Care Home: Time Court

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What the care home does well There was a relaxed calm atmosphere on all the units visited and the home is homely and comfortable. This new home provides a very bright and airy environment throughout and individual en suite accommodation of a good standard for residents. Rooms are a good size and a range of equipment is provided for residents support which is well maintained. Overall the home was very clean tidy and safe for residents who are cared for by staff members who were both caring and professional in their relationship with residents. Health and Safety requirements are attended to satisfactorily. The responses from residents and families interviewed were very favourable and positive comments were made about the caring attitude of care staff by many of them. I was told that the staff and management are kind and helpful and that food at the home is good. Care assessment and care planning is now good with residents now involved in their care reviews. Staff recruitment practices are good and care is taken to make sure that they are experienced and safe to work with residents. There is a high level of involvement from health care professionals in the intermediate care unit who work with staff to enable these residents to return to their homes. There is a good management structure with enough supervisors available to support staff and residents. Residents and families said that the manager is excellent and always very helpful. What has improved since the last inspection? The care staff on the intermediate care unit have been given adequate information about residents care needs especially regarding how to safely support them in a way that they can most easily understand. Written and verbal communications between these staff and the healthcare professionals such as occupational therapists have now improved and this was said by a number of care staff and clinical staff. Residents care plans are now reviewed each month and residents and families are invited to contribute their views on these plans. The recording of medication given to residents by staff has been improved and records show that recording of medication given is now consistent and is being checked by management. The management have checked whether there are enough staff on the intermediate care unit and now there are enough staff to the support needed. Work has been done by management to better monitor night support at the home and residents said responses from staff to provide support when requested have improved. Care staff induction and training has been improved so that all staff have now been fully informed about their job and responsibilities. All staff supervisors have had up to date training in areas such as risk assessment and protection of residents. Care staff now receive supervision much more often and have it least every two months but more often in the case of new staff. What the care home could do better: The home must include fees charged to residents for care and suport and any other charges in the residents contracts. Residents self help skills such as their ability to make teas or coffee or dress themselves should be made clearer in care plans so that they can be supported to be independent in these areas. The home must review the use of bedrails so that they are only used to protect residents from falls. The medication policy must be reviewed to more fully include the assessment and support provided for residents to manage their own medication where possible. Lockable cupboards must be provided in residents bedrooms for the purpose of storage of medication if appropriate and for their valuables. The homes manager must register with the Care Quality Commission. Key inspection report Care homes for older people Name: Address: Time Court Woodlands Terrace London SE7 8DD     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: Sean Healy     Date: 1 1 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Time Court Woodlands Terrace London SE7 8DD 02083018080 02083018099 timecourt.admin@sanctuary-housing.co.uk www.sanctuary-care.co.uk Sanctuary Care Ltd care home 56 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: 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: 56 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 Time Court first opened on 28th June 2004 and was one of three new Neighbourhood Resource Centres operated by Ashley Homes and replaced four homes previously operated by the London Borough of Greenwich for older persons. Since then the role of registered provider has changed and Sanctuary Care Ltd are the registered provider. The home is situated in Charlton and provides nursing care for 20 service users 10 on Capella unit and a further 10 in the category of intermediate care on Ross unit. This unit provides a specialist rehabilitative service prior to final discharge back into the community residents having either been admitted from the community or direct from hospital. A further 36 service users are within the category of conventional care for Care Homes for Older People Page 4 of 31 0 56 Over 65 56 0 Brief description of the care home older persons and are accommodated over three other units; Ursa, Orion and Carina. Within this 36, one placement is for emergency admissions and two placements for respite carer breaks. There is a Day Centre run by the registered provider in a separate part of the building and which provides communal facilities for residents to use if they choose including dining areas hairdressing facilities and numerous quiet areas and transport for outings for service users. Meetings for residents and relatives are held on a regular basis and a League of Friends for the home has been set up. The email address for the home is timecourt.admin@sanctuary-housing.co.uk Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The quality Rating for this service is 2 Star. This means that the people who use this service experience Good quality outcomes. The inspection was unannounced and took place as a visit to the home on the 11th of November 2009. The home provided an Annual Quality Audit Assessment (AQAA) which was also used to inform the inspection. The registered care manager facilitated the visit supported by the deputy manager. I interviewed four residents and two families about the care provided and observed staff supporting a range of other residents. I received completed inspection surveys from six other residents and their families. I examined eight residents care assessments and care plans looking at risk assessments and plans for support. Care Homes for Older People Page 6 of 31 Three care staff had discussion with me about their employment and understanding of their job. An Occupational Therapist and the deputy manager were also interviewed. Four other care staff responded to the Care Quality Commissions inspection survey. Five staff employment files were examined to check whether they had been properly recruited trained and supervised. Comments made by the local safeguarding authority were also considered regarding improvements made in safeguarding and adult protection. The inspection involved a tour of the premises and examination of a range of management documentation. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? The care staff on the intermediate care unit have been given adequate information about residents care needs especially regarding how to safely support them in a way that they can most easily understand. Written and verbal communications between these staff and the healthcare professionals such as occupational therapists have now improved and this was said by a number of care staff and clinical staff. Residents care plans are now reviewed each month and residents and families are invited to contribute their views on these plans. The recording of medication given to residents by staff has been improved and records show that recording of medication given is now consistent and is being checked by management. The management have checked whether there are enough staff on the intermediate care unit and now there are enough staff to the support needed. Work has been done by management to better monitor night support at the home and residents said responses from staff to provide support when requested have improved. Care staff induction and training has been improved so that all staff have now been fully informed about their job and responsibilities. All staff supervisors have had up to date training in areas such as risk assessment and protection of residents. Care staff now receive supervision much more often and have it least every two months but more often in the case of new staff. Care Homes for Older People Page 8 of 31 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 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Appropriate information is provided for residents about the home and their care needs are assessed before they move in. Written and verbal communications between care staff and healthcare professionals is now fully effective and information about terms and conditions for living at the home is now provided to all residents but fees need to be included. Evidence: There is an up to date Statement of Purpose and Statement of Terms and Conditions for living at the home and the residents I met said that they had received a copy of these. The manager is making further improvements to these documents so that the information prospective residents will have will help them to be more informed in their decision about moving to the home. All residents have full and detailed assessments of need on file. I examined eight Care Homes for Older People Page 11 of 31 Evidence: residents files and all were seen to have a detailed assessment of their health and social care needs. The residents at the home have been placed mainly by Greenwich local authority with a small number of private residents also in residence. Core care assessments have been provided and they show the primary care needs of the residents to be associated with ageing needs with secondary care needs such as dementia and physical disability support being prominent. Physical rehabilitation support is provided by the home and residents on this unit are fully assessed with support from relevant clinicians such as Occupational therapists and physiotherapists. Detailed assessments regarding moving and handling and development support needed were on all files examined All residents files examined showed that they had a contract in place which do not yet include individual fees to be paid for their care but did show the service they can expect from the home and their rights and responsibilities. The home must ensure that these contracts are improved to include fees and who is responsible for paying these fees. (Refer to Requirement OP2) The home does provide intermediate care for residents and there was a requirement made at the last inspection for the management to ensure that communications between health care assistants and professional clinicians be improved. This has now been done and this requirement is now met. Discussion with two care staff and one clinician showed that the care staff now feel more aware of the information they need to convey to clinicians and said that conversation between them now take place with much more ease both in formal weekly meetings and during the course of the days work. This has lead to more progress with residents rehabilitation and also fostered a more friendly work atmosphere. Management also expressed that they felt confident that the rehabilitation unit is now functioning well. It was generally felt that the treatment time for residents ahd also improved with many being discharged to go home after between four to six weeks. Comments received from residents and families were that there was now a friendly and enabling atmosphere where residents were supported to walk around and meet others. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience 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 experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Health and personal care needs are well set out in care plans and care plans and risk assessments are now consistently reviewed each month. Health care needs are being met and medication is well managed Evidence: There were three requirements made at the last inspection for the home to improve risk assessments and to ensure that provision was made for long term residents to have their end of life wishes included in their care plans. These requirements have been met. I examined eight residents care plans and risk assessments and found that the home has done significant work in improving the care plans so that residents are better enabled to do more for themselves and to be sfaer during personal care when supported by staff. A high number of residents at the home receive support in bathing currently 39 of the total of 50 residents. I found risk assessments and care plans to Care Homes for Older People Page 13 of 31 Evidence: now contain some improtant brief guidance for staff in how to provide the support and also showing what residents can do for themselves. This is vitally important for residents on the rehabilitation unit to enable then to increase their independence more rapidly and this seems to be the case as the discharge rate has increased. Seventeen new residents have been admitted to the home in the past 12 months. Discussion with staff and cone clinician revealed that some residents are now suported to use facilities to make tea and coffes and snacks which help debvelop their independence and feeling of wellbeing. This is a positive development and it was felt that it is important to now start to include areas of self help such as these in care plans so that they can be consistently supported to develop these skills. (Refer to Recommendation OP7) Care plans I examined now included reference to residents wishes about end of life care needs and there was also a file note for those who did not want to discuss this issue. There were risk assessments in place regarding the use of bedrails but in at least one case I found that the bedrail was desired by the resident but was not in fact necessary for his protection, although it was his choice to have it there for other reasons. The home must review the current assessments for residents who use bedrails to determine whether they are still needed to protect individual residents and in consultation with any relevant residents encourage and promote that the not be used. This does not suggest that the current use of bedrails is unsafe but rather that further work should be done to determine that they are only used when necessary. (Refer to Requirement OP7) Care plans are well written and are reviewed every month and show a full range of support needs for residents. One I looked at was also being translated into French for a French speaking resident. Care plans for residents who have high personal care supports needs now have written guidance for staff to follow to protect residents from risk and to also enable them to do things for themselves. Care plans and risk assessments are now being reviewed each month and residents are being asked about important areas so that they can have an effect on the care given. I examined care plans for 8 residents and found that all had a care plan based on their assessment of health and social care needs. All were comprehensive and were reviewed on a monthly basis. Many included high levels of personal care support needs where areas of risk are assessed especially regarding moving and handling. The care plans also showed residents food preferences preferred activities health care needs and emotional support needs. The majority of the residents have support needs in bathing dressing. About a third of residents also have support with the care of Care Homes for Older People Page 14 of 31 Evidence: dementia. Continence care and physical support are also provided for other residents. I found these areas to be included clearly in care plans and staff spoken to understand their responsibilities. The homes management and staff understand how to provide the care residents need in both health and personal care and in maintaining an active and social life. GP visits happen a number of times each week and the residents and the manager said that the GP is quick to come out when needed. Chiropody and Oral Hygienist visits happen regularly and Dentist visit at least once a year or when a new resident comes to the home. Tissue viability management is good with only one resident currently needing support in this area. Fifteen residents have dementia care needs and their care plans include how to support them with activities and with eating support when necessary. The level of activities offered to the residents is very good and residents and families said they are excellent and available to all who want to attend them. (See Standard 12) There were two requirements made at the last inspection regarding the safe management of mediaction. I found that both of thes had been met. One was to ensure that the staff acted in accordance with the homes medication policy in completing medication record sheets and in signing for medication given. I examined seven residents medication records and found that these were now being properly completed and all medication geven is now appropriately signed for. The other requirement was for the home to begin assessing residents for their ability and wishes to self medicate. Records examined showed that the home had started to do this and had developed a form for this assessment. However I found that the providers medication policy did not include a system for assessing self medication and the provider must review the policy to include a system for carrying out these assessments and for implementing self medication processes for residents who would benefit from being more independent in this area. (Refer to Requirement OP9) Apart from this issue I found that medication is now well managed and storage and return of medication is safe. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent 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 experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents are satisfied with their lifestyle and more stimulating in house activities and exercise opportunities are now being provided in a generic manner. They are supported to maintain contact with family and friends. Residents are involved with making decisions about their life and are given a choice of good and wholesome food. Evidence: Residents care plans include a list of activities offered a daily basis which are recorded on a daily activities chart. I examined this chart and it was consistently completed by staff. The home employs an activities coordinator who is well regarded and who provides a broad range of in house activities for residents and also organises day trips. Residents I spoke to confirmed that she sees them regularly and has asked them about individual activities they would like to be involved in. Activities include cinema hairdressing manicure reminiscence sessions story reading dancing and shopping and outings twice a week on two buses provided by the home. There is a very good range of in house and community activities available and each resident has a written profile of the activities they like to take part. This is included in the homes assessment process. There is an activities room used for meetings with residents music bingo and Care Homes for Older People Page 16 of 31 Evidence: for film evening each week. All residents and families who commented as part of this inspection said they were very happy and impressed by the activities provided by the home and that the coordinator is doing an excellent job. All the residents I spoke to said they had family who visit and also who take them out on a regular basis. They are able to entertain visitors in their room but can also use a number of other rooms available to them to speak privately with their visitors. Three family members I spoke with said that they always receive a welcome when they visit the home and they feel that they can visit at any time. All said that the staff and manager are very welcoming and there is always a friendly atmosphere. Residents financial support needs are assessed on admission and support to manage finances is offered when necessary. The support needed is included in their care plans. Currently all of the residents or their families are responsible for their own finances bank accounts and benefits. The home provides a wholesome and nutritious diet for residents and offers a choice of food on a daily basis. Four residents whom I spoke with said that the food is good and they are offered a choice every day. The homes menus reflect residents preferred meals and that the residents now have what they want on each day. Residents are asked the day before about the food that they want to eat the next day and residents said that on each day they could change their minds and get something else if they really wanted. I looked at records of food provided and sampled a meal and found that the food was wholesome and well presented. Good records of food eaten are maintained as part of the homes system for monitoring healthy diets. A record is kept in each residents own individual file. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience 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 experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Satisfactory systems are in place to manage complaints and the protection of vulnerable adults. Evidence: The homes complaints policy adequately shows how complaints are to be managed and residents have been given a copy. Six residents and two families confirmed this. The registered manager is at the home on a daily basis and residents commented that they are available to speak with her whenever they need to and that she is very quick in responding to any concerns and in acting to deal with any problems. There have been four complaints made since last inspection. Two were upheld and two are still being dealt with. I examined records kept and these were complete and showed action being taken. The Statement of Purpose includes a summary of complaints policy and all of staff had received training in how to deal with complaints. Complaints are well managed by the home. There have been two safeguarding allegations made since the last inspection. These were properly reported to Greenwich social services and to the Care Quality Commission. They were investigated by the home under the direction of social services and the outcomes were recorded. The home acted appropriately and have complete records of these events and of the final view of social services. There has Care Homes for Older People Page 18 of 31 Evidence: been significant improvement in the homes approach to managing safeguarding issues and protecting residents since the arrival of the current manager. This is evidenced by the reduction of reports to the safeguarding team who have expressed confidence in the management of safeguarding at the home. The home has a written policy and procedure in relation to Adult Protection. The procedure states that all suspicions or allegations of abuse must be referred to the local authority for investigation under their procedures. A copy of the local authoritys Adult Protection procedures is available to staff in the home in addition to the homes own policy. Five staff I interviewed had a good awareness of adult protection and how to manage an allegation or suspicion of abuse. The home now manages safeguarding and protection of residents well and responsibly. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience 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 experience Good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents live in a safe and well-maintained environment. The home was clean, pleasant and hygienic. Evidence: The home is situated in Charlton and provides nursing care for 20 service users 10 on Capella unit and a further 10 in the category of intermediate care on Ross unit. This unit provides a specialist rehabilitative service prior to final discharge back into the Community. Residents are admitted from the community or directly from hospital. A further 36 service users are within the category of conventional care for older persons and are accommodated over three other units Ursa and Orion and Carina. Within this 36 one placement is for emergency admissions and two placements for respite carer breaks. The home is generally well provided for in terms of communal facilities for service users including dining areas hairdressing facilities and numerous quiet areas. Meetings for residents and relatives are held on a regular basis and a League of Friends for the home has been set up. Equipment to assist and promote residents wellbeing and comfort is provided. Care Homes for Older People Page 20 of 31 Evidence: Occupational therapists have been involved in carrying out assessments to ensure that appropriate lifts and hoists and other equipment are provided. This included pressure relief mattresses and cushions profile beds hoists raised toilet seats grab rails and standing aids. All of the equipment provided was in working order and maintained in accordance with the required schedule. Residents bedrooms do not currently have a lockable space or cupboard and the home must provide these for residents to use to lock up personal valuables or for the storage of medication if needed. (Refer to Requirement OP24) The home is modern and has good natural light. It is well maintained and decorated throughout. There is a maintenance plan in place and separate maintenance staff are employed by the registered provider to keep the environment well maintained and well decorated. Residents bedrooms and bathrooms are suitable for their care needs and are comfortable and well decorated. The manager stated in the AQAA that there are further plans to make bathrooms more homely and comfortable and to finish decoration of all bedrooms. The home is very clean and hygienic and without any unwanted odours. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the 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 numbers and skill mix of the staff meets residents needs and they are in safe hands at all times. Residents are now protected by the homes recruitment and induction practices. Staff are trained and competent to do their jobs. Evidence: There were four requirements made at the last inspection regarding the adequacy of staff numbers and the induction and training of staff. I inspected five care staff and nursing staff files and spoke to four staff and found that all of these requirements have been met. The staff team is made up of a registered manager who is an experienced manager and a deputy manager who is a qualified nurse who provides clinical supervision for all the nursing staff. There are 62 care staff on various part time and full time contracts and 10 nurses seven of whom are permanent and three of whom are bank nursing staff. Cleaners are also employed in adequate numbers. There are seperate ancillary staff for cooking cleaning and facilitating repairs and maintenence. More than 80 of care staff are qualified to NVQ level 2/3 which is a good level ofqualified staff. The new deputy manager has developed a good rapport with residents and staff and clinical and care staff said they are very pleased with her support and direction. There is a Care Homes for Older People Page 22 of 31 Evidence: separate experienced secretary who has some responsibilities for organising administrative systems in the home and does this well. Good recruitment policies and procedures are in place. Five employee personnel files were viewed. These were well kept and included all of the information required by regulation. There is an induction schedule in place for new staff which is in line with the Skills for Care requirements. All required information is included on the induction schedule and the new staff employed have been inducted using this system. The manager has taken steps to ensure that other longer serving staff who need it are having a refresher induction as they may have missed some of the induction points under previous management. The home has a training schedule which includes equal opportunities diversity health and safety fire safety moving and handling infection control medication and food hygiene dementia and end of life care. The home has now reviewed the training schedule for staff and there is a good training plan in place for all care and nursing staff. The manager said the home has signed up for the gold standard in end of life care and various staff have completed a course in this area of care. It was pointed out during the inspection that the lead nurse in the rehabilitation unit may need some additional support while another nurse is on long term leave. The deputy manager said she will ensure that she gets this support. The following additional training areas are recommended for the home and the manager agreed to see work to see it is provided. These are Malnutrition and assistance with eating and cultural and diversity training. (Refer to Recommendation OP30) Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience 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 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 has an experienced manager and accountability for residents safeguarding and staff induction and training have been improved. The home is run in the best interests of residents. Residents financial interests are safeguarded appropriately. The health safety and welfare of staff and residents are promoted and protected. Evidence: There was a requirement made at the last inspection for improvements to be made to ensure that staff supervision happened at least six times a year and that records of these be kept. This requirement is now met. I inspected five staff files and spoke with four staff and received comments from another four staff regarding the management of the home and their supervision. All confirmed that supervision is now scheduled and takes place consistently every two months but usually more often especially for newer staff. The new deputy manager is now fully involved in providing supervision for all the nursing staff and comments received were that supervision was of good quality Care Homes for Older People Page 24 of 31 Evidence: and very supportive. The homes manager is not yet registered with the Care Quality Commission but has said she is now ready to put forward an application. This must happen in order to comply with regulations for this home. (Refer to Requirement OP31) The manager is very experienced and has the qualifications and management ability needed to manage the service. This comment has been supported by all of the staff and residents who took part in this inspection. The manager has achieved NVQ 4 qualification in care and management and is supported by a deputy manager who is a registered nurse and who has taken responsibility for the clinical supervision of nursing staff. Residents spoken with said they were very happy with how the home was run. Two visitors commented that they were also very happy with the homes management and that their relative was very happy living there. They said they were fully consulted about the move to the home and are confident that they can speak with the manager when they need to. Ten residents who responded to the inspection surveys or who spoke with me also said they were very happy with management andd that the current manager has made many changes for the better in the home in the past year. Formal monthly monitoring inspections of the care provided including care plan reviews the management of staff and of the repairs renewals and refurbishments needed so that the quality of the care and the home are now maintained to a good level. The home has a system for carrying out residents surveys and has a system for carrying out annual quality audits. There is also a current development plan in place. An Annual Service Audit was carried out by the provider in November 2009 and the findings were very positive showing many improvements had taken place. Residents financial support needs are assessed on admission and support to manage finances is offered when necessary. All of the residents or their family are responsible for their bank accounts and DSS benefits. The home only manages small amounts of cash deposited with them for personal spending such as hairdressing or small shopping. In these cases receipts and records are being maintained. All for staff files examined showed supervision to be happening well with good notes being kept. Five staff files examined also showed good records of these supervisions are being kept. These files also showed that an annual appraisal system is in operation for all care staff. Care Homes for Older People Page 25 of 31 Evidence: All health and safety and fire safety documentation was checked and found to be up to date and in order. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 The registered provider and manager must ensure that residents contracts contain information about fees charged and who is responsible for payment of these fees. This is in order to ensure that residents are aware of their rights and financial responsibilities 31/03/2010 2 7 13 The registered provider and manager must ensure that the use of bedrails be reviewed for relevant residents and ensure that they are only used for the protection of residents and remove them where necessary This is to protect residents from any possible barrier to safe entry and exit from their beds and to protect their freedom of movement 31/03/2010 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 9 12 The registered provider 30/06/2010 must ensure that the homes medication policy includes a system for assessing and enabling residents to take control of their own medication should they have the capacity This is in order to promote residents independence 4 24 23 The registered provider and manager must ensure that all residents have a lockable cupboard or similar in their rooms as discussed in this report This is to ensure that they are able to lock away personal valuables or medication safely 30/06/2010 5 32 8 The registered provider 31/03/2010 must ensure that an application for the registration of a manager for the home is submitted to the Care Quality Commission. This is to ensure tha a manager who demonstartes full knowledge of the Care Standards applicable to this home is in charge of the day to day running of the home Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The registered provider and manager should see that self help skills are included in care plans for residents who wish to develop these skills as discussed in this report The registered provider and manager should include malnutrition and eating training and cultural diversity training in the homes schedule for staff training as discussed in this report 2 30 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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