Care Home: The Old Vicarage

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What the care home does well The home provides a homely and friendly environment for people to live in and to visit. There is written information available for people to help them decide if they wish to live in The Old Vicarage. They are also welcome to visit the home to help them make up their minds. There is a range of activities for people to take part in, including visits outside the home. There is sensitivity to the wishes of people who prefer not to take part in organised activities. There are regular residents meetings where ideas are discussed about meals and activities. The home provides a varied menu of good home cooked food. People told us they liked the meals. The home has a clear complaints procedure that is made available to people who live in the home and their representatives. The premises are kept clean and people are able to bring their own belongings in to make their room personal to them. There are sufficient care staff on duty both by day and night to ensure that the needs of the people who use the service can be met. People like the staff and spoke highly of the way in which the staff care for them. The manager has promoted a supportive and open feeling in the home amongst the staff and the residents. There is regular formal supervision for staff. What has improved since the last inspection? People`s support needs are now written more clearly in their care plans to help ensure staff know how to meet these needs. People`s confidential Records are being held more securely. The range of activities has increased and people are benefiting from the weekly gentle excerice classes. People`s medication is being managed more safely. Some parts of the home have been decorated and improvements made such as a new boiler. There is now a new bath hoist chair that enabled people to bathe more safety and comfortably. Staff have been offered a lot of training to help them do a good job. All but one of the care staff now hold a care qualification.There is now a First aider on duty each day. Better checks are being carried out on new staff before they start work. They will now be given an in depth induction before taking on the role of carer unsupervised. The manager`s skills have increased and she has developed ways of getting feedback on the service to help guide improvement plans. What the care home could do better: The Service User Guide needs to be update and it could be changed to make it more accessible for older people. People`s care plans need to include clear guidence for staff about how all main care needs are being met. Communication with people`s families can be improved to help ensure care plans are accurate and there is full satisfaction with the service provided. The plans to provide staff with training around specific health conditions and topics relevant to elderly care should be followed through. A new cook needs to be employed so the manager can focus on running the home withot also being the cook. It would benefit the service if the manager continues to attend training on elderly care and benchmarks the quality of the service against other similar services. She should also obtain the Registered Managers Qualification. Key inspection report Care homes for older people Name: Address: The Old Vicarage Ford Street Wigmore Near Leominster Herefordshire HR6 9UW     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: Jean Littler     Date: 0 8 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Old Vicarage Ford Street Wigmore Near Leominster Herefordshire HR6 9UW 01568770564 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): UG Care Ltd Name of registered manager (if applicable) Sherry Joy Guimbal Guanzon Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 16 The registered person may provide the following category of service only: Care Home Only (PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other categories (OP) 16 Date of last inspection Brief description of the care home The Old Vicarage is a large, detached period house and a ground floor extension has been added to the home. It has a central location in the small village of Wigmore a rural area in the north of Herefordshire within easy reach of the local amenities, such as the church, post office, village stores and public houses. Accommodation for the residents is on two floors; access to the first floor is via a shaft lift although this is not Care Homes for Older People Page 4 of 31 Over 65 16 0 Brief description of the care home big enough to take a wheelchair. There are thirteen bedrooms, three of which are shared. There are two lounges.The home is owned and managed by UG Care Ltd and managed by Mrs Guanzon. It is registered to accommodate up to sixteen people. People who live in the home must have care needs arising from old age.Fees are GBP500 per week; further information about fees can be obtained from the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, the Commission, carried out this Key Inspection over one day. We talked to people who use the service, some visiting relatives, staff and the manager. We looked around the home. We saw some records that must be kept by the home to show that it is being run properly. These included records relating to the care of people who live in the home, medication and staff recruitment and training. Before we visited the home had completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that tells us how the home thinks they are performing, what they think they are doing well and what they think they could do better. This helped us to plan how to do the inspection, and some information from the AQAA is included in this report. We also received completed surveys from seven people who use the service and five from staff. The information in these helps us to understand how well the home is Care Homes for Older People Page 6 of 31 meeting the needs of the people who live there. During the year since the last Key Inspection in April 2009 we have been to the home on three other occasions. These visits are called Random Inspections and the reports are available on request from us. We visited in July to see if the requirements made at the Key Inspection had been met. Some had not and other concerns came to light. The October and December visited were made to ensure the manager and owners had taken action to address the shortfalls. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Peoples support needs are now written more clearly in their care plans to help ensure staff know how to meet these needs. Peoples confidential Records are being held more securely. The range of activities has increased and people are benefiting from the weekly gentle excerice classes. Peoples medication is being managed more safely. Some parts of the home have been decorated and improvements made such as a new boiler. There is now a new bath hoist chair that enabled people to bathe more safety and comfortably. Staff have been offered a lot of training to help them do a good job. All but one of the care staff now hold a care qualification. Care Homes for Older People Page 8 of 31 There is now a First aider on duty each day. Better checks are being carried out on new staff before they start work. They will now be given an in depth induction before taking on the role of carer unsupervised. The managers skills have increased and she has developed ways of getting feedback on the service to help guide improvement plans. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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. People are given information about the home. This is not always kept up to date. People are encouraged to visit and try the service out. An assessment of a persons needs will be carried out before a place is offered. Evidence: There is a Service User Guide that provides people with information about the home. A copy of this and the last inspection report were on display in the home. The Guide was last updated in November 2009. It needs some amendment as some information is now out of date. For example the number of staff who are qualified has increased, it incorrectly indicates that an activities coordinator is employed, and in different places it states the home is for 15 and 16 people. The design could be made more accessible for older people if it was in a larger print and more simple language. The current fees need to be included so people have all the facts they need to help them make a decision about where to live. The manager told us that a copy of this document is provided to each person on admission. In their surveys the residents told us that they Care Homes for Older People Page 11 of 31 Evidence: had received enough information about the home before they came to live there. One person spoken with said her family had been given all the information and took care of arrangements for her. At the last Key Inspection we read the file for the person who had moved in most recently and found that there was an assessment in place that was carried out before their admission. This was sufficiently detailed but the information had not been written into a plan of care to guide staff about how to meet that persons care needs. There are eight residents and none were new since the last Key inspection so it was not possible to judge if the procedures have been improved. People living locally do stay for respite care but the funding authority complete the assessment for these peoples needs. The manager told us that people interested are encouraged to look round to help them make a decision about whether to move in. They would be offered a months trial before making their mind up. The home does take people as emergency admissions and there is a policy about how the home manages this. There is a policy in place that included ensuring that an assessment of the persons care needs is carried out or that the home receives information from the agency that referred the prospective resident. Care Homes for Older People Page 12 of 31 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. People have the majority of the support needs described in their care plans and these are being kept under review. People are having their health and personal care needs met in the way they prefer. Peoples medication is now being managed safely. Evidence: People living in the home appeared well presented and they told us their needs are being met. Seven residents returned surveys. All were positive and comments included, They look after us well; I am happy; The care is good. Most had been supported to complete them by the manager. It was be positive if for future surveys a third party could be involved such as a relative or advocate. In their surveys people told us that they thought that their health care needs were well attended to by the home. Within each persons file was a record of contacts they had with their GP and district nurse. It was evident from these that people were referred when problems were identified with their health. Better records are now being made about health appointments such as chiropody, dental or optical care. Care Homes for Older People Page 13 of 31 Evidence: The shift handover was observed. Staff spoke about people with dignity and exchanged appropriate information about current health issues, who had bathed, visitor and what activities were arranged for the day. People usually have a bath once a week but the manager said this can be more often if required. Recently a new bath seat has been provided, prior to this some people were not able to bath and could only have a full body wash. We read two peoples care plan files. Both contained the new care plan format that the manager has introduced over the last year. The information was tidy and easily assessable for staff. Some specific guidance was missing. For example one person has physiotherapy equipment they brought in with them following a Stroke. There was no specific care plan about how she is to be supported to use this and how often. Discussions with the staff and manager indicated that the equipment was used and the resident was being encouraged to maintain mobility. Discussions with relatives visiting the person showed there had not been clear communication about what they felt should be provided and what was being provided. From this we established that the manager had not offered to show the care plan to the person or her family, (with her consent). Discussions with this persons relatives also showed they had concerns about the level of personal care and attention given to hand and foot care where the lady had special needs. Our initial enquiries indicated that appropriate care was being provided but this was obviously not being demonstrated in a transparent way. The manager said she would address this and discuss with the resident about having record charts in her bedroom accessible to her family. Discussions showed staff thought they could not trim peoples nails, while the manager said she had trained staff recently and expected them to now do this. Each resident has an identified Key worker with a role of ensuring the service is as personalised as possible. This situation indicated that this role as a communicator between all parties ensuring peoples needs are being met can to be developed further. The plans contained risk assessments for areas such as moving and handling and pressure care. In some the action taken as a result of the risk could be made clearer, for example one ladies pressure care risk rating was high but there were no comment about arrangements in place. Discussions indicated that the district nurse was aware and was monitoring. Pressure relieving equipment was being used. A care plan review and monitoring system has been set up and Key workers are checking the information is accurate each month. This is positive but the process needs to also look for gaps in Care Homes for Older People Page 14 of 31 Evidence: the planning process. A requirements to improve care planning was made at the last Key Inspection and was not deemed to be met until the Random Inspection in December 09. A requirement was made at the July 09 Random Inspection about the lack of a risk assessment for the use of bedrails with one person. This was complied with and then the same shortfall was found on another residents plan at the December Random Inspection. Although no negative outcomes were found on this occasion the shortfalls identified above show that this is still an area the manager needs to develop. Further training about care for older people should be considered as she cannot rely on visiting professionals to identify which health and care areas need a specific care plan for each individual. The medication in current use is stored in a suitable trolley that is fixed to the wall in a separate cupboard. The keys are being held securely by someone trained to administer the medicines. The administration record were clearly laid out and showed that prescribed doses had been given. Systems are now in place to create an audit trail of the medicines received into the home. Suitable storage and a register are in place for the management of controlled medicines, however, currently none are in use. Guidance is now available for staff about the use of any As Required medication such as pain relief tablets, and the circumstances in which it should be used. The medicines that people are prescribed are included in a profile in their care plans. These could be improved if the contained information about how the person prefers to take their medicines and if they have full mental capacity and consent to the home managing and administering their medication on their behalf. All staff who administer medication have received Safe Handling of Medicines training. Care Homes for Older People Page 15 of 31 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 are supported to maintain choice in their daily lives. Activities for people to take part in are being provided and people are supported to continue any personal interests. A varied menu of nutritious food is provided. Evidence: There is a homely atmosphere and people told us it feels like their home. Interactions observed were friendly and relaxed. One resident gave a warm greeting to the manager and her husband. Another decided to go and sit outside in the sun and a worker spoke nicely to her offering to get her a blanket. Staff confirmed what the manager told us, that people choose their daily routine e.g. they get up and go to bed when they choose and decide when to socialise and what activities to take part in. We saw people decide where to spend their time, either in the lounge or in their room and one person chose to go for a walk. Care plans and feedback indicated that people are encouraged to remain as independent as possible. Staff told us that one lady is assisted into the bath and then she likes to wash and get herself out. This is positive, however, it may increases the risk of her falling than if staff helped her. One man does not like using the foot plates on his wheelchair and will kick them out of the way. He is therefore moved in his Care Homes for Older People Page 16 of 31 Evidence: wheelchair without them, which could result in a foot or ankle injury. The manager was advised to ensure that where people want to be independent or make choices that may seem unwise that the risks are discussed with them and a risk assessment completed. This should indicate whether the person has full Mental Capacity. If they do not then a Best Interest meeting should be held with them, their representatives and any relevant professionals. The new care plan format includes information about peoples interests. Staff showed a good knowledge of individuals preferred routines and hobbies. In their surveys people told us that they were happy with the level of activities provided. The manager said she hopes to increase the variety of things offered particularly outings in the better weather. The home has shared use of a minibus with other homes in the group. Currently there are quizzes, floor games such as carpet skittles, weekly gentle exercise classes, DVD film showings and arts and crafts sessions (Easter decorations were being made). Special occasions have been celebrated, for example there was a Harvest Supper and peoples birthdays. Residents meetings are held regularly and the manager told us the residents have asked her to chair these. She said activities are always discussed and the Easter party was on the next agenda. The manager said people had suggested outings that had then been arranged, for example two groups went out for a meal and the manager took one lady into town to buy personal shopping. Staff said some people like the gardens. One worker had assisted a resident to walk round the garden the previous day looking for daffodils. A Vicar visits about once a month to provide Holy Communion. We saw some information in the care plans about peoples spiritual needs. This was cross referenced when relatives of the person were spoken with and the information they shared was different. This indicates that improvements can be made in how social and emotional needs are assessed and planned for. People living in the home told us that their visitors were welcome at any time. The quiet lounge can be used for meeting in private. People told us that they enjoyed the meals. One said the manager was a very good cook. Most people choose to eat in the dining room. Breakfast is served in peoples bedrooms when they are ready for this. The meals seen were nicely presented and looked appetising. The manager told us the menu is kept under review and discussed at the residents meetings. She felt peoples preferences are taken into consideration. The meal for the day is displayed on a board in the dining room. A record of peoples preferences is kept in the kitchen but this needs to be brought up to date. The Care Homes for Older People Page 17 of 31 Evidence: manager said special diets are catered for but no one in the home at this time required one. We saw that drinks were offered at regular intervals and a water cooler machine has been purchased and placed in the lounge. The home achieved a rating of Very Good from the local environmental health department for their food hygiene standards in January 09. Care Homes for Older People Page 18 of 31 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. People have access to a complaints procedure. They feel they can approach the manager with any concerns and she will take them seriously. During the year the manager has become familiar with the local multi agency protection procedures and she has made appropriate referrals. People are being better protected because of this and because the requirements to improve health and physical care arrangements have now been complied with. Evidence: There is a copy of the complaints procedure in each persons room, it is on display in the hall and also in the Service User Guide. Five of the seven people who returned surveys said they knew how to make a complaint if they needed to. The information in the AQAA told us that one complaint has been received in the last year. This was about the laundry service and the manager said she took prompt action. One persons family had raised a complaint about the conduct of a worker and issues about how their mothers needs are being met. They were meeting with the manager when the inspection started. Afterwards they spoke to us and said the manager was very helpful and took their concerns seriously. The manager informed us that she had reported the allegation about the workers conduct to the Herefordshire Council Safeguarding team that morning. They had advised that an investigation would be carried out. A referral was made to Herefordshire Safeguarding team by us following the Random inspection in July 2009. This was because we had serious concerns about the care Care Homes for Older People Page 19 of 31 Evidence: arrangements for five residents. Community based professionals came into the home and supported the manager to improve care planning, risk management and health care arrangements. Two people were moved to nursing care where their needs could be better met. After this support, monitoring visits by the Local Authority Contracts and two further Random inspections by us to ensure compliance the Safeguarding team decided to close the procedure in December 2009. The manager has learnt from this experience but needs to ensure that standards of care management do not fall below acceptable standards in the future. In the last year the manager has attended the Local Authority training for managers on Protecting Vulnerable Adults from Abuse. Staff have all attended a similar course relevant to their role. Some staff had had this training before but have used this as a refresher about good practice. Feedback indicated that staff were aware of their duty to report any concerns. Staff find the manager and owners approachable and helpful. People are being better protected now the manager is following more robust recruitment procedures. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The house is homely and comfortable. Improvements are being made, however, others plans are still outstanding. Evidence: The Old Vicarage is a detached house in the village of Wigmore. Whilst the home is set in large gardens these are not separated from road or car park access and there are some trip hazards. There is a ramp to one door to provide disabled access. There is a homely feel about the house. There is one main lounge furnished with armchairs and a new large television. Another lounge is available but this is used more for staff handovers and other meetings. There is a separate dining room, a kitchen and a laundry. The bedrooms are located on both the ground and the first floor. There are thirteen bedrooms, three for shared use. Although it is not good practice for people who do not know each other to share there are curtains separating the beds to help privacy, but not round the washbasins. The single bedrooms that we saw were well personalised. People can use the house phone but the manager said most people have their own phone line in their room. Two bedrooms have en-suite facilities. There is an assisted bath but the home does Care Homes for Older People Page 21 of 31 Evidence: not have a shower. People living in the home do not therefore have a choice about whether to shower or bathe. A new bath hoist has been fitted recently as the other one broke and for several weeks some people were unable to have a bath. Access to the first floor is via a staircase or a shaft lift. Handrails are in place but the staircase is steep and not easy for people to negotiate. The shaft lift is small and is not able to take some wheelchairs. This means that people with mobility problems may have difficulty accessing the first floor. The manager told us there are plans to replace the shaft lift at some stage when funds allow. The new owners have made good progress to upgrade the home. These include new laundry equipment, upgraded fire protection equipment, a new boiler, some new soft furnishings and decoration of two bedrooms. The manager said she plans to replace the cooker, which is only a four ring domestic one, with a professional appliance. Some improvements identified at the last Key Inspection are still outstanding such as; -One bedroom we saw had vinyl floor covering. Carpet should be provided in bedrooms unless there is an identified need. -Call bells can be cancelled on the board located in the small lounge. There should only be facility to cancel them at point of call, that is where the resident has called for assistance. The current arrangement carries the risk of the call being switched off at the board and the call not answered. The husband of the manager works as the handyman for the home. There is a maintenance book where staff record matters that need attention. The home appeared clean and smelled fresh. This was also reported to be the case in the surveys people returned. In the AQAA the manager told us that all staff have been trained in infection control. Infection control arrangements are in place such as protective clothing and hand washing facilities. Alcogel handwash dispensers are situated by washbasins in toilets throughout the home. A cleaner is employed on weekdays and she told us she has the equipment she needs and enough time to complete the cleaning schedule. The home does not have a carpet shampooer so the odour in one room has to be managed without shampooing until the managers husband periodically hires a machine. Domestic machines are not expensive and this may help keep this persons room fresh every day. Red dissolvable bags are used to separate soiled laundry and there is a sluice facility on the washing machine. Yellow bags are used for clinical waste which is collected weekly. The storage bin was visible from the road and was overflowing. To help protect the dignity of people in the home the amount of storage should be increased so the bags are hidden. Care Homes for Older People Page 22 of 31 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. There are enough staff on duty to meet the needs of people who use the service. People are being better protected by improved recruitment and induction procedures. Staff are being given good access to training opportunities and feel well informed and supported. Evidence: People living in the home told us that they liked the staff. Most felt staff always listen to them. All felt staff were available when needed. The staff told us that they enjoy working in the home and they try hard to meet peoples needs. One said, The staff and manager always go the extra mile to accommodate peoples wishes, even in our own time. Staff said the manager is helpful and approachable and her style of management means they are kept fully informed about residents needs whilst there is a friendly atmosphere in the home. They confirmed the manager was providing them with regular one to one supervision which helped them with their role. As there are currently only eight people in the home only two staff are working during the waking day 8am to 8pm. There are usually two shifts and a short meeting is held to exchange information at shift handover. The manager sometimes works directly with the residents and on other shifts she is additional to numbers. Overnight there is Care Homes for Older People Page 23 of 31 Evidence: one waking night staff and one person sleeping and on call either in the home or from the managers house which is in the grounds. At the Random Inspections we carried out in July 09 there were concerns that two staff were needed at night to assist one person and only one was being provided. This person no longer lives at the home so the current arrangements are acceptable. At the last Key Inspection requirements were made as the way new staff were being recruited and inducted into the role did not meet acceptable standards and therefore residents may have been put at risk. The manager took appropriate action and improved arrangements were confirmed at a Random Inspection. No new staff have been started since this time. Two staff have left in the last year. The manager said she has found a new worker but is waiting for checks to be returned. She is trying to recruit a cook and an additional care worker. She confirmed no-one will start until all the required checks are in place. A new induction programme for care staff has been put in place and this meets the standards set down by Skills for Care, the sector training organisation. The manager has continued efforts to arrange appropriate training for the staff. Staff feedback showed staff feel the training has helped them with their role. The manager told us that all staff have completed basic safety courses including infection control and food hygiene. She has attended a course to learn about training others in moving and handling techniques and had recently given all staff refresher training. Some staff have also attended courses on specific knowledge areas such as malnutrition, the Mental Capacity Act, medication, and a distance learning course on dementia care. Several staff are now First Aiders and have been trained to use a defibulator. She plans for staff to attend courses on diabetes, stroke, hypertension, falls prevention and also a palliative care course when spaces become available in the summer. Staff are now being paid when they undertake mandatory training, which is positive. Seven of the eight carers hold an NVQ award and some have also achieved the level 3 award. Training is being discussed during the quarterly supervision sessions with the manager and the annual appraisals she has held. She has taken prompt action to challenge any poor practice reported to her. Care Homes for Older People Page 24 of 31 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 style in the home is open and appreciated by staff and residents. The year has been a learning curve for the management and this now needs to be consolidated into ongoing good practice that promotes the health and well being of the people who live in the home. Evidence: The manager has previous care management experience up to deputy manager level, working with older people for five years and then with younger people with a Learning Disability. She holds the NVQ 4 in Care and she is working towards the Leadership and Management of Care services award. Since taking the role she has been attending relevant training to increase her knowledge about elder care such as a three day course on Dementia. The management style in the home is open and inclusive. The manager lives on site and is available when needed. She is well known by the residents and the staff and they appreciate the daily contact. Staff feedback indicated that the team now feel Care Homes for Older People Page 25 of 31 Evidence: better informed. One worker said, We now know where things like the hospital admission forms are kept. They are appreciating how responsibilities are now being delegated and the increased training opportunities. The manager still works regularly as a direct carer and since December 09 has been providing cover for the vacant cooks post. This takes away time from management tasks such as care planning and ensuring good communication with relatives. She has improved arrangements in several areas of the service during the last year in areas such as staff recruitment and induction. Some developments, however, have only been actioned as a direct result of pressure from external agencies when standards were found to be below safe and acceptable standards, such as medication management and care planning. At times shortfalls have needed to be identified on more than one occasion before standards have been improved and enforcement action was being considered by us prior to the December 09 Random inspection. In the coming year the management team need to ensure that standards continue to improve and peoples changing needs are planned for and met. People using the service, professional agencies and the regulator can then gain confidence about the reliability of the quality of service provided. In the last year a quality assurance policy has been developed and as well as the regular residents meetings feedback surveys have been sent out. The manager compiled a summary of the feedback shortly after the inspection. She found that most feedback was positive. Comments included, I like my room and feel happy and confident; I get a good variety of food; I like the gentle exercises; The staff are good and very friendly and helpful; When I ask the staff for something, I get it straight away. Two criticisms were made, I feel disturbed sometimes with other service user shouting; Some people are not happy about the way staff managed the laundry. The manager told us she has taken action to address these areas. The home returned the AQAA as requested. This told us that policies and procedures had been kept under review and all equipment serviced as required. In general the content was quite brief and did not always focus on how outcomes for residents could be improved. For example, under management of the home the planned improvements for the coming year were, To be a good role model for staff and continue good relationship with staff. This indicated that business planning for the service needs to be developed further. Arrangements for the management of health and safety are in place such as regular checks of fire equipment and food storage temperatures. Personal safety for residents has been improved from the increase in risk analysis and improved moving and Care Homes for Older People Page 26 of 31 Evidence: handling arrangements. Care Homes for Older People Page 27 of 31 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 28 of 31 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 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 1 Update the Service User Guide and consider making the content more accessible for older people. Include the current fees as required by Regulation 5. 2 7 Further develop the Key working system to help ensure the support areas that are important to residents and their families are planned for. Encourage residents and their representative to read, contribute to and approve the care plan documents. 3 8 Ensure specific guidance is in place for identified health needs such as physiotherapy routines. Ensure staff are clear about their duties when providing personal care e.g. trimming nails. The care plan monitoring process should identify gaps in planning as well as check current information is still accurate. 4 9 Further develop peoples medication profiles. Care Homes for Older People Page 29 of 31 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 5 12 Carry out assessments with people and their representatives when the life choices they are making may place them at increased risk of injury or harm. Develop care planning further around peoples social and emotional needs. Follow through plans to provide staff with training around specific health conditions and topics relevant to elderly care. The manager should continue to attend training to develop her knowledge base and complete the Registered Managers Award during 2010. Develop business planning and a clear action plan for how sustained improvement to the service can be achieved. consider benchmarking the service by visiting other services to explore good practise models. 6 7 14 30 8 31 9 33 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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