Care Home: The Westcliff Residential Care Home

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What the care home does well People tell us they are well looked after and praise staff highly. Comments we received include;"Staff are wonderful", "They take good care of me" and "They treat me like a queen". The home works closely with health and social care professionals so that people have their personal and health care needs met. Comments we received from professionals include; "Provides an excellent level of care to all their residents, maintaining dignity and respect for each and everyone", "The staff are very caring and understanding and very supportive and helpful to the residents" and "I have always found the staff very helpful and respectful". The home is in a good location for local amenities and some rooms have lovely sea views. There is a relaxed atmosphere, visitors are made welcome and residents are treated with dignity and respect. The menu offers a wide range of meals that are home cooked, nutritious and appetising. What has improved since the last inspection? Since our last inspection medication procedures have improved. Staff were observed administering medication safely and appropriately and secondary dispensing has ceased. Staff training is also more thorough and includes an assessment of their knowledge and competency. What the care home could do better: The home is registered to provide care to ten people with dementia but they are not providing a specialist dementia care service. Their Statement of Purpose needs to more clearly specify the services they offer and if that includes admitting people with dementia the environment and the expertise of staff should be developed. The home should build on their current programme of activities and entertainment so that people are given greater opportunities to participate in a wider range of group and individual activities. This will enable people to remain active and have purpose and meaning in their lives. The service needs to ensure that they keep their fire risk assessment up to date, periodic fire drills take place and infection control procedures are thorough and robust. Key inspection report Care homes for older people Name: Address: The Westcliff Residential Care Home The Westcliff Residential Home 51 Leopold Road Felixstowe Suffolk IP11 7NR     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: Tina Burns     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 27 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 27 Information about the care home Name of care home: Address: The Westcliff Residential Care Home The Westcliff Residential Home 51 Leopold Road Felixstowe Suffolk IP11 7NR 01394285910 01394271154 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Hazelwood Care Limited care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Westcliff is registered as a care home for older people. The Home comprises two Victorian houses, situated on parallel roads in the town of Felixstowe and close to the seafront. The town facilities are close by and include various shops, a library, post office and Doctors surgery. Initially the two houses were linked by a single storey extension, however an extension linking both houses at first floor level was completed in September 2001. The second floor is reached by shaft lift on the West wing and by stair lift on the East wing. There is a small patio area leading from the dining room, with a small enclosed garden at one end of the property. There is limited parking at the front entrance of the property. The Home was first registered in 1972. Mrs Crowley became Manager in June 2001 and Care Homes for Older People Page 4 of 27 Over 65 10 33 0 0 0 8 1 2 2 0 0 8 Brief description of the care home Hazelwood Care Limited purchased the home in October 2003. In June 2006 the home registered to care for up to 10 older people with dementia. Mr Singh is the Responsible Individual acting on behalf of the company. The Home is registered for 33 older people with 29 single bedrooms and two shared rooms. At the time of inspection fees ranged between £500 and £625 per week. Care Homes for Older People Page 5 of 27 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 an unannounced key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. During this inspection our inspector was joined by an Expert by Experience. An Expert by Experience is somebody that has an expert opinion on what it is like to receive services, in this instance for older people. Our expert on this occasion was Joyce Groves from Help the Aged. She spent the morning at the home speaking with staff, relatives and residents and looking specifically at how people spend their time and opportunities they have to participate in activities. Following the inspection our expert sent us a report. We have included information from their report in the section Daily Life and Social Activities. The inspection process also included a tour of the premises and examination of a wide Care Homes for Older People Page 6 of 27 range of documents and records including three residents care plans and three staff files. We also observed activity at the home and spoke with several residents, visitors and care workers throughout the course of the day. Information has also been gathered from the homes Annual Quality Assurance Assessment (AQQA) submitted to the commission in October 2009, and survey forms completed by eight residents, one staff and four health and social care professionals. The registered manager Mrs Margaret Crowley was not present on the day of inspection, however the homes deputy manager was on duty and they were helpful and co-operative, provided us with all the information we required and fully contributed to the inspection. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 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. Most people can expect to have all the information they need to make an informed choice about the suitability of the home, however people with dementia cannot be certain that the home will always be able to meet their specialist needs. Evidence: The homes AQAA tells us that people are encouraged to visit the home prior to admission to have a look around, meet staff and residents, and discuss their personal requirements. It also tells us that pre admission assessments are undertaken to ensure that the service can meet the needs of prospective residents and the home is suitable for them. On the day of inspection people we spoke with and records we looked at reflected the information provided in the AQAA. Eight out of eight people that completed service user surveys confirmed that they were provided with enough information about the home before they moved in. A copy Care Homes for Older People Page 10 of 27 Evidence: of the homes brochure and statement of purpose was available in the entrance of the home together with a copy of the homes last inspection report, certificate of insurance and the procedure for making complaints. We looked at the records of three people that had moved into the home since our last inspection. They covered areas such as communication, health and medication, hobbies and interests, getting up and going to bed, time awareness, social and emotional support, continence, foot care, oral health, sight and hearing, personal care, physical mobility and disability, family and friends and money management. Further more local authority assessments undertaken by social care professionals had also been provided. Two of the four surveys received from health and social care professionals told us that the homes assessment arrangements always ensured that accurate information is gathered and the right service is planned for people and the remaining two surveys said usually. We asked the deputy manager how many people living at the home were diagnosed with dementia. They told us that there were currently eight people with mild dementia. They confirmed that since our last inspection two residents had moved to alternative care or nursing homes as they had been unable to meet their changing needs. One complaint had been received by a relative regarding this matter. Some discussion took place about the homes registration for ten people with dementia, the fact that dementia is a progressive condition and dementia care guidance. The deputy manager agreed to ensure that the homes Statement of Purpose and Service User Guide was reviewed so that it fully reflected the level of dementia care provided and the fact that the home may not be a permanent home for people whose needs significantly change or become challenging. The home does not provide intermediate care. Care Homes for Older People Page 11 of 27 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. People using the service can expect to have their personal and healthcare needs met in a way that protects their privacy and dignity. Evidence: The AQAA tells us that since the last inspection care plans have been revised and updated in order to specify the actual support people require. It also tells us that care plans have been developed to account for peoples likes and dislikes, to preserve their Independence and mobility and to enable them to maintain choice and control over their lives. We looked at three care plans and we could see that the service has worked hard to improve their care plans; they are more person centred and better reflect peoples needs and preferences The care plans we looked at covered areas such as; diet and weight, sight, hearing and communication, personal care, oral health, foot care, mobility and dexterity, history of falls, continence, mental state and cognition, social interests and hobbies, religious and cultural needs, personal and health care, family involvement and social contacts. Care Homes for Older People Page 12 of 27 Evidence: People we spoke with and records we looked at also evidenced that the home works closely with a range of health care professionals to ensure peoples health care needs are met. For example district nurses, physiotherapists and GPs. Two out of four people that completed surveys for health and social care professionals said that residents social and health care needs are always properly monitored, reviewed and met by the service and two said usually. Out of the eight surveys returned to us by people that use the service seven confirmed they always received the care and support they need and one said usually and eight confirmed that the home always makes sure that they receive the medical support they need. Comments we received from people about the care and support provided included; I think its brilliant, They take good care of me and They treat me like a queen. We asked social and health care professionals their views about what the home does well and their comments included; Provides an excellent level of care to all their residents, maintaining dignity and respect for each and everyone, The staff are very caring and understanding and very supportive and helpful to the residents and I have always found the staff very helpful and respectful. Since our last inspection medication procedures have improved. Staff were observed administering medication safely and appropriately and secondary dispensing has ceased. Staff training is more thorough and includes an assessment of their knowledge and competency. There was also evidence that the management team undertake medication audits and spot check observations. The medication records we looked at were appropriately completed, signed and dated. We were concerned that the homes controlled drug cabinet may not meet current requirements so we asked the deputy manager to liaise with their pharmacist. They addressed this matter promptly and notified us that they had ordered a replacement cabinet within forty eight hours. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most peoples daily lives meet their expectations but they cannot be sure that they will always have access to activities that they find interesting and make the most of their abilities. People can expect to maintain contact with families and friends and will benefit from a well balanced, varied and nutritious menu. Evidence: People we spoke with and observations made during our visit confirmed that residents friends and families are made welcome and people were seen coming and going throughout the duration of the inspection. Visitors we spoke with spoke highly of the home; they told us that they felt able to visit when they pleased and staff were always cheerful, friendly and helpful. The AQAA tells us that residents are encouraged to continue pursuing their interests and hobbies despite being in the home and the care plans we looked at did include information about individuals interests and how they prefer to spend their time. We looked at the minutes of residents meetings and we could see that events and activities are discussed. At the most recent residents meeting people were consulted about Decembers events and the possibility of organising a coach trip. Care Homes for Older People Page 14 of 27 Evidence: The programme of Decembers events was typed in small print and displayed on a notice board in the hallway. The notice board was not in a prominent place. The events for December were; Holy Communion, Way to life singers, a local school choir, Song Birds singers, A visit from the Mayor of Felixstowe, the Salvation Army carol service and the Christmas party with music and entertainment. The expert by experience focused on speaking with people about activities at the home. They spoke directly to several residents, a visitor and the activities coordinator. They gave us the following information; One person told them that they mostly preferred the privacy of their room, where they enjoyed reading the newspaper and chatting with their visitors. However, they had enjoyed some of the entertainment provided particularly when some local school children had come to sing to everyone. Another resident told them that they mostly spent their time in their room doing crosswords, reading and watching TV. They said that they were unaware of any communal activity or planned entertainment. Another person was observed sitting alone in the lounge by the main entrance. They said that activities and entertainment were very limited. They were unaware of any past events and they said they did their best to entertain them self. Another person visited in the privacy of their own room clearly enjoyed talking to the expert by experience. They told them about their past and took the opportunity to chat. They had been reading the newspaper and listening to the radio. They were not interested in communal activities or entertainment. The expert by experience spoke with two other residents, one said that they were quite independent and especially enjoyed walking to the local church to participate in Sunday worship. The other said that they relied on a member of staff to take them out and this had worked very well until recently when the activities co-ordinators hours had changed. This means that they are no longer available to take them out on a regular basis. However, both people said that they always enjoyed the programme of entertainment provided. The deputy manager told the expert by experience that the communal area next to the dining room tended to be favoured by everyone so that they could watch what was going on. The expert by experience did not observe any activities taking place in that area on the morning of their visit. Their report told us; There was no activity engaging people in the lounge except watching what was going on in the nearby Care Homes for Older People Page 15 of 27 Evidence: dining area. Similarly there was no example of peoples hobbies on display around the home. The expert by experience spent some time with the activities co-ordinator. They talked about their role, the activities they offer and their efforts to motivate people to take part in activities. The expert by experience concluded their report by saying; Westcliff Care Home has an excellent Activities Co-ordinator who is doing her very best with limited resources, time and opportunity to provide a far from ideal environment in which to further her commendable ideas and enthusiasms. It is probable that she needs much more support and encouragement from the Management, who are rightly occupied and concerned with the physical caring conditions that they see as their priority. The home had a four week rolling menu in place. The range of meals looked varied and people were offered alternatives if they did not want the main choice. On the day of inspection the main lunch time meal was chicken and vegetable casserole with potatoes and vegetables. The dessert was semolina and Jam. Out of the eight residents surveys returned three people told us that they always liked the meals and five said usually. The most recent food hygiene inspection had been undertaken by the local council in December 2008 and they found that there was a high standard of compliance across all areas. Care Homes for Older People Page 16 of 27 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. People who use this service can expect to have complaints taken seriously and be protected from abuse. Evidence: The AQAA tells us that the home has an open door policy. People are encouraged to discuss problems and raise concerns so that they any issues can be dealt with quickly and before they become formal complaints. The homes complaints procedure is on display in the entrance to the home. It is clearly detailed and includes relevant contact details and information about the different stages of the complaints process. People that completed surveys told us that they know how to make a complaint. They also told us that they know who to speak to if they are not happy. Since the last inspection the home has received one formal complaint which was handled through their complaints procedure and responded to by the manager. This complaint is referred to in the first section of the report. Information provided in the AQAA and discussion with the deputy manager confirmed that the service has made one safeguarding referral since the last inspection. In doing so they have demonstrated that they understand local authority safeguarding Care Homes for Older People Page 17 of 27 Evidence: procedures and how to report concerns. Staff we spoke with had also undertaken Safeguarding Adults Training. Care Homes for Older People Page 18 of 27 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. Residents can expect to benefit from a homely environment that is safe, clean and well maintained. However, people with dementia cannot be certain that the environment will be appropriate for their specialist needs. Evidence: The home consists of two detached properties that have been joined by and extension between the two. There is a small driveway to the main entrance but no visitors parking. Accessible outdoor space consists of a small decked area. This has been identified as an area for improvement so that people are more able to enjoy spending time outdoors when the weather is suitable. With the exception of two double rooms all bedrooms provide single accomodation. Most bedrooms have the advantage of en-suite facilities, others have a hand basin in the room. Bedrooms we saw were personalised with residents own belongings and people we spoke with said that they could chose whether to spend their time in the privacy of their own room or one of the communal lounges.There are two communal lounges, one at either end of the home, and a large dining room with an additional adjoining lounge area situated in between. We we were advised that it is this area that most people chose to congregate. At the time of inspection all areas seen were tidy, safe and clean and there were no Care Homes for Older People Page 19 of 27 Evidence: unpleasant odours. Seven out of the eight residents surveys returned said that the home was always clean. The furniture, decor and facilities provided were comfortable and pleasant and created a homely and relaxing environment. Observations made, information provided in the AQAA and discussion with the manager confirmed that the home has an ongoing redecoration and maintenance plan in place. Since the last inspection the AQAA tells us that 5 bedrooms have been redecorated and carpets have been replaced in 3 bedrooms. The AQAA does not tells us how the service ensures that the environment is suitable for people with dementia. During our visit we did not see any evidence of appropriate signage or visual aids for people with dementia care needs. The laundry was appropriately equipped with two washing machines and a tumble dryer. Procedures were in place to ensure that clinical waste and soiled linen was handled safely. There was a stock of disposable aprons and gloves for staff use. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be safeguarded by robust recruitment procedures but although staff are generally trained and competent we are not assured that they have the specialised knowledge or skills required to support people with high dementia care needs. Evidence: The deputy manager advised us that there is usually five care staff on duty between 8:00am and 2:00pm, four care staff between 2:00pm and 9:30pm and two from 9:30pm until 8:00am. During the day one of the carers is a senior carer and there is usually the manager or deputy manager present and supernumerary. There is also a part time activities co-ordinator and a team of ancillary staff that includes a maintenance worker, cooks and domestic staff. On the day of our visit our observations were that there was a good staff presence and care staff were available at all times to attend to peoples needs. Seven out of eight residents that completed surveys told us that staff were always available when they needed them and one said that they were usually available. Seven said that they always received the care and support they need and one said usually. Comments we received in surveys and from people we spoke with gave high praise to Care Homes for Older People Page 21 of 27 Evidence: staff and included; The staff are wonderful, Staff are helpful and respectful and They take good care of me. People we spoke with and records we examined confirmed that appropriate recruitment checks are carried out before people start working at the home. There was also evidence that staff induction programmes meet the skills for care common induction standards and ongoing training is provided in core areas such as manual handling, safeguarding adults, first aid, food hygiene, fire safety, health and safety and care planning. The AQAA tells us that three of the sixteen care staff employed have completed NVQ 2 in care or above. However discussion with the deputy manager and some of the staff on duty confirmed that since the AQAA was completed the percentage of qualified staff has improved but is still below fifty percent. The AQAA tells us that dementia training for staff has improved in the past twelve months but it does not specify how. There was evidence that the manager had completed a three day course run by the Alzeimers society but other than that staff we spoke with had completed a half day dementia awareness course. The level of training provided is very limited bearing in mind the home is registered to provide care to ten people with dementia. Further we know that since the last inspection two residents have moved because the home were unable to meet their changing needs that were associated with dementia. Care Homes for Older People Page 22 of 27 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. People tell us that the home is well run and the managers are helpful and friendly, however they cannot be certain that their health, safety and welfare will always be promoted and protected. Evidence: Margaret Crowley is the registered manager and has worked at the care home for many years. She has the Registered Managers Award and NVQ level 4 in management of care. She was not present on the day of inspection, however the homes deputy manager was on duty and they were helpful and co-operative and provided us with all the information we required. Feedback we received in surveys and people we spoke with throughout the course of the inspection confirmed that they found the management team approachable and helpful. The home has quality assurance processes in place that include asking for the views of residents through surveys, residents meetings and individual reviews. Further more we could see that plans to create a better outdoor garden area and raised flower beds in the coming year have come about as a result of listening to residents views. Care Homes for Older People Page 23 of 27 Evidence: The AQAA that was submitted in Oct 2009 gave us some useful information however where we have asked for evidence to show us what they do well information is not always clear enough or detailed enough. Regulation 26 visit reports were viewed and confirmed that the registered provider visits the home on a regular basis during which time they look at matters relating to the home and agree an agenda for action. Staff training included health and safety, food hygiene, moving and handling, infection control and fire safety. The AQAA tells us that manual handling equipment and fire protection equipment is regularly serviced. During our visit there was good evidence of routine health and safety checks such as hot water temperature tests, call system tests, portable appliance tests and fire equipment tests. However we found that the homes fire risk assessment had not been updated or reviewed since 2007 and there had been no fire drills carried out since our last visit. We raised these matters with the deputy manager at the time of inspection as we found them concerning. They agreed to address them immediately and they provided us with a new risk assessment within twenty four hours and confirmed that a fire drill had taken place. Staff were supplied with disposable gloves and aprons for the purpose of infection control. However we observed three staff wearing their gloves in communal areas after assisting people with the toilet. We spoke with the deputy manager about this matter, they understood that it was poor practice and potentially an infection control risk and agreed to address the matter immediately by speaking with staff. The AQQA confirms that the home has an action plan to deliver best practice in prevention and control of infection. However there was no evidence that this was the case during the inspection. The deputy manager confirmed that although there was a company policy for infection control and procedures were in place they were not aware that a full infection control audit and development plan was in place. They agreed to liaise with the health protection agency about this matter. The home does not handle residents pensions, benefits or financial affairs. However, it does hold cash for safekeeping. On the day of our visit twenty people had money held in the homes safe. Records were maintained appropriately and the safe was only accessed by the manager and deputy manager. Care Homes for Older People Page 24 of 27 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 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 The home should build on their current programme of activities and entertainment so that people are given greater opportunities to participate in a range of group and individual activities. This will enable people to remain active and have purpose and meaning in their lives. We strongly recommend that all staff, including the manager and deputy manager undertake further, more in depth training in dementia care so that they can be sure that they have the skills they need to support people with dementia as their needs change. 2 30 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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