activities programme for July 2009 was viewed and it was noted that there were activities provided on a daily basis, which included reminiscence activities, quizzes, games, Holy Communion, slide shows and arts and crafts. The minutes from a recent resident meeting were viewed, people were asked for their suggestions about activities and people were advised that the home had purchased a Wii games console, a computer with internet access and a mini bus, all for the use of people that lived at the home. The computer was in the small lounge for the use of people that lived at the home. A notice was posted on the notice board in the home inviting people to the setting up of the Wii games console and that it could be used to improve movement. We talked to people that lived at the home about the Wii and they found it quite amusing that they were going to be playing on a games console and they said that they were interested to see what it was all about. People told us that they had been Care Homes for Older People Page 17 of 32 Evidence: out in the mini bus for a drive and to buy an ice cream, which they said that they had enjoyed. During the inspection a staff member was observed to plan future outings in the mini bus with several people who lived at the home. The service user survey asked if there were activities at the home which they could take part in. Three answered always, one answered usually, four answered sometimes and one did not answer. People that were spoken with told us that there was always something to keep them occupied in the home and they proudly showed us the very attractive art work, such as coastal paintings and painted butterflies, that were displayed in the lounge and dining area of the home. They told us that a person came to the home twice a week to take the art classes. A person told us that they particularly enjoyed the art classes and the exercise classes. People told us that they had their chosen newspapers delivered to home and people were observed to read their newspapers and offer them to other people in the home when they had finished with them. During the morning of the inspection people were observed to be enjoying a quiz with a visiting activities co-ordinator. People were also observed to listen to music, read books and chat with staff and each other. The AQAA stated that they provided bingo, quoits, reminiscence therapy, giant snakes and ladders, slide shows, comedy, music, singing, manicures, hairdressing, chiropodist, residents shop, art classes and exercise classes. Encourage family/advocates to join in. Other activities suggested to suit all capabilities. Risk assessments had been developed, which identified risks in the planned activities and methods of minimising the risks. The assessments included visits to local areas and the in house activities, which showed that people were safeguarded. The manager showed us a safety pack which they had received from a local zoo, which people had recently visited. The manager was spoken with and agreed that they would consider methods of recording who had participated in activities, which would identify people who regularly did not participate and how they could engage them in activities of their choice. After lunch the home was very busy with several visitors arriving at the home to visit their friends and relatives. It was noted that all people were welcomed into the home and staff were observed to inform them of their relatives well being. Visitors that were spoken with told us that they were always made welcome in the home. Since the last inspection, a small lounge which had previously been used a dining room had been refurbished and was used by people who wished to entertain their visitors in a quiet area other than their bedroom, which offered people increased choices of the areas of the home that they used. During the inspection people were observed to entertain Care Homes for Older People Page 18 of 32 Evidence: their visitors in their bedrooms, in the small lounge and in the communal areas of the home. There was also a large garden, with new garden furniture and a summer house, which they could use if they chose to. The records of three people were viewed and they identified the contacts that they chose to maintain with their family and friends. During the inspection people were observed to be provided with a choice of hot drinks throughout the day and there were jugs of cold drinks in the lounge that people could help themselves to. In the lounge there was also a large bowl of cherries that people could help themselves to. The homes menu was viewed and it was noted that people were provided with a choice of meal and a balanced and varied diet. There were two choices for each meal and the manager told us that if people wanted an alternative this would be provided. People that were spoken with confirmed this. They also told us that the food at the home was very good and they particularly enjoyed the fish and chips that were provided on Friday. The service user survey asked if they liked the meals at the home. Two answered always, five answered usually and two answered sometimes. During the inspection, which was a Friday, people were observed to enjoy their meal of fish and chips and a choice of brown or white bread and butter. It was noted that there was not much food left on the plates when people had finished eating. The meal looked and smelled appetising. We observed a staff member speaking with a person about the choice of a salad that they had made and if they wanted it at lunch time or for their evening meal. We observed the staff ask people what they wanted to eat for their evening meal, which was a choice of sandwiches or poached egg on toast. The AQAA stated we offer a well balanced, varied, nutritious menu, catering for all diets including diabetics as required. Our fresh produce is sourced locally and seasonal. All service users choices are met where possible. Kitchen assistants complete menu choices daily and service users are offered a second option. All meals are freshly prepared and cooked. Care Homes for Older People Page 19 of 32 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 use the service can expect to be protected from abuse and to have their complaints listened to and acted upon. Evidence: The homes complaints procedure was viewed and detailed the actions that would be taken on receipt of a complaint. The complaints procedure was summarised in the Statement of Purpose, which was provided to people with an interest in moving into the home, and in the Service Users Guide, which was provided to people who lived at the home. People that lived at the home who were spoken with told us that they knew how to make a complaints about the service that they were provided with. Nine service user surveys said that they knew who to speak to informally if they were not happy and eight surveys said that they knew how to make a complaint. Five staff surveys said that they knew what to do if a person wished to make a complaint about the service. A health professional survey said that concerns had been usually responded to appropriately. The AQAA stated that people were informed of the complaints procedure by display complaints procedure/policy in a prominent place, copy of complaints procedure/policy is part of the Service Users Guide given to all service users on admission or on request, service users questionnaires also state our complaints procedure. Care Homes for Older People Page 20 of 32 Evidence: Several thank you cards and letters were viewed, which thanked the staff at the home for the support that they had provided to people. The complaints book was viewed and there had been no complaints made since the last key inspection. However, a recent whistleblowing incident had resulted in the prompt actions taken by the providers, which included notifying us and the local authority safeguarding team and they had taken appropriate actions to ensure that people were safeguarded. The staff team had recently been provided with safeguarding training. Staff that were spoken with told us that they had not previously been provided with formal safeguarding training and that they were aware of actions that they should take should they have concerns about a persons well being. The staff training records that were viewed confirmed that the staff had been provided with the training. The safeguarding procedure had recently been updated and it clearly identified the actions that should be taken if the staff at the home had concerns that a person was being abused. However, the procedure stated that a safeguarding alert should be made to the Welsh safeguarding team, the providers to the home were based in Wales. This was pointed out to the manager and they agreed that the procedure would be amended immediately. However, the local authority safeguarding guidelines for Suffolk were available in the office for staff information, which identified how an alert should be made to the Suffolk safeguarding team. Care Homes for Older People Page 21 of 32 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 who use this service can expect to be provided with a clean, homely and comfortable place to live in. Evidence: A tour of the building was undertaken during the inspection and it was noted that the home was clean throughout and there were no offensive odours, which provided people with a pleasant environment to live in. The AQAA stated that they provided a clean, tidy, safe and odour free environment and home is always full of fresh flowers and is homely and welcoming. Peoples bedrooms which were viewed were clean, tidy and personalised with items of memorabilia, which reflected their choice and individuality. There was one bedroom which was shared by two people who were related to each other and it was noted that there was a screen provided to ensure that their privacy was respected. The AQAA stated that they undertook checks on rooms, service users bathrooms and living areas twice a day by senior health care assistants. The manager told us that they had advertised a job for a painter and decorator in the local job centre and that when the post was filled the home would be redecorated. Care Homes for Older People Page 22 of 32 Evidence: The communal areas in the home consisted of a lounge where people could use the computer, watch television or entertain their visitors, a larger lounge/dining area, which was light and comfortable, a small quiet area where people could read and a large garden, which provided a summer house, benches and newly purchased garden furniture. It was noted that there were fresh flowers in all the communal areas of the home. People were observed to use all communal areas during the inspection and they told us that they chose where they wanted to sit in the home and that they could wander around the gardens if they wished to. People told us that they were happy with the environment and that it was always clean and fresh. The laundry was viewed and we were told by the manager that new washing and drying machines had recently been installed, for which the staff had been provided with training to ensure that they were used safely. The manager pointed out the clean and dirty areas of the laundry and explained the methods for minimising cross infection. The manager showed us baskets which they had recently purchased and explained that they were have labels of the names of individuals living at the home which would ensure that they were provided with their own laundry. The laundry, toilets and bathrooms provided hand wash liquid and disposable paper towels which minimised the risks of cross infection. Staff were observed to demonstrate good infection control procedures, which included wearing gloves and protective clothing when working with food. The AQAA stated we have achieved a four star rating from Environment Health for our kitchen department, which shows that the kitchen area was hygienic and well maintained. Care Homes for Older People Page 23 of 32 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 use this service can expect to be supported by staff that are trained to meet their needs and to be protected by the homes recruitment procedures. Evidence: During the inspection we observed the interaction between staff and people who lived at the home to be friendly, caring, respectful and professional. The staff were attentive to the needs of people and it was noted that there were staff members available to attend to peoples requests throughout the inspection. People that lived at the home and visitors who were spoken with were complimentary about the staff team. The service user survey asked if there were staff available when they needed them, two answered always and seven answered usually. The staff survey asked if there were enough staff to meet peoples needs, one answered always, three answered usually and one answered sometimes. The manager told us that the home was fully staffed and that they had a waiting list for people who wished to work at the home. They explained that they employed a handy man and that they were hoping to employ a painter and decorator to redecorate the home. The manager told us that there were four staff members that worked on the morning and afternoon shifts and two waking night staff during the night. The staff rota was viewed and observations of the staff working at the time of the inspection the Care Homes for Older People Page 24 of 32 Evidence: home confirmed this. The AQAA stated that they provide the appropriate number of staff each day on rota, to meet service users needs, encourage all staff to work as a team but also on their own initiative, all staff are very happy and committed to the job in hand and will always go the extra mile for the service users, we are always aware how to keep a happy balance of staff remembering to pull on individual skills and encouraging them to work as a team and exchange their knowledge and skills. Never had to use Agency Care Staff enabling us to maintain continuity of care. The home had almost met the target of 50 of staff to have achieved a minimum of NVQ (National Vocational Qualification) level 2 as identified in the National Minimum Standards relating to older people. The AQAA stated that there were fifteen care staff that worked at the home and six had achieved an NVQ qualification in care. The manager told us that four newly employed staff had recently completed their induction and were due to commence their NVQ awards and that the cooks and domestic staff in the home had recently registered for an NVQ award which was relevant to their roles. The manager told us that they had obtained the service of a local training provider, who could provide the mandatory training to the staff in the home and they said that the quality of the training was good. Staff that were spoken with told us that the training at the home had improved and that they had recently been provided with training on safeguarding, manual handling and health and safety. The staff that were spoken with had a clear understanding of their roles and responsibilities. The staff survey asked if their induction covered everything that they needed to know to do the job, one answered very well, two answered mostly, one answered partly and one stated I started (X) years ago so my answer is based on that. Four staff surveys said that they had been provided with training which was relevant to their role, gave them enough knowledge about health care and medication, that helped them to meet peoples individual needs and that introduced them to new ways of working and one said that the question was not applicable due to them not being a member of care staff. The training records of three staff members were viewed, which included training certificates and lists of training that individual staff had undertaken, which included a Common Induction Standards induction course, safeguarding, manual handling, infection control, medication, food safety and food hygiene. The recruitment of three recently employed staff members were viewed and they showed that the appropriate checks had been made to ensure that people were Care Homes for Older People Page 25 of 32 Evidence: safeguarded. The records held two written references, their work history, identification, CRB (Criminal Records Bureau) checks and POVAfirst (protection of vulnerable adults) checks. Five staff surveys said that the checks such as CRBs and references were undertaken before they started work. Care Homes for Older People Page 26 of 32 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 who use this service can expect to live in a home which is managed in their best interests and to have their health, safety and welfare promoted and protected. Evidence: The Registered Manager had ceased working at the home since the last key inspection. The current manager was undergoing the CQC Registered Manager application process and they were due to attend their fit person interview the week following this key inspection. The manager had several years experience of working at the home, had achieved an NVQ level 4 in care, were due to commence their LMA (Leadership and Management Award) and they had attended several training courses such as safeguarding, health and safety, medication and manual handling. However, they told us that they had not yet attended training on the Mental Capacity Act and Deprivation of Liberty, which they said that they would. They told us that they were aware of the Act and that it had been discussed in a recent safeguarding training course which they had attended. Care Homes for Older People Page 27 of 32 Evidence: The manager was receptive to the inspection process and responded to our requests promptly. The requirements made in the previous key inspection had been met and the AQAA stated manager and administrator have both attended training sessions held at Head Office. Manager will continue to do so. Administrator has updated all paperwork pertaining to service users contracts, contracts of employment etc. The manager had a good understanding of their role and responsibilities in the management of the home and ensuring that people that lived there were provided with good quality outcomes. The manager told us that they had recently attended management training at the organisation head office and that they had been provided with a mentor to ensure that they were supported in their role. Staff and people that lived at the home were very complimentary about the management style of the manager and we observed a card from the people that lived at the home congratulating them on their job. The AQAA stated communication at all levels to a very high standard with service users, advocates and staff. Everyone working part of a team. Adapted a more honest and open approach to management, allowing the home to run smoothly with a relaxed atmosphere, where service users and staff feel able to put forward suggestions or concerns, however small. A requirement made in the previous key inspection was that Regulation 26 visits be undertaken on a monthly basis. During this inspection the visit reports were not available for inspection, however, they were forwarded to us on the next working day and the Responsible Individual assured us that copies had been sent to the home. The Regulation 26 visit reports which were viewed and showed that people that lived at the home and staff were provided with the opportunity to express their views about the home and the reports showed that the running of the home and the records that were maintained were regularly monitored. People were further provided with the opportunity to express their views about the home in house meetings, review meetings and satisfaction questionnaires. The results of satisfaction questionnaires were viewed and the manager told us that people had been written to and where issues had been identified they were addressed. The minutes from a recent house meeting were viewed and it was noted that representatives from the organisation had attended and informed people about changes that had occurred in the home, plans for the future and they were provided with the opportunity to make suggestions about the running of the home. The financial records of two people were viewed and it was noted that their transactions were clearly documented. The manager told us that people and/or their representatives were billed for spending in the home, such as using the hairdresser Care Homes for Older People Page 28 of 32 Evidence: and delivered newspapers, which reduced the need for storing money in the home. Peoples health, safety and welfare was promoted and protected. There was a fire risk assessment in the home and the fire safety records were viewed and showed that fire safety checks were regularly undertaken which ensured that people were safeguarded. Records of regular water temperature checks and records of electrical appliance checks were viewed. Risk assessments were in place which showed that possible risks in the environment and in activities both inside and outside the home were assessed and the methods of minimising the risk were clearly identified. However, it was noted that there was a step down into a toilet on the ground floor, which we identified may be a risk to people and the manager told us that they would ensure that a risk assessment would be completed. Staff were informed about their responsibilities in health and safety procedures and attendance on training courses such as safeguarding, manual handling, infection control, food hygiene and fire safety. The AQAA stated that they ensure health & safety of service users, staff and visitors to the home. Take pride in our home and continue to look for ways to improve the service users quality of life. Care Homes for Older People Page 29 of 32 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 32 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 31 It is recommended that the manager access training on the Mental Capacity Act and Deprivation of Liberty, which informs them of how they impact on the service provided to people and how they can be incorporated into the service provision. It is recommended that a risk assessment be completed about how risks can be minimised when entering the toilet under the stairs on the ground floor. 2 38 Care Homes for Older People Page 31 of 32 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. 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