Care Home: The Manor House Nursing Home

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What the care home does well We found that people like living at the service and they and their relatives are pleased with the care provided. People feel that their health and personal care needs are being met and that they are treated with respect and their dignity promoted. Comments include: ` They look after me well, keep me clean and tidy, `Care has been excellent throughout`, `Mum is happy, well looked after, clean, fed and well cared for. `Patients/ residents dignity well applied` and `Care for mum gives her dignity`- ask her what she wants and needs`. People have choices about how they live their life. They can join in with activities or not, they can stay in their bedroom or sit in the communal areas and they have choices over the food they eat. The service has started to put in place person centred plans which give staff much clearer information about how to provide people with the care they need in the way they want. People living at the service are positive about the staff and have good relationships with them. Comments made include: `All the staff do their best to keep me happy` and `The staff are thoughtful and considerate`. People enjoy an excellent standard of accommodation both private and communal. Accommodation is modern and all bedrooms have en suite facilities. What has improved since the last inspection? Since we made our last key inspection the service has made improvements in the standard of care it provides. New management arrangements are in place including a new Responsible Individual and a new manager. The manager still needs to register with the Commission. Medication arrangements are better with recording improved and audits now taking place. People have a better lifestyle having more chances to take part in activities including on an individual basis and having trips out. The service now makes sure that everyone using bed rails is assessed to use them safely and that regular checks are undertaken by the care staff every time they are used. The monitoring and evaluation of the service has improved with the manager undertaking a range of audits to check the quality of the care provided to people. What the care home could do better: Although the service has improved and is overall providing good outcomes for people there remain some issues to be addressed to further improve the standard of care. We are confident that the manager will address these issues.The service needs to ensure that the information in their documentation fully describes the care they are providing so people are clear over what the service offers. The service still has some areas of the medication administration, particularly relating to administering creams and sprays, that need to be addressed so that people can be fully confident that they are getting the support they need. People have access to a complaints procedure but the service needs to make sure that full records are always kept. This will make sure that complaints can be audited effectively. The previous recruitment system was not always making sure that staff were fully checked before starting work and we have asked the service to make sure any gaps in the records are addressed. We saw that there was one error in looking after one person`s money. The service had started to address this during the inspection. We have also made a number of recommendations that will improve the standard of the service for people that live there. Key inspection report Care homes for older people Name: Address: The Manor House Nursing Home The Manor House Nursing Home Hyde Lea Stafford Staffordshire ST18 9AT     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 Capron     Date: 0 6 0 1 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 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 Manor House Nursing Home The Manor House Nursing Home Hyde Lea Stafford Staffordshire ST18 9AT 01785241351 01785251824 cleaver42@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Hyde Lea Nursing Homes Limited care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 42 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 42 Old age, not falling within any other category (OP) 42 Date of last inspection Brief description of the care home The Manor House Nursing Home is located in Stafford, the service provides a service for people with general nursing needs, physical disability and palliative care. It also provides an intermediate care service on a spot contract basis. The service is situated within a quiet residential area and is accessible via public transport. The three-storey property is set within its own grounds, providing accommodation for forty-two people. Bedrooms are located on both the ground and first floor. All rooms have ensuite facilities. The service also offers good communal areas having two large lounges and Care Homes for Older People Page 4 of 30 0 42 Over 65 42 0 Brief description of the care home smaller sitting room. The service provides a range of equipment including nursing style beds, tissue viability equipment, ceiling hoists and adapted bathing facilities. The service provides people with information about the service in its Service User Guide. This does not contain the fees and therefore people considering moving to the service would need to contact the service directly to discuss the fees. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This inspection took place over an 11 hour period. The service did not know we were visiting. Prior to the visit we had information from the Annual Quality Assurance Assessment that the service sent us. This is a document that the service completes that tells us about the service they provide, improvements they have made and how they intend to improve the service in the future. We also looked at information that the service sends us about incidents that have occurred. These are a legal requirement. We also looked at information we have about any complaints or safeguarding incidents that have occurred. We received surveys from seven people living at the service, two relatives and eight staff. At the service we looked at how the service is meeting peoples health and personal care needs and whether peoples privacy and dignity is respected. We also looked at whether people can live the life they want and whether choice is promoted. We looked at how the service is protecting people and whether there are systems in place to listen Care Homes for Older People Page 6 of 30 to the views of people. As part of this inspection we looked around the service including a sample of bedrooms. During the inspection we spoke to people that live at the service, relatives, staff and the manager. Since the last key inspection we have completed two random inspections to check that the service has complied with requirements made at the key inspection. On the first visit the service had failed to comply and we issued a Statutory Enforcement Notice. On our subsequent visit the service had made sufficient progress to comply with the requirements. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Although the service has improved and is overall providing good outcomes for people there remain some issues to be addressed to further improve the standard of care. We are confident that the manager will address these issues. Care Homes for Older People Page 8 of 30 The service needs to ensure that the information in their documentation fully describes the care they are providing so people are clear over what the service offers. The service still has some areas of the medication administration, particularly relating to administering creams and sprays, that need to be addressed so that people can be fully confident that they are getting the support they need. People have access to a complaints procedure but the service needs to make sure that full records are always kept. This will make sure that complaints can be audited effectively. The previous recruitment system was not always making sure that staff were fully checked before starting work and we have asked the service to make sure any gaps in the records are addressed. We saw that there was one error in looking after one persons money. The service had started to address this during the inspection. We have also made a number of recommendations that will improve the standard of the service for people that live there. 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 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 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering using the service are provided with information about what the service can offer but this should always be kept accurate. People can be confident that an assessment of their needs will be completed to make sure that the service can provide them with the care they need. People moving to the service can be assured that they will be welcomed and supported to settle in. Evidence: The Annual Quality Assurance Assessment states that people are given clear and detailed information about the service and that an assessment is completed prior to admission to make sure the service can meet their needs. Since our last key inspection there has been a change in the Registered Individual, the manager and the ownership arrangements. This has necessitated changes to the information provided to people. An updated copy of the Statement of Purpose and a revised service user guide are available to provide people with information about the Care Homes for Older People Page 11 of 30 Evidence: service. Everyone that responded to our surveys tells us that they feel they had enough information about the service to make a decision that it could meet their needs. We did raise with the service that it had admitted people that are not included in the information in its Statement of Purpose. There is no indication that the service cannot meet these peoples needs but we informed the service that it must provide accurate information about the service it can provide and the people it will admit. Examination of records confirms that the service undertakes an assessment of peoples needs before deciding to offer them a place. People tell us that they feel welcomed when they move to the service. The service provides them with flowers and a card to welcome them. One comment from a relative said All the staff made every effort to welcome and assist [my relative] to settle in including gathering in the doorway to sing Happy Birthday to her on her fourth day there. On our last key inspection we found some areas of the intermediate care service needed to develop and the service has acknowledged this and is currently only providing this service on a spot contract basis. These people are supported by a range of health professionals that visit the service. We spoke to two people receiving this service and they are satisfied with the support they are receiving. Care Homes for Older People Page 12 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 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 can be confident that their health and personal care needs are identified and met. People living at the service are treated with dignity and have their privacy respected. People appear to be receiving their medication but there are areas of record keeping that can be improved to ensure that effective monitoring can always be completed. Evidence: The AQAA tells us it has introduced person centred plans and has revised the risk management system. It also states that it meets peoples health care needs and promotes people to be as independent as possible. Case tracking of three people confirms that the service has made good progress in developing its care planning process. The manager tells us that 50 of plans are now person centred and that they are continuing to introduce these for everyone. The new files show how peoples individual needs are to be met. These care plans show that the service is identifying peoples care needs and keeping them under regular review. Case tracking shows that the service is identifying peoples health care, personal care, Care Homes for Older People Page 13 of 30 Evidence: communication and spiritual needs and has clear plans giving staff information over how each persons needs should be met. Files contain ongoing tissue viability, fall, continence, nutritional and continence assessments that are reviewed on a monthly basis. Moving and handling assessments are in place that show the level and nature of support people need. Bed rails are used by some people and we found that risk assessments are in place and that regular checks are made to ensure their safe use. We confirmed that peoples individual needs are being met. This was the view of the people, both relatives and those living there, that responded to our surveys, who all felt that their medical needs were being addressed. For example one person that is very dependent and is identified as at high risk of developing pressure sores is having pressure relieving support including having an airway mattress, pressure relieving cushion and is being supported to regularly move their position. This person is also being peg fed and we confirmed that their swallowing has been assessed by a speech and language therapist and staff know how to manage the process. Another person was admitted to receive pressure sore care and records confirm that the service involved the specialist tissue viability nurse for advice and that their care has led to an improvement in the persons skin. Records confirm that people are weighed regularly and in one case we examined we saw that the service referred to the dietitian when the persons weight dropped significantly. As a result this person had a specialist assessment and a specialist diet provided. All the records examined confirm that the service supports people to receive primary health care services including seeing the GP. and receiving dental and eye checks. Records confirm that people are referred for podiatry care. People if needed are referred for specialist health care. Records and discussions confirm that peoples personal care needs are being met. One person that answered our survey said [they] look after me well, keep me clean and tidy. A comment from a relative said Mum is happy, well looked after, clean, fed and well cared for. I commend this home to you. We saw that people are able to have regular baths or showers and people being cared for in bed have daily bedbaths. Records also confirm that people are receiving oral health care including teeth cleaning and oral sprays for people that are nil by mouth. Our observation shows that people are suitable dressed and that they receive nail and hair care. We saw several people having their nails manicured. We also saw that the hairdresser visited weekly. Care Homes for Older People Page 14 of 30 Evidence: Staff confirm that if people are not well enough to attend the hairdresser or to be bathed they can have their hair washed in bed. When we spoke to staff they could tell us about peoples individual needs and how they are to be met. They are able to describe how they make sure that people are treated with respect and their privacy promoted. Comments from relatives include dignity well applied and care for mum gives her dignity- ask her what she wants and needs. We looked at the arrangements for managing medication. This has been an issue at the last key and random inspections but the service had satisfied us that it had improved its arrangements. On this inspection we saw that medication procedures have been revised, staff are trained and the storage of medication improved. The service has some Controlled Drugs and a full check confirms these are being stored, administered and recorded correctly. We checked a sample of medication and feel that people are receiving their medication. The service had an assessment and protocol in place for one person partly self medicating. We did however see some minor errors in recording including one gap in the Medication Administration Record (MAR) although the person has received the medication, a gap in one of the records of medication in stock and the absence of an effective record system for administering some creams and mouth sprays. The manager tells us that she is observing staff administer medication and we advised of the need to keep a record to ensure staffs competency. We also saw that the service has introduced a monthly medication audit system to identify any shortfalls so it is likely that these errors would have been picked up. 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. People living at the service can be assured that they will be able to make choices about their lifestyle. People are offered the chance to take part in activities of their choice. People are offered a varied menu and can make choices about what they eat. Evidence: The AQAA states that the service has increased the amount of activities it provides and that these are more varied. Case tracking confirms that the service completes an assessments of peoples social care needs and identifies the activities they wish to undertake. Records of activities provided and undertaken are kept and these are evaluated monthly. Information about activities is available in everyones bedroom and on a notice board in the dining area. Our surveys tells us that most people feel that activities are always provided. We saw that there is an increase in the amount of group and individual activities provided. Case tracking confirms that the service provides 1:1 sessions for people that do not wish or are unable to take part in group activities. For example we saw that one person is supported individually with drawing and another one who is cared for in their bedroom has regular 1:1 sessions. Regular activities include bingo, skittles, crafts, gentle exercise, reminiscence sessions, quizzes and entertainers visiting the service. A Care Homes for Older People Page 16 of 30 Evidence: relative brings in their dog which people enjoy. The service also offers a weekly trip out either in a small group or individually. Over Christmas people had the chance to go out for a meal and to a carol service. During the inspection we saw a group of people with the activity staff member chatting together whilst having their nails done. The service provides people with the opportunity to have their spiritual needs met. Church leaders can visit and there is the opportunity to go to church. One person has dietary needs due to their religious beliefs and the service has responded to this need. The service tells us it has plans to increase peoples opportunities to take part in activities for example in the summer encouraging people to spend more time outside taking part in for example bowling and gardening. Whilst everyone either takes part in group activities or has 1:1 with the activity organiser we feel that there is scope for increased interaction and stimulation for people with dementia care needs. We observed a small group of people left alone in the lounge for a period with no contact with either staff or other people living there. The service provides a flexible routine. There are no set times for getting up and going to bed. People can remain in their bedroom or sit in the communal areas. For example we spoke to one person that prefers to sit in her bedroom and watch the television and another person who likes to sit in a small room off the dining area and draw. We also saw that people can have their meals where they wish although the service does encourages people to sit in the dining area so they have contact with other people. Our examination of a sample of bedrooms confirms that people can bring in some of their own belongings. The service encourages people to either manage their own money or for relatives to do this although it does look after small amounts of money for some people. It also manages two peoples money. We checked the records and confirm that suitable records are kept. We did see that one persons money is being paid into the services account and informed the service that this must be altered to make sure that this persons money is fully protected. This service started this change during the inspection. The people that answered our surveys say that they always or usually like the meals. People we spoke to are happy with the food provided. We saw that there is a menu on the notice board. This is in a written form and the manager assured us that it is planned to have this in a more accessible format that includes pictures. The menu confirms that a varied menu is provided. Choice is provided for all the main meals and Care Homes for Older People Page 17 of 30 Evidence: we saw people being offered the choices. We did advice the manager to consider providing a choice of puddings and a choice for those people on soft/ pureed diets. People are offered fruit every day with a fruit salad being served for those that want it during the afternoon. People are offered hot and cold drinks throughout the day and we saw that the staff always provide people with a choice of drinks. Records confirm that peoples nutritional needs are assessed on admission, people are weighed regularly and that if weight changes significantly this is addressed. A number of people require feeding and we saw this being completed in a respectful manner. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service are able to express their concerns and have access to a complaints procedure. Staff knowledge of safeguarding issues is improving the protection of people that live at the service. Evidence: The AQAA states that the service now spends more time talking to people and visitors discussing any concerns at an early stage. They say that this has reduced the number of final complaints. People that use the service and most relatives tell us that they know how to make a complaint and say that the service always responds to any concerns. People also tell us that the staff listen to them and act on what they say. We, the Commission, have not received any complaints since the last key inspection. The service tells us that it has received one complaint since the new management arrangements have been in place and that this has been responded to. An examination of the complaints record shows us that it needs some attention to ensure that is easy to understand and gives clearer details of any complaints received and actions taken. The new management team accept this and assure us that this issue will be addressed. The AQAA states that staff are aware of safeguarding issues and of the services whistle blowing procedures. Staff we spoke to could tell us about potential signs and symptoms of abuse and about the services whistle blowing procedures. The manager Care Homes for Older People Page 19 of 30 Evidence: is aware of the referral process if abuse if suspected. We do feel that it would be beneficial for staff to understand the actions the manager would take if an incident is referred to her. The service uses bed rails that can be used as a restraint. Examination of records confirms that an assessment is undertaken prior to installing bed rails and that consultation takes place with relatives to gain their views. The manager is aware of the Deprivation of Liberty aspect of the Mental Capacity Act and confirms that currently no one is being restricted. Prior to the current management there have been two safeguarding incidents. These were investigated by the local authority and actions taken to address the issues raised. Care Homes for Older People Page 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living a the service enjoy excellent communal and private accommodation that is kept clean and tidy. Evidence: The AQAA tells us that all its bedrooms have en suite facilities and are lockable and that there are private areas for individuals cultural and specialist needs. It also tells us that it has continued to upgrade the service. The clinical room has been upgraded and the kitchen restructured providing separate areas for food preparation, cooking, serving and washing up. There is also an area for relatives to make drinks. We saw that the service provides good accommodation. Bedrooms are all en suite and are all lockable. People are happy with their bedroom accommodation and can bring in small items of furniture and belongings. There is good communal accommodation. There is a large lounge area and two smaller sitting areas and a separate room for meetings. There are two dining areas available. The service appears well maintained and a record of maintenance completed is kept. The service is light and airy. Two people did tell us that they feel that the service is too hot and we asked the manager to look into this. The service tells us that it has policies in place for the control of infections. Care Homes for Older People Page 21 of 30 Evidence: Information provided in the AQAA confirms that staff are trained in infection control. Everyone that answered our surveys said that they feel the service is always clean and fresh. Comments from relatives include the home is well maintained - excellent housekeeping and always very clean. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are being supported by sufficient numbers of staff who receive training to undertake their role. The services recruitment process has not always ensured that people are fully protected. Evidence: The AQAA tells us that the service encourages and supports its staff providing induction and ongoing training including vocational qualifications. It also states that there has been a considerable change in staff and in their attitude due to an increase in the expected standards of care since the new management arrangements. The service provides adequate staffing to meet peoples needs although the roster shows that there have been a few occasions especially over Christmas when the service dropped below the staffing levels it tries to provide. There are two nurses and seven or eight care staff on duty during the day. One of the nurses is the Care Manager and we have asked the service to consider whether being on the care roster means that her management duties takes away from the required nursing tasks. The service tells us that it intends to recruit another nurse but has found this difficult. The service told us on our last visit that it intended to increase the numbers of nursing staff employed. Responses to our surveys from people living at the service state that staff are always or usually available. Care Homes for Older People Page 23 of 30 Evidence: We observed positive relationships between staff and people using the service. Comments from people include: All the staff do their best to keep me happy and all the staff are thoughtful and considerate. We checked a sample of staff files and these show that staff recruited since the new management arrangements have all the required checks but two people recruited prior to this have gaps in their documentation. Two people have only one reference and another person that started working without a full CRB did not have risk assessment completed. We have asked the manager to address this. The service tells us that it provides staff with training and has a range of training planned. Sampling of records confirms that staff receive training including medication, palliative care, stoma care and peg feeding. We would advice the service to complete competency assessments to confirm staffs ability to undertake tasks safely. We do feel that if the service is to provide nursing care to people with a learning disability staff should have some knowledge of these needs. We also saw some gaps in the mandatory training that staff should receive. The manager said that this was in the process of being addressed. Currently the service has seven staff with an NVQ qualification. This is below the expected level of at least 50 qualified. The Care Manager tells us that there are plans in place to address this. Care Homes for Older People Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service are benefiting from a service that is run in their interests and that takes account of their views. The service provides staff with training to promote the safety of people that live there. Evidence: The AQAA tells us the manager has lengthy experience in managing care services. It also states that she completes ongoing training to keep up to date. The AQAA also states that it has put in place a new quality assurance system. The manager has been in post for three months. She has lots of experience in managing care services. She still needs to apply for registration with the Commission. Since the new management arrangements we have seen an improvement in the quality of the service provided to people. The service has made a number of changes and there has been a high number of staff leaving the service. We are told that this is because the management is addressing poor staff attendance and is working to Care Homes for Older People Page 25 of 30 Evidence: improve the standard of care. Staff report that they feel that positive changes are being made and one staff member commented in their survey that they have already made lots of changes and are working hard to put everything right. Staff tell us that they feel that the manager is making changes to the services and they feel that she is firm but fair. The service has plans for further development and is aware of most of the issues we have raised. These include finishing the improvements in care planning, recording of complaints and the training and recruitment of staff. We are confident that the service will address these issues. The service has implemented a new quality assurance system that includes regular audits of medication, tissue viability, monitoring of the use of bed rails and accidents and falls. Surveys are to be sent out yearly to gain the views of people that use the service and relatives. The service provides staff with individual supervision and has started a system of observed practice aimed at monitoring and improving the staffs knowledge and competence to lead to an increase in the standard of care provided. Staff meetings are being held but we would advice the manager to keep proper records of these. The service looks after some peoples money and suitable records are kept. Money and valuables are kept in a safe. The service has a Health and Safety policy in place and employs on a retainer basis a person trained in Health and Safety issues. Records confirm that the service is completing regular checks of equipment including fire equipment, hoists and bed rails. The service has provided a range of health and safety training including moving and handling, fire, infection control and food safety. This is ongoing to ensure that all staff are fully trained. We would advice that an improved monitoring system be put in place to ensure that all staff are up to date as we saw a few gaps in peoples training. People that needed their fire training updated received this on the day of the inspection. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Where people are receiving medication including creams or sprays proper records should be kept. This will ensure that people can be assured that medication is being given as prescribed. 07/02/2010 2 14 20 Where the service is looking after peoples money this must be kept in an account separate from the account used in connection with running the business. This will make sure that peoples money is kept safe. 08/02/2010 3 28 19 Where people have been recruited without having the full employment checks the service must take action to ensure that this is addressed. This will ensure that people receiving care are protected. 20/02/2010 Care Homes for Older People Page 28 of 30 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 2 1 9 The information provided by the service must reflect the service it is providing. Where medication is handwirtten onto MAR sheets this should be signed by the staff member and a second person should check and sign its accuracy. Records of checks on staffs competency to administer medication and undertake health related activities such as stoma care and peg feeding should be kept. The service should look at how it can increase the interaction and stimulation for people that have cognitive impairments for example dementia care needs. The service should maintain a clear record of complaints that identifies the nature of the complaint and the actions taken to respond to it. The service should review its nursing staffing levels to ensure that there are always sufficient nurses on duty. Where staff are undertaking health related tasks such as stoma care and peg feeding a system of staff competency should be introduced. Staff should have more knowledge and understanding of the needs of people with a learning disability if the service is to provide nursing care to people with these needs. 3 9 4 12 5 16 6 7 27 30 8 30 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). 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