Care Home: The Village Care Home

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What the care home does well The home is clean and warm and residents are encouraged to personalise their bedrooms. People who have maintained their interest in attending social activities in the community and like to go out of the home are supported by staff to do this. The residents are supported to maintain links with relatives, friends and other social contacts. Residents health needs are met and staff ensure that they have access to all health services. Staff support people who have behaviours that challenge and ensure that they receive consistent care. Families have confirmed that they are satisfied with the services in the home and stated that they are always kept up to date about any changes in their relatives needs. What has improved since the last inspection? There have been significant improvements with the written care plans for most of the people who live in the home. The meal time arrangements are now better organised by involving the catering staff and giving care staff more time to spend supporting people during the meal. Clear written and photographic menus are in place and these assist people with making choices. Staff training has continued to be provided. And formal staff supervisions have been introduced. What the care home could do better: Written care plans must continue to be developed and risk assessments must also be introduced when working with people who have behaviours that challenge. And a system must be developed and put into place that confirms that care plans are evaluated at least once monthly. The staff should ensure that the supplying pharmacist provides medicines administration sheets that are clear and well set out in order to avoid the potential for errors to occur. The manager should develop and implement a range of activities that provide appropriate stimulation for those residents who have dementia or other cognitive impairments. The maintenance plan should identify how decoration and refurbishment will take place particularly in relation to those areas that we have commented upon in this report and which were discussed with the manager. The registered provider should review the current staffing level particularly between the hours 8am - 9pm. And if necessary they should be increased in order to ensure that there are sufficient numbers of staff to meet the needs of the residents. The registered manager should ensure that written records are available to confirm all staff are receiving formal supervision at least 6 times yearly. Key inspection report Care homes for older people Name: Address: The Village Care Home Hylton Bank South Hylton Sunderland SR4 0LL     The quality rating for this care home is:   two star good 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: Clifford Renwick     Date: 0 2 1 2 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 34 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 34 Information about the care home Name of care home: Address: The Village Care Home Hylton Bank South Hylton Sunderland SR4 0LL 01915342676 01915341427 thevillagecarehome@googlemail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Village Care Home Limited care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 40 Dementia - Code DE, maximum number of places: 9 Mental disorder, excluding learning disability or dementia - Code MD, maximum number of places: 9 Physical disability - Code PD, maximum number of places: 6 Date of last inspection Brief description of the care home The Village Care Home provides personal care for 40 older people over the age of 65 years, some of who may have dementia or mental health needs. It does not provide Care Homes for Older People Page 4 of 34 2 7 0 2 2 0 0 9 9 9 0 6 Over 65 0 0 40 0 Brief description of the care home nursing care and any health needs are dealt with by the Community Nursing Services. Registration includes 6 places for people with a physical disability and as such has designated rooms on the ground floor, which offer easy access to the outside grounds. The house is detached Victorian in construction and two storeys high, with bedrooms being on both ground and first floors. Each floor has a variety of lounge and dining areas. In addition to this there is a large conservatory area on the ground floor. The home provides a designated area for the residents to smoke. The upper floor has a sun terrace, which overlooks a patio area. The interior furnishings of the home are in keeping with the period of the house and due to its age many of the rooms are unique in design and layout. The home is sited on the main road into South Hylton Village, which is close to the metro station, enabling easy access to Sunderland city centre as well as Newcastle and Gateshead. There are some small shops in the village, which include a post office, chemist and general dealers, as well as a social club, all of which are in walking distance of the home. A local bus service can be accessed to the city centre and surrounding areas. The scale of charges for the home is #402.00 for residential residents and #442.00 for people suffering from dementia. Care Homes for Older People Page 5 of 34 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 2 stars. This means that the people who use this service experience Good quality outcomes. Care Homes for Older People Page 6 of 34 Before the visit. We looked at. Information we have received since the last visits in February 2009. How the service dealt with any complaints & concerns since the last visit. Any changes to how the service is run. The Visit. An unannounced visit was made on the 2nd December 2009. During the visit we. Talked with a number of the people who live in the home and also staff who were on duty. Held discussion with the manager and also people who were visiting the home. Held discussion with the community nurses who visited the home. Observed staff working practices. Looked at information about the people who live in the home and how well their needs are met. Looked at other records, which must be kept in relation to health and safety and staffing. Checked that staff had the knowledge, skills & training to meet the needs of the people they care for. Looked around the home to make sure it was well maintained, safe and free of any hazards. We also gathered information from looking at care records to assess how staff supports the residents with their assessed needs. And after the visit we held discussion with the registered providers representative. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Written care plans must continue to be developed and risk assessments must also be introduced when working with people who have behaviours that challenge. And a system must be developed and put into place that confirms that care plans are evaluated at least once monthly. The staff should ensure that the supplying pharmacist provides medicines administration sheets that are clear and well set out in order to avoid the potential for errors to occur. The manager should develop and implement a range of activities that provide appropriate stimulation for those residents who have dementia or other cognitive impairments. The maintenance plan should identify how decoration and refurbishment will take place Care Homes for Older People Page 8 of 34 particularly in relation to those areas that we have commented upon in this report and which were discussed with the manager. The registered provider should review the current staffing level particularly between the hours 8am - 9pm. And if necessary they should be increased in order to ensure that there are sufficient numbers of staff to meet the needs of the residents. The registered manager should ensure that written records are available to confirm all staff are receiving formal supervision at least 6 times yearly. 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 34 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 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are suitable arrangements for making sure that peoples needs are assessed before they are admitted into the home. This means that people using the service can be confident that staff will know how to meet their needs. Evidence: In discussion with the manager it was confirmed that prior to anyone being offered a place in the home the manager ensures that a full assessment of needs is carried out. This is to ensure that only peoples needs that can be met are admitted. We looked at the assessments that had been completed for 3 people who had moved into the home since our last visit. And we also looked at the assessment for one person who is spending a short break in the home whilst awaiting rehousing. Care Homes for Older People Page 11 of 34 Evidence: The pre admission assessment covered a lot of areas relating to physical needs and the kind of assistance that people required. Though the assessment did not contain a lot of information about a persons previous lifestyle,background or social needs. Discussion with the manager confirmed that once someone has moved into the home the staff then try to involve the families as much as possible in gaining further information as part of the ongoing assessment process. This then assists staff in compiling as much information as possible to help them with the care practices. The manager also confirmed that before people decide to move into the home they have the opportunity to visit the home to meet people who are currently living here. And also if they wish they can have a trial visit where they can stay over and experience the services that are offered. At the time of our visit there were 25 people living in the home of whom one was spending a short break up until Christmas. Care Homes for Older People Page 12 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, personal and social needs are met by care practices in the home, in a manner that promotes their privacy and dignity. However the written care plans do not include sufficient information to ensure that care practices are consistent. Evidence: During our visit we looked at five individual care files as part of a process we call case tracking and this involved us looking at all care records and records that related to health needs. Good records continue to be maintained to confirm that peoples health needs are being met. And evidence was available to demonstrate how staff had consulted a medical consultant to review a persons medication and the effects it was having on their behaviour. Care Homes for Older People Page 13 of 34 Evidence: Another person is currently confined to bed and staff have put into place a plan of care which involves regular positional turns to avoid getting pressure sores. The community nurse who were present during our visit confirmed that the manager and staff were doing well in caring for this person. And the community nurses were arranging for some specialist equipment to be provided so that the person could be assisted to sit in their chair in their bedroom due to the positive progress they were making. The information that we looked at in the individual care plans varied with some care plans being detailed. For example some care plans identified how a person wished to be addressed and what support they needed with daily routines. And others did not contain enough information to enable us to establish how people were being supported by staff. The care plans which should be evaluated at least monthly or sooner if there is a change in needs are not always being completed. For some people their care plan was last evaluated in June and there was no evidence to confirm what had happened between then and now. For another person a care plan was in place to support them with their continence needs but the charts that were in use to monitor this were not being completed by staff. One care plan that we looked at was very detailed and gave a good account of how staff were supporting the person with their assessed needs.And how they were enabling them to spend a fairly independent lifestyle which included accessing community activities. In discussion with the manager and a senior member of staff they were able to confirm what actions they were taking to support people.And it was clear that they have amassed a great deal of knowledge about the people who are living in the home. And observations confirmed that staff are carrying out good consistent practices especially with one person who has very challenging behaviours. However there was no written care plan in place or updated risk assessment to Care Homes for Older People Page 14 of 34 Evidence: confirm this. And a lot of observed positive practices that staff are carrying were not recorded in the care files. Discussion was held with the manager and also the registered providers representative about how staff are supporting a person who displays behaviours that challenge. As there were no records to confirm how staff were working with this person. Following the inspection this matter had been addressed and an up to date risk assessment and care plan had been implemented for this person. That demonstrated the consistent approaches that are being carried out by staff. During our visit we also looked at the receipt, storage and administration of prescribed medicines. Staff are following the appropriate guidelines when administering medicines. And as part of the pre - admission assessment process the residents are given the opportunity to self administer their medicines. And records are available to confirm that this is discussed at the time of admission to the home. The forms that staff use to record the administration of medicines are provided by the supplying pharmacist. The print quality on the forms in use was faint and this made it difficult to distinguish between the boxes that staff have to sign. It is quite possible that an administrative error could occur due to the boxes not being clearly defined and this was discussed with the manager who was advised to contact the pharmacist. Care Homes for Older People Page 15 of 34 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. Peoples lifestyle is good with regular contact being maintained with relatives and friends and the residents receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Evidence: The home is still without an activities coordinator and the manager stated that they are advertising for a person to work 5 hours per week. In the interim staff are involved in organising activities in the home though this at times is difficult as the current dependency level of the people who live in the home places high demands on staff time. A list was on display thoughout the home that advertised what activities are available in the morning and the afternoon. The activities included reminiscence, dominoes, bingo and craft sessions. Though there was not a lot of information to demonstrate what specialist activities are organised for those people with dementia or other cognitive impairments. Care Homes for Older People Page 16 of 34 Evidence: A file is maintained that lists when someone has taken part in an activity but the level of information in this file was not detailed. It does not demonstrate whether people have been offered activities or declined to take part. And the information showed that for some people they rarely took part in activities with records showing that they were involved in 2 activities in a month. There was insufficient evidence to confirm that specialised activities are in place to support those people who may have dementia or other cognitive impairments. On the day of our visit the main activity was attending the hairdresser who visits the home once weekly. In discussion with the manager it was stated that every Tuesday for a 4 week period some senior pupils are visiting the home and they assist with the bingo. On a Thursday afternoon 3 people who have a learning disability visit the home with their teacher and are involved in carrying out craft sessions with the residents. So fat the sessions have included making Christmas cards. A Christmas party has been organised for the residents to take place on 16th December and two carol services have been booked. These will take place in the home and 1 is to be carried out by local school children and the other by the church choir. For those residents who are able to pursue their own interests outside of the home this is supported by staff. One person goes out dancing with their family every Thursday afternoon and another person goes to a stroke club every Wednesday. At the time of our visit one person had gone to the cinema with members of the stroke club. Another person attends what is known as a male meeting group every Friday which is run by Age Concern. One person is also taken out three times a week by a person employed by a domiciliary care agency and who enables them to access community activities. This is a long standing arrangement and has been organised by the family of the resident. Care Homes for Older People Page 17 of 34 Evidence: During our visit we had lunch with the residents and his was a good opportunity to hold further conversation with people who live in the home. As well as giving us the opportunity to observe staff practices during the mealtime. In discussion with people they confirmed that they are always offered a nice selection of food and there is always a choice. This element of choice was observed during the lunchtime. When one resident who wasnt particularly keen on the meal that had been served. The staff were quick to pick up on this and offer an alternative dish which the resident preferred to have. Menus are available in the two dining areas and these are in large print as well as containing photographs of the meals that are provided. And this assists residents with making a choice. Catering staff take responsibility for serving meals from a hot trolley in the dining room and this enables staff to have more time with people during the meal and offer support and assistance where needed. Staff were observed assisting people to eat their meal and were attentive throughout the whole process. The menu on the day offered two choices for both the main course and dessert. Hot and cold drinks were available throughout the meal and staff offered people refills throughout. The meal was well presented, hot and tasty and a good portion was served. In discussion with a person who has recently moved into the home they said that they had been surprised how good the food was. They also said that they looked forward to the breakfast each morning as there was always a choice of a cooked breakfast. There are two dining rooms and staff worked between the two as there three people who require a lot of staff support due to their behaviours which are challenging. Staff solely work with these three people in a dining room of their own and offer appropriate support to ensure that they can eat their meals whilst at the same time minimising any disruptions. In discussion with the cook it was confirmed that refreshments and snacks such as biscuits and homemade cakes are always available in between meals. And other hot drinks include Ovaltine and Horlicks. The menus confirmed that there a Care Homes for Older People Page 18 of 34 Evidence: lot of meals provided which could be termed traditional home cooking as well a lot of home baked products. Care Homes for Older People Page 19 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust policies and procedures are in place that ensures residents are protected from abuse and an effective complaints procedure ensures that any complaints are resolved. An evidence is available to confirm that staff has received updated training in safeguarding adults in order to demonstrate that they are kept up to date with best practice Evidence: The home have policies and procedures that deal with complaints and copy of the complaints procedure is contained within the homes statement of purpose. A copy of the statement of purpose is given to to the person or their relative when they move into the home. And this ensures that they know how to raise any concerns and how they will be dealt with. There have been no recent complaints about the service. And our previous knowledge has indicated that if a complaint is made then this is addressed quickly by the manager. And to the satisfaction of the complainant. In discussion with relatives who were visiting at the time of the inspection they confirmed that they were satisfied with the home. Care Homes for Older People Page 20 of 34 Evidence: They went to say that the manager and staff are very approachable and would have no hesitation in discussing any concerns that they may have. Policies and procedures are in place that deal with safeguarding adults and staff are aware of how to deal with any safeguarding concerns. Most of the staff have undergone safeguarding adults training with Sunderland Social Services and two staff have yet to do this training. Discussion with the manager confirmed that arrangements were in place for staff to do this training in a weeks time. There have been no recent safeguarding alerts in the home. One alert that was made by social services and related to diet and nutrition for one person was resolved quickly by the home. And did not need to progress to a safeguarding strategy meeting. A satisfactory outcome was achieved for this person and records are in place to confirm this. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, pleasant and hygienic which supports the health and lifestyles of people living there. However the environment is not as well maintained as it could be and this potentially has an impact on the people living in the home. Evidence: During this visit we looked at all communal areas and all bedrooms that are currently occupied. Since our last visit the owners have decided that due to the low occupancy (25 residents) to close the first floor of the home. What this means in practice is that for the 4 people who have a bedroom on the first floor is that when they arise they spend their day downstairs with the other residents. And only use the first floor for sleeping. Discussion with the manager confirmed that this was discussed and agreed with the families of the residents. It was evident from looking around that the building is now showing signs of wear and tear particularly in corridor areas and some bedrooms. Care Homes for Older People Page 22 of 34 Evidence: The carpets in some corridors were stained and show signs of heavy use. And though the home have their own professional carpet cleaning machine it is difficult for staff to keep some areas clean. On one carpet in the Wesley wing there were what appeared to be bleach stains to the carpet. The paintwork on handrails and door frames are chipped due to wheelchairs banging against them. And in 5 bedrooms a number of minor faults were noted that needed addressing. These ranged from cracks in the ceiling to wallpaper lifting off the wall. And in one room the bedroom drawers had a broken front. These were discussed with the manager who was advised of what actions needed to be taken. The bathroom/shower room in the Wesley wing has a badly stained floor. We did comment on this bathroom during our last visit but no actions have been taken. And since our last visit it was noted that the floor covering is now starting to lift at the seam beside the toilet bowl. This could compromise the hygiene and infection control in the home. Similarly seals around baths have perished and need replacing. The carpet in the office is heavily soiled and the whole room would benefit from decoration. The maintenance plan which was dated 2008/09 and which was dated as being compiled on 1st April 09 does not offer sufficient information as to how general wear and tear to the building is to be addressed after April. There is a maintenance book in place and this used to list any works/defects that need to be addressed by a person who is engaged on an ad hoc basis to deal with minor repairs. However it is not clear from the information in the book as how quickly these jobs are dealt with. Care Homes for Older People Page 23 of 34 Evidence: In discussion with the manager it was confirmed that they have a person who calls every day for 2 hours to carry out general maintenance work and changes light bulbs. This person also keeps the garden tidy and deals with the falling leaves on pathways. For any other works such as plumbing or electrical faults the home engage external contractors. Care Homes for Older People Page 24 of 34 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. There are times when there are not enough staff on duty to meet the current needs of the residents to ensure their safety and welfare is promoted. Robust recruitment procedures are in place to prevent unsuitable people being employed, and this ensures residents are protected and their welfare is promoted. Evidence: In looking at staffing rotas it was noted that since our last visit there have been a number of amendments to the rota in order to provide additional cover at peak times in the morning. And also to break up the 12 hour shift that some staff work so that they have more flexibility in terms of work, life, balance. Some of the new shifts which have been introduced are 7am - 1pm and 2.30pm -9pm. And though the morning shift is an added bonus in having an extra person in from 7am the configuration overall has resulted in reduced staffing cover at key times. For example with these new rotas there is one member of staff less between the hours 1-4pm which has also resulted in 21 hours per week being deducted from the rota. Care Homes for Older People Page 25 of 34 Evidence: In addition to this the staffing levels on night shift have reduced by one person. The manager stated that a call out system is in place during the night should a member of staff need to be called into the home. And so far there has been no need for this. The number of people currently being cared for are similar as noted during our last visit and we reported then that staffing levels should not be reduced, however reductions have taken place. It was clear from our observations that the level of needs being presented in the home place heavy demands upon the staff. For example one person is displaying a range of behaviours that challenge and as such required one to one attention of a member of staff all throughout our visit. Another person was unwell and confined to their bed and required to be supported by staff every 30 minutes with their positional turns as part of their pressure care management plan. And though staff were observed being able to manage the above they had little time to do anything else such as activities. Or have sufficient time to spend talking with residents. And in addition to this should it be that someone needs to attend hospital or a medical appointment staff need to support the person with this. The manager confirmed that rotas can be adjusted to arrange escorts for these appointments. These staffing changes do have an impact on the managers time who was called upon by staff on a number of occasions during our visit to assist staff. It was evident from our observations that the staffing levels particularly during the day are not sufficient and this was discussed with the manager. And also the registered providers representative following our visit. In discussion with the manager it was also confirmed that administrative support within the home had been reduced 20 hour per week to 18 hours. There were sufficient staffing to provide catering and housekeeping services and 2 hours a day is allocated to maintenance work by a person calls to the home on a daily Care Homes for Older People Page 26 of 34 Evidence: basis. There have been no new staff appointed since our last visit so we did not look at staffing files. Though previous visits have demonstrated that the home have robust procedures in place when recruiting people. In discussion with the manager it was confirmed that training opportunities have been made available to all staff. In total 17 staff have completed training in the Mental Capacity ACT and the newly introduced Deprivation of Liberty standards. Five members of staff have completed training in dementia awareness and all but four of the staff have completed updated training in infection control. Three staff are also undergoing a course on team leading and this is being carried out by Durham College. Care Homes for Older People Page 27 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by an experienced and qualified person, and good practices are in place to ensure the health, safety and welfare of the people who live and work in the home. Evidence: The manager has continued to attend training in order to keep her skills and knowledge updated particularly in light of the changes with the Mental Capacity Act. The manager receives administrative support from the registered providers representative who is based in the home during the week and there is also an administrative worker who deals with other administrative matters such as invoices and service users personal allowances. We looked at some of the records that relate to service users personal allowances and these confirmed that this is being managed satisfactorily. Care Homes for Older People Page 28 of 34 Evidence: Monies are currently being held for 23 people and each person has their own book in which any transactions are recorded. Receipts are obtained for any purchases made on behalf of service users and staff sign for each transaction. We also looked at accident records and this confirmed that staff are following correct procedures when someone has an accident. Staff also record any action taken following an accident and also the outcome. And in turn the manager carries out an analysis of the number of accidents on a monthly basis as part of a health and safety process. And should there be any increase in the number of accidents caused by falls. Then a referral is made to the falls adviser team. The manager reported that the number of accidents in the home has steadily reduced since our last visit earlier in the year. Records available confirmed that staff are taking part in regular fire drills and also receiving fire instruction training. And the manager said that a period of fire instruction was due to be carried out again this month. A maintenance plan is in place and this confirms that any equipment in use would be serviced and checked by specialist contractors. However there is insufficient detail in the maintenance plan to show how everyday matters are to be dealt with. And this was previously noted in sections 19 - 26 of this report. The manager ensures that staff are kept up to date with health and safety training and four staff have recently undergone updated training on moving and handling. The manager confirmed that she is carrying out formal staff supervisions and three have recently been completed. The records available confirmed that one of these had taken place in October and two in September. In our discussion the manager stated that she was behind with supervisions and these were not being carried out in accordance with the timescales as set out in the national minimum standards. However she went on to say that a senior member of the staff team had now taken on board responsibility and was carrying out supervisions with care staff. Care Homes for Older People Page 29 of 34 Evidence: No records were available to confirm when future supervision sessions were planned and this was discussed with the manager. In terms of quality assurance there is little in the way of documented evidence to confirm that effective quality assurance monitoring systems are in place. And there has been some delays in progressing actions within the agreed timescales. To fully implement the requirements set out in our last inspection report. In discussion with the manager it was confirmed that she is working hard to ensure that the home is run in the best interests of service users. And at times she will assist staff with the care process which has an impact on her time and the ability to keep all written records up to date. Care Homes for Older People Page 30 of 34 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 31 of 34 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 7 15 Care plans must continue to 31/03/2010 be developed for each person in the home. And include the detailed actions that staff are carrying out to help people. And when implemented the care plans must be kept under review and evaluated at least monthly. This will ensure that staff are following consistent practices when supporting people with their assessed needs. And also addressing any new needs that may be identified. 2 27 18 The registered provider must review the current staff rota. And ensure that the staffing numbers between the hours 8am 9pm are sufficient to meet peoples needs. This will ensure that at all 31/01/2010 Care Homes for Older People Page 32 of 34 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 times there are enough staff to look after the residents. And maintain there safety, health and welfare 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 12 Further work should be carried out in developing stimulating activities for those residents who have dementia. The registered owner should produce a maintenance plan that confirms how the matters identified in this report. And also how those matters that were discussed with the manager will be addressed. Records should be available to confirm that all staff receives formal supervision from their manager at least 6 times per year. And the records should show when future supervisions have been planned. 2 19 3 36 Care Homes for Older People Page 33 of 34 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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