Care Home: The Paddocks

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What the care home does well The home is very family orientated, with various other family members involved in different roles, whether it be managing, training or maintenance. The home provides care with a person centred approach, with the best interests of the residents being a central focus. The home understands the importance of having enough information when choosing a care home. Admissions are not made until a full assessment of needs has been carried out so that prospective residents and their representatives can be sure their needs will be met. This home has a complaints policy, which is easily accessible to residents and visitors to the home. It details expected timescales for responses, and guidance for any complainant that remains dissatisfied with investigatory outcomes. Safeguarding is addressed with staff in this home through the induction process, and is also included in the mandatory training schedule. The training matrix indicated that all the staff have attended this training. The home provides a clean, comfortable and safe home, which is well maintained, for the people who live here. Observations of staff and residents interactions indicated that there is a familial, relaxed and friendly atmosphere in this home, and generally the staff were confident and competent in their roles. Care plans had been completed in sufficient detail to ensure that staff could provide consistent care. They included personal preferences and had been written in consultation with individuals and their representatives. Medication records were generally in order, contained the required entries and had been signed appropriately by staff. The service has a strong commitment to ensuring residents maintain personal relationships that are important to them. Suitable and meaningful activities are encouraged, and individual`s are assisted and supported to make personal choices. This service recognizes the importance of training and delivers a programme that exceeds the National Minimum Standards. We addressed the supervision records for six members of staff with the area manager. This is taking place on a regular basis, and additional `observation of practice` supervision has been introduced since the last inspection.The PaddocksDS0000014943.V376561.R01.S.docVersion 5.2 What has improved since the last inspection? The gardens are secure and can be easily accessed by residents, via gentle sloping ramps, allowing them the freedom to wander. Recruitment procedures are fully adhered to so that residents are protected. Since our last visit, new care plan documentation has been introduced. It clearly identifies one `need` per page, and a very specific prescription of care for staff to follow, ensuring that continuity is maintained. For each `need` there is a corresponding evaluation sheet in place. During this inspection we examined the health and safety file. This contained numerous health and safety risk assessments including one for fire and one relating to hot water temperatures. Records identified that health and safety checks including water temperatures, fire call bells, freezer and food temperatures are being recorded appropriately, and any issues are addressed in a timely fashion. What the care home could do better: When we visited the kitchen we did note that produce is not always dated when opened, and there was some out of date ham. All the medication that was dispensed in blister packs, and the medication prescribed on a regular basis and dispensed in boxes reconciled correctly. However for some of the `as required` medication such as paracetamol, it was not always clear how many tablets had been carried forward from month to month, and therefore was sometimes difficult to reconcile. We discussed this matter with the area manager and the manager, and a review of their auditing process was agreed and addressed immediately. Key inspection report CARE HOMES FOR OLDER PEOPLE The Paddocks Springfield Road Wellhead Nr Dunstable Bedfordshire LU6 2JT Lead Inspector Mrs Louise Trainor Key Unannounced Inspection 09:30 20th July 2009 DS0000014943.V376561.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 2 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 The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Paddocks Address Springfield Road Wellhead Nr Dunstable Bedfordshire LU6 2JT 01582 601317 01582 673287 kenjanes@supernet.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Kenneth Janes Mrs Lilian Janes Mrs Lilian Janes Care Home 10 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (10), of places Physical disability over 65 years of age (10) The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th July 2008 Brief Description of the Service: The Paddocks was registered to provide for ten older persons who may also have physical disabilities and/ or dementia. The registration for physical disabilities was not required because disabilities associated with old age could be met under the category for older people. Mr and Mrs Janes have operated the home since its original registration several years previously. Mrs Janes is the registered manager. The home was located in a small hamlet close enough to the town of Dunstable to take advantage of its amenities but at sufficient distance to retain the peaceful environment of this rural location and the pleasant countryside views from each window. The accommodation, which had been suitably adapted, was distributed over two floors that were accessed by a shaft lift and comprised ten single bedrooms with washbasin and call bell facilities. Adapted toilets and bathrooms were located for convenient access on both floors. Communal sitting areas, three interlinking rooms, lounge, dining room and an all weather conservatory were located on the ground floor as was the kitchen. An office was in the basement as were the proprietors private living quarters. An extension to the building housed the laundry, storage areas, another office and training room facilities. The rear of the property overlooked an attractive garden and extensive other grounds used to grow vegetables and fruits for the home. The weekly fees for this home range from £457.86 to £500.00, exact fees were specified in individual service users contracts. These fees did not include newspapers, hairdressers, personal telephone, toiletries, or private chiropodist; these services would incur an additional charge. The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was carried out in accordance with the Care Quality Commissions (CQC) policy and methodologies, which requires review of the key standards for the provision of a care home for older people that takes account of residents views and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and judgments made within the main body of the report include information from this visit. This was the first Key Inspection for this year for this service. Regulatory Inspectors Mrs Louise Trainor carried it out on the 20th of July 2009 between the hours of 09:30 and 15:00 hours. The home Area Manager Mrs Kirsty Janes and the home Manager Mrs Lillian Janes were present throughout the visit to assist with any required information. Verbal feedback was given periodically throughout the inspection and at the end of the visit. During the inspection the care of two people, including the most recent admission to the home, were case tracked. This involved reading their records and comparing what was documented to the care that was being provided. Documentation relating to: staff recruitment, training and supervision and medication administration, complaints, quality assurance and health and safety in the home were also examined. We also had a tour of the premises and spent some time in the communal areas of the home, talking to the residents and observing the care practices and interventions that were carried out during this five and a half hour inspection hour inspection. We would like to thank everyone involved for their support and assistance during this visit to the home. The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 6 What the service does well: The home is very family orientated, with various other family members involved in different roles, whether it be managing, training or maintenance. The home provides care with a person centred approach, with the best interests of the residents being a central focus. The home understands the importance of having enough information when choosing a care home. Admissions are not made until a full assessment of needs has been carried out so that prospective residents and their representatives can be sure their needs will be met. This home has a complaints policy, which is easily accessible to residents and visitors to the home. It details expected timescales for responses, and guidance for any complainant that remains dissatisfied with investigatory outcomes. Safeguarding is addressed with staff in this home through the induction process, and is also included in the mandatory training schedule. The training matrix indicated that all the staff have attended this training. The home provides a clean, comfortable and safe home, which is well maintained, for the people who live here. Observations of staff and residents interactions indicated that there is a familial, relaxed and friendly atmosphere in this home, and generally the staff were confident and competent in their roles. Care plans had been completed in sufficient detail to ensure that staff could provide consistent care. They included personal preferences and had been written in consultation with individuals and their representatives. Medication records were generally in order, contained the required entries and had been signed appropriately by staff. The service has a strong commitment to ensuring residents maintain personal relationships that are important to them. Suitable and meaningful activities are encouraged, and individual’s are assisted and supported to make personal choices. This service recognizes the importance of training and delivers a programme that exceeds the National Minimum Standards. We addressed the supervision records for six members of staff with the area manager. This is taking place on a regular basis, and additional ‘observation of practice’ supervision has been introduced since the last inspection. The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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 The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 8 order line – 0870 240 7535. The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6 People using the service experience good quality outcomes in this area. The home understands the importance of having enough information when choosing a care home. Admissions are not made until a full assessment of needs has been carried out so that prospective residents and their representatives can be sure their needs will be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There is a combined Service User Guide and a Statement of Purpose in place for this home. This document is held electronically and reviewed at regular intervals, then issued to people as they enquire about the home. The document we were shown had been reviewed within the last month however some amendments relating to the recent changes in details for the Care The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 11 Quality Commission (CQC) are required. We appreciate that over the past few months there have been numerous changes to these details, and the manager was going to make these amendments immediately. Since the last inspection this document had been amended and now contains the full range of fees relating to the service. There are clear details of what is included in the fees, and what is provided at an additional cost, such as hairdressing and chiropody. The individual fees for each resident are also clearly identified within their contract of terms and conditions. We looked at the file of the two residents; both had been admitted since our last inspection in July 2008. The pre admission assessments had both been carried out in advance of the admission, and contained sufficient detail to ensure that staff would be able to meet his needs. Contracts were checked and were all signed and dated appropriately. This home does not provide intermediate care The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 People using the service experience good quality outcomes in this area. Care plans had been completed in sufficient detail to ensure that staff could provide consistent care. They included personal preferences and had been written in consultation with individuals and their representatives. Medication records were generally in order, contained the required entries and had been signed appropriately by staff. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: During this inspection we looked at the files of two residents in detail. Files were tidy and generally well organised. The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 13 Care plans were well written, and contained sufficient detail to ensure that staff could deliver care with continuity. Since our last visit, new care plan documentation has been introduced. It clearly identifies one ‘need’ per page, and a very specific prescription of care for staff to follow, ensuring that continuity is maintained. For each ‘need’ there is a corresponding evaluation sheet in place. These were being reviewed and updated as and when individual’s needs changed. The area manager told us that she also hopes this will encourage staff of all levels to make changes and become more involved with the care planning process, using them as working documents, as they do the daily log sheets. Both of the files that we looked at contained numerous care plans ranging from personal care to social activities and behaviour. These were generated by the pre admission assessment, and gradually built on to include more specific information. They were written in detail and in a person centred way, so that staff knew the level of assistance required to meet this persons needs in a way that they prefer. For example; for one resident there was a care plan that identified the need for staff to encourage him to do as much as possible for himself, and identified that he would ask for more help if he was struggling. It identified that he could brush his own teeth and use an electric shaver himself, however was unable to stand alone and would need some assistance where this was involved. He had a catheter in situ, and it clearly identified how and when staff should change the bag, keep records of output and how they could recognise if there was a problem that required input from the District Nurse, and how they should contact her. Problems with mobility and transferring were identified, and instructed how staff should maintain his walking frame and assist him. It identified that he had a good grip with his hands, but needed back support from staff. His choices and wishes were included in the care plans, as was the input required by other health professionals such as the dentist and chiropodist. Risk assessments for issues such as falls, pressure area care, nutrition and dependency levels were in place in the files; these were all numbered and were reflective of, and reflected in the care plans. Each file contained a care plan agreement appropriately signed and dated by the resident or their representative. Two of the resident in this home have resuscitation orders in place that are fully completed and reviewed on a monthly basis by the GP in consultation with other health professionals and families. All residents have a profile completed related to their wishes in relation to end of life care. Residents in this home were relaxed, happy and well presented. Observations of care, identified people being treated with respect, and addressed in a way The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 14 that was their preference. They were encouraged to participate in activities, however this was their choice. During this inspection we examined the Medication Administration Record (MAR) sheets for all the residents who live here. These were tidy and well completed with signatures and omission codes where necessary. However there is presently some confusion over codes, as the printed MAR sheet’s coding varies on some sheets. For example some identify ‘R’ as the refused code, and others ‘A’. The manager is addressing this matter with the pharmacy provider. All the medication dispensed in blister packs, and the medication prescribed on a regular basis and dispensed in boxes reconciled correctly. However for some of the ‘as required’ medication such as paracetamol, it was not always clear how many tablets had been carried forward from month to month, and therefore was sometimes difficult to reconcile. We discussed this matter with the area manager and the manager, and a review of their auditing process was agreed and addressed immediately. There is presently one resident in the home prescribed Controlled Drugs. These were all stored and recorded appropriately, and reconciled correctly with stocks remaining. The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience good quality outcomes in this area. The service has a strong commitment to ensuring residents maintain personal relationships that are important to them. Suitable and meaningful activities are encouraged, and individual’s are assisted and supported to make personal choices. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Generally in this home, activities are arranged and delivered by all the care staff, although there is one member of staff, who has two hours a day, six days a week allocated to this specifically. She keeps a file of who does what each day, and how they benefit from the particular activity. Activities are ‘tailor made’ for each resident, and although they are all encouraged to participate, it is accepted that not everyone wishes to do so all the time. The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 16 For one resident who had previously had a career in baking, he is invited and encouraged to bake cakes, scones etc with staff on a regular basis. He told us how much he enjoys this, and other residents expressed how much they enjoyed the benefits of his baking session too, particularly his fruit cake. Also for this particular resident, the garden pond and Koi Carp, play an important role in his life, both for leisure purposes and for monitoring his mobility progress. He had been admitted to the home some weeks previously, unable to stand or walk. He is now able to walk as far as the fish pond and feed the fish. This is a tremendous achievement for him that he was keen to share with us. Another resident in the home has a visual impairment; however we observed staff giving her verbal directions to pursue her knitting project. We were also told that although she is not interested in ‘talking books’, one member of staff reads her a chapter from novels of her choice each shift, and this she does enjoy. Families and friends are welcome in this home at any time, and residents are encouraged to maintain these relationships. There is a four week rolling menu plan in place for this home, which identifies a wide range of healthy nutritious meals. However at present, as there are only seven residents in the home, they discuss each day, what meats etc are available in the kitchen and decide, from that, what they would like. Fresh vegetables are prepared freshly from the homes gardens. The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 People using the service experience good quality outcomes in this area. The complaints procedure is supplied to everyone living in the home. Staff working at the home understand the procedures for safeguarding, and know when incidents need to be reported externally. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: This home has a complaints policy, which is easily accessible to residents and visitors to the home. It details expected timescales for responses, and guidance for any complainant that remains dissatisfied with investigatory outcomes. We viewed the complaints and compliment files. The home had not received any complaints since the previous inspection. There were however numerous cards of thanks. One read. “Thank you for the care and loving attention you have always shown to my mum, over the past 3 years her natural character has been given free rein which I am sure has contributed to her living to such a great age.” The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 18 Safeguarding is addressed with staff in this home through the induction process, and is also included in the mandatory training schedule. The training matrix indicated that all the staff have attended this training. We are aware that this service liaises closely with the safeguarding team and the CQC when appropriate. The training matrix also indicated to us that the Mental Capacity Act (MCA) and the Deprivation of Liberty (DOLS) are being address with staff through training, and documents relating to these were present in the client files that we looked at. The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 People using the service experience good quality outcomes in this area. The home provides a clean, comfortable and safe home, which is well maintained, for the people who live here. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home was clean and free from offensive odours, and generally well maintained. This home has ten single bedrooms, all of which are decorated individually to meet with each person’s preferences. The residents can identify their rooms The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 20 both by door numbers, photographs and pictures which are significant to them, displayed on the doors. The rooms are furnished with personal assets, ornaments and photographs that reflect the lifestyle and personal history of each resident. Some of the rooms have stunning views of the ‘Dunstable Downs’, and for one resident that we spoke to, this holds many fond memories, as he had spent his life in the local area. The rooms are all equipped with a telephone jack, so that residents can make personal phone calls in the privacy of their rooms if they wish. Communal areas were homely and comfortable, and all doors had signs on them, so that those residents who were confused could find their way round more easily. This home is surrounded by beautiful large gardens laid mainly to lawn, with fruit trees and an extensive vegetable patch that is very productive and provides the home with seasonal fresh fruit and vegetables. The gardens are secure and can be easily accessed by residents, via gentle sloping ramps, allowing them the freedom to wander. There are plans to lay a new pathway across the lawns, which will enable all residents to access all areas of the garden. There is also a pond in the garden, which is home to a large shoal of Koi Carp. At the moment this is playing a significant role in one particular resident’s life as detailed in the Daily Life and Social Activities outcome area of this report. The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience good quality outcomes in this area. This service recognizes the importance of training and delivers a programme that exceeds the National Minimum Standards. Recruitment procedures are fully adhered to so that residents are protected. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The usual staffing levels during the day in this home are two care staff and the manager, supported by cleaning, maintenance and kitchen staff. However at present there is no cook in place, so the staff team are addressing the food preparation and cooking between them. With resident numbers down at the moment this is quite acceptable. During the night there is only one carer on duty, and the manager who lives on the premises remains on call at all times. It had previously been recommended that the staffing levels at night should be reviewed. However at present there are only seven residents in the home and therefore these staffing numbers are The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 22 sufficient. The review of staffing numbers is maintained as the resident numbers and individual needs change. We examined the personal files of three staff. All three had Criminal Record Bureau checks and POVA first checks in place. All had fully completed application forms that detailed employment history and personal qualifications, and two appropriate references. All three had completed, or were presently working through an induction programme. Home Office documentation was in place where appropriate. Contracts of terms and conditions were in place. This home has its’ own trainer and training room, and both the manager and the area manager are NVQ assessors. Training records indicated that over 50 of staff have achieved NVQ certificates in care at varying levels, and a wide range of training course are available to staff including Dementia, Challenging Behaviour and Death and Bereavement. Most of the staff have attended mandatory training and refresher courses as required, and where they are due, courses have been booked. Observations of staff and residents interactions indicated that there is a familial, relaxed and friendly atmosphere in this home, and generally the staff were confident and competent in their roles. The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37, 38 People using the service experience good quality outcomes in this area. The manager has a clear understanding if the key principles of care in this home. She has a person centred approach to care with effective outcomes for people who live in this home. The AQAA was accurately completed and demonstrated a clear vision of planned improvements. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 24 The manager and her husband have owned this home since 1993. She is very dedicated to the home, and has many years experience in the caring profession. She has undertaken numerous courses including advanced training in Care Management, and is also trained as an NVQ assessor and a moving and handling instructor. The home is very family orientated, with various other family members involved in different roles, whether it be managing, training or maintenance. The home provides care with a person centred approach, with the best interests of the residents being a central focus. The care is delivered by a committed team of staff, some of which have worked in the home for several years. Record keeping in this home is clear and concise. Files are tidy and well maintained and stored securely. People who live in this home are encouraged to manage their own money wherever practicable. The home does not keep money for any of the residents who are presently living in the home, and residents have the option of a key for their bedroom if they so wish. We addressed the supervision records for six members of staff with the area manager. This is taking place on a regular basis, and additional ‘observation of practice’ supervision has been introduced since the last inspection. The manager understands and follows the reporting processes for accidents and injuries in this home, and liaises with both CQC and the local safeguarding team appropriately. During this inspection we examined the health and safety file. This contained numerous health and safety risk assessments including one for fire and one relating to hot water temperatures. Records identified that health and safety checks including water temperatures, fire call bells, freezer and food temperatures are being recorded appropriately, and any issues are addressed in a timely fashion. We did however note that fridge produce was not always dated when opened, and there was some out of date ham. We advised the manager, who immediately disposed of what was necessary and assured us this would be monitored more closely. This home addresses quality assurance on an annual basis via questionnaires to residents, relatives and visiting health professionals. This year’s annual report is still in progress. We look forward to seeing the completed document. The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP38 Good Practice Recommendations The home should consider reviewing their medication audit process. The home should consider how they monitor expiry dates of fridge produce. The Paddocks DS0000014943.V376561.R01.S.doc Version 5.2 Page 27 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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