Care Home: Threen House Nursing Home

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What the care home does well The home provides a pleasant, comfortable home close to local amenities. People say that they like living in the home and staff are kind. What has improved since the last inspection? Two bathrooms have been refurbished to a high standard. A pleasant garden room has been constructed to provide space for meetings, activities and training. What the care home could do better: Some of the home`s documentation, such as the Service Users` Guide and the brochure, needs to be brought up to date and, with the necessary amendments, reissued to the people living in the home. The Registered Manager needs to ensure that she has systems in place for stock checking the medication and this is carried out regularly and recorded. People living in the home should be offered varied, wholesome and nutritional meals and sufficient information must be recorded to evidence this. A pre-planned menu should be available, to enable and encourage people to chose what they wish to have. The Manager must ensure that the Care Quality Commission is informed when safeguarding issues are raised and that, should she be absent, her staff are aware of the procedure for reporting. The fire risk assessment needs to be regularly updated, and the staff aware of the precautions, so that fire doors are not left propped open as was seen on this inspection. The Manager must ensure that, when staff are recruited, all of the dates of employment are thoroughly checked and recorded, and they have the appropriate level of Criminal Records Bureau disclosure. When the views of people living in the home, and their families, are sought, the information needs to be incorporated into the home`s quality assurance procedures and used to help improve and develop the services. A report of this information is required to be in place. The home did not provide evidence of all of the staff having the opportunuity for support through regular one-to-one supervision and team meetings, and this needs to be shown. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Threen House Nursing Home 29 Mattock Lane Ealing London W5 5BH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Collisson     Date: 2 0 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home Name of care home: Address: Threen House Nursing Home 29 Mattock Lane Ealing London W5 5BH 02088402646 Telephone number: Fax number: Email address: Provider web address: threenhouse@hotmail.com Name of registered provider(s): Type of registration: Number of places registered: Mr Alan Hannon care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 26 The registered person may provide the following category of service only: Care Home with nursing - Code N 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 Physical disability - Code PD Date of last inspection Brief description of the care home Threen House Nursing Home is an attractive, detached house situated in a residential area of Ealing. It is registered for twenty six older people. The large shopping centre of Ealing Broadway, which includes a library, is close by and a theatre is within walking distance of the home. The home is also opposite Walpole Park. It is within ten minutes walk of Ealing Broadway and West Ealing Stations and several bus routes. There is Care Homes for Older People Page 4 of 32 Over 65 26 0 0 26 Brief description of the care home parking to the front of the home. The home has twelve double bedrooms and two single bedrooms, located on each of the four floors. Each bedroom has a wash hand basin. One double room has an en suite facility. There are five bathrooms, located throughout the home, some with assisted facilities and one has a shower. The lounge and conservatory, which leads to the garden, provide both seating and dining areas. There is a new garden room, at the end of the garden, with facilities for activities and for private meetings. There is a lift between the basement and the second floor. The home is privately owned and the Registered Provider works in the home on a regular basis. There is a Registered Manager, and team of registered nurses and health care workers. There are two cooks, kitchen assistants, a laundry person, and domestic workers. An accountant/administrator is employed to deal with finances. The current fees are £725 for shared rooms and £750 to £800 for the single rooms. Additional charges are made for chiropody, reflexology, physiotherapy, private optical and dentistry work, toiletries and newspapers. Care Homes for Older People Page 5 of 32 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: This unannounced inspection took place on the 20th July 2009 from 10am to 6.30pm. The Manager and Registered Provider were present. We were accompanied by an Expert by Experience. The Care Quality Commission is trying to improve the way it engages with people who use services so as to gain a real understanding of their views and experiences of social care services. It uses Experts by Experience who are an important part of the inspection team to help Inspectors get a picture of what it is like to use a social care service. The term Expert by Experience used in this report describes a person whose knowledge about social care services comes directly from their experience of them. There were twenty five people in the home and, as one person was choosing to occupy a shared room, there were no vacancies. We met the majority of the residents. Most were in the lounge and conservatory, reading newspapers, books or watching Care Homes for Older People Page 6 of 32 television. We spoke to several in the communal areas and one in private. We also spoke to two visitors. The Expert had lunch with a group of the residents. Since we last inspected the home, in August 2007, there have been a number of changes to the environment. These include the refurbishment of two bathrooms and the addition of a garden room, which had just been completed. This provides a space at the end of the garden for activities, private meetings and staff training. This had recently opened and had only been used for an art class so far. The home also has planning permission to extend the conservatory and plans to do so. We found the home to be clean and bright, with a well maintained garden. We examined a variety of records, which included care planning files, staff files, medication administration, maintenance and complaints. The Manager had completed the Care Quality Commissions Annual Quality Assurance Assessment which provided details of how the home is operated and the improvements that the home has made or intends to make. The Assessment also provided statistical information, regarding the people living in the home, the staff, training and maintenance. A consistent staff team remains in place and the Manager has been in the home since 1993. There were few specific cultural needs identified or being catered for. We were informed that culturally appropriate meals being provided, for one person, from time to time, and no others are required at present. Peoples religious needs are met by representatives from religious denominations visiting the home. Overall we found the home to be providing good support to its residents. The Expert by Experience wrote, The staff were respectful to the residents and were very active throughout my visit talking to residents and distributing drinks. At lunch-time all residents ate at the same time although a lot, perhaps half, needed assistance for which there were sufficient staff. I thought the home was providing good care, with the one disadvantage of shared rooms. I thought there could be some discussion about food choice with the residents and a menu could be provided before each meal. At the last inspection in August 2007 there were seven requirements which have now been met. Nine requirements have been made at this inspection which are detailed under What the service could do better. 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 set out on page 4. Care Homes for Older People Page 8 of 32 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 32 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 32 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. People are provided with information about the home but it requires updating and completion. People are assessed prior to being admitted to decide if the home can meet their needs. People are aware of the terms and conditions and charges for additional services. Evidence: The home provides people with information about the home to enable them to know the services provided. We did find that the Service Users Guide and Statement of Purpose have been updated but had not been fully completed. They also need to include further information about the way in which needs can be met by the home, particularly those with dementia. There were also some factual errors which needed to be changed. The small brochure provided to people is also in need of updating as it makes reference to the home being registered with the Health Authority and not the Commission. This could be misleading to people and their representatives and needs to be changed. Care Homes for Older People Page 11 of 32 Evidence: There is a copy of the contract/terms and conditions in the Service Users Guide. The Manager said that every person has a copy of the documentation in their rooms. The majority of the residents are admitted privately and so no assessment is received from the Local Authority. The Manager said that she carries out a pre-admission assessment and has a form for this purpose. The home provides nursing care and there are facilities for people with poor mobility, as there is a lift to each floor, wheelchair accessibility, and assisted bathing facilities. There are twelve double rooms and those that share are seen to have signed to say they have agreed to this. The home is not registered for dementia care but does have people who have developed the illness and some who have been admitted after diagnosis. The Manager said that their primary need is nursing care. However, the home does need to show how it can meet their specific needs with its activities, environment and staffing levels. Although there is the opportunity to visit the home prior to being admitted, the Manager said that families often look at the home for the person, as they may be unwell or in hospital and not able to visit themselves. The home has no Intermediate Care, so this standard was not assessed. Care Homes for Older People Page 12 of 32 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 care needs are met by good local services and regular general practitioner reviews. Care plans are in place but could be more personal and reflect more fully the wishes and needs of the residents. Evidence: We looked at the system for recording health, personal and social care needs in the care plans for five of the people living in the home. The home uses a nursing system, with pre-printed forms, so that care plans, risks assessments and a variety of health assessments are all included in one file and are hand-written. While these record all of the basic support needs required, there is limited information about the person and their individual choices and needs. The plans, as they are handwritten, would not be easy for a person to understand and agree although they are signed by the person or their representative. The Manager has considered a more user-friendly system. We recommended that further consideration is given to this as it may be more productive to have typed plans, which can be easily reviewed and amended where required. There is a system of monthly reviews but the care plans would have to be re-written in full if there were changes. Care Homes for Older People Page 13 of 32 Evidence: It has been a requirement in 2007 that the risk assessments must be in place for the people who have bed sides. We saw that these have been completed and people or their families have agreed to these being used. Although risk assessments are in place for moving and handling, we saw that some lacked detail. We saw that health needs are met by general practitioners in the area. As some people have lived locally, they can retain their own general practitioner or transfer to another local practice. The Manager said that the doctors are visiting regularly to review health needs and medication. Some of the nurses are trained in phlebotomy to enable them to take blood samples. We saw a sheet being maintained of all visits from opticians, dentists and chiropodists. as well are the general practitioner visits and reviews. There is a local clinic for hearing problems or people are referred to Ealing Hospital for more serious conditions. The home currently had one person requiring support with a enteral feed and a catheter. The Manager confirmed that no-one in the home has a pressure sore. There are body maps in the care planning system for recording any injuries, pressure areas or bruises. We examined the medication, which is dispensed from bottles and packets and found that there were small discrepancies in the amounts of medication in the sample we saw. The Medication Administration Record sheets run for twelve weeks and are handwritten by the staff. Not all of the medication, for each person, is synchronised to arrive at the same time, which makes checking more difficult. The home has been recording when the medication is commenced, which was a previous requirement. It also needs to have regular stock checks, or to keep running total of use, so that an audit can be made and there is always an audit trail of medication received, used and disposed of. A system must be introduced so that it can be shown that medication is given as it is required. The Manager should consider meeting with the general practitioners and pharmacy to try and get a system in place, of regular medication deliveries, so that it can be better managed. The Manager said that there are no controlled drugs being used at present. Although four-monthly visits are planned by the pharmacist, we saw the last visit was in March 2008. Care Homes for Older People Page 14 of 32 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. People live in a pleasant environment, close to facilities. There is some opportunity for activities and outings, but some people would benefit from new or more frequent activities. The choice and variety of meals is not always clear, or accurately recorded, to demonstrate a good range of varied and nutritional meals are available. Evidence: There is no Activities Organiser, but we were informed that two volunteers provide additional activities, including art. The home regularly has student nurses on placement from a local college and one of the residents told us that they had supported them with activities. There are also work placements from schools in July and August. We noted that there has been a visit to Kew Gardens in June and another was planned to Syon House in September. A garden party was due to be held in September and a pantomime visit in November. The staff said that film afternoons are planned and families are bringing in films to show. The Expert by Experience wrote, The lounge was L-shaped, with a conservatory, and almost all the residents were there during the visit. This made it quite crowded but they were in little groups or on their own reading their papers. There were plenty of spare chairs so it was possible to sit down beside a resident to chat. It would be Care Homes for Older People Page 15 of 32 Evidence: difficult to have a private conversation. The garden was very attractive with a path lined with lavender and roses to a garden room at the end recently completed and used, perhaps for the first time the previous day, for an art group. Several residents mentioned the room and the art which they had enjoyed. The families of several residents are involved in the home and participate in fund raising, and attend quarterly meetings. A summer fair had been held just prior to the inspection. The committee also arranges some of the activities. As well visits to the nearby theatre, a trip was being arranged to a local church theatre. It was reported in the Annual Quality Assurance Assessment that the home hopes to add further activities in next 12 months. From the information recorded on the care plans, which includes contact and outings with relatives, we saw that people had between two and four activities recorded in a month. These included the visits from religious representatives. If this recording was accurate, the home needs to bring forward its plans for more activities to ensure that people have the opportunity to enjoy the local facilities, such as the park and shops. Two people mentioned that they had become bored with those which did take place. Where people do not have visitors, it needs to be recorded that they have the opportunity for outings as we only saw outings with families recorded. The home has regular fortnightly visits from a physiotherapist and a reflexologist. Residents who wish to participate pay additional sums for these services. On the day of the inspection the hairdresser was in the home and there is a small room in the basement used for this purpose. One of the shared bedrooms was being used as an additional space for people to have their hair dried. We were informed that the residents of that room had agreed to this. The Registered Provider was helping the hairdresser with hair and nail care. We saw two visitors during this inspection to whom we spoke and who said they were happy with the care the home provides. People confirmed that their visitors are welcome. The Expert by Experience wrote The ones I spoke to had visitors but they mentioned there were a number who never had any. All the residents were nicely dressed and had their hair done, evidently once a week. Several had their nails done and their faces made up that morning. While the majority of people were seen in the lounge and conservatory there are a small number of people who wish to spend longer in their rooms and said that they are able to do so. We saw people toward the end of the visit making a decision about the time they wished to retire to their rooms. Care Homes for Older People Page 16 of 32 Evidence: It was a requirement at the last inspection that a better choice at meals times is provided. While the cook informed us that the choices for the day were steak and kidney or meatballs, she showed us the table menus, which were not actually being used, and these had a different meal shown. The pre-printed recording sheets, to record the meal the individual resident had, showed only a mixed grill which was not on offer. The cook said that staff are supposed to change the record to show the meal taken. This had not been done. Therefore it would not be possible to ascertain the meals a person had actually eaten, whether they had a choice, and whether they had a good nutritional intake. There was no weekly menu to show the variety of food or the choices on offer, which would also assist with the purchasing of the food. The Expert by Experience wrote, I had lunch with three residents. They did not know what the lunch was to be although I had been told and I had been given a choice. She was also given a larger amount than the residents and a different vegetable. The people said that they would have liked what the Expert was offered She said,There did not seem to be any discussion about food but they did say they would say if they really disliked something e.g. sausages, and this seemed to be respected. We noted in the staff meeting minutes that changes had been made to the way in which food is served. We were informed this was in relation to pureed food which is now being served as separate items rather than pureed together. We discussed our findings with the Manager. We found that the home needs to look at its menu, menu planning and the way in which choices which are offered. Staff must be aware of the importance of providing evidence of nutritional, well balanced meals with people given every opportunity to have a choice, rather than just an alternative if they dont like what is on offer. The range of meals available needs to advertised to the people who live in the home to ensure that they are fully aware of these and are enabled to make positive choices. Care Homes for Older People Page 17 of 32 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. There is a complaints procedure, to which everyone has access, and people say they would make a complaint if it was necessary. Staff are supported to understand safeguarding issues and capacity issues through training, but senior staff must be aware of when these need to be reported. Evidence: There were no complaints made through the Commission for Social Care Inspection, Care Quality Commission or recorded in the home. People we spoke to said that they would feel able to make a complaint should it be necessary. Several people have families who visit regularly and some are involved in the relatives committee, so a number of people have an advocate should there be problems. There have been no safeguarding issues reported to the Commission for Social Care Inspection or Care Quality Commission. However. the Manager informed us that one Safeguarding Meeting had been held recently. The Manager had not informed the Care Quality Commission or sent a Regulation 37 notice, which should have been done. The Manager must ensure that the appropriate notifications are made in future and the Commission informed. All of the staff team attended training in safeguarding in March 2009. The Manager told us that she was aware of the deprivation of liberty legislation but had not yet been involved in assessments. Staff have had training on the Mental Care Homes for Older People Page 18 of 32 Evidence: Capacity Act. Care Homes for Older People Page 19 of 32 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 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 comfortable and homely. Areas are provided for different activities and relaxation. Suitable equipment is provided for people with physical disabilities. Cleanliness is maintained. Evidence: We walked around the home with the Manager and saw that most of the areas were well maintained. However, we saw one fire door being propped open, by a brick, on this inspection. The Manager said that the Registered Provider had rehung the door and the battery operated device, which keeps the door open, needed to be replaced and would be done shortly. The doors need to be kept closed while the devices are not working to ensure that people are protected in the event of a fire. The Expert by Experience wrote about the facilities, It is on four storeys, with a small lift covering all four floors. Most rooms are double rooms but most are quite large. There did not seem to be a lot of space for personal possessions, only several shelves but in some instances only the top one, where the bed was in front of the other shelves. There were some items of furniture probably brought by the residents. The rooms were attractively furnished and were bright, and everything very clean and well-cared for. There were bathrooms on each floor and adequately equipped with disability-adapted showers or baths. Care Homes for Older People Page 20 of 32 Evidence: Since the last inspection, there have been changes to two of the bathrooms and both have been nicely refurbished, one with an assisted bath and one with a shower. Throughout the four floors of the home, there are five bathrooms with a variety of different facilities. One double room is en-suite and the remainder have wash hand basins. The lift is suitable to take wheelchairs and all areas of the home are accessible. On the top floor, one bedroom was arranged so that the hoist could be used for the residents. For its communal areas, the home has a large lounge and adjoining conservatory. Both rooms are used for meals. It is planned that the garden room will be able to be used for people to meet in private, if they wish, or to have family gatherings. It is also planned that the conservatory area will be extended and planning permission has been granted for this. The garden provides a pleasant area, with plenty of seating, so that people can meet privately with their friends and relatives. Since the last inspection changes have been made, with the garden room added and new areas of planting. We found the home to be bright, clean and fresh in all of the areas we saw. Care Homes for Older People Page 21 of 32 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. There are sufficient staff on duty to meet the needs of the current residents. Staff have all of the basic training courses provided and are updated on their practice. People are protected by staffs health and safety training. Recruitment checks help to maintain safety but need more attention to detail. Evidence: At the time of the Annual Quality Assurance Assessment being written, there were twenty eight nurses and care staff, and seven non-care staff, in post. There were six staff on duty and this appeared to be sufficient to meet the needs of the people in the home. The expert commented that there were sufficient to assist people with their meals. There are six staff in the morning, five in the afternoon and three during the night. One or more trained nurses are on each shift. The Manager said that they had vacancies for staff and were short of staff at the time of this inspection because of holidays. No agency staff are used. The information we received on the training records showed that all of the staff had moving and handling training in February 2009. We examined five of the staff files. Although they were generally satisfactory, there are some areas which require more attention to detail such as ensuring that all of the dates are recorded on the application forms. The Criminal Records Bureau disclosure Care Homes for Older People Page 22 of 32 Evidence: information was provided to us. The earliest Criminal Records Bureau disclosures were not enhanced. Although not all the staff work directly with the residents in the home, all those that do should have an enhanced Criminal Records Bureau disclosure. The home must look at obtaining these. We saw that the Registered Nurses PIN information, with the Nursing and Midwifery Council, were up to date. The Annual Quality Assurance Assessment says that it is part of the improvement plan that a checklist will be added to the recruitment files. This should be introduced in the near future to ensure that everything has been checked before staff commence. The training records showed that most staff had the basic training courses in the last year. These included infection control in June 2008, first aid and CPR in February 2009, food hygiene, health and safety and fire safety in March 2009. They had also had training in the Mental Capacity Act in February 2009 and dementia in June 2008. Medical training on enteral feeding was held in June 2008 and a diabetes update in February 2009. Nine of the staff are Registered General Nurses (RGNs) and four care staff have the National Vocational Qualification. The Manager said that the nurses are enabled to maintain and develop their professional competence, including using distance learning training. Some also work in hospitals, so participate in the training courses there. One of the senior nurses has been on a mentoring course for supporting the student nurses and the Manager and senior nurse attend the Primary Care Trusts groups on such topics as tissue viability and palliative care. Care Homes for Older People Page 23 of 32 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 management of the home is satisfactory, with the Registered Provider involved in most aspects of the homes running. The Manager has the skills and experience to manage the home. Staff would benefit from the records being being streamlined and archived. Evidence is needed that staff are supported on a regular basis by supervision and staff meetings. Evidence: The Manager, who is a Registered General Nurse, who has worked in the home since 1993. She has the Registered Managers Award and National Vocational Qualification Level 4 in care. The home has a pleasant and friendly atmosphere. The Registered Provider provides regular support in the home and is responsible for its maintenance. The home has only two small offices for the management staff. The record keeping in the home would benefit from streamlining as there were several files which were not Care Homes for Older People Page 24 of 32 Evidence: current and information was not easily accessible. Others contained information which could be archived. The policies and procedures were not examined but the Annual Quality Assurance Assessment reports these were all reviewed in May 2009. People living in the home have been asked about their views but no report has been produced other than a graph to show the excellent and good responses. A quality assurance report should be produced which examines all areas of support and shows how improvements can be made in response to any shortfalls. Relatives are actively involved in the home as there is a relatives and residents group, which meets four times a year. Their views, and the views of those less active, should be shown to be included in any development plan. The Manager said that the home does not handle money on behalf of the residents and it invoices them, or their families, for any expenses incurred. These include hairdressing, newspapers and the activities which are charged for, such as physiotherapy and reflexology. The Manager was carrying out most of the supervision sessions and a nurse, who does night shifts, was supervising the night staff. The senior nurse undertakes supervision of the weekend staff. It was not possible to see from the files we examined that the National Minimum Standards of six sessions a year had been reached. We saw supervisions carried out only in 2008 but appraisals had been done in 2009. We advised the Manager to have a chart of all the sessions undertaken so that she is able to monitor that all of the staff have the opportunity for regular supervision and she can show that the National Minimum Standards have been met. We saw that staff meetings have been held in June and February of 2009 and May and July of 2008. A more regular pattern of meetings would ensure that some of the issues raised with the Manager could be brought to the attention of the staff more regularly and discussed. It was a requirement in 2007 that the Fire Risk Assessment was put in place. This has been done but dated from January 2008 and has not been reviewed. The individual risk assessments for people living in the home, in relation to mobility and support required in the event of a fire, have been completed. These could not initially be located and staff need to ensure that records are sufficiently orderly for items to be found easily. The fire alarm system was checked in April 2009. The London Fire and Emergency Planning Authority last visited in January 2008 when the home was deemed to be satisfactory. Fire tests, which incorporate a drill, are held monthly. As part of the Fire Risk Assessment the frequency of drills services and other tests Care Homes for Older People Page 25 of 32 Evidence: required should be listed to ensure that these are being met. We checked a sample of records. The insurance certificate which expires in February 2010 was displayed. Water tests were carried out in July 2009 and the lift was serviced in November 2008. The nurse call system was tested in February 2009. The Ealing Environment Health Officer visited in May 2009 and the home was awarded an excellent rating. Care Homes for Older People Page 26 of 32 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 32 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 1 4 The Registered Provider must ensure that the Statement of Purpose, Service Users Guide and brochure contain the up-todate and correct information. To ensure that people have accurate information. 30/09/2009 2 9 13 The Registered Manager 31/08/2009 must ensure that the medication stock is regularly checked for accuracy and a system must be in place to record the outcome of the checks. To ensure that people have the correct medication, as and when it is required. 3 15 16 The Registered Manager 31/08/2009 must ensure that people have the opportunity to choose a meal from a good variety of varied, wholesome and nutritious meals and Page 28 of 32 Care Homes for Older People 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 have information to know what meals are available. To widen the choice available and enable people to make choices. 4 18 13 The Registered Manager 14/08/2009 must ensure that the Care Quality Commission is informed when safeguarding issues are raised. To ensure that the Commission is aware of any issues raised in the home which affect the wellbeing of the residents. 5 19 23 The Registered Manager must ensure that where fire doors cannot be kept open safely, they must be kept closed. To ensure that people are protected. 6 29 19 The Registered Manager must ensure that all of the information required in respect of people employed in the home is in place. This incluces the appropriate level of Criminal Records Bureau disclosures and records of employment. To ensure that people living in the home are protected. 30/09/2009 10/08/2009 Care Homes for Older People Page 29 of 32 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 7 33 24 The Registered Provider must ensure that when peoples views are sought, the information is used to develop and improve the home. To ensure that there is a regular review of the care and support which is improved in line with the residents wishes. 30/09/2009 8 36 18 The Registered Manager 30/09/2009 must ensure that the regular supervision of staff is evidenced. To ensure that staff are supported. 9 38 13 The Registered Provider must ensure that the fire risk assessment is reviewed regularly. To ensure that people are not put at risk. 31/08/2009 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 9 That the Manager arranges with the general practitioners and pharmacy for a system which supports better stock control of the medication. That the records are streamlined and archived to improve access to the records and staff benefit from more orderly Page 30 of 32 2 37 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations recording. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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