Care Home: The Queens Residential Home

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What has improved since the last inspection? All staff that administer medication have completed appropriate training. A full programme of refurbishment has commenced. All windows have been replaced, seven bedrooms have been fully refurbished and a medication room with a treatment room has been created. All of this work has been carried out to a very high standard.The Queens Residential HomeDS0000072767.V375428.R01.S.doc Version 5.2 Page 7 What the care home could do better: Two staff should sign medication administration records when hand written entries are made to ensure accuracy. Key inspection report CARE HOMES FOR OLDER PEOPLE The Queens Residential Home 271 Queen Street Withernsea East Yorkshire HU19 2NW Lead Inspector Diane Wilkinson Key Unannounced Inspection 14th May 2009 10:00 DS0000072767.V375428.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 Queens Residential Home DS0000072767.V375428.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 Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Queens Residential Home Address 271 Queen Street Withernsea East Yorkshire HU19 2NW 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) 01964 613 975 01964 613 975 Chaptercare Limited Paula Watson Care Home 46 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only Code 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 category, Code OP - maximum number of places 2. Dementia - Code DE, maximum number of places The maximum number of service users who can be accommodated is: 46 Date of last inspection Brief Description of the Service: The Queens Residential Home is a care home that is registered to provide care and accommodation for 46 older people, including those with dementia related conditions. It is located in Withernsea, a seaside town in the East Riding of Yorkshire. The home is close to shops, transport facilities, leisure facilities and health services. Bedroom accommodation comprises of 38 single rooms and 4 shared rooms, although shared rooms are currently being used for single occupancy. Some of the bedrooms have en-suite facilities and some have French doors that overlook the internal courtyard. Accommodation is provided over three floors; the first and second floors consist mainly of bedrooms and bathing facilities, but there is also a lounge area on the first floor. There are two lounges and a dining room (with a small seating area) on the ground floor. All areas of the home are accessible to people via the use of a passenger lift and stairs. Information about the service is available in the statement of purpose and service user’s guide. The manager told us on the day of the site visit that the current accommodation fees are from £362.04 to £411.18 per week. The Queens Residential Home DS0000072767.V375428.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 3 star. This means that people who use this service experience excellent quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Inspection of the home on the 11th December 2007, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day. It began at 10.10 am and ended at 4.40 pm. On the day of the site visit the inspector spoke on a one to one basis with two residents, a member of staff, the deputy manager and the registered manager as well as chatting to other residents, staff and relatives. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. The registered manager submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. As part of the inspection process we sent survey forms to some residents and staff; seven were returned by residents and three were returned by staff. Responses in surveys and comments from discussions with people were mainly positive, for example, ‘the home is under new management and the building is being improved’ and ‘I am happy here’. At the end of this site visit, feedback was given to the registered manager and deputy manager on our findings, including recommendations that would be made in the key inspection report. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 6 Care needs assessments are thorough and people are only offered a place at the home if their needs can be met. Care planning is thorough and care plans are updated appropriately as a result of monthly reviews. Any identified areas of risk are supported by individual risk assessments. People’s individual health care needs are met, including the administration of medication and the provision of specific mobility equipment. People are supported and encouraged to live their chosen lifestyle, within a risk management framework. Good hygiene practices are adhered to by staff and this reduces the risk of cross infection. Staff only commence work at the home following robust safety checks – this helps to protect people from the risk of harm. Staff receive in-depth induction training and this is followed up by regular training updates that continually improves their practice. The home is well managed and this is reflected in well developed recruitment, training and care planning practices and procedures. The quality assurance systems in place enable people living at the home to affect the way in which it is operated. Money handed to the home for safekeeping on behalf of people living there is held securely. The health and safety systems in place protect people from the risk of harm. What has improved since the last inspection? All staff that administer medication have completed appropriate training. A full programme of refurbishment has commenced. All windows have been replaced, seven bedrooms have been fully refurbished and a medication room with a treatment room has been created. All of this work has been carried out to a very high standard. The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 7 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. The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 8 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 Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 9 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): 3. Standard 6 was not assessed, as there is no intermediate care provision at the home. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are assessed prior to their admission to the home and only admitted if it is considered that their assessed needs can be met. EVIDENCE: The manager told us that information is recorded when people make initial enquires about care, either on a respite or permanent basis. Potential residents are then visited at home or in hospital so that a full care needs assessment can be undertaken; the assessment form used by the home to record this information has recently been updated. We noted that the initial assessment undertaken by the manager is a thorough record of a person’s The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 10 capabilities and needs. The manager gave us instances of when someone would not be offered a place at the home. For example, they would not offer a place to someone with a dementia related condition if they only had a room available on the first or second floors. We saw that each care plan included a copy of this assessment form and that, in addition to this, a community care assessment and care plan had been obtained from Social Services care management teams when they had commissioned the placement. All of this information is used to develop an individual care plan for new people living at the home. The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 11 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 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are a thorough record of a person’s capabilities and needs and how these are met by staff, including health care and medication needs. A person’s right to privacy and dignity is respected. EVIDENCE: Care plans include information about a person’s life history and strengths and needs. Care plans are very detailed and any areas identified as having an element of risk are accompanied by a risk assessment, such as poor nutrition, hearing impairment, memory impairment and smoking. Information about allergies is clearly identified on both care planning and medication documentation to highlight to staff that they need to take extra care. The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 12 Where particular risks are identified, care plans reflect these and appropriate records are held. For example, if poor nutrition is identified as an area of risk, there are daily fluid intake/output charts, nutritional intake charts, weight charts and positional turn charts in place. Daily records made by staff also reflect areas identified in care planning documentation. Care plans are reviewed by the manager on a monthly basis and we saw that care plans had been updated as a result of these checks. Formal reviews are arranged by Social Services for people whose care is funded by them, and we saw that people attended their reviews along with family and friends if they wished this to be the case. We noted that staff prepare information for care managers in preparation for these reviews. Any contacts with GP’s, district nurses and other health care professionals are recorded, including the reason for the contact and the outcome. The deputy manager told us that equipment needed for pressure care or continence care is arranged via the district nursing services, and that the home has a good relationship with both GP’s and district nurses. We noted that some people living at the home had been supported to obtain wheelchairs and electric wheelchairs for use around the home and for outside use, and that some people had a mobility vehicle – storage facilities are in place for both. We asked the deputy manager if any bed rails were in use and we were told that only one person has a ‘half’ rail at the head of the bed, and that the home only use bed rails if essential, and following completion of a risk assessment. The maintenance person checks any rails fitted to beds for safety on a regular basis. We were told that only senior carers have responsibility for the administration of medication; staff that are promoted to a senior position have to have achieved NVQ Level 2 in Care and be working towards this award at Level 3. All staff undertake basic medication training via DVD training and, in addition to this, senior staff undertake medications training provided by the National College of Further Education (NCFE); evidence of this was seen on the day of the site visit. Following training, senior staff are observed by the deputy manager to ascertain that their practice is to the required standard before they administer medication unaccompanied. We saw sample signatures for staff that have responsibility for the administration of medication – these are held with medication records. The medication room has been refurbished and divided into two rooms – one is a treatment room for use by GP’s and district nurses and the other is used as a medication room by staff. The treatment room has been fitted with cupboards for district nurses to store their equipment and notes and also has a hand wash basin. The medication room has metal cabinets that have been fixed to the wall – one of these is used for the storage of controlled drugs. We checked the records for controlled drugs currently prescribed to people living at the home and found these to be accurate. The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 13 Other medication is stored in medication trolleys and these are fastened to the wall of the medication room. Most medication is supplied in blister packs by the pharmacist used by the home. Medication administration records (MAR) were checked and we noted that there is a photograph of each person at the front of their MAR record and that staff record the amount of medication delivered each month; there were no gaps in recording. Controlled drugs are recorded on MAR sheets and in the controlled drugs book. We recommend that any hand written entries on MAR sheets are witnessed by two staff to reduce the risk of mistakes being made. The home has a special medication fridge that is lockable and has a temperature dial. The senior carer told us that the temperature of the fridge is checked and recorded twice daily. One person having respite care brought their medication into the home in a monitored dosage pack that had been prepared by their family. We advised that any medication being brought into the home should be in the original containers to ensure that staff have the full details of the medication prescribed and can then administer accordingly. Alternatively, if a risk assessment evidences that a person is able to self medicate, they could bring the medication into the home in a monitored dosage pack, as staff will have no responsibility for administration. We observed that a person’s right to privacy and dignity is respected by staff working at the home and that the philosophy of the home promoted this. We observed staff knocking on bedroom and bathroom doors before entering and that a person’s preferred name is used. There is a dedicated laundry assistant in place and this helps to ensure that laundry is not lost and that clothing is returned to the right person. The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 14 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 and 15 People using the 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 encouraged and supported to live their chosen lifestyle and to remain part of the local community; family and friends are made welcome at the home. Meal provision is good. EVIDENCE: Care plans record a person’s previous lifestyle and family history. A record is kept of how a person spends their day including any activities that they take part in, any trips out and any visitors seen. There is an activities coordinator employed at the home on five days a week, and they spend time organising group activities as well as spending ‘one to one’ time with people. On the day of the site visit the notice board advertised a movement to music session at 2.00 pm and we observed that the activities coordinator was speaking to each person living at the home about their views on a ‘curry’ evening (as part of their forthcoming topic on India). People told us that church services of different denominations are held weekly or monthly. The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 15 Several people went out for a walk to the sea front or to the shops on the day of the site visit; some people have mobility scooters or electric wheelchairs to enable them to do this independently and have been supported by staff at the home to obtain these. We saw that some people have a telephone in their room and one person has a laptop; this enables them to keep in touch with family and friends and to take part in ‘on line’ activities. People’s bedrooms were a reflection of their hobbies and interests and again, the home had obtained items to enable people to maintain these, as well as providing storage facilities in bedrooms such as extra shelving and storage boxes. People told us that they had been able to bring some of their own furniture and personal belongings into the home. Information about advocacy services was displayed in the hall, an area that is accessed by residents and relatives. In addition to this, detailed information about the planned refurbishment of the home was displayed, along with fabric and paint swatches to enable people to express a choice and take part in the redecoration programme. The daily menu was displayed in the dining room. This included a choice of main meal at lunchtime and we noted that one person chose to have a salad instead of the hot meal of the day. People told us that they ‘usually’ like the meals at the home. We noted that a member of staff offered everyone a piece of fruit following their pudding and that a lot of people took one; some people said that they would take this to their room for later. Appropriate assistance was offered by staff with eating and drinking and lunch time was a social occasion; people were in no hurry to leave the dining room after lunch. The manager told us that the dining room is one of the next rooms to be refurbished. New dining tables had just been delivered and new dining chairs were due to be delivered on the day of the site visit. The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 16 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 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are encouraged to share concerns and complaints with staff and there is evidence that any issues are dealt with appropriately. People are protected from the risk of harm by the arrangements in place at the home and by staff training. EVIDENCE: Information about the home’s complaints procedure is displayed on the notice board. We examined the complaints log and noted that one complaint and two safeguarding issues had been recorded since the last key inspection. Information about the investigation that was undertaken by the manager and the outcome was also recorded, and this evidenced that all issues were dealt with professionally. The manager told us that they intend to add documentation to each care plan so that any concerns expressed by people living at the home can be monitored, for example, for issues such as missing clothing. It is hoped that any minor issues would be dealt with, so avoiding the need for people to make a complaint. The manager also said that, when people raise an issue, they are always asked if they would like it to be dealt with as a formal complaint. All of the people living at the home that returned a survey told us that staff listen to them and act on what they say, and that they The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 17 know how to make a complaint. All of the staff that returned a survey told us that they know what action to take if anyone has any concerns or complaints. Two people living at the home told us in surveys, ‘I am happy living here’. The home considers safeguarding to be mandatory training; staff cover this topic as part of their induction training and then on an annual basis. Most care staff at the home have undertaken NVQ 2 in Care and many are continuing with NVQ Level 3 in Care. They have undertaken training on safeguarding adults from abuse as part of these training programmes. Staff also undertake separate training on whistle blowing. The surveys returned by staff confirmed that they are satisfied that they receive appropriate training. The manager attended refresher training on Safeguarding Adults (management training) in January 2009. The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 18 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 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A programme of refurbishment has commenced and those areas already refurbished and redecorated have been done to a very high standard. Laundry facilities are good and protect people from the risk of cross infection. EVIDENCE: The home is in need of refurbishment and repair and the new providers have started this process. All windows have been replaced and some damaged areas of the property have been re-plastered. Seven bedrooms have been fully refurbished – this includes new skirting boards, redecoration, new carpets, new furniture and new soft furnishings. The refurbished rooms were seen by the inspector and were found to be of a very high standard. The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 19 Medication and treatment rooms have been created and again, these have been fitted to a very high standard. One of the people living at the home who returned a survey told us, ‘the home is under new management and the building is being improved’. Some bedrooms have French windows that open on to an enclosed courtyard and there are plans in place for this area to be landscaped. Two of the bedrooms on the second floor are in urgent need of refurbishment – one has an uneven floor and carpet and this creates a trip hazard. The other has a damaged area of wall that needs to be re-plastered. The occupants of these rooms have been offered the opportunity to move into one of the refurbished bedrooms but both have declined. The manager told us that these two rooms, a further three bedrooms and the dining room are the next rooms to be refurbished. The home employs a full time maintenance person and the team of decorators will be working at the home for the foreseeable future. There is a maintenance programme in place and the maintenance person is responsible for general maintenance and all health and safety checks such as water temperature tests and weekly fire tests, and these were found to be up to date. The laundry room is equipped with suitable appliances and, although in need of updating, is kept clean and hygienic. There is a dedicated laundry assistant in post and this reduces the need for staff to be involved in handling soiled laundry as well as the risk of cross infection in the home. We observed good hygiene practices being followed by staff on the day of the site visit and noted that all staff have been supplied with individual packs of disinfecting liquid to carry around with them. Training records evidence that staff are observed washing their hands five times a year by the deputy manager to ascertain that they are washing their hands thoroughly. All toilets include information about good hand hygiene. There were slight odours in some older areas of the home and the manager told us that these were the areas to be refurbished early on in the programme. All areas of the home were clean on the day of the site visit – one person told us in a survey, ‘a valiant effort is made by the staff’. The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 20 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 and 30 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All safety checks are in place prior to staff commencing work at the home and there is a robust training programme in place; this ensures that people living at the home are supported by skilled and experienced staff. There are sufficient staff working at the home to ensure that individual care needs can be met. EVIDENCE: The staff rota records that there are four staff on duty during the day and the evening, and that there are three staff on duty during the night. In addition to this, there is a cook, a kitchen assistant, a domestic assistant and a laundry assistant on duty during the day. There is also a maintenance person on duty from Monday to Friday who deals with fire tests, water temperature tests etc. and an activities coordinator who spends time undertaking both group and ‘one to one’ activities. This enables care staff to concentrate on the time they spend with people living at the home. The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 21 We examined the recruitment records for two new members of staff. These evidenced that application forms completed by applicants record their previous employment history, the names of two referees and a criminal record declaration. A record is kept of interview questions and responses. We noted that two written references and a Protection of Vulnerable Adults (POVA) first check were in place prior to staff commencing work. The manager told us that, when time allows, they do not give people a start date until they receive a Criminal Records Bureau (CRB) check. Staff employed prior to the receipt of their CRB check only work under the supervision of an experienced carer. New staff commence Induction training as soon as they start to work at the home; records evidence that this training meets Skills for Care requirements and is completed by staff within their first six weeks of employment. Staff also undertake core training during this period, i.e. principles of person centred care, moving and handling, fire safety, medication administration, food hygiene, abuse and raising concerns/whistle blowing. The training and development plan records that staff undertake more specialised training in addition to core training, such as palliative care, dementia care, customer service, the mental capacity act and deprivation of liberty. We noted that some core training is undertaken by ancillary staff as well as care staff; this is good practice. The deputy manager told us that staff get paid for attending training courses but that they undertake distance learning programmes at home in their own time. All staff complete a training evaluation and this information feeds into the training and development plan for the year. Staff also complete a staff development questionnaire annually and this asks them to record any training needs that they feel they have; there are plans in place for staff to have training on infection control this year. Some training at the home is provided via DVD’s and discussion with the deputy manager confirmed that staff have to complete a questionnaire and an evaluation as well as having a discussion on the topic at supervision to check that they have fully understood the content of the training programme. Almost all staff have achieved National Vocational Qualification (NVQ) Level 2 in Care and many staff are continuing with NVQ Level 3 training. Only staff that have achieved or are working towards NVQ Level 3 are able to become senior carers. Cooks and housekeepers are also undertaking NVQ qualifications. The manager told us that the maintenance person is now qualified as a Fire Marshall and that he is in the process of developing new fire training that will include the people living in the home as well as staff. The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 22 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, 33, 35 and 38 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager has achieved NVQ Level 4 in Care and Management and also the NVQ Internal Verifier and Assessor awards. She is currently working towards an NVQ in Customer Care (along with other staff from the home, including one of the directors). The manager undertakes some training along with the rest The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 23 of the staff group, such as dementia care, palliative care and medication. She is a member of a local support group that includes a psychologist, a community psychiatric nurse, a GP, a pharmacist and four registered managers of care homes. They share information and promote good practice, and this is reflected in standards of practice within the home. For example, care planning documentation, recruitment practices and staff training requirements are continually updated. The manager told us that she also uses the CQC website to obtain the latest information on care provision. The home has achieved the Quality Development Scheme (QDS) part 1 – this is the quality award issued by the local authority that commissions most of the placements at the home. There is a quality assurance plan in place and this includes the distribution of surveys to people living at the home, relatives and health and social care professionals on a six monthly basis. Information from returned surveys is collated and the outcome is displayed in the hall – this was seen on the day of this site visit. The manager told us that any points that need urgent attention would be actioned immediately, and other information is used in future planning; this information is included in the home’s end of year analysis. Staff meetings are held every six months – three meetings are held to cover the same topics – one for day staff, one for evening staff and one for night staff. Staff told us that they are encouraged to make suggestions and discuss issues at these meetings, and we noted that minutes are taken. Management meetings and senior carer meetings are also held to discuss consistency, practice issues and training issues. Residents meetings take place more frequently and minutes taken evidence that a wide variety of topics are discussed. People living at the home are very involved in the refurbishment programme, for example, choosing furnishings, suggesting the provision of a shower and one person suggested that they should have a bar. Some people commented that breakfast and lunchtimes are too close together and, as a result, the mealtimes have been changed and will be reviewed again at the next meeting. Quality audits take place on a regular basis on topics such as water temperature tests, fire drills and redecoration, and documentation is retained to evidence that these audits have taken place and to record any action taken as a result. Monies are held on behalf of some of the people living at the home. A receipt is given to those relatives that request one, but we advised that a receipt should be given to everyone that hands money to the home for safe keeping, to protect staff and others from any misunderstandings. We noted that these monies are held securely and that appropriate records are held; receipts are obtained for any purchases made on behalf of people and money handed to people. On the day of the site visit we checked some monies and associated records and these were found to be accurate. The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 24 We examined health and safety records held at the home. There are environmental risk assessments in place and these are displayed in the relevant areas of the home, for example, in bathrooms and toilet facilities. The maintenance person undertakes room temperature tests, water temperature tests and tests of the fire alarm system on a regular basis; these take place consistently and were up to date on the day of the site visit. The fire alarm system, emergency lighting and nurse call system have all been checked by a qualified contractor, and a portable appliance test and gas safety test have taken place. There is evidence that the passenger lift and all mobility and bath hoists (including slings) are serviced on a regular basis. All staff, including catering, domestic and maintenance staff, undertake health and safety training on a regular basis and this helps to protect people living at the home from the risk of harm. The Queens Residential Home DS0000072767.V375428.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 X 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 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 The Queens Residential Home DS0000072767.V375428.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 Refer to Standard OP9 Good Practice Recommendations Two staff should sign any hand written entries on medication administration records to reduce the risk of mistakes being made. People having respite care should bring medication into the home in its original containers to ensure that it is administered accurately. The programme of refurbishment should continue until all areas of the home reach the same standard as the areas already refurbished. A receipt should be given to anyone handing money to the home for safe keeping on behalf of residents. 2 OP9 3 OP19 4 OP35 The Queens Residential Home DS0000072767.V375428.R01.S.doc Version 5.2 Page 27 Care Quality Commission St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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