Care Home: The Lodge

What the care home does well There was a good admission process. Everyone who completed a survey indicated that they received enough information to help them decide whether The Lodge was the right place for them. The manager carried out an assessment with new people to make sure that staff could understand and meet their needs. There were good relationships between the staff and residents. One resident told us, "The girls are all good, very respectful and sympathetic." Another said, "Staff are friendly and we have a laugh." Residents and relatives were satisfied with the care and support they received. A resident said that, as she had no family, it was nice to know there was someone who cared for her. A relative told us that staff were very good when their relative was ill. The manager made sure that staff had regular training and supervision to help them carry out their roles. Residents we spoke to were happy with their daily lives in the home. One person said, "I have nothing to compare it with but I am quite happy and satisfied with it here." Residents told us that they had choices about their routines, including what time they got up and went to bed. The opportunities for joining group or one to one activities had recently improved. A resident told us "There is something going on most days." There was a varied menu and people could have an alternative meal if they did not like what was on offer. Various residents described the meals as, "reasonable, good or excellent." One said, "There is good choice and variety and it is homemade, no complaints." There were regular health and safety checks in the home. All equipment and appliances in the home were serviced and maintained. This helped to ensure the health and safety of residents and staff. What has improved since the last inspection? There had been improvements to the environment, which increased the residents` comfort. Several areas had been decorated. There were discreet signs around the home to assist people to find their way and there were new signs on bedroom doors. A relative told us that these had been a great help to residents. The manager had taken action to meet the two requirements we made at the last inspection, about lighting and bathing facilities. Staffing levels at weekends had improved. There were always three staff on at weekend, which meant there were enough staff to meet the care needs of the current residents. Staff told us that having three staff on at weekend meant they had more time to do activities with residents. Over half of the staff held a national vocational qualification (NVQ) in health and social care. This helped to ensure that staff had the knowledge and skills to understand and meet the needs of the residents. What the care home could do better: Care plans must be more detailed to make sure that staff have enough direction to support residents safely, and in the way they prefer. They must be kept up to date so that staff carry out accurate care to meet residents` needs. Health care risks must be assessed and plans put in place to minimise any risks to residents` health and safety. Some medication records were not completely safe and could increase the risk of errors and place people at risk. The staff who are responsible for managing medication must make improvements in the way medicines are recorded. Not all staff were clear about what to do if residents were placed at risk of harm because of the behaviour of other residents. There must be further training or guidance on safeguarding residents. Staff must not start work at the home until they have undergone full employment checks and the manager is satisfied that they are fit and safe to work with the residents. Key inspection report Care homes for older people Name: Address: The Lodge Watton Road Ashill Thetford Norfolk IP25 7AQ     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: Jane Craig     Date: 2 4 1 1 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 Lodge Watton Road Ashill Thetford Norfolk IP25 7AQ 01760440433 01760440043 kaz1509@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Irene Margaret Squire,Mr Kenneth John Squire care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Date of last inspection Brief description of the care home The Lodge provides personal care for up to 20 older people with dementia. The home was originally a large detached family home, and it retains many of its original features. There are two large lounges and a separate dining room. There are a mix of single and shared bedrooms. A small number have en-suite facilities. Bedrooms on the upper floor are accessed via a stair lift. There is a large lawn at the front of the home which provides a good sitting area for residents, with smaller gardens at the side and rear. There is a car park at the front of the home. The home is situated on the outskirts of the village of Ashill, on the Swaffham to Watton Road (B1077). Information about the home, including the range of fees, is available from the registered manager. 0 2 1 2 2 0 0 8 0 Over 65 20 Care Homes for Older People Page 4 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: The last key inspection on this service was completed on 2nd December 2008. We also carried out a random inspection on 18th August 2009 after a safeguarding investigation had highlighted concerns about staffing levels in the home. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 24th November 2009 by one regulatory inspector. At the time of the visit there were 20 residents in the home. We met with a few of them and asked about their views of The Lodge. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. Care Homes for Older People Page 5 of 30 We talked to the registered manager, visitors to the home and members of the care team. We looked around the home and viewed a number of documents and records. As part of the key inspection surveys were sent out to residents and staff. Residents were assisted to complete their surveys by relatives. Survey responses have been taken into account when making judgements about the service. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. 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: Care plans must be more detailed to make sure that staff have enough direction to support residents safely, and in the way they prefer. They must be kept up to date so Care Homes for Older People Page 7 of 30 that staff carry out accurate care to meet residents needs. Health care risks must be assessed and plans put in place to minimise any risks to residents health and safety. Some medication records were not completely safe and could increase the risk of errors and place people at risk. The staff who are responsible for managing medication must make improvements in the way medicines are recorded. Not all staff were clear about what to do if residents were placed at risk of harm because of the behaviour of other residents. There must be further training or guidance on safeguarding residents. Staff must not start work at the home until they have undergone full employment checks and the manager is satisfied that they are fit and safe to work with the residents. 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. The admission process helped to ensure that the home was suitable to meet the needs of the people who moved in. Evidence: The service users guide comprised a collection of documents that gave comprehensive, up to date, information about the service and facilities people could expect. The documents were primarily designed for relatives of people coming into the home. We discussed with the manager how a shorter and less complex guide might be more accessible to people with dementia. People who completed surveys indicated that they received enough information about the home to help them to decide whether The Lodge was the right place for them. People thinking of moving into the home were assessed by the manager before being offered a place. The manager also obtained copies of social care assessments. This helped to make sure that people were not admitted to the home unless their needs Care Homes for Older People Page 10 of 30 Evidence: were understood and could be met. The assessment process continued after admission. This ensured that staff had enough information about the persons abilities, needs and preferences to draw up initial care plans. 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. Not all of the care plans provided staff with the information they needed to meet peoples personal and health care needs. Some medication records were not completely safe and could place people at risk. Evidence: We looked at the care records for three residents as part of the case tracking process and others to check on specific issues. The standard of care records varied. We saw some good examples of person centred care plans. This meant that the plans directed staff to provide support to meet the individual residents needs and preferences. Others were vague and could be applied to any resident. For example, a plan to help a resident to bathe just indicated that they need assistance. The lack of personal detail could result in residents not receiving care in the way they prefer. Documents to record when staff had helped a resident with personal care were not all up to date. Staff signed to say that care plans were reviewed every month. However, there were no review notes to summarise the care given, or to indicate whether it had Care Homes for Older People Page 12 of 30 Evidence: been effective. Assessments and plans were not always changed when the residents needs changed. This made it difficult to tell whether all care records were accurate and up to date. The manager told us that residents or their relatives were consulted about care plans but there were no records of these discussions and plans were not signed to indicate that they had been agreed. Each care file included a brief psychological assessment. These should have provided information about the residents needs associated with dementia but some were not completed appropriately. Care plans generally addressed residents physical and personal care needs relating to dementia. However, we did not see any plans to instruct staff how to support residents with regard to their needs associated with memory loss and disorientation. Staff we spoke to said they had received training in dementia care and supporting people with difficult behaviour. They told us the training had been of some help when supporting a resident who regularly displayed aggressive behaviour. However, the risk assessment and written care plan were not adequate and did not help staff to provide a safe and consistent approach. For example, the plan did not indicate the level of supervision needed by this resident. This lack of direction could result in staff and other residents being harmed. Care records included risk assessments associated with manual handling, pressure sores, falls and nutrition. However, these were not all up to date and plans were not always put into place to minimise identified risks. For example, one residents nutritional assessment had not been reviewed for a number of months. Another resident was assessed as being at high risk of developing pressure sores but there was no plan in place to help to minimise risks. One person did not have a risk assessment to support the safe use of bed rails. The manager had already identified some of these shortfalls during her weekly audits of care records and had taken some steps to address them. She had arranged for staff to have further training in care planning techniques and had provided written guidance for them to refer to. A member of staff had also been nominated to provide advice to the others. Residents we spoke to said they were well looked after. Those who returned surveys indicated that they received the support they needed and staff always made sure they received medical attention when they needed it. One wrote, The home looks after my physical needs. A relative told us that he would give the staff, top marks for the way they looked after his wife when she was ill, and another commented, The home Care Homes for Older People Page 13 of 30 Evidence: cares for residents well. Care files showed that residents with health care needs were usually referred to outside agencies for advice and treatment. There were care plans to support residents with ongoing physical health needs such as diabetes. Despite a recommendation following the random inspection the directions for staff were not explicit enough to ensure that staff knew when they should consider referring for medical advice. The service had a charter of rights that covered issues of privacy and dignity. During the course of our visit we saw that there was a good rapport between residents and staff. A number of residents and relatives praised the staff team. One resident told us, The girls are all very respectful and very sympathetic to us. A relative commented, they (residents) are treated with kindness and patience. Residents told us that staff respected their privacy when they were in their bedrooms and we saw staff knocking on bedroom doors before entering. However, there were no privacy locks on the toilet or bathroom doors, which meant that residents could not use the facilities without the possibility of another resident walking in. None of the residents were able to manage their own medication. All staff who had responsibility for handling medicines had received training. Medicines were stored safely and there was no excess stock. There was a safe system for ordering medication. There were complete records of medicines received, disposed of and of any stocks of medicines carried over from the previous month. These records contributed to the audit trail and helped to ensure that prescribed medication was always available. There were no gaps on the medication administration record (MAR) charts. With the exception of one MAR chart, appropriate codes and notes were used when medicines were omitted. Some entries on the MAR charts had been changed from regular doses to when required. There was no evidence that this had been authorised by a doctor. There were some handwritten entries on MAR charts but these had not been checked to reduce the risk of transcribing errors. Some of the entries did not completely match the instructions on the prescription. In one case, the staff had not copied the special instructions for administration onto the MAR chart. This could potentially lead to instructions not being followed and the integrity of the medicine could be affected. Some residents were prescribed medication to be given when required, which meant that it was at the discretion of staff whether the resident needed the medicine. There was insufficient guidance to tell staff when particular residents needed medication with a sedative effect. This could potentially lead to residents being over or under Care Homes for Older People Page 14 of 30 Evidence: medicated. Controlled drugs were recorded, stored and administered in accordance with good practice guidance. However, we discussed that controlled drugs that were taken infrequently should be checked on a regular basis to reduce the risk of errors. 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 majority of people received the support they needed to lead their chosen lifestyle. Evidence: Information about peoples social histories and past interests were recorded in their care file. This information was not always used in a consistent way, for example, to plan activities. The standard of social care plans varied. One person did not have a plan at all. Another had a plan that gave a detailed description of what they enjoyed doing but there were minimal directions for staff as to how to support her to continue with her interests. None of the plans we looked at contained a record of what activities had been offered or undertaken. This meant there was a lack of information to assist in evaluating activity plans. Some residents who returned surveys indicated that there were not always enough activities for them to join in. One person commented, Residents spend many hours just sitting in the lounges. However, the manager and staff told us that the activity programme had improved recently. Staff said they had time in the morning and afternoon to organise group activities or to sit with residents who preferred to stay in their rooms. Residents confirmed that there were activities going on, although they could not remember just exactly what and how often. On the day of our visit there Care Homes for Older People Page 16 of 30 Evidence: were ball games in the morning and dancing in the afternoon. The church choir also came in to sing hymns, which is a weekly occurrence. Care plans included information about residents religious and spiritual beliefs and the manager ensured that any special needs were explored. Residents told us that they had choices in their daily routines and those we spoke to said they generally followed the same patterns they had when they were at home. One said, I can have a bath either morning or night, it depends on what is going on that day. Someone else told us that they could have a bath every day if they wanted to. Another told us that they were not forced to go to bed at any particular time. One person described sitting up watching TV with a couple of other residents and said that staff brought them a cup of tea. A relative told us that when they visited, the residents always seemed to be happy. Those residents we spoke to confirmed that they liked living at The Lodge. One said, I have nothing to compare it with but I am quite happy and satisfied here. Another said, I am very keen on the place. There was an open visiting policy which meant that people could receive visitors whenever they wanted to. Visitors said they were made to feel welcome. One told us that relatives were invited to the large Christmas party that was being planned. They could also join their relative for Christmas lunch, which helped people to maintain family contacts. There was a rotating menu, which we were told was flexible. Residents who completed surveys said they always, or usually liked the meals and those we spoke to were satisfied with the food. One said, There is good choice and variety and it is homemade, no complaints. Another said, They know if there is something I dont care for. On the day of the visit the meal looked appetising and residents could choose whether they ate in the dining room or in their own rooms. The dining room was pleasant and there was a social atmosphere. Residents received help if they needed it. The manager had recently purchased some special plates and non slip place mats, which helped to improve residents independence whilst eating. However, we observed that plastic or melamine cups, plates and dishes were used for everyone. We discussed with the manager that this could automatically label people as being incapable of using everyday crockery and could impact negatively on their dignity and self esteem. The manager told us that she would review this. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures were in place to ensure appropriate responses to formal complaints and explicit allegations of abuse but less obvious incidents may go unrecognised. Evidence: Everyone who completed a survey indicated that they knew who to speak to if they were unhappy about anything and a resident we spoke to named a member of staff they would go to if they had a problem. Two people who returned surveys indicated that they did not know how to make a formal complaint. Everyone received a complaints procedure in their service users guide and there was one on display in the home. The procedure outlined the process for making complaints and how the complaint would be dealt with, including timescales and other parties who may be involved. It was very detailed and informative for relatives and other visitors. However, the format and content may be difficult for some of the residents to understand and we discussed with the manager how the procedure might be summarised and made more accessible to people with dementia. There had been no complaints made directly to the home in the past year. All staff had received safeguarding training. However, there were indications that aggression perpetrated by any resident towards another resident may not be managed in accordance with established procedures. Some of the records we looked at showed that some residents had been subjected to threatening and aggressive behaviour by other residents. The manager said she had involved the GP but had not been able to Care Homes for Older People Page 18 of 30 Evidence: access the mental health services. None of the incidents had been referred under safeguarding procedures. Some staff perceived that because the residents who were aggressive had dementia then it was not a safeguarding issue. This may indicate the need for further training or guidance. Before the end of our visit the manager made a safeguarding referral to social services. There had been two safeguarding referrals in the past year. Both had been investigated under safeguarding protocols. The first had involved poor staffing levels at weekends, which had impacted negatively on the care of all residents. There was also allegations of lack of appropriate care for a resident with ongoing health care needs. This referral had been partially substantiated and the manager had improved staffing levels and arranged specific health care training for staff. The second referral was not substantiated. Staff have received training in the mental capacity act and deprivation of liberty safeguards. One of the care files we looked at contained an assessment that concluded that at that time the resident lacked capacity. However, the assessment was not dated and it was not clear what issue the assessment referred to. None of the other care plans or associated records that we saw made mention of the residents capacity to agree to, or to make decisions about, their care. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Lodge provided people with a comfortable and homely place to live. Evidence: There had been a number of improvements to the environment since the last inspection. One of the lounges had been refurbished, there were new carpets in some areas and the dining room and some bedrooms had been decorated. A relative wrote, There are always improvements going on around the house. The manager was aware there was still work to be done to improve the environment and, although she did not have a written plan, she had prioritised the areas that were most in need. Plans were in place to create a sensory garden, which should be completed before next spring. The other garden area was still in need of clearing. This would ensure that the residents whose rooms overlooked it had a more attractive view. Radiators throughout the home were guarded to minimise the risk of burns. There were no restrictors on any of the windows. This had not been risk assessed to ensure that the lack of restrictors did not impact on residents safety and security. Whilst looking around the home we noted that one of the lounges and some of the bedrooms felt quite cool. This had also been raised at the last inspection. One person, who was sitting in the lounge, had two blankets covering them and a resident in one of the bedrooms said they felt cold. Another resident told the manager that she Care Homes for Older People Page 20 of 30 Evidence: sometimes felt cold in the mornings. Other residents and visitors we asked said they did not have a problem with the temperature. The manager increased the thermostat for the heating, which improved the situation. Before the end of the inspection she had purchased some thermometers so that she could monitor and keep temperatures at a comfortable level. Following a requirement at the last inspection to improve the bathrooms, work was in progress to convert the upstairs bathroom into a wet room. This would give residents a choice of a bath or a shower and assist people to be more independent. In response to a previous requirement to ensure the home was adequately lit, the manager had installed sensors on the lights on the ground floor corridor, where the residents toilets were located. This had partly addressed the problem but the lights did not always stay on long enough. Also residents may be unwilling to approach the area because it would initially appear dark. Most of the bedrooms were personalised with pictures, ornaments and small pieces of furniture. This helped to make the environment more familiar and assisted residents orientation. Residents who we spoke to were happy with their bedrooms. There were signs around the home to assist residents to find their way. A relative wrote, The new signs on the doors are a great help to the residents. Residents who returned surveys indicated that the home was clean and fresh and those we spoke to agreed. On the day of our visit there were no unpleasant odours. Staff had received training in prevention and control of infection and one talked about how the staff followed infection control procedures when handling waste and laundry. There were adequate handwashing facilities and staff had access to gloves and aprons. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practices could place residents at risk of harm. Evidence: Following a complaint earlier in the year, weekend staffing levels had increased to three care staff. The staffing rotas confirmed that the numbers had not dropped below that number. Staff we spoke to said this was enough to meet the needs of the current residents. Residents themselves said that staff had time to spend with them and to have a chat. The home employed a cleaner and a cook so that staff did not have to spend long periods of time on non care duties. However, care staff still had to finish preparing and clearing away the evening meal. On the day of our visit there was no evidence that this had a negative impact on residents but it should be kept under review. We looked at the recruitment files of two staff. Both had started working with residents before their pre-employment checks were completed. Neither had a POVA first or CRB disclosure and both only had one reference. This meant that the manager would not have been aware of whether either person had a criminal record, which might have precluded them from working in a care setting. Other required information, such as a full employment history and reasons for leaving previous jobs, had not been obtained. This meant that the manager had not put into place all possible safeguards to ensure that they were fit to work with the residents. The issue Care Homes for Older People Page 22 of 30 Evidence: of poor recruitment practices had been identified during the last inspection. There were no records to show there were discussions between the manager and any applicant with previous criminal offences. There was no evidence that potential risks to residents were assessed prior to employing staff with previous offences. New staff were provided with induction training, which included watching training videos, shadowing experienced staff and being observed working with residents. The manager signed off the training in individual workbooks when they had completed the induction. It was not clear whether the topics covered during induction matched the common induction standards, as recommended by the national training organisation. Staff received supervision following their induction. The records showed that the sessions looked at how the new staff member was progressing and highlighted any areas for further training or guidance. Staff continued to receive regular supervision and support from the manager. The central training record was not available on the day of the inspection and was forwarded to us the following day. The record showed that all staff had received training in the mandatory topics in the past year. In addition to health and safety subjects, these included dementia care training. New staff had in-house awareness training and were then booked on the next available full course. This meant there were new staff who were using moving and handling techniques without having had practical training. We observed one inappropriate manoeuvre, which could be a result of this shortfall. Over half of the care staff held a national vocational qualification (NVQ) at level 2 or above. 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. Management and administration systems were not effective enough to ensure that the home was always run in a way that safeguarded peoples health and welfare. Evidence: The registered manager had run the home for a number of years. She had the appropriate management qualifications and was undertaking a degree in dementia care. The manager was supported by a deputy manager and senior carers. The manager told us that over the past year she had assumed more responsibility for the homes budget. As a consequence she had more autonomy, for example, over staffing levels and expenditure on improvements to the environment. The quality monitoring process focused on the views of residents and staff. Most residents had been assisted by relatives to complete their questionnaires. Staff were also asked the same questions about meals, care, daily living, environment and management. The last survey had been conducted in August this year. The manager did not collate and publish the findings but said that any negative responses would be Care Homes for Older People Page 24 of 30 Evidence: addressed immediately. All residents responses and comments were positive but staff had highlighted some concerns around team working, which had been actioned. At the time of our visit the only audits of procedures and processes were on care plans and medication, which the manager said had definitely brought about improvements. The manager completed the annual quality assurance assessment (AQAA) when we asked for it. Although all sections had been filled in, some of the information was too brief, especially relating to which areas of the service needed improvement and the plans for improvement over the next year. Accidents and incidents were recorded but there was not always enough information in the reports about the incident and events preceding it. The manager did not carry out audits of accidents or incidents to identify patterns or trends. The service did not manage residents finances or hold any money on their behalf. All staff had received fire safety training. Staff told us there were regular fire drills and those we asked were familiar with the fire procedure. Fire alarms were tested and other fire safety equipment had been serviced. The fire risk assessment had recently been reviewed. The AQQA told us that maintenance and servicing of other equipment and installations were up to date. Following a previous recommendation, there were no potentially hazardous items, for example, denture cleaner, stored in areas that were accessible to residents. Care Homes for Older People Page 25 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 26 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 Care plans to support residents with ongoing health and behavioural needs must be specific enough to ensure that staff provide care to meet individual needs in a safe and consistent way. This is to promote the residents health and safety. 28/02/2010 2 7 15 Assessments and care plans must be kept up to date. This is to ensure that residents receive the care and support they need to meet their needs. 28/02/2010 3 8 13 Risks to residents health 28/02/2010 caused by nutrition, falls, pressure sores, moving and handling and bedrails must be assessed and appropriate plans drawn up to minimise the identified risks. Care Homes for Older People Page 27 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 This is to promote residents health and safety. 4 9 13 Handwritten entries on MAR charts must accurately reflect the instructions on the medicine label. This is to ensure that residents receive their medication as it is prescribed and any special instructions are followed. 5 18 13 By means of training or 31/12/2009 other methods, the manager must ensure that staff are clear about what to do in the event of residents being subjected to abuse by other residents. This is to safeguard everyone living at the home. 6 19 13 Risk assessments must be carried out to ensure that possible risks linked to unrestricted window openings are controlled. This is to protect the residents safety. 7 29 19 Staff must not start work at 18/12/2009 the home until all the required pre-employment checks have been completed and the manager is satisfied 31/12/2009 31/12/2009 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 that the person is fit to work at the home. This is to protect the health, safety and welfare of the people using the service. 8 30 13 Staff must have appropriate practical training before using moving and handling techniques and equipment with residents. To protect the health and safety of residents and staff. 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 18/12/2009 1 2 3 7 9 12 There should be review notes to summarise the care given and to indicate whether it had been effective. There should be clear guidance to alert staff when to give medicines that are prescribed when required. Social assessments and care plans should be further developed to ensure that everyone receives support to meet their social and recreational needs in the way they prefer. The temperature in the lounges and bedrooms should be monitored and maintained at a comfortable level. The process for monitoring the quality of the service should be extended to include internal audits of procedures and processes, for example, recruitment, accidents and incidents. 4 5 19 33 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. 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