Care Home: The Red House

What the care home does well Information is available to help people make up their minds if the service is right for them. People`s needs are assessed to provide good information on which to plan their care. They are supported to attend medical and other appointments, to help ensure they stay healthy and well. They receive satisfactory basic care. People get on well with the staff who look after them. Comments included "Staff are nice and friendly" and "They can`t do enough for you". Visitors are made welcome and can see people at any reasonable time. People say that the food at the Red House is good, that they have what they like so they enjoy their meals. The home is kept clean, fresh and tidy. Important checks are carried out before people start work at the home, to make sure they are fit for their jobs. The Manager is open and approachable, so that people feel comfortable raising any matters of concern. Regular checks and maintenance are carried out on essential equipment around the home so that people living and working there can stay safe. What has improved since the last inspection? The home`s Statement of Purpose and Service Users` Guide have been updated, so that people have current information about what the service provides. People`s personal records have been reviewed and updated, so that they are better organised and important information is easier to find. People`s medication has been reviewed by their doctor, to ensure they are prescribed what they need. Arrangements for handling and storing medication have improved, and staff have had "refresher " training. This helps make sure that people get their medicines safely and at the right time. A visitors` book is now in place, and information available about local advice and advocacy organisations. Important documents supporting staff recruitment are now available. This shows that the service does the things it should to make sure that staff employed are fit for their jobs. The Manager has attended training about the Deprivation of Liberties Safeguards, to help keep his knowledge and skills up to date. A new handrail has been fitted on the staircase, and decoration and refurbishment around the home is ongoing, so that people can enjoy the benefit of living in a comfortable and safe environment. Proper arrangements have been made for the storage of toiletries and cleaning materials and soap dispensers and hand driers installed. These things help to reduce risks of cross infection. Two of the residents now use the lounge and dining room more frequently, providing them with extra opportunities for social interaction. Staff records are better organised and a rota put in place, as previously required. What the care home could do better: People`s assessments should be further reviewed to make sure that all their care and support needs are identified and planned for. Care plans should be developed to make them more detailed and person-centred. This is to help ensure that people get the support they need in the ways that suit them best. People`s contracts should be updated with current information, so that all parties are clear about their responsibilities. Clear and complete records should be maintained of audits of medication stocks. This is to ensure that all medicines kept in the home are properly accounted for. Opportunities for people to get exercise and mental and social stimulation need to be developed. Better use should be made of professional advice to ensure that people get all the help and support they need to stay healthy and well. Staffing levels should be reviewed also, to ensure that this can be effectively realised. The furnishing and layout of the home`s communal areas needs to be improved, so that they are more accessible to people with mobility support needs. The staff training and development plan should be further developed, to ensure that staff have all the knowledge and skills they need to do their jobs well. Effective systems for quality assurance and monitoring of the service should be put into place. Work needs to be done to ensure that people are appropriately engaged in this process. This is to ensure that the service is developed and run for the benefit of the people who use it. Key inspection report Care homes for older people Name: Address: The Red House 8 The Village Kingswinford West Midlands DY6 8AY     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: Gerard Hammond     Date: 1 6 1 0 2 0 0 9 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Red House 8 The Village Kingswinford West Midlands DY6 8AY 01384291757 01384291757 davidjodonnell@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Shirley Nita O`Donnell,Mr David John O`Donnell care home 8 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 who can be accommodated is: 8 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 (OP) 8 Date of last inspection Brief description of the care home The Red House is a 200 year old Grade 2 listed building next to the local church, where there is car parking. It is accessible from the main Kingswinford to Dudley Road, where there is public transport. Care and accommodation is provided for up to 8 older people, some of whom have confusion and memory loss. The owners (one of whom is also the registered manager) have rooms on the 2nd floor and share all communal areas with people in the home. On the ground and first floor there are 4 single and 2 double bedrooms for people, some with ensuite facilities. Access is by a passenger lift or staircase. Care Homes for Older People Page 4 of 31 Over 65 8 0 0 6 0 3 2 0 0 9 Brief description of the care home There is a dining room and a lounge for communal use. Assisted bathing and shower rooms are on the ground and first floor; communal toilets are throughout the home. There is a small enclosed patio garden, at the back of the house. The service should be contacted directly for information about current fees and charges. 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: This is the homes first key inspection during the current year 2009-10. We gathered information from a number of places to inform the judgements made in this report. We made two visits to the home. We met all of the people who use the service, and spoke with the Manager and his partner (who are also the home owners) and members of staff on duty. We looked at records including personal files, care plans, staff files,previous inspection reports, safety records and other documents. Thanks are due to the residents, owners and staff team for their support throughout the inspection process. Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? The homes Statement of Purpose and Service Users Guide have been updated, so that people have current information about what the service provides. Peoples personal records have been reviewed and updated, so that they are better organised and important information is easier to find. Peoples medication has been reviewed by their doctor, to ensure they are prescribed what they need. Arrangements for handling and storing medication have improved, and staff have had refresher training. This helps make sure that people get their medicines safely and at the right time. A visitors book is now in place, and information available about local advice and advocacy organisations. Important documents supporting staff recruitment are now available. This shows that the service does the things it should to make sure that staff employed are fit for their jobs. The Manager has attended training about the Deprivation of Liberties Safeguards, to help keep his knowledge and skills up to date. A new handrail has been fitted on the staircase, and decoration and refurbishment around the home is ongoing, so that people can enjoy the benefit of living in a Care Homes for Older People Page 7 of 31 comfortable and safe environment. Proper arrangements have been made for the storage of toiletries and cleaning materials and soap dispensers and hand driers installed. These things help to reduce risks of cross infection. Two of the residents now use the lounge and dining room more frequently, providing them with extra opportunities for social interaction. Staff records are better organised and a rota put in place, as previously required. 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 8 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 9 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. Information about the service that the home provides is available, to help people decide if it is what they want. Peoples needs have been assessed to provide information for planning their care and support. Contracts need to be updated, so that all parties are clear about their responsibilities. Evidence: We saw copies of the homes Statement of Purpose and Service Users Guide. These documents have been updated since our last inspection, as recommended. This is so that people have information available to help them decide if the service provides what they are looking for. The Manager told us that this is available in large format if required. We sampled peoples personal records to see if their care and support needs had been properly assessed. There have been no admissions to the home since the last inspection. All of the files we looked at contained an assessment completed at the Care Homes for Older People Page 10 of 31 Evidence: time of admission. We also saw that a considerable amount of work has been done since the last inspection to update current assessments. Clear efforts have been made to improve the information available, to provide a sound basis for planning and mamaging peoples care. We noticed that assessments now follow a uniform format. We recommend that these are reviewed to ensure that all the areas identified in National Minimum Standard 3.3 are covered explicitly. We looked at peoples contracts. Everyone has a written statement of terms and conditions, but these need to be updated to reflect the current position. The agreement should show the room occupied and the correct amount of fees or charges payable, and by whom. This is so that everyone concerned is clear about their responsibilities. Care Homes for Older People Page 11 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. Peoples care plans have improved, so that staff have guidance about how to give individuals care and support. Some more work is needed on these to make sure that people get their care and support in the ways that suit them best. Some improvements are needed to make sure that people get all the support they need to stay healthy and well. People have a good working relationship with staff looking after them, and feel that they are treated with respect. Evidence: We looked at peoples personal files to see how their care and support is planned and managed. All of the files we saw had a current care plan, including night time care plans as previously required. A new format for these has been introduced since the last inspection, and all of the plans we saw followed this. It is clear that a lot of work has been done to improve plans since the last inspection. Plans were supported with risk assessments, including moving and handling, falls and pressure sores. Plans would be better if they were more person-centred: it is difficult to see how Care Homes for Older People Page 12 of 31 Evidence: individuals have been directly involved in drawing up or agreeing their plans. Some further work is required to develop care plans, to ensure that people get the care and support they need in ways that suit them best. Plans should include clear statements about what people can do for themselves. This is to ensure that staff are guided to promote and encourage their independence, and avoid doing for instead of doing with. Statements such as needs help with washing should say exactly what help is required. Help with dressing (supervision)should state clearly what this means. We could see from the records we looked at that people are being supported to access health and support services regularly. We saw records of weight monitoring and nutrition screening, as required at the last inspection. Records showed that people had been supported to access GP and hospital appointments. Peoples medication has been reviewed by their doctor since we last visited the home. We saw that people have had appointments with opticians,dentists, chiropodists and community / district nurses. One person is currently receiving treatment for a pressure sore: the district nurse visits regularly and a pressure relieving mattress has been obtained. Some work needs to be done to develop opportunities for people to increase their levels of activity (see next section also)and get some exercise. It has to be acknowledged that the ages and varying degrees of mobility of the people currently living at the home mean that achieving this presents significant challenges. However, it is important that this is addressed so that people get the support they need to be as mobile as they can be. This is to ensure that the risks of developing problems such as pressure sores or of losing mobility are kept to a minimum. It is recommended that professional advice (e.g. from a Physiotherapist or Occupational Therapist)be sought in order to get the best support available for this. A number of issues relating to the handling and administration of medication at the home were highlighted at the last inspection. We saw that the medication store has now been relocated to the cellar, to ensure that medicines are stored at an appropriate temperature. Checks of the temperature in the cabinet are now recorded twice each day. A system has now been put in place for recording medication returned to the pharmacy: this includes a signature from the person receiving returned medication. We also saw that separate secure storage is provided for controlled drugs, and a register maintained. We audited this and the stocks held tallied with the record. We saw that copies of prescriptions are kept, and that there is a list of specimen signatures of staff responsible for giving medication. Most of the medication is supplied in blister packs; we saw that other medication was labelled with the date of opening, as required. The Manager told us that he audits medication stocks but it was not possible to see when this had been done from available records. No pharmacy Care Homes for Older People Page 13 of 31 Evidence: audit reports were available. We recommended that the stocks carried forward are entered in full on the Medication Administration Record, so that it is possible to see at a glance the stocks that should be in hand at any given time. Also that the Manager keeps a written record of the audits he completes. Training records show that staff responsible for administering medication have done a refresher course in safe handling of medicines since the last inspection. We directly observed staff knocking on the door before entering peoples rooms. We saw that people were well dressed in good quality clothing and had clearly been given the support they needed with their personal care and hygiene. We saw and heard staff interacting with people. This was done in a warm and friendly manner, and both seemed at ease in each others company. Staff spoke positively about the people in their care. We asked people how they thought they were treated. One person told us The girls are lovely, they cant do enough for you. They couldnt do better - I love it here. Another said,Staff are friendly and treat me with respect. Another person told us: Ive got people here who look after me - theyre very nice. Nobody currently shares a room, but we noted that privacy screens were available in a double room. Care Homes for Older People Page 14 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More needs to be done to provide a wider range of activity opportunities for people to enjoy, and to proactively support them to engage and participate. This is to ensure that their health and wellbeing are more actively promoted, and to prevent social isolation. Evidence: We looked at peoples personal records and spoke to them to find out how they spend their days in the home and local community. Records about what people actually do are limited. This makes it difficult to make a fully informed judgement about what choices people are offered each day, and how they are encouraged to engage in meaningful activity. Three of the five people currently living in the home seldom leave their rooms. As reported above, the ages and mobility of the people in the home present particular difficulties in relation to supporting them to engage in activities. People also make positive choices about enjoying their own company. We spoke with the Manager about the opportunities that people enjoy for activities. He told us that it was difficult to motivate people to engage in things they did not want to do. This has to be acknowledged, but there are also issues of actively promoting peoples health and wellbeing that need to be considered. The home needs to be more proactive about supporting people to engage in activities, particularly those designed to promote and Care Homes for Older People Page 15 of 31 Evidence: maintain their mobility, and to provide mental stimulation. There should be clear links between peoples assessments and their activity plans. It is necessary to ensure that people are actively engaged to help prevent social isolation, encourage mobility and prevent pressure sores, and generally better promote peoples health and wellbeing. Consideration needs to be given to adapting the communal areas to make them more readily accessible for people with restricted mobility. These things cannot be achieved in isolation: it is recommended that the home actively seeks to engage with local community groups for advice, assistance and support where this is appropriate. This could also help to provide additional opportunities for people to consider. Social contact appears to be limited to individuals personal vistors. We saw that there is now a visitors book in place, and that this is being used appropriately. We saw that people are visited regularly by their friends and family members. We met with one persons visitor, who confirmed that staff always made him welcome whenever he came to visit his friend, and that their privacy was respected. People told us that they were able to receive visitors whenever they came. One person visits others in their rooms. Two of the residents make use of the dining room and communal lounge when they want, and we were able to directly observe this. We saw that people had access to books, magazines and televisions in their rooms. One person has a keyboard which she likes to play occasionally. The Manager told us that he had bought a DVD about the foundry where one of the residents worked for many years, and he had enjoyed watching this and reminiscing about his working life. These are examples of good practice that should be developed and built upon for all of the people in the home. We noted that the Service Users Guide now includes contact details of local advocacy and support services, so that people and their families can obtain external support and advice if they wish. None of the people in the home manage their finances independently, relying on family members or official bodies for this. The Manager has now provided lockable facilities in each persons room for secure storage of valuables and personal items. We looked at food stocks in the house and saw that these were plentiful and included fresh produce. Records of meals showed that people have a good range and variety of food. The main cooked meal of the day is generally served at lunchtime. We noticed that everybody usually ate the same meal: staff said that menus were drawn up on the basis of what food people liked, and we saw some information about this in peoples care plans. We noticed that there was evidence of different choices being made in what people had for tea or supper. Only two people make use of the dining room, others take all their meals in their rooms. We saw that food was attractively presented, and that people who needed assistance to eat their meals were supported appropriately. Previous reports have shown that the standard of Care Homes for Older People Page 16 of 31 Evidence: food produced in the home is very high. People told us that they enjoyed their meals and could have what they wanted. Comments included I like the food and am very happy with what I get and The food is lovely. I like the food a lot. Care Homes for Older People Page 17 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 can be confident that concerns are listened to and acted upon. Staff knowledge and understanding of safeguarding and mental capacity needs developing. This is to make sure they can support people to stay safe and maintain control over their lives. Evidence: The home has appropriate policies and procedures in place covering complaints and safeguarding (adult protection). We saw that the updated Statement of Purpose and Service Users Guide included information about making a complaint, and that the safeguarding policy is linked to local multi-agency guidelines. We spoke with people living at the home about making a complaint. Four out of the five people currently living there were able to tell us that they knew they could complain if they had any concerns. They said they would speak to the manager or a member of staff, or that they could get support from their families or friends. We also noted that the Service Users Guide now includes contact details of local advocates and advisory organisations. We looked at staff records to see that recruitment and selection practices offer protection to people living in the home. We saw that records included checks with the Criminal Records Bureau, previous employment histories and written references, as required. Training records show that some staff have done training in adult protection. We spoke to staff on duty about this. They were able to show their understanding of Care Homes for Older People Page 18 of 31 Evidence: the different nature and forms of abuse, and of the things that might lead them to suspect that abuse had taken place. They were clear about their responsibilities in the event of witnessing or suspecting abuse. At the time of the last inspection, following complaints received about the service, referrals had been made to the Local Authority under safeguarding policy guidelines. The outcome of their investigation into these matters was incomplete at the time of this inspection. This matter should be concluded at the earliest possible time. During our visits to the home for this inspection, we had free access to all of the people living there. We saw that they appear to have a cordial working relationship with the people who look after them, and both staff and residents seemed comfortable and at ease in each others company. The Manager told us that they have not had any complaints since the time of the last inspection: we have not received any further complaints about the service either since then. Following concerns expressed at the last inspection about the use of night time sedation, all of the people living at the home have had their medication reviewed by their doctor. Two people have alarms fitted to the doors of their rooms, to alert staff if they come out. One of these is only activated during the night, and both people are in agreement with the use of the alarm. There is no suggestion that the alarms are used to restrict peoples movement, only to ensure that staff are on hand to provide appropriate support. The Manager has also consulted the local authority Deprivation of Liberties Co-ordinator in this matter. It is important that all staff working at the home receive training to ensure that they fully understand their responsibilities under the Mental Capacity Act and Deprivation of Liberties Safeguards. Care Homes for Older People Page 19 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. People enjoy the benefit of living in a house that is adequately maintained and kept clean, fresh and tidy. Some improvements are needed to make communal areas fully accessible, to promote the independence and mobility of all people using the service. Evidence: The Red House is an attractive Grade 2 listed building;The Village is a cul-de-sac and the house is set back some distance from the main Dudley - Kingswinford road and accessed via a shared private driveway. There is parking for visitors at the rear and side of the property, and a private garden at the back of the house. We looked around the home during the two visits we made to complete this inspection. Currently there are five people who use this service living in the home. The owners also live on the premises. At the time of the inspection none of the people using the service were sharing a room, though we noticed that privacy screens were available in the designated double rooms. Though lockable facilities have been provided in peoples rooms, the locks on peoples doors are still said to be under review. We saw that peoples rooms were furnished and decorated to an acceptable standard. We could see that maintenance and decoration in the home is ongoing. One person is currently accommodated in a vacant room while her own room is refurbished and a new carpet fitted. She told us that she had been asked about this, and was happy with the arrangement. Her agreement to this was recorded appropriately in her personal Care Homes for Older People Page 20 of 31 Evidence: file. We saw that people had access to a call system, to summon staff for assistance. Some concerns were expressed about people being unable to access this, at the time of the last key inspection. However, improvements were noted at a subsequent random inspection. During our visit we saw staff regularly checking people in their rooms: we saw and heard that they knocked on the doors before going in. We also saw that staff ensured that mobility aides, TV remote controls, magazines, etc. were to hand for people. We also saw that peoples rooms are individual, with personal possessions and effects (such as family photographs, pictures, ornaments, TVs, music players etc.)in evidence. There are sufficient toilets, bathing and washing facilities to meet the needs of the people living in the home. Some rooms have en-suite facilities: there is a shower room on the first floor and an assisted bathroom on the ground floor. At the time of the last key inspection, concerns were raised about the storage of cleaning materials and toiletries in the shower and bath rooms, including those used by a member of the owners family, who was staying in the house at that time. This person is no longer living in the home, and we saw that toiletries and cleaning materials were appropriately stored during our visits. Also that liquid soap dispensers and hand driers have been installed. These practices help to ensure that risks of cross-infection are reduced. We saw that there is a separate laundry room, sited away from food preparation areas. The washing machine has a sluice cycle and there are separate hand washing facilities for staff to use. We saw that the home was clean and fresh, with no unpleasant smells. A new handrail has been fitted on the main staircase, to make this easier and safer to manage. However,there is a passenger lift available for people unable to climb stairs safely. Some concerns were raised at the last key inspection about the furnishing and layout of the communal areas in the home, notably the lounge and dining rooms. Both these rooms are comfortably furnished to a good standard. However, only two of the five current residents regularly access these rooms. While it has to be acknowledged that people do make positive choices not to come downstairs from their rooms, it also has to be recognised that the current arrangements may make a negative contribution to this. The furniture in place, though of good quality and in good condition, is not the best for promoting the independence and mobility of people who may significant support needs in these areas. This has previously been discussed with the Manager: in the homes action plan this is shown as being under review, and that new seating appropriate for a care home would be provided. This should include the layout of these rooms, as well as the type of furniture, to take into account wheelchair access Care Homes for Older People Page 21 of 31 Evidence: and the use of other mobility aides. It is suggested that professional advice (e.g. from an Occupational Therapist or other suitably qualified person) be sought to ensure that this is done effectively. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that important checks have been carried out to ensure that staff employed at the home are fit for their jobs. There are enough staff at the home to meet peoples basic care needs, but this should be reviewed to ensure that opportunities for meeting their needs for exercise, mental and social stimulation are improved. Evidence: We looked at staff records to see how people working at the home have been selected and recruited. Some concerns have been expressed in previous inspection reports about this. We saw that each person employed at the home has a separate staff file. We looked at the records for the staff most recently recruited. These contained a completed application form and employment history,two written references, declarations of physical fitness, and evidence of checks with the Criminal Records Bureau (CRB). We also saw a record for someone who had applied to work at the home, but had not been recruited. This is because satisfactory references and police checks were not provided. These things show that the service does what is required to make sure that people working at the home are fit for their jobs. We saw that a staff rota is now in place, as required at the time of the last key inspection. The rota shows that there are two people on duty at all times. Night time cover is provided by the owners between the hours of 9.00 p.m. and 7.00 a.m. The Care Homes for Older People Page 23 of 31 Evidence: rota shows that on alternate days one does waking cover, while the other does sleepin cover. There have been no new admissions to the home since the referrals made to the Local Authority (under multi-agency adult protection guidelines) at the last key inspection. The owners agreed to this at that time. During our visits to the home for this inspection, we saw that people are receiving satisfactory support to meet their basic care needs. However, we are concerned that people do not enjoy more opportunities for exercise, and mental / social stimulation, as detailed earlier in this report. We noted that the night time care arrangements do not allow for the owners, who are a married couple, to have a break from work or time off together. We could see that the Manager is not currently in the best of health. We are also concerned that the current staffing arrangements would be inadequate in the event of peoples healthcare needs or mobility deteriorating further, or current vacancies being filled. We recommend that staffing cover for the home be reviewed, and plans put in place to address these issues, so that meeting peoples ongoing care needs is not compromised. This is clearly also a matter for discussion with the relevant commissioning authorities. We recommend that no further admissions to the home are made until these things are satisfactorily resolved. It should be acknowledged here that the owners have signified their intention to sell the business as a going concern (see next section Management and Administration). Previous inspection reports show that 50 of the staff team is qualified to NVQ level 2 or above. No agency staff are employed at the home, promoting continuity of care. We looked at the available training records, and these showed that staff have recently attended refresher training in the safe handling of medication and also manual handling. We saw that a training matrix is in place, and that the newest member of staff has recently completed her induction programme. We recommended that the staff training and development plan should be presented in spreadsheet format. This should show (for each member of staff) training completed and qualifications gained (with dates), and highlight any gaps. These should include refreshers, with their due dates, and show when such training has been scheduled. Training complete should, where possible, be validated with proper certification. Each staff member should have an individual portfolio including their certificates. Doing these things should provide the Manager with an instant overview of the teams training and development needs, and a valuable tool for managing these effectively. We did see some certificates for training completed by staff, though not for all. Not all of the current staff team has completed safeguarding training or training about the Mental Capacity Act and Deprivation of Liberties safeguards,as reported above. 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. Some improvements are required to way in which the service is managed and administered, to ensure that it is run in the best interests of the people who use it. Evidence: The Manager is appropriately qualified and has many years experience of running this home. The service is managed as a partnership between Mr. and Mrs. ODonnell: as owners of the business they also live on the premises, and so are a constant presence around the home, adopting a very hands on approach. We spoke with staff and they told us the Manager is aproachable and that they are comfortable raising any matters of concern with him. The owners said that they have always tried to run the business as a family home: other members of Mrs. ODonnells family are part of the small staff team. We saw that the Manager has attended some training about the Deprivation of Liberties Safeguards so as to update his knowledge, since the last key inspection. It is clear that the Manager has made positive efforts to meet requirements made at Care Homes for Older People Page 25 of 31 Evidence: the last inspection, though some concerns remain about how the service is being run. While acknowledging the work that has been done to develop care planning and management, there is still room for improvement. Care planning needs to become more person-centred, with its focus broadened from merely meeting peoples basic care needs. We have referred to the need to develop peoples opportunities for exercise and mental and social stimulation throughout this report. The service needs to be more proactive about developing ways to engage people more effectively. Making the communal areas in the home more accessible and user-friendly for elderly people with significant mobility support needs would be a good place to start. The staffing arrangements for the home need reviewing in order to create opportunities for people to become more directly involved in the life of their local community. Record keeping needs development across the board. Staff need to be supported so that they can take a more active role in this, becoming more involved in developing and reviewing peoples care plans. However, we saw that a lot of work has been done since the last inspection to improve the organisation and presentation of records, so that information is easier to find, and this should be acknowledged. We saw that records were stored securely in the homes office. Quality assurance and monitoring are currently ineffective. We saw evidence of past activity in this area, and copies of a very limited recent questionnaire on files we looked at. As with care planning and management in general, this process needs to become more person-centred. Time needs to be spent engaging with people who use the service, their families and friends, professionals involved in their care, and any other relevant parties. This is so that their views about the service can be obtained effectively. The information gained from this exercise should be collated and analysed, and used to improve the service for the benefit of the people who use it. This should be reported on annually, and the outcome shared with all interested parties. The service does not take responsibility for managing peoples finances. This is generally dealt with by their family members. We sample checked records relating to health and safety matters in the home. These included regular checking of fire alarm and emergency lighting systems, routine maintenance of essential equipment, and regular checking of food, fridge, freezer, water and medicine store temperatures. We saw that a risk assessment on the cover for a radiator in the downstairs bedroom has now been put in place, as previously required. During this inspection, Mr. and Mrs. ODonnell advised us that it is their intention to sell the business so that they can retire from care home management. Mr. ODonnell does not currently enjoy good health, and both owners said that they found the Care Homes for Older People Page 26 of 31 Evidence: demands of running the service very heavy. 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 2 2 3 Update contracts so that all parties are clear about their responsibilities Review assessment format so that all areas of need shown in National Minimum standard 3.3 are covered explicitly. This is so that peoples care and support can be planned for fully. Develop care plans to make them more person-centred and more detailed. This is to ensure that people get the support they need in the ways theat suit them best. Seek professional advice to ensure that people get all the support they need to stay healthy and well. Ensure that balances of medication stocks carried forward are entered on the MAR sheet,and keep a record of medication audits. This is to ensure that medication is being fully accounted for at all times. Develop activity opportunities for each person in the home, with direct reference to their assessed needs and wishes. This is to ensure that everyone has opportunities for exercise, mental and social stimulation and to promote their physical and spiritual wellbeing. Page 29 of 31 3 7 4 5 8 9 6 12 Care Homes for Older People 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 7 17 Ensure that all members of staff are trained and supported to understand their responsibilities under the Mental Capacity Act and Deprivation of Liberties Safeguards. This is to ensure that people in their care are supported to maintain as much control over their lives as possible. Ensure that all members of staff receive training in protecting vulnerable adults from abuse (safeguarding). This is to make sure they have the knowledge and skills they need to support people to stay safe. Seek appropriate professional advice about furniture and layout of the home, so as to maximise peoples opportunities for independence and mobility. Replace and rearrange furniture as advised, in order to achieve this objective. Review staffing arrangements so that improvements can be made to peoples opportunities for exercise,and mental and social stimulation. Develop the staff training and development plan, so that it is clear when training has been completed and when refreshers are due. This is to ensure that staff have all the knowledge and skills they need to do their jobs well. Put in place effective measures for monitoring and assuring the quality of the service provided. This is to ensure that it is developed and run in the best interests of the people who use it. 8 18 9 19 10 27 11 30 12 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!