Care Home: The Old Library

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What the care home does well The manager visited people before they were admitted to the home to see if their needs could be met and then a detailed care plan was developed so the staff knew what care the person needed. The home had made sure that when they have identified that a resident may be at risk, they write and carry out a plan of care to reduce the risk. They look at care plans in detail on a regular monthly basis to check that the care plan was still relevant. They checked regularly that people had not lost or gained too much weight so that their health was maintained. They had developed links with the local hospital to make sure that any issues relating to peoples diet could be quickly addressed. The manager provided lots of information for the staff about peoples individual health needs so that staff knew the care that was required. The home provided clean, tidy and well-maintained accommodation. Complaints and protection of people living in the home was taken seriously and procedures and staff training was in place. The manager had made sure that people living in the home would be safe with the staff employed in the home by obtaining criminal record checks and references before staff started work. They made sure that new staff had an induction to the home and to the work they were expected to carry out so they know the policies and procedures and the standards expected of them. Staff received training to care for people safely and regular updates were provided. What has improved since the last inspection? To protect peoples privacy and meet data protection legislation care plans were now kept securely. To evidence that complaints had been fully investigated records of the investigation of complaints had been improved. To ensure that appropriate investigations are undertaken and people are fully protected, where allegations of abuse had been made a referral under safeguarding procedures had been completed. The management had improved systems to ensure effective communication in the home between management and staff including regular supervision. What the care home could do better: To evidence that peoples needs have been assessed prior to admission records of the assessments completed prior to admission must be available for inspection. Where people are not funding their own placement the placing authority should be advised of all third party top up fees and the relevant documentation completed.To ensure that staff have all the information required to meet peoples needs consistently and safely the care plans must be updated as needs change. Where care plans have been updated these these should always be dated and signed by the person completing the update to provide a complete audit trail and to evidence that care plans were updated in a timely manner. To ensure the safe handling of medication and to minimise the risk of errors evidence that training has been completed and competency tested must be provided. Accurate medication records must be maintained. Staff should maintain professional boundaries and not discuss their personal issues when they are providing care. This is to ensure that the person receiving the care is main focus in the task and feels their privacy and dignity is protected. The provider must access some training in safeguarding vulnerable adults and familiarise himself with the procedures. This is to ensure appropriate action to protect people is taken in response to an allegation of abuse. A review of both the easy chairs and dining chairs in the lounges should be completed as part of the programme of renewal and those which are worn should be replaced. New members of staff should be supported to finish their induction workbooks to ensure that all areas are fully understood. To ensure that the quality of the service continues to improve and to ensure that it provides good outcomes for people living in the home the systems to monitor and review the quality of the service provided must be reinstated and maintained. Confidentiality should be maintained when managing issues relating to the staff group to ensure that staff are encouraged to be open about any concerns they may have. Key inspection report Care homes for older people Name: Address: The Old Library Isaac`s Hill Cleethorpes North East Lincs DN35 8JR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kate Emmerson     Date: 2 5 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 Old Library Isaac`s Hill Cleethorpes North East Lincs DN35 8JR 01472601364 01472694111 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Charles William Jackson care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Old library is a 30-bedded care home registered for older people. The accommodation is set in a Victorian style building, retaining much of its original features. It is set in the seaside town of Cleethorpes, with views of the main thoroughfare to the sea front. There are eighteen single rooms and six shared rooms; one of the shared rooms has en-suite facilities. The home has two lounges and an adjoining dining area; all rooms are decorated and furnished to a good standard. The fees for the home are £377 per week plus a £16 per week third party top up. A top up is a fee paid over and above the contribution paid by the person living in the home and the funding authority. 2 2 0 1 2 0 0 9 0 Over 65 30 Care Homes for Older People Page 4 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was unannounced and took place over two days in January 2010. To find out how the home was run and if the people who lived there were pleased with the care they got, we spoke to staff working in the home at the time of the inspection and people who lived in the home. During the course of the inspection we observed how the staff cared for people. Some of the records kept in the home was checked. This was to see how the people who lived in the home were being cared for, that staff were safe to work in the home and that they had been trained to do their job safely. We also checked records to make sure that the home and the equipment used was safe and checked regularly. A tour of the home was conducted to see if it was kept clean and tidy. The home provided a very friendly atmosphere and people who lived in the home and Care Homes for Older People Page 5 of 30 visitors said they were happy with the care provided. Unfortunately, at the time of the inspection, both the deputy manager and the manager were on leave due to personal issues. The provider was providing hands on management support in the short term. He was being proactive in trying to familiarise and work through the procedures in the home. There were some areas that he did not have sufficient knowledge of and he had sought external advice. He responded immediately to areas of concern brought to his attention at the time of the inspection. It has come to the Commissions notice that the provider has changed. The home is no longer run by the individual provider, Mr Charles Jackson, but by the company, The Old Library Residential Home Limited, also owned by Mr Jackson. Mr Jackson failed to inform the Commission of this change as is required by law and we have been working with him to ensure that the home is correctly registered as soon as possible. Failure to complete this process may lead to further regulatory action. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: To evidence that peoples needs have been assessed prior to admission records of the assessments completed prior to admission must be available for inspection. Where people are not funding their own placement the placing authority should be advised of all third party top up fees and the relevant documentation completed. Care Homes for Older People Page 7 of 30 To ensure that staff have all the information required to meet peoples needs consistently and safely the care plans must be updated as needs change. Where care plans have been updated these these should always be dated and signed by the person completing the update to provide a complete audit trail and to evidence that care plans were updated in a timely manner. To ensure the safe handling of medication and to minimise the risk of errors evidence that training has been completed and competency tested must be provided. Accurate medication records must be maintained. Staff should maintain professional boundaries and not discuss their personal issues when they are providing care. This is to ensure that the person receiving the care is main focus in the task and feels their privacy and dignity is protected. The provider must access some training in safeguarding vulnerable adults and familiarise himself with the procedures. This is to ensure appropriate action to protect people is taken in response to an allegation of abuse. A review of both the easy chairs and dining chairs in the lounges should be completed as part of the programme of renewal and those which are worn should be replaced. New members of staff should be supported to finish their induction workbooks to ensure that all areas are fully understood. To ensure that the quality of the service continues to improve and to ensure that it provides good outcomes for people living in the home the systems to monitor and review the quality of the service provided must be reinstated and maintained. Confidentiality should be maintained when managing issues relating to the staff group to ensure that staff are encouraged to be open about any concerns they may have. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided people with information about the services provided in the home and peoples needs were assessed prior to admission. However not all the records to fully evidence processes were available. The home did not provide intermediate care. Evidence: In the surveys received by the Commission people stated that they had received adequate information about the home before they moved in and had been provided with written information about the terms and conditions of residency. There was signed evidence in individuals files of agreement to the contract or statement of terms and conditions. These indicated that some people had signed to agree and were paying a third party top up fee. At the last inspection the manager was advised that the placing authority must be advised of all third party top up fees Care Homes for Older People Page 10 of 30 Evidence: and the relevant documentation completed. We were unable to check whether the placing authorities had been made aware of this additional fee as the contracts provided by the Local authority could not be found at this inspection. The home offered a trial period and people were encouraged to have a short visit to the home for a meal before they decided to stay in the home. A pre admission assessment of peoples needs was completed by one of the management team and this was signed and agreed by the resident. A care plan was then developed to show how peoples needs were to be met. In the four care files examined all but one had a completed assessment on file. The assessment and personal profile details for the person most recently admitted to the home could not be found. A detailed care plan was in place which indicated that this process must have been completed. In surveys staff stated that they were provided with information about the care needs of people they supported and cared for. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were detailed care plans in place to support the care needs of people living in the home. However these had not always been updated when care needs had changed. This means that staff may not always have up to date information to enable them to meet peoples needs consistently. The homes medication policies and procedures had not been followed by staff in all areas which may put people at risk. However the provider acted immediately to address the issues. Staff did not always act professionally during care tasks and people felt that confidentiality and privacy and dignity were not always promoted. Evidence: Random selections of care plans were examined. The care plans were detailed and focused on the individuals abilities as well as areas in which they required assistance. There was evidence in the plans that individual risk assessment was undertaken: risk assessments for moving and handling, tissue viability, falls and nutrition were in place. Care Homes for Older People Page 12 of 30 Evidence: Daily diary records were well maintained and detailed. There was evidence that peoples health was monitored and professional advice sought for pressure area care and dietary needs. Where people had a specific health problem the manager provided detailed information for carers from NHS direct in the care plan. Monthly evaluations were detailed although where changes in peoples needs had been identified care plans had not always been updated. For example a persons difficulty in eating had been identified and appropriate advice had been sought. However the information relating to the persons new care requirements had not been updated on the homes care plan. The risks to the person were minimised as the information from the dietitian had been filed in the care plan and the staff had been informed and they were observed to provide care and assistance appropriately. Where care plans had been updated these were not always dated and signed to provide a complete audit trail and to evidence that care plans were updated in a timely manner. There was evidence that some of the care plans had been formally reviewed with the person living in the home since the last inspection and this should be completed for all, at least annually, to ensure that the plan of care remains appropriate. There was some evidence that care plans had been discussed and agreed with people but the home should endeavour to ensure that this is evidenced by always having the person or their representative sign them. Care plans were now stored in an locked cupboard ensuring peoples privacy and data protection legislation were met. The provider had employed an external consultant to monitor the care plans in the managers absence. They had already completed some work in this area and identified areas for completion and improvement which the staff were addressing. The home had well developed procedures in place for the safe handling of medication, which included self-administration of medication and accredited training for the staff. However there were some issues which may put people at risk. One member of staff had been promoted to a senior position with responsibility to administer medication but there was no evidence that accredited training had been completed and competency had been checked. The staff member stated that they had completed this training and had provided the certificate to the manager for filing. Records of receipt, administration and disposal of medication were maintained. On checking these one medication which had been signed as given was still in the medication tray and hand transcribed prescription details in the medication records Care Homes for Older People Page 13 of 30 Evidence: had not been witnessed and signed to evidence that accuracy of the record had been checked. There was also some confusion as to who would be ordering repeat medication in the managers absence. The temperatures of the medication storage cupboard and medication fridge had not been checked and recorded on a consistent basis. This must be completed at least daily to ensure the quality of the medication is not compromised. The provider was advised of these issues and he immediately arranged for the pharmacist to complete an audit of the medication and arrange reordering of the medication. This had been completed by the second day of the inspection. Additional training had also been arranged for one staff member so they could under take the task of reordering medication in future. The induction program covered peoples rights to privacy and dignity. To encourage privacy and dignity to be respected terms of address were indicated on the care plans, a telephone was available for use in private, personal mail was handed directly and unopened to the person to whom it was addressed, unless otherwise agreed and privacy locks had been provided on private accommodation and toilets and bathrooms. Observation of staff during the inspection identified that they were patient and courteous at all times. There were some concerns from staff about confidentiality in the home and one person living in the home said that staff discuss issues when they are providing care although this was mainly about their own personal lives. This does not respect professional boundaries, may make people feel uncomfortable and does not protect peoples privacy. Care Homes for Older People Page 14 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 felt they were able to exercise control over their lives. They were provided with a varied activities plan and good quality meals. Evidence: Activities on offer were planned and people were informed of the activities in advance as the plan was displayed in the lounge. Peoples interests and social needs were assessed and care plans had been developed. Activities provided were varied and included entertainers such as singers visiting the home and outings. A small group had recently visited the local cinema. In surveys people indicated that there were activities made available to them. In discussion with people living in the home they stated that they enjoyed the activities on offer. Staff were observed to actively encourage people to join in activities. Newspapers were also provided for people living in the home and they were observed sharing these. The provider was considering the purchase of a a mini bus for the home to further expand the activities available. People living in the home said they could rise and retire when they wished, and a cup of tea and breakfast in bed was available. The people who lived in the home could Care Homes for Older People Page 15 of 30 Evidence: chose where to sit and had the opportunity to watch the television programmes of their choice or listen to music. The meals were provided on a four-week rotating menu and the menu was written daily on a board. The menus showed a variety of meals were provided. Choices were available at breakfast and tea time. Whilst the menu did not offer a separate choice at lunch time records of food served showed that individual preferences were catered for. Peoples nutritional status was monitored and the home worked with health professionals to ensure they provided an appropriate diet for people who required assistance. One person was observed to require assistance with their meals. A care plan was in place together with records to monitor the diet taken. A staff member was observed assisting this person to take their lunch in an encouraging and patient manner. People living in the home were very positive about the meals provided to them and all spoken with said the food is very good. One person preferred their family to bring in their food and the home accommodated this. The home had received four stars in an inspection of the kitchen by the environmental health officer, prior to writing this report the provider informed us that after a further inspection the kitchen now had five stars. Care Homes for Older People Page 16 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensured that people were made aware of the complaints procedure and had the opportunity to raise issues. The home had processes in place to protect people from abuse and there had been improvements in respect of referral to appropriate agencies for investigation where an allegation of abuse had been made. However in the absence of the manager the person responsible for the management of the home did not have adequate knowledge of the procedures to ensure that appropriate action to protect people would be taken in the event of an allegation being brought to his attention. Evidence: The home had a policy and procedure for management of complaints. They made sure that people were aware of the complaints procedures by displaying the procedures in the home and in information about the home. People visiting the home had the opportunity to comment about the service in a comments book provided alongside the visitors book. Surveys indicated that people knew how to complain or raise issues. No complaints were made to us during the inspection and people were happy with the service they received. Information provided to the Commission by the home prior to the inspection stated that the home had received one complaint since the last inspection. Records showed that this had been ongoing at the time of the last inspection and had been Care Homes for Older People Page 17 of 30 Evidence: investigated appropriately. Records of complaints and investigation were maintained. There were improvements in relation to the detail of the records and referral to appropriate agencies was evidenced. Staff commented that there was some improvement in how their concerns were dealt with by the management and staff felt communication had improved over the past year. However there were still comments from staff about the continuing lack of confidentiality with regard to some issues that were raised with the management which may impact on staff being open and willing to come forward with concerns. The staff all commented on how much this had improved since Christmas when the provider had taken a more hands on role in the home. They all stated they felt able to discuss things with him and felt that action would be taken where necessary. The staff had access to a copy of the multi agency safe guarding adults policy and procedures. The home had also developed their own detailed safeguarding policy, which linked in with this document. Policies on restraint, dealing with aggression, whistle blowing and managing finances were in place. We were advised by the Local Authority training coordinator that staff had accessed their safeguarding adult training with the Local Authority. The management had been proactive in ensuring that new staff also completed this training with the Local Authority as part of their induction. The provider had little awareness of these policies and procedures. He was advised to access some training in this area and familiarise himself with the procedures. This is to ensure he understands his role and responsibilities, particularly in the absence of the manager, if an allegation of abuse came to his attention. Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, tidy and well maintained and provides a comfortable environment for people living in the home. Evidence: The home is located in a very central area, close all the local amenities and the sea front. The home has three floors that are accessed via stairs or passenger lift. The general condition of the decoration was of a good standard. Redecoration and refurbishment was ongoing. Some bedrooms had been redecorated and new carpets had been laid. New beds had been purchased for four rooms. Following an unfortunate lightening strike some of the electrical systems had to be replaced such as the call bell and fire alarm system. All areas seen as part of this inspection were clean and tidy. Odour control was well managed. One room which had been odorous due to the carpet had a new carpet fitted on the day of the inspection as part of the refurbishment plan. The seating in the large lounge was placed around the outside edges of the room with the dining tables, which hardly anyone used, being placed in the center of the room. This does not encourage or enable people living in the home to interact with each other. The seating also extended under the wall mounted TV which meant staff or Care Homes for Older People Page 19 of 30 Evidence: people living in the home were at risk of knocking themselves and people sat under the TV would not be able to see the programmes. The provider was advised that he should review how this room was organised with the people living in the home. We have been advised that since the inspection the lounge had been rearranged following discussion with the people living in the home. Some of the easy chairs and dining chairs in the lounge were very worn and would benefit from being replaced. Policies and procedures were in place for control of infection and this was covered in the induction training for new staff. Staff confirmed that they had adequate supplies of protective clothing. There was evidence in staff files that staff had completed training in infection control. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Trained staff were provided in sufficient numbers to meet peoples care needs. The recruitment procedures were adequate for the protection of people living in the home. Evidence: The home was registered for thirty residents and at the time of the inspection there were eighteen people accommodated. Three staff were provided on day shifts between 7am and 10pm. The residential forum was used to calculate the staffing levels appropriate to the dependency of the people living in the home. There was evidence from staff training records, staff discussions and discussion with the Local Authority training coordinator that the home had an active training program, which included mandatory and service specific training such as moving and handling, fire safety, dementia awareness and arthritis awareness. In surveys staff indicated that they had all received training relevant to their role and one staff member said we have updates regularly regarding training. The provider had been proactive in the absence of the manager in checking with the Local Authority training coordinator that all the training was up to date and she was visiting the home on the day of inspection to discuss future training needs. The home was committed to staff receiving NVQ training and information provided to us prior to the inspection stated that of eighteen care staff employed twelve had Care Homes for Older People Page 21 of 30 Evidence: achieved at least NVQ 2. Adequate checks were completed prior to employment of staff including POVA (Protection of Vulnerable Adults) 1st checks and CRB (Criminal Records Bureau) checks. New staff completed skills for care induction training workbooks. A new staff member stated that they had started this workbook but was waiting for the manager to check their work before completing this piece of work. They also stated that they had spent two weeks shadowing senior staff to learn their about the role. Their records showed that they had also completed a variety of training since their employment and this had included moving and handling, safeguarding adults and dementia. People living in the home generally gave very positive comments about the staff which included they look after me well, staff are friendly, happy and very helpful and they care for me well. One person thought the standard of carers was variable. Care Homes for Older People Page 22 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management was disrupted due to the absence of both the manager and the deputy manager. The provider and his wife were providing providing management cover and they were being proactive in trying to ensure systems were maintained and in some areas had made improvements. Staff were now regularly supervised and staff morale had improved. Health and safety was generally well managed although some systems had not been maintained in the managers absence. This was addressed by the provider during the inspection. Evidence: The current manager had been in post since February 2008. She had previously worked as the deputy manager for a year and had a long career in the care industry and had been the deputy manager for four years in her previous employment. The manager had completed a wide range of training relevant to her role including NVQ 4 Care Homes for Older People Page 23 of 30 Evidence: in care and the Registered Managers award. She was supported in her role by the deputy manager who had previously been been the manager of the Old library. Unfortunately both the deputy manager and the manager were on leave due to personal issues. The provider was providing hands on management support in the short term. He was being proactive in trying to familiarise and work through the procedures in the home. There were some areas that he did not have sufficient knowledge of and he had sought external advice. He responded immediately to areas of concern brought to his attention at the time of the inspection. The manager had still not made an application to be registered with the Commission at the time of the inspection and she has been formally advised by the Commission to complete this process as soon as possible. A system of monitoring the quality of the care provided had been maintained until September but there had been little input since then due to the deputy managers absence. There was evidence of involvement in the process from people who lived in the home in completed surveys but the responses had not been audited and an action plan produced. The provider needs to ensure that this process is reinstated and maintained in the deputy managers absence. People living in the home and visitors spoke highly of the care provided at the home. Comments included they look after me well and the home do everything well, I like it here. At the last inspection there were tensions within the staff group. Staff did not feel supported and did not feel that their complaints were taken seriously. There was also a lack of effective communication between management and the staff group. At this inspection there had been some improvements in this area due to improved communication and supervision processes. Staff stated that they now felt more supported and particularly so since the provider had taken a more hands on role in the managers absence. There was evidence in the staff files examined that the frequency of supervision had improved and staff had had appraisals since the last inspection. There remained concerns that confidentiality in the home with regard to staff issues was not always maintained and this must be addressed to ensure that staff are encouraged to be open about any concerns they may have. There were very clear records maintained by the administrator where the home was Care Homes for Older People Page 24 of 30 Evidence: assisting people with their finances and receipts were held for transactions. Health and safety in the home was generally well managed. Systems were in place to ensure that safety checks were completed as required on equipment such as hoists, the lift and electrical equipment. Detailed fire and environmental risk assessments were in place and individual risk assessments were held in care plans. The fire alarm and emergency light systems had been tested regularly up until the managers leave commenced in late December. There had been no tests completed in January 2010. The provider was advised to complete a test on the day of the inspection. This was completed and by the second day of the inspection new procedures in relation to fire alarm testing and recording test had been implemented. A member of staff had also been delegated the responsibility to ensure that these tests were completed on a weekly basis in future. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 8 15 The care plans must be updated as needs change. To ensure that staff have all the information required to meet peoples needs consistently and safely. 30/03/2009 2 9 13 Accurate medication records must be maintained To provide an audit trail whilst medicion is in the home and to minimise the risk of errors. 30/04/2009 3 9 18 Training must be provided to 30/04/2009 staff prior to them administering medication. To ensure the safe handling of medicaion and to minimise the risk of errors. Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Records of the assessments completed prior to admission must be available for inspection. To evidence that peoples needs had been assessed prior to admission. The care plans must be updated as needs change. To ensure that staff have all the information required to meet peoples needs consistently and safely. 31/03/2010 2 7 15 30/04/2010 3 8 17 Accurate medication records must be maintained. To provide an audit trail whilst medication is in the home and to minimise the risk of errors. 01/04/2010 4 9 13 Evidence must be provided that all staff responsible for administering medication have completed an 01/04/2010 Care Homes for Older People Page 27 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action accreddited course and are competent in this task. To ensure that medications are administered safely and peoples health safety and welfare are protected. 5 18 13 The provider must access 31/03/2010 some training in safeguarding vulnerable adults and familiarise himself with the procedures. This is to ensure appropriate action to protect people is taken in response to an allegation of abuse. 6 33 24 The systems to monitor and review the quality of the service provided must be reinstated and maintained. To ensure that the quality of the service continues to improve and to ensure that it provides good outcomes for people living in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 30/04/2010 1 2 Where people are not funding their own placement the placing authority should be advised of all third party top up fees and the relevant documentation completed. 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 2 7 The care plans should be formally reviewed at least annually with the person living in the home to ensure that the plan of care remains appropriate. The person or their representative should sign their care plans to evidence that these have been discussed with them and they have agreed to the plan of care. Where care plans have been updated these should always dated and signed by the person completing the update to provide a complete audit trail and to evidence that care plans were updated in a timely manner. The temperatures of the medication storage cupboard and medication fridge should be checked and recorded at least daily to ensure the quality of the medication is not compromised. Hand transcribed prescription details in the medication records should be witnessed and signed to evidence that accuracy of the record had been checked to minimise the risk of error. Staff should maintain professional boundaries and not discuss their personal issues when they are providing care. This is to ensure that the person receiving the care is main focus in the task and feels their privacy and dignity is protected. A review of both the easy chairs and dining chairs in the lounges should be completed as part of the programme of renewal and those which are worn should be replaced. New members of staff should be supported to finish their induction workbooks to ensure that all areas are fully understood. Confidentiality should be maintained when managing issues relating to the staff group to ensure that staff are encouraged to be open about any concerns they may have. 3 7 4 7 5 9 6 9 7 10 8 19 9 30 10 32 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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