Care Home: Tower House II Residential Home

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What the care home does well Prospective residents` needs are assessed before they are offered a place in the home, to make sure that the home will be able to meet their needs. People using the service in the home generally appeared well cared for and receive a good standard of personal care. They have the opportunity to engage in the local community by going to the day centre, taking part in shopping activities, and visiting health care professionals who provide their services locally. Bedrooms of people using the service are personalised and offer comfortable accommodation. The home has redecorated peoples bedrooms and replaced carpets with wood effect flooring. Care plans were found to be of good standard and regular review with service users input was evident. Detailed activity records demonstrate that people using the service have active and stimulating lifes. What has improved since the last inspection? The home has met 23 of the 24 requirements issued during our last key inspection, which demonstrates to us that the home has put a lot of time and effort in improving the quality outcomes for people using the service. This has been reflected in the overall quality rating for the home. The statement of purpose has been reviewed and now reflects the care provided by the home and provides current and prospective people using the service with up to date information about the home. Contracts for people who are self funding are drawn up by the home and contracts with the placing authority are in place. This ensures people using the service can be clear of what to expect from the home. People using the service are involved in the reviewing and implementation of care plans ensuring that their wishes in regards to meeting their needs are taken into consideration. Clear guidance in regards to peoples mobility is in place ensuring that people using the service can be confident their mobility needs are met. Equipment provided to aid peoples mobility is maintained ensuring that people using the service can use these safely. Medication administration procedures are followed and medicines is safely administered to people using the service. People`s wishes in regards to life threating illnesses and death are taken into account within the care planning process. Staff demonstrate a good understanding of adult protection procedures and people using the service can be confident allegations of abuse are dealt with appropriately. The home only admits people as stated in the registration certificate, ensuring the needs of people using the service are met according to Care Homes Regulations. Window restrictors have been fitted ensuring people using the service are protected from accidental falls. While the hot water flow in one of the bathroom remains a problem the second bathroom is working well which is sufficient for the number of people living at the home. The damaged flushing mechanism in the en-suite toilet in room 5 has been repaired. People using the service live in a comfortable and warm environment, which is free from offensive odours. Over 50% of care staff employed hold or work towards appropriate qualifications in care, which ensures that people using the service can be confident that they are supported by qualified staff. New staff are vetted appropriately and people using the service are protected from unsuitable staff. Appropriate training is provided to staff, ensuring peoples needs are met. Up to date Health and Safety certificates ensures services users health wellbeing. Since the last inspection the home has undertaken extensive redecoration work. Carpets have been replaced in communal areas and in bed rooms. Service users rooms have been redecorated and new furniture has been purchased. The kitchen has been redecorated, a new range cooker and American style fridge/freezer has been purchased. What the care home could do better: We have made five new requirements during this key inspection. One of the previous requirements has been reinstated and formed part of a statutory requirement notice, which has not been complied with during this key inspection. Enforcement action is being considered in respect of the unmet requirements. The unmet requirement, which will also form part Statutory Requirement Notice (SRN) which will be re-issued is around the lack of a working quality assurance systems, which does ensure that quality outcomes to people can be monitored and maintained. The five new requirements are as follows: The home must ensure that toilets and bathrooms have a locking mechanism, which ensures peoples privacy is ensured. The home must continue to arrange adult protection training to staff, which ensures people using the service can be confident allegations of abuse are dealt with appropriately. The home must investigate and resolve the slow flow of hot water in bathroom 1, ensuring people using the service are able to maintain the personal care needs comfortably. All staff must receive a minimum of six planned supervisions, which ensures people using the service can be confident that they are supported by staff which are supported appropriately. The home must maintain their Health and Safety records, to ensure the Health and Safety of people using the is not compromised. Key inspection report Care homes for older people Name: Address: Tower House II Residential Home 11 Tower Road Willesden London NW10 2HP     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: Andreas Schwarz     Date: 1 7 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Tower House II Residential Home 11 Tower Road Willesden London NW10 2HP 02085371707 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): towerhouse1@yahoo.com Mary Christabell Chongo Mundy Name of registered manager (if applicable) Mrs Rosalia Daracan Type of registration: Number of places registered: care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Tower House II is located in Tower Road off Pound Lane in Willesden. It is easily accessible by cars and public transport. The home is about five minutes walk from Pound Lane, which is served by buses. There is a small parking area in front of the home for about 4 cars. Additional parking is available on the road, but this is paid parking or for residents only. The home was registered on the 11th January 2007 for three elderly residents of mixed gender who require personal care. It consists of a Care Homes for Older People Page 4 of 29 Over 65 9 0 Brief description of the care home semi-detached House. There is a kitchen, lounge/dining area and a bedroom on the ground floor and two bedrooms and a bathroom on the first floor. The home does not have a lift. All bedrooms are en-suite with a toilet and washbasin. There are pleasant and well maintained garden/patio areas in front and at the backof the home. Tower House II is owned by Ms Mary Mundy. She has another care home next to Tower House II at number 9 and 10. There are a lot of interactions between the two homes and many activities are shared as, they are next to each other.The home charges £580.00 weekly and also accommodates residents who are publicly funded. They do not have to pay a top-up.There were 3 residents in the home at the time of the inspection. Care Homes for Older People Page 5 of 29 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 key unannounced inspection started on the 17th March 2010 at 09:30 am and lasted 7.5 hours. This is the third key inspection for the period 2009-2010. The last key inspection took place on the 6th November 2009 and during that inspection the home was rated as an adequate (1 star) service. The registered provider Mrs Mundy is also the manager of the home. During this key inspection the lead inspector Mr Andreas Schwarz, was accompanied by Fay Bennett Regulation Inspector from the Care Quality Commission (CQC) enforcement team to assess compliance with Statutory Requirement Notices issued during our previous key inspection. The Commission has also received an application from the provider to increase the number of residents in Tower House II from 3 to 9 as the provider has extended the home (number 11), to include numbers 12 and 13 Tower Road. During the inspection we spoke to all people using the service, two members of staff and the provider. Care Homes for Older People Page 6 of 29 We toured premises and looked at a sample of records that the home keeps. We would like to thank all the people using the service, Mrs Mundy and all her staff for their assistance and kind support during the inspection. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The home has met 23 of the 24 requirements issued during our last key inspection, which demonstrates to us that the home has put a lot of time and effort in improving the quality outcomes for people using the service. This has been reflected in the overall quality rating for the home. The statement of purpose has been reviewed and now reflects the care provided by the home and provides current and prospective people using the service with up to date information about the home. Contracts for people who are self funding are drawn up by the home and contracts with the placing authority are in place. This ensures people using the service can be clear of what to expect from the home. People using the service are involved in the reviewing and implementation of care plans ensuring that their wishes in regards to meeting their needs are taken into consideration. Clear guidance in regards to peoples mobility is in place ensuring that people using the service can be confident their mobility needs are met. Equipment provided to aid peoples mobility is maintained ensuring that people using the service can use these safely. Medication administration procedures are followed and medicines is safely administered to people using the service. Peoples wishes in regards to life threating illnesses and death are taken into account within the care planning process. Staff demonstrate a good understanding of adult protection procedures and people using the service can be confident allegations of abuse are dealt with appropriately. The home only admits people as stated in the registration certificate, ensuring the needs of people using the service are met according to Care Homes Regulations. Window restrictors have been fitted ensuring people using the service are protected from accidental falls. While the hot water flow in one of the bathroom remains a problem the second bathroom is working well which is sufficient for the number of people living at the home. The damaged flushing mechanism in the en-suite toilet in room 5 has been repaired. People using the service live in a comfortable and warm environment, which is free from offensive odours. Over 50 of care staff employed hold or work towards appropriate qualifications in care, which ensures that people using the service can be confident that they are supported by qualified staff. New staff are vetted appropriately and people using the service are protected from unsuitable staff. Appropriate training is provided to staff, ensuring peoples needs are met. Up to date Health and Safety certificates ensures services users health wellbeing. Since the last inspection the home has undertaken extensive redecoration work. Carpets have been replaced in communal areas and in bed rooms. Service users rooms have been redecorated and new furniture has been purchased. The kitchen has been Care Homes for Older People Page 8 of 29 redecorated, a new range cooker and American style fridge/freezer has been purchased. 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 29 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 29 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. The home is providing detailed information to prospective and current people using the service, which enables people to make an informed decision if the home is suitable for them and able to meet their needs. People are only admitted based on a comprehensive needs assessment. Contracts are in place for people who are self funding, but there are some shortfalls with people being funded by the local authority. Evidence: We viewed the homes statement of purpose and service users guide, which has been updated since the last key inspection. Both documents are now compliant and relevant to the support and care provided by Tower House 2. The documents are easily available and a copy was found in each of the service users rooms and on the notice board in the entrance hall of the home. The home makes copies for the last three key inspections available to people using the service and visitors. The service users guide and statement of purpose is made more accessible by the use of some pictures. While people using the service were not able to tell us that they have seen the documents Care Homes for Older People Page 11 of 29 Evidence: we are confident that they can access them whenever they choose to do so. We viewed contracts of all three people using the service. One of the people living in Tower House 2 contract has been signed by the persons solicitor and detailed information of fees and charges is provided. Two of the three contracts have not been signed by the service users, the home however has individual agreements with the sponsoring local authority in place, which is seen as adequate. We however recommend to obtain signatures from the person using the service or their representative to validate the individual contracts provided in peoples care plan folders. The home had no new admissions since the last key inspection. The home has currently three people using the service residing on the premises, which reflects the conditions or the registration. We assessed assessments undertaken in all three care plan folders viewed. Assessments are detailed and provided necessary information about peoples needs and plans in how the home anticipates to meet these needs. The home does not provide intermediate care. Care Homes for Older People Page 12 of 29 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. The home ensures that people using the service have detailed care plans in place, which are implemented and reviewed with their input. Appropriate procedures ensures the safe administration of medication. Peoples health care needs are monitored and met and outside professionals can be accessed if required. The home home maintains peoples privacy and dignity. Evidence: We have assessed care plans of all three people using the service. It was evident that the home has put a lot of thought and effort into the care plans since the last key inspection. Care plans are judged as detailed and have been reviewed monthly by the key worker. The home is also using a template for person centred planning, which has been completed. The person centred plans use pictures and symbols to make the care plans more accessible to people using the service. Information about the individuals likes, dislikes, wishes and aspirations are detailed and relevant to the person. Each care plan folder has a consent sheet signed by the person stating his/her participation in the care planning process. People using the service informed us that they have discussed the care plan with their key worker. We recommend to put a system in Care Homes for Older People Page 13 of 29 Evidence: place which enables people using the service to have more involvement in the review process. The home has records of people using the service being visited or visiting health care professionals in place. Since our last key inspection people have been visited by an optician, and visited the GP, chiropodist and hospital for regular check ups. One person is visited twice a week by a community nurse to provide pressure care. Nutritional assessments are undertaken during the initial assessment and peoples weight is checked on a monthly basis. We viewed medication records for all people using the service. Medication Administration Sheets (MARS) were up to date and had no omissions. A signatory list for staff competent in the administration of medicines is provided. We assessed all staffing records which detailed that staff have attended medication training. This was confirmed by two staff spoken to during this key inspection. Medication is safely stored in a medicines trolley, which is locked in an under-stairs cupboard. None of the people using the service spoken to raised any concerns that their privacy or dignity is compromised and our observations during this key inspection confirmed this. The home has a cordless phone, which can be used by people using the service in their room or the communal lounge. New staff are inducted based on the common induction framework from Skills for Care, which has one unit dealing with privacy and dignity within a care home. The home has only single rooms. We noted in the bathroom that it can not be locked from the inside and asked the home to provide a safe locking mechanism for people using the service. Care Homes for Older People Page 14 of 29 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. The home provides a range of stimulating activities for people using the service. People using the service can take part in the activities or do things they found more interesting to them Meals are healthy, nutritious, home cooked and nicely presented. People using the service can welcome visitors at any time and visitors can take part in meals if they wish to do so. Evidence: People using the service told us, that the home encourages regular contact with friends, family and relatives. Daily records viewed during this inspection confirmed this. The registered manager told us during discussions, that one of the peoples relatives visited the home the whole Christmas day and New Years day. The home has weekly activities displayed on a notice board in the lounge, records show that people can take part in these activities if they choose to do so. Since the weather has improved people using the service can make better use of the large garden and one staff member informed us that she has recently planted flowers together with service users. The Home has introduced good individual activity records, which showed that people using the service are active and have a stimulating life. The home has changed one of the bathrooms to an activity room, which is currently in the process of being completed and furnished. Care Homes for Older People Page 15 of 29 Evidence: People using the service told us that they go to local parks or visit the local high street together with staff or family members.The registered manager told us that increased community contact will recommence once the weather and temperature improves. Staff spoken to are very enthusiastic about supporting and encouraging people using the service to take part in activities. The home does not manage peoples finances, they are either managed by the family or by a an appointed solicitor. Rooms viewed were nicely decorated and people using the service have brought their own possessions making them more personal and homely. A member of staff told us in discussions that she likes working in Tower House 2 in particular as people are enabled to choose independently in what they want to do, when they want to get up or whom they want to interact with. During the day of this inspection people using the service were offered roast chicken and/or stewed pork. The meal was freshly prepared and a lovely smell was noted throughout the early part of this inspection. The home invited us to taste the lunch, which was nicely prepared, healthy and very tasty. People using the service told us that they like the meals in the home and staff were observed supporting people using the to eat their meals. The home has a weekly menu plan in place, which is drawn up together with the residents and food eaten by service users is recorded separately. The home has refurbished the kitchen, which is now more accessible and a large range cooker enables the cook to prepare meals much easier. Care Homes for Older People Page 16 of 29 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. The provider views complaints as an opportunity to improve the service and takes these seriously. Allegations and suspicions of abuse are taken seriously by the provider and staff. There is however a need for staff to be appropriately trained. Evidence: We assessed complaints records; the home did not receive any complaints since the last key inspection in November 2009. A complaints procedure is available in the home and can also be accessed in the Service Users Guide. People using the service spoken to told us that they would raise any concerns with the manager and are confident that the manager would deal with these concerns. The home had one referral to the safeguarding adult team of the local borough, this has been dealt with satisfactory and has been resolved. We discussed the management of allegations and suspicions of abuse with the provider and two members of staff. Everybody spoken to was clear of the action to take if they come across allegations and suspicions of abuse. The registered manager has had training in adult abuse. The two members of staff spoken to told us that they had received adult protection training. We assessed training records of five staff employed by the home and found that three of five staff have taken part in adult protection training. We informed the provider of this and stressed the need that all staff employed must receive regular adult protection training, which ensures that people using the service Care Homes for Older People Page 17 of 29 Evidence: are protected and appropriate procedures are followed. In light of the new legislation around Deprivation of Liberty and Mental Capacity Act staff working at the home have not received training. This is to ensure that staff are updated and are aware of current legislative practices and procedures in this area. Care Homes for Older People Page 18 of 29 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 live in a nicely decorated and pleasant home. The home is clean and free of any offensive odours. Maintenance work is pro-active rather then reactive to ensure regular updates are undertaken. Evidence: Since our previous key inspection, the home has repaved the patio area in the front of the home and planted flowers and some shrubs. Pictures and photographs have been put up in the communal lounge and the area has been re-carpeted. The home was clean and tidy and free of any offensive odours. The home has complied with all requirements made during our previous inspection. The home has a large garden which has partially been repaved, during the day of tis inspection new material has been delivered to pave the outstanding area. The registered manager told us that this should happen during the course of the current week. Peoples rooms have been redecorated and new furniture has been purchased. Room doors have been individually numbered and personal pictures are on each of the doors making it easier for people to find their room. We viewed bathroom 1 in Tower house 11, the bath chair provided by the home was in good working order and the paper towel dispenser has been removed. We noted that the water flow is very slow and it took the hot water a considerable amount of Care Homes for Older People Page 19 of 29 Evidence: time to heat up satisfactorily. We require that this is addressed to ensure that the home is able to meet peoples personal care needs now and in the future. Since the last key inspection the new decoration has improved the overall living experience for people using the service. The home felt light, airy and the temperature was comfortable. The home was clean and free of any offensive odours. To address the strong urine odour noted during our last key inspection, the home has replaced all carpets with wood effect flooring, which makes it easier to clean and maintain. The registered manager informed us that the home employs a domestic cleaner and a person to wash service users clothing. Staff informed us that they have attended infection control training on the 15/02/2010. Care Homes for Older People Page 20 of 29 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 can be confident that only staff which have been appropriately vetted is supplied by the home. Staff employed are appropriately trained and skilled ensuring the needs of the people living at the home can be met safely. Evidence: We assessed the homes rota, which shows that the staffing ratio is suitable for the number of people living at the home. During the day of this inspection two carers and the registered manager were working in the morning and during the afternoon, during the night one waking night staff is on duty. Staff told us that the manager is very hands on and is available throughout the week and can be contacted during weekends. We assessed six training folders during this inspection, which reflects all staff employed in Tower House 2. Four out of the six staff hold or are working towards National Vocational Qualifications in Care Level 2 and 3. We assessed recruitment records of all staff employed by Tower House 2 all folders viewed had the necessary documents such as Criminal Records Bureau (CRB) check, two references, proof of the right to work in the UK, application form and contracts in place. We noted in one of the folders, that the references obtained for the member of staff did not contain a reference of the employees previous workplace. The person Care Homes for Older People Page 21 of 29 Evidence: however has provided two references. Training records have been updated and staff have recently taking part in a manual handling refresher. One member of staff told us that she took part in Health and Safety and infection control training on 15/02/2010, but the certificate was still outstanding. Care Homes for Older People Page 22 of 29 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 can be assured the owner/manager is experienced in the care of older people. There are concerns that the lack of an effective quality management system for the home means that residents cannot be confident that the home is being monitored to ensure that they receive a quality service. Residents health and safety is not compromised, there is however a need that the Health and Safety is continuously monitored and recorded. Evidence: Mrs Mundy as the owner of the home is now the manager. Mrs. Mundy is a registered nurse and has experience of caring for the elderly. Mrs Mundy informed us that she has employed a new manager, who will be registered with the Care Quality Commission (CQC). The new manager is known to the CQC and has a good track record and has already been registered with us during her previous employment. Mrs Mundy informed us that she is doing all the care planning, supervisions and managerial tasks at the home, we recommend she delegates this to some staff which are judged by her as competent. Staff spoken to told us that the registered provider Care Homes for Older People Page 23 of 29 Evidence: Mrs Mundy is supportive and involved with the care of people using the service. During our key inspection in November we noted shortfalls in the homes quality assurance systems. While it was noted during this inspection that the responsible person has obtained information about working quality assurance systems, these were not found to be implemented and forms viewed were either not completed or partially completed. We informed the registered manager of this shortfalls and told her that the CQC will reinstate the Statutory requirement Notice which has been send to the home on the 10/12/2009 with a new compliance date. The provider informed us that she does not keep any personal money for residents. The personal money is either managed by relatives/friends of residents or by the local authority that placed the resident. We viewed supervision records of all staff employed in Tower House 2 and noted that staff did not receive any planned supervision in 2010. Staff appraisal forms were present in two folders, but have not been completed. Staff told us that the manager is available regularly, which was confirmed by people using the service. The presence of the registered manager ensures regular support to carers, but does not replace the need for six planned supervisions per calendar year. We assessed Health and Safety records and monitoring sheets during this inspection. We noted while they were present and detailed, they have not been completed and lacked information and evidence of ongoing monitoring of the Health and Safety of people using the service. We viewed the homes fire records which were all up to date; a current contract is in place to maintain the homes fire system. Fire drills are undertaken monthly and the fire equipment is checked regularly. The homes gas safety certificate and portable appliances test certificate is current and the electrical wiring certificate is up to date Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 33 24 The registered provider shall 01/05/2010 establish and implement a system for evaluating the quality of the services provided at the care home. Previous timescales of 31/03/08, 31/10/08, 30/09/09 and 23/02/10 not met. The statutory requirement notice will be extended. Care Homes for Older People Page 25 of 29 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 10 23 The responsible person must 01/05/2010 ensure that toilets and bathrooms have a suitable locking mechanism. This ensures that people using the service can use the bathroom and toilets privately without the risk of being disturbed. 2 18 13 The responsible person must 01/05/2010 continue to provide adult protection training to all staff employed. This ensures people using the service are protected and can be confident that allegations of abuse are dealt with appropriately. 3 21 23 The responsible person must 01/05/2010 investigate the slow water flow and the lack of appropriately hot water in bathroom 1. This ensures that all people Care Homes for Older People Page 26 of 29 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 using the service can safely and comfortably have a relaxing bath and their personal care needs can be met. 4 33 24 The registered provider shall 01/05/2010 establish and implement a system for evaluating the quality of the services provided at the care home. Previous timescale of 31/03/08, 31/10/08, 30/09/09 and 23/02/10 not met. Enforcement action is being considered This ensures people using the service can be confident the quality of care provided by the home will be maintained. 5 36 18 All staff must receive six planned supervisions per calendar year. This ensures that people using they service can be confident they are supported by staff who are monitored by the manager. 01/05/2010 Care Homes for Older People Page 27 of 29 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 6 37 17 The responsible person must 01/05/2010 ensure that Health and Safety records must be be kept up to date and available for inspection. This ensures the Health and Safety of the environment is regularly monitored and people using the service can confident that they are protected. 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 2 We recommend that even if a contract is in place with the funding authority, that individual contracts are drawn up and people using the service or their representative are encouraged to sign this, ensuring their validity. The home should design a system which enables people using the service to take more part in the care plan review process. The home should look into Mental Capacity Act and Deprivation of Liberty training for staff, which ensures correct procedures are followed and people using the service and relatives can be confident in the skill and knowledge of staff. The responsible person should obtain references from the current and previous work place of the applicant. It is recommended to delegate some of the managerial tasks to experienced carers to ease the demands on the registered manager. 2 7 3 18 4 5 29 31 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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