Care Home: Tregertha Court

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What the care home does well Tregertha Court provides personal care and support for a maximum of 38 people. On the day of the inspection residents looked well cared for. The `expert by experience reported that `All spoken with made appreciative comments about the manager and staff saying, `The staff are very good`, `All very nice people`, `No problems with the staff`, `They are very caring and take very good care of all the elderly and infirm people living here`. Staff were observed working with people in a positive manner which resulted in individualised care and support. Pre admission assessments are always carried out to ensure that the home can meet the needs of the person. Ongoing training means that staff are up to date and have the skills to look after the residents. Documentation and records seen were well organised, up to date and stored as required. People are given choices about how they spend their time. Entertainers are bought into the home regularly and the variety of communal space means that people can spend time where and with whom they like. The `expert by experience` reported that `All spoken with were very appreciative of the services of the activities co-ordinator who attends for six hours three times a week and leads craft, quiz and bingo sessions. Outside entertainers also visit`. What has improved since the last inspection? Some areas of the home have had carpets replaced and a number of rooms have been redecorated. This ongoing redecoration and refurbishment means that people have a safe, homely and comfortable home in which to live. Staffing levels have been reviewed resulting in 2 care staff starting work at 7am to support the night staff and therefore offering residents more choice about their daily routine. The work to improve bathing facilities is ongoing but some improvements have been made. What the care home could do better: The manager should ensure that care plans and associated risk assessments are update to reflect peoples changing needs. This means that care staff would always have the most up to date information about how to care for and support a resident. The provider should continue with upgrading bathroom facilities to ensure people have sufficient and suitable facilities that are adapted to meet their needs. Doors to peoples private accommodation should be fitted with locks suited to their abilities and accessible to staff in emergencies. Service Users should be provided with keys unless their risk assessment suggests otherwise. Until this has been achieved the provider should ensure that the Service Users Guide states that there are no locks on the doors and if one is required this should be discussed with the manager who can make individual arrangements. Each person should have lockable space for medication, money and valuables and be provided with a key which they can retain (unless the risk assessment suggests otherwise). Until this has been achieved the provider should ensure that the Service Users Guide states that if lockable space is not yet provided but if it is required this should be discussed with the manager who can make individual arrangements. The registered provider should continue to consider moving the laundry to a more accessible position or making the current one more accessible and safe for staff. The registered provider should ensure that the manager has access to the internet (from Tregertha Court) to ensure she (and other relevant staff) have access to the CQC website, Department of Health website and other relevant websites to enable them to keep up to date with current good practice recommendations and new legislation. This will benefit the staff and the ongoing welfare of the residents. Key inspection report Care homes for older people Name: Address: Tregertha Court Station Road East Looe Cornwall PL13 1HN     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: Mandy Norton     Date: 2 0 1 0 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 28 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 28 Information about the care home Name of care home: Address: Tregertha Court Station Road East Looe Cornwall PL13 1HN 01503262014 01503262014 enquiries@tregerthacourt.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Tregertha Court Limited care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Service users to include up to 3 adults aged over 65 years with dementia (DE(E)) Service users to include up to 35 adults of old age (OP) Service uses to include up to 3 adults aged over 65 years with a mental illness (MD(E)) Total number of service users not to exceed 38. Date of last inspection Brief description of the care home Tregertha Court is part of the Adlington group of homes, a privately owned, family run company. It is situated in Looe overlooking the river and on the outskirts of the town. It is approached by a ramped access as well as railed steps. A number of the bedrooms are en-suite and those in the front of the home have good Care Homes for Older People Page 4 of 28 Over 65 3 3 35 0 0 0 Brief description of the care home views. There are four double rooms. The first and second floors are reached by a series of stairs or stair-lifts. There are two lounges at the front of the home that include large conservatories and views of the river and a further lounge and large dining room at the back of the home, all on the ground floor. There is seating outside the front of the home and a small garden area to the side. Limited car parking is available. The current scale of charges range between £400 - £600 each week. Service Users are expected to pay for the following items themselves: hairdressing, chiropody, newspapers and shopping etc. People funded through the Local Authority process have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.u The home has a Statement of Purpose and Service Users Guide, both of these are available in the office. Each person has a copy of the Service User Guide in their bedroom. The last inspection report is displayed at the front entrance. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced Key Inspection took place from 9.45 am until 2.45pm on 20th October 2009 with one inspector and an expert by experience*. It was conducted with the manager. A tour of the home was carried out and residents and staff were observed and spoken to informally during this time. A variety of records were seen during the course of the day. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred), the annual quality assurance assessment (AQAA) (a self assessment document that the home completes annually and submits to the Commission) and completed surveys from both care staff and residents was also used to help form the judgements made in the report. *An expert by experience is a person who, because of their shared experience of using services or ways of communicating, visits a service with an inspector to help Care Homes for Older People Page 6 of 28 them get a picture of what it is like to live in or use the service. The three tasks that an expert by experience can do are to talk to people who use services, staff and management, observe daily life in the service and the interaction between staff and people who use services and look around the premises. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: The manager should ensure that care plans and associated risk assessments are update to reflect peoples changing needs. This means that care staff would always have the most up to date information about how to care for and support a resident. The provider should continue with upgrading bathroom facilities to ensure people have sufficient and suitable facilities that are adapted to meet their needs. Doors to peoples private accommodation should be fitted with locks suited to their abilities and accessible to staff in emergencies. Service Users should be provided with keys unless their risk assessment suggests otherwise. Until this has been achieved the provider should ensure that the Service Users Guide states that there are no locks on Care Homes for Older People Page 8 of 28 the doors and if one is required this should be discussed with the manager who can make individual arrangements. Each person should have lockable space for medication, money and valuables and be provided with a key which they can retain (unless the risk assessment suggests otherwise). Until this has been achieved the provider should ensure that the Service Users Guide states that if lockable space is not yet provided but if it is required this should be discussed with the manager who can make individual arrangements. The registered provider should continue to consider moving the laundry to a more accessible position or making the current one more accessible and safe for staff. The registered provider should ensure that the manager has access to the internet (from Tregertha Court) to ensure she (and other relevant staff) have access to the CQC website, Department of Health website and other relevant websites to enable them to keep up to date with current good practice recommendations and new legislation. This will benefit the staff and the ongoing welfare of the residents. 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 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that peoples diverse needs are identified and planned for before they move to the home. Evidence: The manager said that she always assesses people prior to them moving into the home to ensure their needs can be met. If people are to be admitted they and their representatives are given as much up to date information about the service as possible, invited to look around and spend some time at the home and ask any questions they may have. A completed pre admission assessment form was seen and included a lot of relevant detail required before deciding if the home is able to meet a persons needs. The Service Users Guide seen was generally up to date and gave people information about Care Homes for Older People Page 11 of 28 Evidence: the services offered by the home, the staff group and what the fees cover. A copy is kept at the main reception along with a copy of the last CQC (formerly CSCI) inspection report. The AQAA told us that We have an open door visiting policy and viewing for prospective Service Users. A full brochure and Statement of Purpose and Service Users Guide is provided pre admission and a copy of the Service Users Guide is provided in each bedroom. The completed Service Users surveys indicated that they had enough information to help them to decide if Tregertha Court was the right place for them. The expert by experience report said that without exception the residents spoken with said they were very satisfied with their choice of home. Care Homes for Older People Page 12 of 28 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 practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will be met. Evidence: The care plans seen were detailed and generally reviewed monthly. At least one had not had the care plan and risk assessment updated following a change in abilities, although the changes had been detailed in the ongoing daily statement and GP records. We saw that care staff complete daily records about a persons welfare and detail what care has been provided. The 3 care plans examined set out peoples needs and contained information about visits made by or to health care professionals such as GPs, district nurses, opticians and dentists. A tour of the home showed that equipment to help skin stay in a good condition and for prevention of pressure sores is available and meets peoples current needs. The manager said that they have enough equipment and specialist equipment is provided by the community nursing services as required. Care Homes for Older People Page 13 of 28 Evidence: The home uses a blister pack system for administration of medicines. They are stored in a locked trolley, which was clean and well organised. The records of administration were being completed as required and a photograph of each resident is kept with the record to aid identification. The procedure for receipt, storage and disposal of unwanted medicines was explained and is in accordance with laid down legislation. Staff were heard and observed interacting with people appropriately and providing care and support in a discreet manner. The expert by experience reported that those (people)asked were of the opinion that they rose and retired at a time of their own choosing. Staff were seen to knock on bedrooms doors and wait before entering. No evidence was seen of personal care being given with doors open. All residents seen appeared clean, dressed in freshly laundered clothes and looked well cared for. Care Homes for Older People Page 14 of 28 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. A range of activities within the home and local community means that people have opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed and staff are available to help make them an enjoyable and social occasion for people. Evidence: The manager said that people are given the opportunity to make choices in how they spend their days. The Service Users Guide states that people should be able to exercise choice in all aspects of your care and life. The expert by experience spoke to nine residents during his visit and said in his report that several people mentioned that they are taken out on trips by their relatives. No one could recall excursions in the minibus and the manager advised that although there had been some trips they had not been so frequent as in previous years due to the inclement weather and the vehicle being unserviceable for a while. All spoken with were very appreciative of the services of the activities coordinator who attends for six hours three times a week and leads craft, quiz and bingo sessions. Some of the craftwork was on display and included paintings, shell boxes, dressed hats, poetry and paper sculptures. Outside entertainers also visit. The manager added that the hairdresser visits 3 times a week Care Homes for Older People Page 15 of 28 Evidence: and that a variety of religious denominations visit the home and see people individually or conduct services. She also said that some residents continue with community activities they took part in prior to living at Tregertha. The AQAA states that we hold regular events in which relatives and the local community are actively encouraged to participate, including Summer Fetes, Christmas events, cheese and wine evenings and involvement in Looe in Bloom in the Summer. Visitors are welcomed at anytime and people were seen coming and going freely during the inspection. There is a small garden to the front and side of the house, accessible to residents, where there are containers with seasonal flowers and plenty of seating so that people can enjoy fresh air and views over the river. The expert by experience reported that comments about the food varied from, the food is very good, to the food is alright. A cooked breakfast is usually available the components of which vary from day to day. Lunch, at noon, is a set meal but people were confident that if it wasnt to their liking then an alternative would be provided. Tea is served at 4 pm when a choice can be made from three items such as a pasty, soup or sandwiches followed by a sweet. At 8pm a hot drink is served with a choice of sandwiches and biscuits. On the day of the inspection the meal served was plated, looked attractive and was suitably hot and tasty. A choice of three cold drinks was available with the meal and hot drinks were served in the lounges. Some residents recalled a recent survey when they were asked for their choice of menu and the topic had been raised at the Residents meeting. Before removing plates, carers asked if the diner was finished. Service users are given a choice of eating in the dining room, a lounge or their bedrooms. We felt that there were sufficient staff on duty to provide any assistance required over mealtimes. Soft diets and diabetic diets are provided and advice is sought from a dietician when necessary. Care Homes for Older People Page 16 of 28 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. Formal complaints and safeguarding policies and procedures are in place and are available to staff at all times. Some staff undertake safeguarding training. This means that people who live at the home are adequately safeguarded. Evidence: The complaints procedure, that has been recently updated, was seen displayed in the home and is included in the Statement of Purpose. It is comprehensive and gives options about who to contact and timescales for responses to be made. There have been no complaints made to the Commission in the last 12 months and the AQAA states that the home have received no complaints in the last 12 months either. The manager said that she and her deputy have regular contact with the residents and their relatives and feels confident that any issues would be bought up with them and would then be dealt with quickly and efficiently. The completed service user surveys indicted they know how to make a formal complaint. One comment made to the expert by experience was I cant fault it here. Records show that a number of staff have attended safeguarding training, they also have information about safeguarding when doing National Vocational Qualification (NVQ) training and during induction training. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ongoing refurbishment, redecoration and maintenance means that people have a comfortable, homely and generally safe environment in which to live. Evidence: The home is close to local shops and facilities of Looe. The home offers bedroom accommodation on the first and second floors, with all communal areas being on the ground floor. Following a tour of the home the expert by experience made the following observations The bedrooms visited were very clean, homely and personalised to varying degrees. The lounges have magnificent views and although tidy and clutter free (with exception of activity materials), were homely and welcoming with comfortable furniture. The dining room is at the rear of the property with natural light from a large skylight plus artificial lighting. The round dining tables were covered by attractive tablecloths and placemats and the dining chairs were comfortable, appeared fairly new and of good quality. Whilst there are enough bathroom facilities for the amount of people who can be accommodated in the home, previous recommendations have been made about the bathing facilities in the home that they should be more suited to the needs of the people who currently live in the home and who are likely to be accommodated in the future. During a tour of the home the manager pointed out areas where the bathrooms had been improved with some new bath hoists in the recent past. It is Care Homes for Older People Page 18 of 28 Evidence: recommended that the registered provider consider turning at least one small bathroom into a walk in shower room, this would offer people choice and be more accessible for a number of residents. The expert by experience reported that he was told that there is often pressure on the ground floor toilets at certain times of the day and it was suggested, by a resident, that this could be alleviated by the provision of urinal facilities. He was also told that at least one person would like to be bathed more frequently but has not asked saying, the staff would not have time. The annual quality assurance assessment states that bathing facilities, though improved, still need further revision and upgrading to cope with Service Users needs. The providers have an ongoing programme of routine maintenance and redecoration and since the last inspection have replaced several carpets and redecorated a number of rooms. A full time maintenance man is employed to deal with routine and ongoing maintenance. The outdoor patio areas to the front and side of the home are well maintained and accessible to residents. They include pots with seasonal plants and plenty of seating for people to use whilst enjoying the views over the river. Limited car parking is available at the front of the house. Not all of the rooms have locks on their doors and lockable space for personal items and money. The manager said that if a person wants to have either a lock on their door or a lockable space this can be done on an individual basis (as long as it is deemed safe following an assessment). At least one door was seen to have a lock fitted. The manager was advised that the Service Users Guide should include information about having a lock fitted and /or lockable space provided, on an individual basis, as required until such time as all rooms have door locks fitted and lockable space provided. On the day of the inspection the home was clean, tidy and hygienic. One of the completed service user surveys indicated that the home is always fresh and clean, the other one indicated that it usually is. The AQAA states that we have a good housekeeping team (1 Housekeeper, 3 daytime domestics and 1 evening domestic) who maintain a high standard of cleanliness. Policies and procedures around infection control are up to date and available to staff at all times. Training on the importance of infection control is routinely offered to staff. The home complies with the local fire service and environmental health department requirements. There is a large laundry in the basement area of the home, with washing machines that are suited to coping with the amount and type of dirty laundry produced. The access to the laundry is by going outside the home down a flight of steep steps and is not suitable for staff who have to carry heavy bags of soiled and clean linen. There is Care Homes for Older People Page 19 of 28 Evidence: access from inside the home via the kitchen, which cannot be used as carrying laundry through a kitchen is unacceptable. It is recommended that the provider consider alternative areas of the home that could be used as a laundry. The manager told us that the staff are instructed not to fill the linen bags to capacity when they need to transport them to and from the laundry and that she continues to try to think of ways that the laundry access can be improved. Care Homes for Older People Page 20 of 28 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. The staffing levels and skill mix are satisfactory meaning peoples needs are being met at all times. The recruitment procedure means that people who live at the home are being looked after by appropriate staff and their welfare is not at risk. Evidence: On the day of the inspection there were appropriate numbers of staff and skill mix available to provide the required care and support for people. The staffing levels have been reviewed and now 2 care staff start work at 7am to support the 2 night staff which, the manager said, has relieved the pressure on the night staff and offers residents more choice about their daily routine . Catering and domestic staff support the carers and the company administrator visits the home regularly to provide administative support. One of the completed staff surveys indicated that there are always enough staff to meet the individual needs of the residents and one that there are usually enough. The expert by experience wrote in his report that With one exception, people thought there were sufficient staff on duty. The exception said there should be more staff on duty during the daytime but did not elaborate on this view. Call bell response time was said to be within five minutes both day and night. There is a stable staff group, the AQAA states that only 4 people have left employment in the last 12 months and the manager said that this was because the people didnt like Care Homes for Older People Page 21 of 28 Evidence: the job but for other personal reasons. Staff files seen show that a variety of training opportunities are provided including first aid, moving and handling and food hygiene. The AQAA states that 60 of care staff have completed at least an NVQ level 2 in care. This is above the required 50 required. The AQAA states that more carers are to start NVQ training. Upcoming training dates were seen displayed on the notice board in the main office. Staff files we looked at all had completed application forms, 2 written references, criminal records bureau (CRB) and protection of vulnerable adults (POVA) clearances, statements of terms and conditions of employment and job descriptions. The AQAA states that four staff have completed an induction process. A completed induction form was seen when looking at staff files, it was detailed and appropriate to the job. One of the completed staff surveys indicated that their induction covered everything they needed to know to do the job when they started very well and one that it mostly did. The manager said that she carries out interviews for new staff, (following a similar format for all of them) and is involved in the induction and ongoing training and supervision of staff. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems and procedures in place are designed to meet the needs of the service as they strive to continually improve the service the home offers to the people that live there. The attitude to health and safety shown by the providers, care and ancillary staff means that people live in a generally safe and well maintained environment. Evidence: The registered manager is appropriately experienced having worked in care for many years and has achieved a Registered Managers Award. She has an open door policy and a number of people approached her during the inspection with a variety of queries that she managed effectively. She was able to demonstrate that the home has appropriate checks in place for various health and safety procedures including portable appliance tests, insurances, environmental health and the maintenance of fire safety. It is strongly recommended that the manager has access to the internet (from Tregertha Court) to ensure she (and other relevant staff) have access to the CQC Care Homes for Older People Page 23 of 28 Evidence: website, Department of Health website and other relevant websites to enable them to keep up to date with current good practice recommendations and new legislation. The homes policies and procedures are up to date and available to staff at all times. We were told about the records kept of all financial transactions on behalf of the residents, the information included how income, outgoings and receipts are managed. Secure facilities are used for storage of money and any valuables. The registered provider maintains the health, safety and welfare of the residents through implementation of the companys policies and procedures. Appropriate records were seen to demonstrate this. The maintenance man carries out ongoing routine house and garden maintenance. The laundry is accessed by going outside the building and via steep steps. Staff have to carry laundry bags up and down these steps and there is potential for staff to trip or fall or for problems to arise due to the difficulty with the manual handling of the bags. The manager has risk assessed the manual handling of the laundry bags and staff are instructed not to fill the bags up to reduce the risk, she said she continues to think of ways to improve the current situation. The people living at the home have contact with the owner or their representative who visits the home regularly and asks people questions about how satisfied they are with the care and the support they are getting. The subsequent report is sent to the home for the manager to see and is made available to CQC inspectors during inspections. The AQAA and accompanying dataset were completed satisfactorily and contained relevant information. The company administrator surveys 3 people at random each month and any concerns that are raised are discussed during the monthly provider visits and appropriate actions taken if necessary. The home appeared well organised, records seen were generally up to date, clear and in good order. Staff knew what they were doing and there were clear systems for delegating care tasks between staff. A communication book is in use and enables staff to highlight any changes that may have taken place with the people living in the home and any other information that staff need to be made aware of. The manager carries out regular supervision sessions with staff, some dates of which were seen regularly booked in the diary. The sessions cover aspects of care practice and ongoing training needs. The annual quality assurance assessment contained details of recent servicing dates of equipment. Some documentation was checked to confirm this information. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The manager should ensure that care plans and associated risk assessments are update to reflect peoples changing needs. The provider should continue with upgrading bathroom facilities to ensure people have sufficient and suitable facilities that are adapted to meet their needs. Each Service User should have lockable space for medication, money and valuables and is provided with a key which they can retain (unless the risk assessment suggests otherwise). Until this has been achieved the provider should ensure that the Service Users Guide states that if lockable space is not yet provided but if it is required this should be discussed with the manager who can make individual arrangements. Doors to Service Users private accommodation should be fitted with locks suited to their abilities and accessible to staff in emergencies. Service Users should be provided with keys unless their risk assessment suggests otherwise. Until this has been achieved the provider should ensure that the Service Users Guide states that there are no locks on the doors and if one is required this should be discussed with Page 26 of 28 2 21 3 24 4 24 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations the manager who can make individual arrangements. 5 26 The registered provider should continue to consider moving the laundry to a more accessible position or making the current one more accessible and safe for staff. The registered provider should ensure that the manager has access to the internet (from Tregertha Court) to ensure she (and other relevant staff) have access to the CQC website, Department of Health website and other relevant websites to enable them to keep up to date with current good practice recommendations and new legislation. The registered provider should consider moving the laundry to a more accessible position or making the current one more accessible for staff. This would ensure risks associated with moving laundry to and from the current laundry are reduced. 6 31 7 38 Care Homes for Older People Page 27 of 28 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). 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