Care Home: The Lindens

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well People using this service are assessed prior to admission and are given the opportunity to visit the home beforehand to ensure it meets their needs. The health and personal care needs of people living in the home are being met. promoting health and well-being and taking into account their preferences and individual requirements. A varied range of activities are available to people using the service to provide stimulation and meet different interests and preferences. The home supports residents to maintain contact with family and friends. The home provides food which meets the nutritional needs and preferences of people living there. The home provides sufficient staff to meet the current care needs of people living there. What has improved since the last inspection? A number of improvements have been made to the environment including repairs to the roof, the installation of new equipment in the kitchen, steam cleaning all carpets, and redecoration of some bedrooms and WCs. A new system of assessment and care planning has been introduced. The home has reviewed its security procedures, both within the building and in the grounds. The home is developing its links with a `cluster group` of other care homes in the area. In particular it is exploring ideas for developing a wider range of activities for people living in the home. The home continues to support staff to complete training towards the attainment of NVQ level 3 in care. What the care home could do better: The registered persons must address weaknesses in staff recruitment and ensure that all aspects of the process conforms to the Regulations and guidance from the Department of Health. The organisation of information in the office should be improved to ensure that records are maintained in good order and that key information is readily accessible to authorised staff when required. All aspects of care planning and care delivery should be integrated and records must reflect the current needs of residents and support good practice in the provision of care.Managers must ensure that good standards of hygiene are maintained in the environment at all times. Records of fire drills must be maintained and be accessible to authorised staff when required. Key inspection report Care homes for older people Name: Address: The Lindens The Lindens Stoke Hammond Buckinghamshire MK17 9BH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mike Murphy     Date: 2 3 1 0 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 30 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 30 Information about the care home Name of care home: Address: The Lindens The Lindens Stoke Hammond Buckinghamshire MK17 9BH 01908371705 01908375075 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Michael Hannelly care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 17. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE). Date of last inspection Brief description of the care home The Lindens is a privately owned care home and is registered to provide residential and personal care for up to 17 older people. The home is situated in a rural area on the outskirts of the village of Stoke Hammond and is within easy distance of Bletchley and Milton Keynes. The home is a large detached Edwardian house set in accessible, extensive grounds. The house has been subject to a programme of refurbishment to comply with the current standards. All rooms are single and have en suite shower and toilets. Additional assisted bathrooms and toilets are provided. There are two goodCare Homes for Older People Page 4 of 30 Over 65 0 17 17 0 1 9 1 1 2 0 0 8 Brief description of the care home sized social areas for service users on the ground floor. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We carried out this inspection in October 2009. The inspection included an unannounced visit to the home on Friday 23 October 2009. The inspection included examination of care plans and other documents relating to the care of people living in the home (residents), discussion with residents, staff and visitors, observation of practice, inspection of some areas of the home, discussion with with one of the owners of the home, and consideration of information submitted in advance of the inspection by the owners. We carried out a survey prior to our visit and the results have been taken into account in this report. We received completed survey forms from staff and residents. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The registered persons must address weaknesses in staff recruitment and ensure that all aspects of the process conforms to the Regulations and guidance from the Department of Health. The organisation of information in the office should be improved to ensure that records are maintained in good order and that key information is readily accessible to authorised staff when required. All aspects of care planning and care delivery should be integrated and records must reflect the current needs of residents and support good practice in the provision of care. Care Homes for Older People Page 7 of 30 Managers must ensure that good standards of hygiene are maintained in the environment at all times. Records of fire drills must be maintained and be accessible to authorised staff when required. 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 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering using this service are provided with information to assist their decision, their needs are assessed by experienced staff to ensure the home can meet those needs, and they have an opportunity to visit the home before making a decision. Evidence: People enquiring about the home and its facilities are provided with information in the form of a brochure. Some information is also available through the homes website. Prospective users of the service and members of their family may also visit the home to view its facilities and talk to staff. Where the enquiry move forward to consideration for admission arrangements are made for an assessment by the manager to be carried out. This is carried out at the persons current place of residence - own home, hospital or another home. The process is structured by the assessment form. In the case of referrals received Care Homes for Older People Page 10 of 30 Evidence: through Buckinghamshire County Council a client assessment report is faxed to the home by the referring care manager. The information acquired during assessment is considered by the manager and proprietor. If it is considered that the home can meet the persons needs then a place is offered. On admission additional relevant information is sought from the persons general practitioner (GP). The home also begins to draw up a care plan for the person. The notes of one person assessed around the time of this inspection were seen during our visit and provided evidence of an assessment of needs prior to admission. Two resident respondents to the survey carried out in connection with this inspection reported that they had received sufficient information prior to moving in to the home. This helped them to decide if it was the right place for them. A health or social care professional reported that the homes arrangements always ensure that accurate information is gathered at assessment. The home does not offer intermediate care therefore standard 6 does not apply. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has systems in place for assessing and meeting the needs of people living there and for the control and administration of medicines. There is a need however, to ensure that the system of care planning which has been introduced since the last inspection reflects the current needs of residents. The registered persons also need to address weaknesses in the control and administration of medicines. Evidence: A plan of care was in place for each person living in the home. Since the last inspection the home had introduced a new system of care planning. This is a commercial system comprised of a booklet for each person covering the care process, from assessment of needs, a range of risk assessments, a care plan to meet identified needs, monthly reviews, and details of contacts with healthcare professionals and organisations. Each booklet includes personal details of the resident, a photograph, health and social care contacts, a brief life history, social and leisure interests, a range of risk assessments (including mental health, physical health, moving and handling, falls, Care Homes for Older People Page 12 of 30 Evidence: behaviour, pressure sore, and nutrition), weight, a care plan and care plan reviews. The booklet also includes a list of medication (which should not be relied on for current treatment). Each section includes a rating scale which enables staff to rate dependency levels. The needs of residents are recorded under such headings as; personal care, diet and weight, sight, hearing and communication, oral health, foot care, mobility, falls, continence, mental state, social interests, and, personal safety. The system provides a very good structure for care planning. It is comprehensive in scope, reasonably detailed and provides a good basis for providing care to meet the needs of residents. Staff expressed satisfaction with the system. However, at the time of this inspection, it did feel as if staff were still getting used to working with it. Four care plans were examined on the afternoon of the inspection visit. Each had been well completed and included comprehensive information on each person. The care plan would generally support the provision of care appropriate to the needs of each person. At the same time however, it is felt that the structure may need adaptation to meet the current needs of residents. This was noted for example in relation to distress and agitation and falls. In the case of one person it had been decided that a degree of separation from others for a period of time would ease the distress, anxiety and agitation which the person was expressing. The dependency assessment in the care plan did not appear to support such action. In another case the falls risk assessment did not match recent history where, when we reviewed accident records, the person was noted to experience a relatively high number of falls (all were properly managed and the home was in contact with the local NHS falls team). In discussion it was suggested that this was due to the fact that the risk assessment in the care plan had not yet been reviewed and updated. This normally occurs monthly. We conclude that in most cases a monthly review in a home such as this may be reasonable. In some cases however there will be a need for more frequent reviews. There is a risk that the care plan structure, in terms of frequency of review, may not match that required to meet individual circumstances. This could pose a risk to the well-being of some residents. While the new care plans have many positive features, the home needs to ensure that, where required, it can be adapted to the meet the current needs of the people living there. Daily notes are maintained on each resident These include records of care activities Care Homes for Older People Page 13 of 30 Evidence: carried out by staff and other care related information. A separate night report is maintained, these too include records of care activity and of two hourly checks during the night. All people living in the home are registered with a GP practice. This provides access to other NHS services, in particular district nurses. On the day of the inspection visit a specialist nurse in chronic obstructive pulmonary disease (COPD) was visiting. Medicines are prescribed by the residents GP and dispensed by Lloyds pharmacy in Milton Keynes. The training programme includes training in the administration of medicines. Arrangements for storage of medicines are satisfactory - a lockable metal cupboard in the office and a small medicines refrigerator. Most medicines are dispensed in the Lloyds monitored dosage system (dosset boxes), each covering a weeks supply. Reference texts available to staff included a British National Formularly (BNF) 2007 and more general textbooks dated 2001 and 1997. These older textbooks are now out of date and should be replaced by more up to date texts. The home did have a downloaded copy of the Royal Pharmaceutical Society of Great Britain guidelines on The Handling of Medicines in Social Care (2007). The homes arrangements had been audited by Lloyds pharmacy in July 2009. The report of the last inspection carried out in November 2008 included a number of observations on medicines administration records and three requirements on this subject. The requirements had been addressed but this inspection also noted some irregularities which need attention. In one case Promazine was being administered on an as required (PRN) basis but the medicines administration record (MAR sheet) and medicine container did not include this as required option. The member of staff present during the inspection gave very good reasons for the as required requirement but was unable to explain why the MAR sheet had not been adjusted. A few days later we discussed this matter with the manager who was on leave at the time of our visit. The manager said that a letter from the persons GP authorising the as required administration had been filed in the medicines folder. It was not visible during our inspection and the MAR chart had not been adjusted in line with the contents of the letter. A MAR sheet entry for Paracetamol did not include the as required option but the medicines container did. One person had been prescribed eye ointment but this had not been transcribed on to the handwritten October 2009 MAR sheet. One MAR sheet included a handwritten reference to two months administration of medicines on a one month chart. Many MAR sheets which were no longer in use were still in the current folder although the home did have arrangements in place for archiving sheets no Care Homes for Older People Page 14 of 30 Evidence: longer in current use. The home needs to carry out a thorough review of its arrangements for the control and administration of medicines. This must include a review of its policy and procedures. It should take account of current good practice guidance (including that published by the Royal Pharmaceutical Society and our guidance (downloadable from our website)), and include external advice as required. Arrangements for ensuring the privacy and dignity of people living in the home are good. The home has a comfortable ambience and residents and staff seemed at each with each other. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a varied range of activities for residents and provides support to people in maintaining contact with families and friends. Evidence: In their pre-inspection papers the proprietors say that their mission is that The staff will help you (the resident) to live your life as you wish - this is your home - there are no unnecessary restrictions. Residents were satisfied with the pace of life and range of activities in the home. One person made a highly favourable comparison with the ethos of The Lindens with one she had stayed in elsewhere. The resident told us that the ethos at The Lindens was more caring and that staff were more attentive. All resident respondents to our survey seleected Yes in answer to the question Can you do what you want (During the day/In the evening/At the weekend). All resident respondents answered Yes in answer to the question Do the care staff and managers treat you well. Residents are supported in maintaining contact with their families. Those who wish to Care Homes for Older People Page 16 of 30 Evidence: are supported in following their religion. Communion is offered by representatives of a local church twice a month. One member of staff who works on Saturdays and has a lead role as an Activities Coordinator - among other duties. This includes holding discussion groups, music and singing sessions, and organising concerts at certain times of the year. A professional musician organises sing-a-longs twice a month. Activities are discussed at the monthly house meeting which is also facilitated by the Activities Co-ordinator. Occasional outings are also arranged. On the day of our visit a DVD was shown in the afternoon and a game of Connect 4 was organised. Residents read, watched TV, listened to music, or just observed life in the home or in the gardens. Photographs of special themed events were on display around the home. These included celebrating in food, costume and decor the national days of Scotland (in November), of Ireland (in March) and of England (in April) and an Easter Bonnet event. At the time of this inspection the home was planning celebrations for Halloween. The home supports a local hospice and a held a successful fund raising tea party for residents and relatives held earlier in the year. We discussed the psychological and social care of residents who were unable to go downstairs and be with others. Staff assured us that this is a rare occurrence and that both staff and residents drop by to have a chat with the person in their room. We discussed this matter in the context of a single individual and were assured that staff would endeavour to ensure that no resident would be left without contact with others. The home is part of a cluster of other care homes locally. Managers of the homes meet quarterly and exchange ideas on activities and other initiatives which have been found beneficial to residents. Meals are prepared in the kitchen. The home employs two part-time cooks. Breakfast is prepared by care staff and consists of cereals, fruit juice, toast and hot drinks. Lunch is the main meal of the day and is served around noon. It is a three course meal consisting of soup, a main course with vegetables, followed by a dessert. Afternoon tea is served at 3:00 pm served with biscuits and cakes. High Tea, served at around five pm consists of a savoury cooked dish, sandwiches, cakes or other sweet snack. Alternatives to planned dishes are prepared individually. The proprietor informed us that Supper is served between 7:00 pm and 8:00 pm and is a personal Care Homes for Older People Page 17 of 30 Evidence: choice. Menus are planned on a four week rotating basis. A fish based dish or quiche is served on Fridays and a roast meat based dish at Sunday lunchtimes. Residents were complimentary about the quality of the food served in the home. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has suitable arrangements in place for responding to complaints by people living there and to ensure that appropriate procedures are followed with regard to safeguarding vulnerable adults. Evidence: A copy of the homes complaints procedures was on display on a notice board on the wall and in the Inspection Folder. Each resident is also provided with a copy. No complaints have been recorded since the last inspection. The owner said that it is the homes policy to deal with matters as they arise. It is noted that the home had received two letters of compliment over the same period. We had received one complaint about this home since the last inspection. The home had provided its account of events. The background to the complaint was discussed with the owner during the course of our visit. This matter is now closed. The home had a copy of the current Buckinghamshire Joint Agency policy on Safeguarding Vulnerable Adults. The home also has its own policy and procedure on this subject. This was last revised in 2009. All care staff had received training on the subject of safeguarding in the two weeks prior to our inspection visit. No safeguarding referrals had been made since the last inspection. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a pleasant and generally well maintained and clean environment for people living there. An ongoing programme of building maintenance aims to ensure that good standards are maintained. Evidence: The home is situated in a semi-rural location about half a mile from the village of Stoke Hammond. The home is set in extensive grounds at the end of a private drive. The Grand Union Canal forms the rear boundary of the property. The house is a three storey, late 19th century property, which has been adapted for its current use. There are pleasant views over open countryside from many parts of the home. There is a large car park and drop off point to the front of the building. The car park has been extended since the last inspection. Steps and a wheelchair ramp lead to the front porch. Steps from the house lead to the garden which is at different levels. The accommodation is situated over three floors with stairs and stair lift access to all levels. The entrance hall leads to a large lounge, dining room, ground floor wc, office, staff administration area, kitchen, laundry and bedrooms. The upper floor accommodation comprises bedrooms and bathrooms. All bedroms are single occupancy and have en suite facilities. The bedrooms seen Care Homes for Older People Page 20 of 30 Evidence: during our visit varied in size. Bedrooms were comfortably furnished and had been personalised in accordance with the wishes of the resident. Since the last inspection new car parking spaces have been added, new carpets have been laid in three bedrooms, and a programme of general maintenance has been maintained. The overall standard of acommodation is good. The home was awarded three stars by the local environmental health department in December 2008. On the day of this inspection the stair lift was out of order for a few hours causing inconvenience to some residents and staff. The staff worked energetically to got a contractor to attend urgently and when their regular contractor was unable to attend for a few days an alternative was found. The stair lift was working again by midafternoon. A bathroom on the top floor was out of order due to water leaking but was scheduled for repair over the following week. The kitchen was in good order when inspected during our visit. Standards of hygiene were generally good. The domestic assistant was on leave at the time of the inspection. Most areas of the home visited were tidy, clean and in good order on the day we visited. One cleaning detail in a ground floor wc was brought to the attention of the proprietor towards the end of our visit. The outcomes of the previous inspection included a requirement that risk assessments be put in place for the use of portable electric heaters in bedrooms. The home has acted on this and information relating to the use of electric heaters has been placed in each bedroom. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides sufficient staff to meet the needs of people living there. Significant weaknesses in the recruitment of new staff could place users at risk from the appointment of staff unsuited to such work. Evidence: Staffing at the time of this inspection consisted of four care staff between 8:00 am and 1:00 pm, two care staff between 1:00 pm and 3:00 pm, three care staff between 3:00 and 9:00 pm, and two care staff at night. In addition there is a part-time domestic assistant and two cooks (one part-time and one full-time). The manager works flexible hours and on-calls. Two senior care workers maintain the on-call support when the manager is not available. The proprietors son (who is also the Responsible Individual registered with the Commission) is responsible for the maintenance of the home and grounds. A number of staff have been recruited since the last inspection. Four files were selected for examination. One file did not have a recent photograph - as part evidence of proof of identity. Some references were open references (i.e. not specific to this particular home or job) and in one case was dated 2006. In a number of instances the home did not appear to be conforming to its own policy as well as failing to conform to the Regulations governing staff recruitment. The home had appointed more than one member of staff in advance of obtaining a POVA First. Care Homes for Older People Page 22 of 30 Evidence: Staff must be appointed strictly in accordance with the Regulations and guidance from the Department of Health. In two of four cases an Enhanced CRB had been received by the home by the time of our visit. In two cases a POVA First clearance had been obtained and the staff member was working under supervision pending receipt of an Enhanced CRB certificate. The home is registered with Investors in People (IIP). We were informed that its next IIP review is scheduled for 2010. Details of staff training events were on display in the office. Details of the induction process for new staff were not clear. Staff training included safeguarding, manual handling and dementia. The organisation uses an independent training agency for in-house training. It also uses Milton Keynes College, training offered by Buckinghamshire County Council and distance learning. Staff to whom we spoke during our visit told us that they valued the homes approach to training and had found a training session on caring for people with dementia which had taken place since the last inspection to be particularly helpful. Information on staff induction and training needs better organisation. Eight of ten care staff have acquired NVQ qualifications at level 2 and above. This figure does not include nurses qualified overseas, appointed since the last inspection, who had already registered for training at NVQ level 3. Staff spoken to during our visit were happy working at The Lindens. They liked the ethos of the home. They told us that they could get to know residents more in a home of this size. Staff turnover was low and they felt that standards of care were good. They valued the training which the home offered. They acknowledged that there was room for improvement in some aspects of the environment. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall management of the home generally provides a safe and comfortable environment for people living there. The home has a positive ethos aimed at meeting the needs of residents. However, weaknesses in some aspects of administration could compromise standards of care to people living in the home. Evidence: The manager had been in post for approximately 18 months at the time of this inspection. The manager has had many years expererience in care services prior to her appointment. The manager had made an application to the Comission to be the registered manager for this service. This application was being processed by registration at the time of this inspection. The manager is accountable to one of the joint owners who also runs another registered care service elsewhere in Buckinghamshire. The second joint owner is the registered provider for the home. Care Homes for Older People Page 24 of 30 Evidence: Consultation with residents and families occurs at three levels. On a day to day basis through informal encounters around the home. In more structured form through the monthly meetings which are facilitated by a member of staff. The notes of such meetings are written up and displayed on a notice board in the entrance hall. The owner told us that a survey form, designed by Counsel and Care, is circulated to residents, relatives and friends twice a year. A copy of the questionnaire was made available for this inspection. The results of surveys carried out since the last inspection were not available at the time of our visit. The manager was on leave on the day of the unannounced visit. The owner visits the home monthly to carry out formal proprietors visits (Regulation 26 visits). These are recorded in handwriting. The reports for August, September and October 2009 were examined during our visit. The reports were comprehensive, informative and detailed. The home has arrangements in place for looking after small amounts of money on behalf of residents. This may be used for small purchases. The home does not act in any formal capacity on behalf of residents. The arrangements for three residents were examined. The home can provide limited secure storage for small amounts of cash. A pouch is provided for each person. All transactions are recorded and receipts retained. Standards of record keeping were variable. Weaknesses in medicines administration records, in the application of procedures for staff appointments, the results of surveys, and in ensuring that assessments in care plans reflect changes in residents current care needs have been referred to elsewhere in this report. Arrangements for maintaining safe working practices generally appeared satisfactory. Staff training in key subjects is accessed through a range of providers. A fire risk assessment was carried out in April 2008. We were informed that a further fire risk assessment was scheduled for 28 October 2009 - five days after this inspection visit. Fire safety training was scheduled for 18 November 2009 - just under a month after this inspection. The date of the last fire drill was not available. Arrangements are in place for daily checks on fire safety matters (such as clear exit routes) and weekly testing of fire safety equipment. Contracts are in place for the maintenance of fire safety equipment. In December 2009 (within time allowed for comment on the draft report of this inspection) the proprietor informed us that the fire training had taken place as planned on 18 November 2009 and that the home had been inspected by the fire authority at the end of October 2009. No requirements were made as a result of this visit. Care Homes for Older People Page 25 of 30 Evidence: The home does not have any gas appliances. Cooking and heating is provided by electricity and oil respectively. Portable electrical appliances (PAT testing) were checked on 2 October 2009 (report dated 16/10/09). The home was awarded three stars for food safety in December 2008. Arrangements are in place for recording accidents although records could be better organised. The home was in contact with the falls team in relation to falls involving residents. Care Homes for Older People Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered persons must 30/11/2009 ensure that care plans reflect the current assessed needs of people living in the home To ensure that all aspects of care plans are up to date and support staff practice in meetings the needs of people living in the home. 2 9 13 The registered person is 30/11/2009 required to ensure that the homes arrangements for the control and administration of administration of medicines conform to current good practice such as that issued by The Royal Pharmaceutical Society of Great Britain on the handling of medicines in social care. To ensure that medicines are administered in accordance with the Care Homes for Older People Page 28 of 30 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 prescription and in the interests of people living in the home. 3 29 19 The registered persons must 30/11/2009 ensure that staff are not appointed before the outcome of appropriate preemployment checks are received in the home. To ensure that resudents are protected from the appointment of people unsuited to working with vulnerable adults 4 38 23 The registered persons must 30/11/2009 ensure that fire drills are held at intervals advised by the fire authority, that records are maintained, and that such records are accessible to authorised staff when required. To ensure that staff know what action to take in the event of fire to protect people living in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 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. 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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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