Care Home: The Rosemary Care Home

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What the care home does well Routines within the home continue to be very relaxed. People were seen to spend time in their own rooms or in one the communal areas. Interactions between residents and staff were observed to be appropriate and friendly. Family and friends are encouraged to visit regularly. Feedback from the Expert by Experience was very complementary of her observations of staff and assistance during our visit. She commented; `my arrival was a surprise to the staff, but they welcomed me warmly`, `the staff were most pleasant and helpful, guiding me to residents who may be able to enjoy a chat with me. Nothing was too much trouble`, `all the staff I came into contact with were pleasant and very busy` and `staff were very attentive to residents needs both offering drinks and assisting at lunch`. She also felt that `the air of contentment in the residents had improved since my last visit, and better efficiencies had been achieved. With continued constructive input going forward, hopefully even more positive outcomes will be produced`. What has improved since the last inspection? The new manager has brought some stability to the team and is starting to make some of the improvements needed. The manager has also developed an action plan detailing areas she considers need improving to enhance the service provision. The recording, handling and administration of medication continues to be managed in a safer way ensuring people receive their prescribed medication correctly. Residents and relatives have become more involved as well as being consulted about decisions within the home, including daily routines, fund raising, activities and meals. Policies and procedures are under review so that staff have up to date information and good practice guidance. What the care home could do better: The registered person must ensure that a comprehensive pre admission assessment is completed prior to people moving into the home. This will ensure that only those people whose needs can be met are placed there. Care files need to be re-organised so that there is one clear and detailed plan of care, including risk assessments and daily notes, making sure that staff are informed of the current and changing needs of people so their well being is not affected. Detailed care plans need to be in place for all residents including those on respite so that staff know what their needs and wishes are and can support them safely. Where specific areas of concerns have been identified ie use of bed rails, nutritional needs, a risk assessments should be completed showing what intervention is required so that they are kept safe.In the absence of the deputy manager suitable arrangements should be put in place to ensure that the management of medication is maintained and people receive their prescribed medication. Further opportunities for people to take part in a variety of social and leisure activities should continue to be developed so that everyone, irrespective of their support needs, are afforded a choice to their daily routine. Ongoing staff training and development must be provided so that staff have the knowledge skills and competences to meet the specific needs of people living at the home. Safer systems need to put in place to ensure that the rights and interests of people are safeguarded so that they are protected from abuse. On-going improvements need to be made to enhance and improve the standard of accommodation provided so that people live in a home that is comfortable and well maintained. The registered person must make sure that written references are sought when recruiting new staff ensuring the recruitment processes are robust and people are kept safe. The registered person must ensure that an application is made by the manager to register with us so that there is clear, stable and consistent management at the home. Arrangements need to be made for the manager to compete all training relevant to her role and responsibilities so that she is able to support and direct the staff team ensuring good practice is followed. Systems to monitor and review the service delivery need to be developed so that ongoing and sustained improvements can be made. Arrangements need to be made for all staff to receive regular supervisions so that they feel supported and directed in carrying out their duties effectively. Key inspection report Care homes for older people Name: Address: The Rosemary Care Home The Rosemary Care Home 13 Newhey Road Milnrow Rochdale Lancashire OL16 3NP     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: Lucy Burgess     Date: 2 3 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Rosemary Care Home The Rosemary Care Home 13 Newhey Road Milnrow Rochdale Lancashire OL16 3NP 01706650429 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Din T Vanat Name of registered manager (if applicable) Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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 The maximum number of service users who can be accommodated is: 27 Date of last inspection Brief description of the care home The Rosemary Care Home is a privately owned residential home, which provides care for up to 27 people. The home is in the centre of Milnrow and is close to local shops and pubs. It provides good access to the motorway network. Accommodation is provided on three floors and there is a passenger lift to all levels. Care Homes for Older People Page 4 of 31 Over 65 27 0 0 3 0 2 2 0 1 0 Brief description of the care home Twenty-one single and three double bedrooms are provided. Two of the bedrooms have the added provision of an en-suite. Two lounges and a dining area are provided on the ground floor and a combined diningroom and lounge on the first floor. A bathroom is provided on each floor and a level access shower room on the ground floor. Two of the baths are fitted with fixed hoists. Toilets are located near to lounge areas and bedrooms. A well maintained garden is available to the front of the home where there is also parking. The most recent inspection report was available in the reception hall. The fees were £370 plus a top up fee of an additional £10. Additional charges were made for hairdressing, trips, newspapers, telephone, alcohol, clothing and personal toiletries. 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 was a key inspection visit, which included a site visit and took place over one day. The inspector was accompanied by an Expert by Experience from Age UK. Their role was to talk to the people who use the care service. They also looked at what happens around the home, see how everyone gets on together and what the home feels like. The service did not know that we were to visit. The purpose of our visit was to look at what progress had been made following our key inspection on the 3 February 2010 and random inspection on the 29 March 2010. Following the key inspection in February 2010 the quality rating for the home was reviewed and rated as 0 stars, outcomes were judged as being poor. Due to this and other concerns the Local Authority are currently not making placements at the home. However those people wishing to stay at the home through private arrangement are able to so. Care Homes for Older People Page 6 of 31 Due to our concerns we held a management review meeting to consider what further action we needed to take. A warning letter was sent to the provider detailing the areas of concern they needed to address and an improvement plan was also requested. We asked the provider to send us a copy of their up to date accounts so that we could look at the viability of the home. These were provided. The home is without a registered manager and the registered provider has failed to retain managers in the past, this has resulted in the home having 3 different managers over the last year. This does not ensure clear leadership and support to both staff and people living at the home. Nor does it demonstrate that effective working relationships have been established between the registered person and manager ensuring the safety and protection of those living at the home. The registered person has been advised that failure to have a registered manager in place could reflect on their fitness, which may result in further action being taken. During our random inspection we check if the home had addressed the requirements made following our last visit. We found that the management of medication was safer as well as further improvements in care planning and staff training and development. As part of the inspection process the home was asked to complete their Annual Quality Assurance Assessment (AQAA). This was provided prior to our first key inspection. During this visit time was spent looking at records in relation to care files, staff recruitment, training and development and health and safety. The Expert by Experience spent their time chatting with residents, having lunch, observing peoples daily routines and interactions with staff as well as looking at the laundry and some parts of the environment. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The registered person must ensure that a comprehensive pre admission assessment is completed prior to people moving into the home. This will ensure that only those people whose needs can be met are placed there. Care files need to be re-organised so that there is one clear and detailed plan of care, including risk assessments and daily notes, making sure that staff are informed of the current and changing needs of people so their well being is not affected. Detailed care plans need to be in place for all residents including those on respite so that staff know what their needs and wishes are and can support them safely. Where specific areas of concerns have been identified ie use of bed rails, nutritional needs, a risk assessments should be completed showing what intervention is required so that they are kept safe. Care Homes for Older People Page 8 of 31 In the absence of the deputy manager suitable arrangements should be put in place to ensure that the management of medication is maintained and people receive their prescribed medication. Further opportunities for people to take part in a variety of social and leisure activities should continue to be developed so that everyone, irrespective of their support needs, are afforded a choice to their daily routine. Ongoing staff training and development must be provided so that staff have the knowledge skills and competences to meet the specific needs of people living at the home. Safer systems need to put in place to ensure that the rights and interests of people are safeguarded so that they are protected from abuse. On-going improvements need to be made to enhance and improve the standard of accommodation provided so that people live in a home that is comfortable and well maintained. The registered person must make sure that written references are sought when recruiting new staff ensuring the recruitment processes are robust and people are kept safe. The registered person must ensure that an application is made by the manager to register with us so that there is clear, stable and consistent management at the home. Arrangements need to be made for the manager to compete all training relevant to her role and responsibilities so that she is able to support and direct the staff team ensuring good practice is followed. Systems to monitor and review the service delivery need to be developed so that ongoing and sustained improvements can be made. Arrangements need to be made for all staff to receive regular supervisions so that they feel supported and directed in carrying out their duties effectively. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive information about the assessed needs of people needs to gathered so that people are able to make an informed decision about the suitability of the placement ensuring needs will be met. Evidence: The Local Authority made the decision earlier this year to suspend placements at the home until such time they were satisfied that people would receive a good standard of care and were kept safe. However those people wishing to stay at the home through private arrangement are able to do so. We were told that one person was staying at the home for a period of respite. They had moved into the home the week prior to our visit. Assessment information was examined for this person. We found that information had been provided by the hospital social work team as well as a pre-admission assessment, which was completed by the deputy manager. Care Homes for Older People Page 11 of 31 Evidence: Some of the risk areas identified by the social worker had not been noted on the homes assessment nor had this been transferred to a care plan. Without such information there is no assurance the needs of people will be met. Standard 6 does not apply as the home does not provide intermediate care service. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans need to reflect the current and changing needs of people so that staff know how people are to be supported in meeting their needs. Evidence: Care Plans were looked at for four people where a specific need had been identified. This included the person who was on respite. Information included a care plan, risk assessments, weight records, a record of visits from GPs etc and diary sheets. Information had been reviewed on a monthly basis. On examination of the records we found that the person on respite had no short term care plan or risk assessments, therefore offering no direction to staff about what care and support was needed and how this should be delivered. The three other files examined were for people who had been at the home for sometime. The new manager was in the process of reviewing all care plans and developing the individual files. Due to this two different documents were being used. On the files provided daily records had been completed up to May 2010 with Care Homes for Older People Page 13 of 31 Evidence: occasional entries through June however the manager advised us that new daily records were now being used. One document needs to be made available to staff so that all information is readily available and ensures on-going monitoring of people. For one resident we also found that there were changes in their health care needs. This person was in receipt of food supplements however this was not fully reflected in their care plan. There was also no nutritional assessment or assessment of bed rails. The registered person must ensure that plans fully reflect the support needs of people and where areas of concern have been identified that these are risk assessed so that staff are clearly directed and people are kept safe from harm. Arrangements in relation to the storing, recording and administering of medication were looked at. The senior carer on duty responsible for medication was observed giving medication to people. Protective clothing was being worn and drinks were provided. People were asked if they required pain relief. Records were signed following administration and the trolley was kept locked when left unattended. Looking at the stocks these were kept to a minimum, records showed that items brought into the home were signed for as well as all items returned to the supplying pharmacy. Controlled drugs were also checked. These are stored safely and a clear record is maintained and double signed when items are administered. Records and stocks were checked and found to be in order. The senior carer told us that the deputy manager takes responsibility for ordering and returning medication and that she would not feel confident in doing this. The manager is asked to address this. In the absence of the deputy manager suitable arrangements must be put in place to ensure that the management of medication is maintained and people receive their prescribed medication. Due to recent issues some of the senior care staff no longer take responsibility for the administration of medication. At present there are only 4 staff that carry out this task. The manager told us that she was currently recruiting a new senior carer who would provide additional support. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines within the home had improved. People are actively being consulted about how these can be enhanced further affording people more opportunities and variety to their day. Evidence: Through discussion with the new manager we found that improvements were being made to afford people more variety to their day. A fund raising forum had been established and involved both residents and relatives. Monies raised would be used to provide activities both in and away from the home. We were also told that there were plans to develop the outside space to the rear of the home, providing a sensory garden with built up flower beds so that people could join in and help with gardening. B&Q had been approached to the fund the project. The manager was to develop a business plan for their consideration. Over the course of the morning and lunch time the expert by experience spent time talking with people as well as having lunch with residents. They commented; There was an agenda for activities, which included gentle exercises, an afternoon of massage and manicure and dominoes were also on the agenda. However, the carer who organised the activities was unable to provide a designated period for activities Care Homes for Older People Page 15 of 31 Evidence: because there was no spare staff to attend to urgent needs of residents which may disrupt the programme. A Residents meeting was planned for the afternoon of the inspection, which was well attended. There is a book of Places to Worship available for residents. The evangelical representatives were regular visitors. Residents were looking forward to a trip out at the end of the month to a major Garden Centre. One resident was pleased that staff took her along to a late residents funeral, she appreciated this very much. A summer fair was advertised for two weeks time and a notice was displayed advising ladies that a company from Shaw was visiting to offer a one to one measuring service for lingerie. Three residents confirmed their length of stay at the Rosemary as being happy, well fed and comfortable with staff. There were two lounges, one appearing very cosy with an aura of contentment, but appeared a different community spirit to the residents in the downstairs lounge. The manager advised that she is trying various ways to encourage better integration between the residents preference. Residents were cared for well by staff, but appeared bored with limited activities to encourage movement and independence. There did not appear to be any enthusiasm for looking forward to any specific activity. However the new manager had now achieved a new rota beginning in July which allows the activities member of staff to have one clear hour every day for five days, to enable her to build and create enthusiasm. A further observations was made of a lady who spent the morning in her wheelchair and not in an ordinary chair. This could have been through choice, although this was pointed out to the manager that headrests could be available to fix to some wheelchairs, to alleviate pressure on the neck. The air of contentment in the residents had improved since my last visit, and better efficiencies had been achieved. With continued constructive input going forward, hopefully even more positive outcomes will be produced. The expert by experience also looked at arrangement for meals and joined residents for lunch. She found, the Cook, a very energetic lady, who made her own pastry and cakes and used fresh vegetables in her menus. The food today was cooked and presented well. In 26 inspections, this was the most nutritious and well cooked meal so far. The menu included homemade chicken and leek pie (I saw the cook making them during my visit), with cauliflower, peas and mashed potato. Cheese bake was an alternative, followed by fruit pie and custard. The tea time menu was also interesting; Care Homes for Older People Page 16 of 31 Evidence: sandwiches and soup or fish fingers and peas. The cook appears to juggle washing up and cooking. This appears to work with current levels of occupation. One resident is struggling with a degenerative illness, which affects their eating. Sometimes they can eat a dinner at lunchtime and sometimes they cannot eat it until teatime. Staff ensured this resident received their chosen meal when it was suitable for them. Staff were on hand to assist at lunchtime and ensured that everyones needs were met. The dining areas offered a pleasing atmosphere to eat in, and everyone appeared relaxed. An air-conditioning system appeared to be in place. 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. Areas of care and support need to be improved along with the completion of relevant staff so that they are aware of what their responsibilities are in keeping people safe. Evidence: Since the key inspection in February 2010 there have been several concerns raised about the care provided, staffing levels and management of personal finances. Specific issues regarding the management of peoples personal finances by the registered provider have been investigated by local authority in line with their safeguarding procedures. A case conference had been convened the week following our visit to conclude findings from the investigations. Two recent issues have also been raised by the visiting district nurses. These were reported to the local authority as safeguarding issues. Investigations were conducted as well as the manager undertaking an internal investigation. Incident reports had been completed and action had been taken to address poor staff practice. Safer systems need to put in place to ensure that the rights and interests of people are safeguarded and they are protected from abuse. The new manager has been revising the homes policies and procedures. Procedures Care Homes for Older People Page 18 of 31 Evidence: are in place covering Adult Protection and complaints. Further information has been introduced covering the Mental Capacity Act and Deprivation of Liberty safeguards. We discussed with the manager our observations of one person who receives day care at the home. The person became unsettled and was requesting to leave the building as well as banging the front door. Staff spoken with said that this was a regular occurrence. Arrangements for this person should be discussed with relevant parties ensuring the support in place is in their best interests. Information was also looked at with regards to staff training. Further plans had been made for staff to attend courses provided by the local authority between April and September 2010. This included 8 staff members attending a safeguarding course and 5 staff to receive training in the Deprivation of Liberty Safeguards. The new manager also needs to complete this training so that she is up to date with relevant legislation and good practice guidance. 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. Rosemary provides spacious accommodation which could be enhanced with further redecoration and refurbishment so that people live in a comfortable, well maintained home. Evidence: We again looked at the environment to see what improvements had been made. The registered person sent us a redecoration and refurbishment plan as requested however no real progress had been made. We were told that due to the low occupancy levels funds available were limited. Through discussion with the manager we were informed that one room had recently been redecorated and two further rooms were being fitted with new flooring due to the needs of people. One of these rooms had been identified at the last key inspection due to its poor condition however little action had been taken to address the matter when we visited again in March 2010. During this visit however we found that this room, the two toilets and a further bedroom situated in the annex to there rear of the ground floor had been closed off and were not being used at this time. The bedrooms areas need to be brought up to standard before being occupied again. Whilst looking round the home we found that the toilet near to the dining room needed attention. The toilet seat was broken, the call bell lead was tied up and the bin Care Homes for Older People Page 20 of 31 Evidence: was not suitable for soiled waste. These were raised with the manager who agreed to address them. She was also asked to check suitable bins were in place in all areas where people are supported with personal care. Communal rooms are spacious. One of the lounges on the group floor is a designated television room with a large flat screen TV. There is also a quite lounge, where people were seen relaxing and listening to music. On the first floor there was another lounge/dining room which is shared by a small group of people. One lady told us that the provider was also going to purchase a large flat screen television for this room too. Whilst looking round the home, areas were found to be generally clean and tidy with no malodour, other than the 2 identified rooms, which were being addressed. Domestic and laundry staff are available throughout the week. One member of staff had been given designated responsibility for infection control. Daily checks were made and sufficient supplies of protective clothing were provided. Staff were seen to wear aprons and gloves when supporting people with specific tasks as well as hand washing provisions in all areas where personal care is provided. The expert by experience also looked at some areas of the home. Her comments included, One resident was aware of a vacant room which made access to the lounge easier for them, relatives and staff. It appears an exercise which brought together, owner, manager, and relatives to ensure the contentment of the resident. The Owner, cleared the room and replaced the carpet chosen by the residents, whilst the relatives redecorated and replaced curtains to their mothers liking. An excellent outcome. A great deal of satisfaction for all concerned. The relatives were very pleased with the cooperation from the owners and management. The home is on a busy road, providing constant changes of views for the residents, some of whom enjoy keeping watch. The garden is small. However, there is a wooden gazebo and bridge which has been erected, to make it more interesting. The expert by experience also said of their inspection of the laundry; The Manager accompanied me to the laundry, which had a new top of the range system in place. It also had the ORTEX system in place which ensures thorough cleanliness against bacteria and re-infection. Much effort has been made to ensure clothing is returned to its rightful owner. This was a huge improvement on last year. Although one residents clothes are still laundered by her relatives, through choice. A general observation was made with regards to the flooring in that, whenever the Care Homes for Older People Page 21 of 31 Evidence: stairs and landing carpet need to be replaced, perhaps a plain pattern could be considered more suitable for residents suffering from forms of dementia. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All checks need to be gathered when recruiting new staff as well as continuous training and development so that people are safely supported by a competent staff team. Evidence: Since our last visit to the home there has been little change to the staff team. Staff rotas were examined to look at the ratios provided throughout the day and night. Based on the current occupancy levels and the needs of people, sufficient staff were on duty. The manager was aware that this would need to be kept under review should occupancy increase. Staff recruitment records were examined for a new member of the team. Information seen included an application form, copies of identifications, Independent Safeguarding Authority check, (ISA, previously known as POVA), criminal record check (CRB), health declaration and a written reference. A second reference had not been received nor had a reference been sought from the persons last employer. Whilst it is noted this staff member did not commence employment prior to receipt of the CRB, all relevant information and checks must be sought ensuring the recruitment process is robust. Staff training and development was again reviewed to see what plans had been made. Care Homes for Older People Page 23 of 31 Evidence: We found that further training had been planned between April 2010 and September 2010. This has been sourced from the local authority. The plan showed that the following courses had been booked; adult protection 8 staff, Infection control 8 staff, moving and handling 3 staff, Deprivation of Liberty 5 staff, dementia care 4 staff, first aid 8 staff and food hygiene 8 staff. NVQ training was also provided for the team. On going staff training and development is requried to ensure staff have the necessary knowledge, skills and competencies to carry out their duties so that the specific needs of people are met. We discussed with the manager arrangements in relation to the induction of new staff as well as supervisions. The manager told us that at present inductions were carried out by the deputy manager. During our previous visit we found that this involved the completion of the Skills for Care workbooks. Staff supervisions had also previously been carried out by the deputy manager in the absence of a manager. The new manager told us that she would be taking on the responsibility for these and would be arranging periodic meetings with all staff. Feedback from the Expert by Experience was very complementary of her observations of staff and assistance during our visit. She commented; my arrival was a surprise to the staff, but they welcomed me warmly, the staff were most pleasant and helpful, guiding me to residents who may be able to enjoy a chat with me. Nothing was too much trouble, all the staff I came into contact with were pleasant and very busy and staff were very attentive to residents needs both offering drinks and assisting at lunch. The Expert by Experience also spoke with the manager and inspector about visiting health and social care people at the home. It appeared that the protocol of visiting people should be queried to ensure satisfactory checks are made. The manager said that she had been looking at the existing arrangements and was making the necessary enquiries. 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. Stable and consistent management is required so that the service can make the necessary improvements ensuring people receive a quality service, which meets their needs. Evidence: Over the last twelve months there has had a great deal of instability in the management team at the home, with a 3rd change in manager over the last 12 months. This is concerning and brings into question the registered providers understanding of their responsibilities in carrying out the service, furthermore since taking ownership of the home in 2004 they have yet to register a manager with us. A new manager has now been appointed and commenced their employment on the 26 April 2010. The manager is a trained counsellor having worked within health settings supporting people with drug related issues. She also has some experience of working with care homes. The manager appeared to have an understanding of the needs of the service and the areas of improvement required. Through discussion with the manager Care Homes for Older People Page 25 of 31 Evidence: it appeared she had developed a good working relationship with the registered provider and was able to take responsibility and make decisions about the day to day running of the home. The manager is aware of her responsibility to register with the Commission and has been proactive in taking the necessary steps to address this. The manager continues to be supported by a deputy manager, who has a number of years experience working within care homes. At present, much of the deputys time is spent providing direct care to residents as well as managing and administering the medication. The home needs a period of stability to ensure that this is sustained and further improvements are made so that people receive a good service. The new manager is currently reviewing systems within the home and has drawn up a plan of action for the forthcoming year to improve and enhance the service provision. Feedback is to sought from all relevant parties, including residents, their families and health and social care professionals, about the service provided and what areas they feel could be improved. This information should be used to inform and further develop the homes business and development plan. Further internal auditing systems also need to be put in place so that that manager is confident that the necessary improvements are being made and sustained. Until recently staff supervisions have been carried out by the deputy manager, however this role will now be undertaken by the manager. The manager is ware that all staff must receive a minimum a six sessions per year so that they are supported and directed in their role. This will also enable the manager to address any areas of learning and development required ensuring staff have the competencies needed to carry out their duties safely. Records were looked at with regards to health and safety. All annual servicing certificates were in place, the five year electric certificate was available along with confirmation of completion of the remedial work required. During our visit evidence could not be provided of up to date PAT testing. Evidence of this was provided following our visit. Further checks are also completed by the registered provider with regards to water temperatures and fire safety. Care Homes for Older People Page 26 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 27 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 1 3 12 The registered person must ensure that a comprehensive pre admissions assessments is completed ensuring only those people whose needs can be met are placed at the home. 30/07/2010 2 7 15 Detailed care plans must be in place for all permanent and short term placements so that staff know how to meet the persons needs safely. 30/08/2010 3 8 13 Where specific areas of concerns have been identified ie use of bed rails, nutritional needs, a risk assessments must be completed showing what intervention is required and why so that they are kept safe. 30/08/2010 Care Homes for Older People Page 28 of 31 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 4 29 19 The registered person must 30/07/2010 ensure that a minimum of 2 written references are sought when appointing new staff ensuring they are suitable for the position offered. 5 30 18 The registered person must 30/09/2010 ensure that staff continue to receive good quality training as outlined within the homes training plan ensuring they have the knowledge skills and competencies needed to carry out their duties safely 6 31 9 The registered person must ensure that all relevant management training is provided so that the manager is up to date with good practice guidance and legislation relevant to her role. 30/08/2010 7 31 9 The registered person must ensure that an application is made by the manager to register with us, so that there is clear, stable and consistent management. 30/08/2010 Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care files need to be re-organised so that there is one clear and detailed plan of care, including risk assessment and daily notes so that staff are informed of the current and changing needs of people ensuring their well being is not affected. In the absence of the deputy manager suitable arrangements should be put in place to ensure that the management of medication is maintained and people receive their prescribed medication. Further opportunities for people to take part in a variety social and leisure activities should continue to be developed so that all people, irrespective of their support needs, are afforded a choice to their daily routine. Safer systems need to put in place to ensure that the rights and interests of people are safeguarded and they are protected from abuse. Areas identified within the home need to be addressed so that are able to use the faciltiities within the home safely. On-going improvements need to be made to enhance and improve the standard of accommodation provided so that people live in a home that is comfortable and well maintained. Systems to monitor and review the service delivery need to be developed so that the on-going and sustained improvements can be made. Arrangements should be made for all staff to receive regular supervisions so that they feel supported and directed in carrying out their duties effectively. 2 9 3 12 4 18 5 6 19 19 7 33 8 36 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. 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