Care Home: The Manor House

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What the care home does well People thinking of moving into the home were given written information and were encouraged to visit, which would help them to decide whether The Manor House was the right place for them. The manager carried out an assessment prior to admitting anyone to the home. This helped to make sure that the person`s needs were understood and could be met by the services and facilities available at the home. Residents said they were well looked after at The Manor House. Those who completed questionnaires said they received the care and medical support they needed. A resident said, "Staff are genial and helpful," and a relative said, "I can`t fault the staff, they inspire confidence." Residents also told us that staff were respectful of their privacy. The residents we spoke to told us they were happy with their daily lives at The Manor House. We saw and heard evidence of residents being given choices in their daily lives, which helped to maintain their independence and self esteem. One resident told us, "There are no restrictions on us whatsoever." There was a programme of in-house activities and occasional trips out, which residents said was sufficient for them. The Manor House had facilities to enable people to bring in their pets, either to live with them or to visit. People were offered a varied and nutritious diet. There were several positive comments about the meals. One resident said, "The food is very good, quite a variety and plenty of it." The home was set in woodland and also had extensive landscaped gardens that were very well maintained. Several residents we spoke to commented about the house and grounds. One told us, "I have the best room in the house, very pleasant indeed." The home was clean and well maintained. A number of areas had been improved since our last inspection and most parts of the home were decorated and furnished to a high standard. The manager made sure that new staff had background checks before they started working at the home. This was to make sure that they were suitable to work with people who use the service. Staff had training to help them to understand the needs of the people who use the service and to protect their health and safety. Over half of the care staff held an NVQ, which is a nationally recognised qualification in health and social care. What has improved since the last inspection? After the last inspection we made requirements to keep care records up to date. Also to ensure that risks to residents` health were assessed and plans drawn up to control the risk. These requirements had been met. The records we saw during our visit had been reviewed regularly and amended to reflect the resident`s changing needs. This meant that staff had accurate directions to work to. The residents we case tracked also had a set of risk assessments and risk management plans, which helped to promote and protect their health and safety. A third requirement, that residents who administered their own medication were assessed and had regular checks to ensure their continued safety, had also been met. The complaints procedure had been revised. It was clear and helped people to understand how and when their complaints would be dealt with. People who returned surveys said they knew how to make a formal complaint and one resident we spoke to said, "There are notices up telling people how to make a complaint." Since our last inspection the manager had registered with The Care Quality Commission. In addition to being a legal requirement, her registration also demonstrated her commitment to the service. Staff who completed surveys told us that they received regular support from the manager. One commented, "Since we had our new manager the home is moving forward, she supports us well." We also heard positive comments about the manager from residents and relatives. What the care home could do better: It was not clear whether staff were administering prescribed creams to residents because the records were not complete and up to date. We made a requirement to improve this. To minimise the risk of errors and to provide safeguards for residents and staff, records of money handed over by residents, for safekeeping, must be reviewed. The procedure must include systems for checking transactions and regular audits. The manager and staff must ensure that any potentially hazardous substances, such as cleaning chemicals are stored safely. This is to protect residents, who may not be aware of the possible danger of handling such chemicals. Key inspection report Care homes for older people Name: Address: The Manor House North Walsham Wood North Walsham Norfolk NR28 0LU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Craig     Date: 0 3 0 3 2 0 1 0 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 29 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: The Manor House North Walsham Wood North Walsham Norfolk NR28 0LU 01692402252 P/F01692402252 admin@themanorhouse.healthcarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Manor House (North Walsham Wood) Limited Name of registered manager (if applicable) Mrs Emma Elizabeth Mary Bye Type of registration: Number of places registered: care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Manor House is a care home providing personal care for up to 52 older people, 10 of whom may have a dementia type illness. The home is located close to the market town of North Walsham and is set in 18 acres of beautiful gardens and woodland, all of which are accessible to residents. The home provides accommodation in 45 single bedrooms and 3 shared bedrooms including 5 apartment type rooms located within a courtyard to the back of the home. Most of the bedrooms have en-suite facilities and the apartments have en-suites and small kitchen areas. Bedrooms are located on the ground and first floors. There is extensive communal space in the home including a conservatory, dining room, lounge, lounge/diner and library. This home has won Care Homes for Older People Page 4 of 29 Over 65 10 42 0 0 2 0 0 4 2 0 0 9 Brief description of the care home awards for its pet-friendly approach and residents are able to bring their own pets into the home. Information about the home, including the range of fees and extras, is available from the manager. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection on this service was completed on 20th April 2009. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 3rd March 2010 by one regulatory inspector. We met with a number of people who use the service and where possible asked about their views of The Manor House. We spent time observing daily routines in the home and how staff interacted with residents. Four residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. We talked to the registered manager, visitors to the home and members of the staff team. We looked around the home and viewed a number of documents and records. Care Homes for Older People Page 6 of 29 As part of the key inspection, surveys were sent out to a random selection of people living and working at The Manor House and their responses have been taken into account when writing this report. The 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 7 of 29 What the care home does well: What has improved since the last inspection? After the last inspection we made requirements to keep care records up to date. Also to ensure that risks to residents health were assessed and plans drawn up to control the risk. These requirements had been met. The records we saw during our visit had been reviewed regularly and amended to reflect the residents changing needs. This meant that staff had accurate directions to work to. The residents we case tracked also had a set of risk assessments and risk management plans, which helped to promote and protect their health and safety. A third requirement, that residents who administered their own medication were assessed and had regular checks to ensure their continued safety, had also been met. Care Homes for Older People Page 8 of 29 The complaints procedure had been revised. It was clear and helped people to understand how and when their complaints would be dealt with. People who returned surveys said they knew how to make a formal complaint and one resident we spoke to said, There are notices up telling people how to make a complaint. Since our last inspection the manager had registered with The Care Quality Commission. In addition to being a legal requirement, her registration also demonstrated her commitment to the service. Staff who completed surveys told us that they received regular support from the manager. One commented, Since we had our new manager the home is moving forward, she supports us well. We also heard positive comments about the manager from residents and relatives. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 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. There was a thorough admission process, which ensured that people were not offered a place at the home unless their assessed needs could be met. Evidence: Since our last inspection the information pack for people thinking of moving into the home had been reviewed and updated. The pack, which included a residents guide, provided people with clear and meaningful information about the services they could expect at The Manor House. The documents were also available in large print. Everyone who returned surveys indicated that they were given sufficient information to help them to decide whether the home was the right place for them. They also said they received a contract or statement of terms and conditions of residency. Prospective residents, or their families, were encouraged to visit before making a choice. One relative told us that as soon as they walked round the home and spoke with the manager they knew it was the right place because of the friendly Care Homes for Older People Page 11 of 29 Evidence: atmosphere. Anyone thinking of moving into the home was assessed by the manager. This was to ensure that people were not admitted unless their needs were fully understood and could be met at the home. These assessments were supported by information from the social worker, or healthcare professionals, involved in the persons care. The preadmission assessments we saw provided staff with sufficient information to enable them to provide support to the new resident. The Manor House does not provide intermediate care. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care met the assessed needs of people using the service. Evidence: We looked at the care records of four people as part of the case tracking process. A new format had been introduced since our last inspection and we found significant improvements in care plans and associated records. One resident, who had been admitted very recently, already had care plans to enable staff to support her to meet her personal care needs as highlighted in her original assessment. The manager explained that staff would further develop and personalise the care plans as they got to know the resident. The other three residents had been at the home for a some time and had a set of care plans to meet their personal, health and social care needs. Residents were able to participate in drawing up care plans and the manager told us that some residents wrote their own plans for personal care. Family carers said that staff always let them know how their relative was and informed them of any changes. Care Homes for Older People Page 13 of 29 Evidence: Care plans were written in a way that told staff how the resident wished to be supported. The plans helped to promote residents wellbeing by providing directions to maintain their independence and take into account their preferences and wishes. Plans to assist people with personal care tasks, such as washing and dressing, were highly individual. There were specific plans to address health care needs. For example, diabetes, prevention of pressure sores and anxiety and agitation. The manager was aware that the style of the plans did not always allow staff to write the very specific directions that may be needed to help support complex needs associated with health or behaviour. In one case staff had written directions in the evaluation notes, which could result in them not being seen by all staff and put into day to day practice. Everyone had a set of assessments to monitor risks to their health, for example, from falls or poor nutrition. Care plans to minimise the risks and promote peoples health, generally attempted to address the cause of the risks. There was evidence that residents ongoing health care needs were monitored and they were referred to outside professionals where necessary. Everyone had a moving and handling assessment and plan. We observed staff using appropriate moving and handling equipment and techniques. Residents who needed help with standing or transferring told us that staff always used the hoist. Following a requirement at the last inspection, care plans and other records were generally reviewed each month and amended if the residents needs changed. We saw some good examples of evaluation notes, which gave a summary of the residents progress over the previous month. Daily notes were generally task orientated rather than providing an account of the persons day and well-being. The Annual Quality Assurance Assessment (AQAA) indicated that this is one of the things the manager is planning to improve over the next year. Residents who completed surveys, and those we spoke to during our visit, said they received the care and support they needed and staff made sure they received the right medical attention. One person said, If I dont feel well I have a day in bed and they look after me very well. Another told us, They are very attentive and look after my needs. The family carers we spoke to were happy with the care their relatives received. One said, They seem to understand exactly what is needed. There was a charter of rights for people living at The Manor House, which covered issues of privacy and dignity. During the course of our visit we observed staff talking to residents in a polite and friendly manner. A number of residents and relatives made positive Care Homes for Older People Page 14 of 29 Evidence: comments about the staff team. A relative said, One of the most important things is the friendliness of the staff, their warmth comes across. Residents told us that staff protected their privacy when they were in their bedrooms or in the bathroom. A small number of residents administered some of their own medicines. Following a requirement at the last inspection, there were risk assessments to support them. Staff also carried out regular checks to ensure that people were taking their medicines safely. The AQAA told us, All staff who dispense medication have received safe handling of medication training, have been given supervised observations to monitor competency and are supported to undertake distance learning in Safe Handling of Medicines at level 2. Medication procedures were also readily available for guidance. Medicines were stored safely and there were no excess stocks. Records of medicines received and disposed of were complete and up to date, which helped with stock control and also provided part of the audit trail. There were no unexplained gaps on medication administration record (MAR) charts, for tablets and liquid medicines. This indicated that people received this medication as it was prescribed. The balance of medicines in stock was checked regularly and the deputy manager carried out a full audit of a small number of MAR charts each month to ensure that staff were continuing to follow procedures. Prescribed creams were recorded on separate MAR charts, which were stored in residents rooms along with the creams. We found that there were a number of gaps on these charts. It was not clear whether these were recording errors or whether residents were not having creams administered as they were prescribed. All MAR charts were handwritten. All entries were witnessed, which reduced the risk of transcribing errors. However the design of the charts meant that staff did not always have room to record any special instructions for administration. This could potentially lead to instructions not being followed and the integrity of the medicine could be affected. Some residents were prescribed painkillers to be given when required. Staff told us that all the residents in question could alert staff if they needed their medication. None of the residents were prescribed sedatives to be given at the discretion of staff. Controlled drugs were stored, recorded and administered safely and in accordance with the policy. Care Homes for Older People Page 15 of 29 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 service supported people to make choices and retain control over their daily lives. Evidence: Several people told us that The Manor House was a nice place to be and they were happy with their daily lives in the home. One person told us they came last year and it was one of the best things they have ever done. Another said, I am happy here and quite satisfied to stay for the rest of my life. Information about residents cultural and religious needs and their preferences with regard to daily routines, meals and interests was included in the pre-admission assessment and used to draw up care plans. Each person had a care plan entitled, how you can help me to enjoy my day. For example, one resident did not join group activities but their plan told staff what newspaper they liked and and which TV station they favoured. Another plan showed that the person liked to do quizzes and walk around the grounds. There was a programme of group activities, which was displayed on the residents notice board. Although we could not find a direct link between residents interests and the activity programme, the activity co-ordinator told us that she took into account the information on care plans as well as discussions with residents when deciding on activities. She also carried out one to one activities and Care Homes for Older People Page 16 of 29 Evidence: shopping trips. Most residents who returned surveys and those we spoke to said there were activities for people to join if they wished. Several people mentioned that they had enjoyed musical entertainment the day before our visit. Residents also told us they did not feel pressured to join in. One person said, I prefer to be in my room but I am never left out of any treat that is going. The AQAA told us that, as far as possible, the service offered a flexible routine so that people could get up and go to bed when they wished and have as much or as little assistance as they desired. Residents we spoke to confirmed that they were able to make decisions and choices. One said, There are no restrictions on us whatsoever. Residents also had plans to tell staff whether they needed help to make choices about anything affecting their daily lives. During the course of our visit we observed residents being given choice about meals and activities. There was open visiting at the home, which helped people to be able to maintain contact with their friends and relatives. Visitors we spoke to said that they were made to feel welcome. A relative wrote that one of the things the service did well was to involve families in social activities. Subject to a risk assessment residents were able to bring their pets to live with them in the home. One resident told us this was the reason they had come to The Manor House. There were very few pets at the time of our visit but the manager told us that residents and relatives appreciated that animals could be brought in to visit. People who returned surveys and those we spoke to said they were happy with the meals. One person said, I have no complaints about meals, if there is something you dont like they try their hardest to get something you do like. Another said, The food is very good, quite a variety and plenty of it. The menus showed that people were offered a balanced diet with a choice at each meal, including a vegetarian option. The residents guide also stated that special diets would be catered for. On the day of our visit the lunchtime meal looked appetising and residents told us they enjoyed it. The dining rooms were attractively laid out with full place settings and residents who needed it were assisted in a sensitive and dignified manner. A member of staff told us that residents could choose which dining room they went to but, in general, people who needed more help stayed in the South Wing because there was more of a staff presence. It was not clear how much residents choice in this matter was influenced by staff and the manager said she would discuss this issue at the next team meeting. Care Homes for Older People Page 17 of 29 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 complaints and safeguarding processes in the home helped to protect people using the service. Evidence: There was a clear complaints procedure on display in the home. Residents also received a copy in their information pack. People who returned surveys and those we spoke to all said they had someone to speak to if they were unhappy about anything and they knew how to make a complaint. One resident said, There are notices up telling people how to make a complaint. Residents said they would feel comfortable talking to the manager. One told us, I dont want any trouble but I speak up if I need to, I would not be frightened of making a complaint. They all said that they thought the manager would sort things out if they did make a complaint. There had been no complaints to the home since our last inspection. The safeguarding procedure had been reviewed. It provided staff with clear information about abuse and their responsibility to report it. Most staff had received updated safeguarding training and those we spoke to were confident that they would be able to recognise poor practice and understood the reporting procedure. The manager was also clear about her responsibility to refer any suspected or alleged abuse, or harmful practice, to the appropriate agencies. Since our last inspection the manager has made a number of safeguarding referrals in Care Homes for Older People Page 18 of 29 Evidence: line with concerns she received regarding poor practice. These were investigated by the police and social services and it was found that these allegations into poor practice were malicious. Three further referrals made to the safeguarding team about alleged poor practice were investigated and upheld. The manager dealt with these matters appropriately. Staff had received training about the mental capacity act and related legislation. The service carried out a brief mental capacity assessment with residents. The assessment gave an indication of the residents ability to make decisions about different aspects of their daily life, for example, finances, personal care and emergency aid. We discussed with the manager that the document needed to make clear that capacity can fluctuate and the residents capacity would need to be assessed whenever a particular issue arose. The manager was aware of this and said she would discuss it with staff to ensure that they did not make assumptions based on the information on the current assessments. Each resident had a care plan that told staff whether they had made any advance directives with regard to care, or whether they had a named person who was looking after their affairs. Care Homes for Older People Page 19 of 29 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 overall standard of decoration and cleanliness gave a homely, comfortable feel to the home and provided a pleasant place to live. Evidence: The parts of the home we looked at were in a good state of repair. The service employed a maintenance person and there was a programme of regular maintenance and renewal. There were safety measures in place, such as radiator guards and thermostatic controls on hot water taps, which helped to minimise the risk of burns and scalds. The AQAA told us about a number of improvements to the environment in the past year. Areas that we identified during our last visit as needing attention had been upgraded. Several communal rooms, bedrooms and bathrooms had been also been redecorated to a high standard. The AQAA showed that there was a clear plan for further improvements to take place over the next year. According to the AQAA, the quality survey carried out by the service last year showed that 100 of residents, relatives and other stakeholders agreed that the home provided a comfortable and homely environment. Residents we spoke with were happy with the general environment. One person said, The sitting room is very comfortable, very nicely appointed. Several residents mentioned the large, well maintained Care Homes for Older People Page 20 of 29 Evidence: grounds, which they enjoyed looking at or walking in. Residents were encouraged to bring in small items of furniture and other possessions to help to personalise their rooms. Residents we spoke to were satisfied with their bedrooms. One person had recently moved to a new room and was happy with the extra space. Another said, I have the best room in the house, it is very pleasant indeed. At the time of our visit the home was clean and free from unpleasant odours. Most of the people who completed surveys said it was always like that. However, when asked what the home could do better, one person wrote, More cleaning staff. We discussed this with the manager who acknowledged that, for a brief period they had been short of domestic staff but this had been resolved. There were also new ways of working for domestic staff which had eliminated any other problems. Staff received training in prevention and control of infection. There were ample hand washing facilities throughout the home. Staff wore gloves and aprons when attending to individual residents, which helped to minimise the spread of infection. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were protected by recruitment practices and staff had appropriate training to help them to understand and meet the needs of the people they supported. Evidence: At the time of our last inspection the staffing levels were under review but there had been no increase in the planned staffing numbers. The service was carrying a few vacancies for care staff and the manager was recruiting new staff. We heard mixed comments about the staffing levels in the home. Most residents who returned surveys indicated that staff were usually available when they were needed and most of those we spoke to said that they did not usually have to wait a long time for staff. One said, There is usually someone around, and another said, If you want staff just press the button and at most you have to wait a few minutes. Other residents had different views. One told us, There are not enough staff, that is the whole trouble, they come as quick as they can but they cant be everywhere at once. Another comment was about feeling rushed because staff were so busy. Staff who completed surveys said there were usually enough staff to meet the needs of the residents. However, when asked what the home could do better, two commented that more staff would give them time to sit and talk to residents. Staff we spoke to during our visit said that when all the staff turned in there were enough but they sometimes had to work with lower numbers. The staff rotas we looked at confirmed that staffing levels occasionally Care Homes for Older People Page 22 of 29 Evidence: fell below the planned numbers. During the course of our visit we did not see any evidence that residents health and personal care needs were not being met. However, there were periods of time when residents were sitting in the lounge in the South Wing without any external stimulation or staff presence, which could reinforce the perception that there was a lack of staff. We looked at the files of three newly appointed staff. They had all completed application forms and had face to face interviews. The interview notes showed that, to help to ensure fairness and equality, applicants were asked the same questions. References were returned before the applicants started work at the home. The application form stated that relatives could not be asked for references but one person had given the names of friends, which meant their comments might not be objective and unbiased. The applicants had CRB disclosures to show that they had not committed any offences that precluded them from working at the home. New staff went through a thorough induction training programme. Staff who completed surveys indicated that their induction training had covered everything they needed to know in order to start work. The records we looked at showed that the training programme covered the common induction standards recommended by the national training organisation. Staff completed workbooks and assessments for each topic and their practice was assessed by senior staff to ensure they were competent to provide care to the residents. Ongoing staff training was organised and delivered through the company training team. it was planned that staff would receive regular updates in a number of health and safety topics. However, the records were not completely up to date, therefore it was not clear whether all staff had received the mandatory training. Staff who completed surveys said they received training that kept their practice up to date and helped them to meet the needs of people using the service. When asked what the service does well, one member of staff said, Excellent training. Over half of the care staff held a National Vocational Qualification (NVQ) level 2 in health and social care. Since our last inspection the programme of staff supervision had restarted. Each member of staff had a named supervisor and records showed that they met regularly to discuss issues concerned with performance, employment and training. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was run by a competent manager who ensured that peoples veiws were listened to and acted upon. Evidence: Since our last inspection the manager has registered with The Commission. She has completed the training required of a registered manager and plans to undertake a further qualification in dementia care. The registered manager was supported by the deputy manager and by senior care staff. The regional manager visited the home on a regular basis and also provided support and supervision to the manager. Staff who completed surveys and those we spoke to said that they were supported by the manager. They also told us that the manager had improved the service since she started at the home. One member of staff wrote, Since we had our new manager the home is moving forward, she supports us well. Another member of staff told us that the manager had lifted morale. Residents and visitors also told us the home was well managed. Two residents told us the manager was very caring. Care Homes for Older People Page 24 of 29 Evidence: There were systems in place to monitor the quality of the service, which included seeking the views of residents, relatives and other people with an interest in the home. The report of the last years survey showed that people were generally satisfied with all aspects of the service. There was an action plan in place to address areas where the scores were lower. The manager had commenced residents meetings and the minutes showed that suggestions they made were acted upon. There were a number of internal audits to ensure that procedures and systems of working were of a high standard. The regional manager visited the home on a regular basis to check that they were providing a good service. The manager and staff did not act as appointee for anyone at the home. Several residents had small amounts of money for safekeeping. Records of amounts deposited and withdrawn were kept in a bound book, which was not completely confidential if residents or relatives wanted to check their accounts. The entries were not witnessed, which meant they were not double checked to reduce the risk of errors. One of the entries was not signed at all. There was no evidence that receipts were given for money handed over. Residents accounts were not regularly audited. The current systems for handling residents money did not provide complete safeguards. There were health and safety policies in place, including a policy for handling potentially hazardous substances. However, we found that cleaning products had been decanted into spray bottles without any emergency aid information. The bottles were in two of the bathrooms and accessible to residents who may not be aware of the potential risks associated with the use of chemical cleaning fluids. According to the central training record, most staff had received bi-annual fire safety training. There were written fire procedures throughout the home and staff we spoke to were aware of the action to take in the event of a fire alarm. Records showed that the maintenance staff carried out regular drills. Fire safety equipment was tested and serviced regularly. The AQAA told us that maintenance and servicing of other installations and equipment was up to date. Care Homes for Older People Page 25 of 29 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 29 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 9 13 There must be complete and 31/03/2010 accurate records of all medication administered to people using the service. This includes prescribed creams. To promote the health and safety of people using the service. 2 35 17 The systems for recording residents money handed over for safekeeping must be reviewed. This is to minimise errors and provide safeguards for residents and staff. Potentially hazardous substances such as cleaning fluids must be stored safely. To protect residents health and safety. 31/03/2010 3 38 13 31/03/2010 Care Homes for Older People Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The care plan documents should be adapted to allow for detailed directions for staff to meet complex needs associated with health care or behaviour. Special instructions with regard to administration of medicines should be included in the MAR chart or, where this is not possible for reasons of space, there should be a note to remind staff to check the packaging. Staffing levels should be kept under review to ensure that there are always sufficient staff to meet the needs of the people using the service. The central training record should be brought up to date and any gaps in mandatory training should be addressed. 2 9 3 27 4 30 Care Homes for Older People Page 28 of 29 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. 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