Care Home: Trentside Manor

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What the care home does well This is a small home where relationships are easily established and maintained between staff and people using the service. There is a very relaxed atmosphere, people engaging in a friendly, relaxed and positive way. We had an open discussion about the home and the changes that have been made. People told us about the major building works just completed to provide a new extension to the home. They were enthusiastic about this and have watched the building work with interest. The work has been external to the home and people said they had not been affected as the work has progressed but had watched with interest. The two visitors seen were clearly comfortable in the home, speaking to staff and people using the service. They said that they were warmly received and kept informed about their relatives progress. One relative of a fairly highly dependent person with complex needs said that he was very satisfied with the care the home provided for his mother. He had no complaints. The other visitor commented how well her mother had settled into the home after only one week, she said that staff had been very supportive and understanding in helping her settle so quickly. Staff promote good relationships with external professionals. A pro-active approach to any changes in health care are referred immediately to the GP or Nursing Service and the home have agreed direct referral routes to Physiotherapists and Occupational Therapists. There is an activities programme to suit the diverse needs of people living in the home. The range of external activities are particularly good - the home is considered part of the village community and people regularly visit the local pub and other community facilities. They are involved in social and fund-raising events providing interest, occupation and funding for outings and events to further improve quality of life. The staff training programme is good - all staff have completed NVQ training and a range of statutory and other training is readily available to all staff. What has improved since the last inspection? The planned extension is being completed and the ground floor. This will provide additional communal lounge and dining space with bathing/shower facility and 6 new en-suite bedrooms will be ready for occupation in early February once approved by our registration team. Risk assessments are now completed for those who self-medicate, although at this time there is no self-medication in the home. All people who fund their own care now have written contracts with the home, in fact others funded by the local authority are also being provided with the same contracts or `terms and conditions`. Staff training in Safeguarding has now been completed all staff. This has heightened knowledge and awareness of Safeguarding procedures including the various forms of abuse and the actions to be taken by staff in reporting suspected or actual abuse.The providers now leave a summary of their statutory monthly visits to the home, although there is ongoing daily contact and sharing of information between providers and the Manager. The already strong links with the local community have been further extended and promoted to achieve even greater social inclusion in village life. The home continue to prioritise this and seek ways of improving quality of life for people in the home. The Manager has undertaken training in the Mental Capacity Act and Deprivation of Liberty Standards. This training is being provided for other staff in January 2010. This will create awareness of capacity and the home are reviewing practices to ensure people are not deprived of their liberty in any way. What the care home could do better: There are shortfalls in several areas of medication administration. There were shortfalls at the time of the last inspection. Improvements must be made in this area to ensure people have the medication prescribed for them to ensure good health. A risk assessment must be completed for a person who smokes. This will ensure safety for the person and other people living in the home. A bedroom door closer was found to be sluggish and noisy in operation. All door closers should be maintained and replaced if necessary to ensure doors close smoothly and quietly. This is particularly important when night staff carry out their hourly checks without disturbing people in the process. All people should be weighed upon admission and monthly thereafter. If there are concerns about weight loss people should be weighed weekly. This will ensure close monitoring of health care needs. DNAR elections must be provided by the GP in consultation with the person or their representative, on the correct forms provided by the PCT - paramedics and hospital staff will not act upon any other forms. DNAR elections must also be regularly reviewed by the GP. Key inspection report Care homes for older people Name: Address: Trentside Manor Endon Road Norton Green Stoke-on-Trent Staffordshire ST6 8PA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Peter Dawson     Date: 1 1 0 1 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 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: Trentside Manor Endon Road Norton Green Stoke-on-Trent Staffordshire ST6 8PA 01782535402 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Trentside Manor Care Ltd care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 15. The number of people accommodated with a dementia related condition will not increase above the current registration of four places until such time an additional quiet lounge/therapeutic communal area is available for use. At that time the condition will be reviewed and if the facility is confirmed as available, then the number of places for people with a dementia related condition will be increased to 15 places. The registered person may provide the following categoy 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 categories: Dementia (DE) 4 Older People (OP) 15 Date of last inspection Brief description of the care home Trentside Manor provides care and accommodation for up to 15 older people. The home has registration to admit some people with dementia care needs and people with Care Homes for Older People Page 4 of 28 Over 65 0 15 4 0 0 4 0 2 2 0 0 9 Brief description of the care home a physical disability. The home changed ownership in October 2007 and new registration and new Manager appointed from that date. There was a history of noncompliance with reguirements made at inspections prior to that, but the long-standing and outstanding issues have been addressed by the new owners and Manager. The home is situated in the village of Norton Green, there is a strong community identity in the village which the home is presently taking advantage of. There are local shops, GP practice, dentist in the village that are easily accessed. Accommodation at Trenside Manor is presently on the ground floor only for residents. All bedrooms are for single use, only one has en-suite facilities but there are adequate bathroom and toilet areas located near to bedrooms and communal areas. There is a very pleasant large open garden area to the rear which has recently been cleared and with good access from the lounge area provides a good facility during the summer - the view is onto local open fields. A ground floor extension was completed in January 2010 providing additional communal space and 6 ensuite bedrooms. This was due to be approved and registered. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was a Key Inspection completed on 4th February 2009. The AQAA (Annual Quality Assurance Assessment) was completed and returned to us prior to this inspection as required. This is a legal document and is an annual selfassessment carried out by the providers of a service to quantify the outcomes for people using the service. Some information from that document is included in this report. The National Minimum Standards for Older People were used as the basis for assessing the outcomes for people in this inspection. The Inspection was carried out by one inspector on one day from 08:30 - 16:30. The Registered Manager was on duty and other staff on duty throughout the day were all Care Homes for Older People Page 6 of 28 spoken with and made contributions to the inspection. There were 15 people in residence - the maximum number. All were seen and the majority spoken with together and separately. Two visitors were seen and spoken with during the day. People told us about the high standards of care being provided at Trentside Manor and the commitment of staff in supporting people. We were able to have open discussions with people in the home and with staff. We also had private conversations with visitors. There was an inspection of the communal areas and a sample of bedrooms were also seen. Standards were good and the home was generally well presented, comfortable and homely. Records relating to the inspection process were examined including care plans, risk assessments, medication and staffing records, policies, procedures and other documents relevant to the outcomes assessed. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? The planned extension is being completed and the ground floor. This will provide additional communal lounge and dining space with bathing/shower facility and 6 new en-suite bedrooms will be ready for occupation in early February once approved by our registration team. Risk assessments are now completed for those who self-medicate, although at this time there is no self-medication in the home. All people who fund their own care now have written contracts with the home, in fact others funded by the local authority are also being provided with the same contracts or terms and conditions. Staff training in Safeguarding has now been completed all staff. This has heightened knowledge and awareness of Safeguarding procedures including the various forms of abuse and the actions to be taken by staff in reporting suspected or actual abuse. Care Homes for Older People Page 8 of 28 The providers now leave a summary of their statutory monthly visits to the home, although there is ongoing daily contact and sharing of information between providers and the Manager. The already strong links with the local community have been further extended and promoted to achieve even greater social inclusion in village life. The home continue to prioritise this and seek ways of improving quality of life for people in the home. The Manager has undertaken training in the Mental Capacity Act and Deprivation of Liberty Standards. This training is being provided for other staff in January 2010. This will create awareness of capacity and the home are reviewing practices to ensure people are not deprived of their liberty in any way. 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 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 have the information they need to judge the suitability of the home for them and pre-admission assessments and procedures ensure successful placements. Evidence: A statement of purpose and separate service users guide are available in the home. They are presented in easy-read format. Suggested additions have been made to include the service provided for people with dementia and clarification of the healthcare arrangements in place for people using the service. At the time of the last inspection we found that not all people who were self-funding had been given a written contract with the home. A sample seen on this visit showed that people funding their own care now had a contract. One person had been living at the home for 8 months and had just been given a contract. This should be provided at the point of admission. We were told that private contracts were now issued by the Care Homes for Older People Page 11 of 28 Evidence: Manager, avoiding a wait from the providers. Pre admission procedures are good. Pre admission assessments are always carried out by the home. This was evidenced in a pre admission assessment seen that gave detailed information about the holistic needs of the person. This was particularly important as the person was funding her own care and there was no multi-agency assessment available. People are informed in writing by the home that their needs can (or cannot) be met prior to admission. Where possible people visit the home prior to admission to make their own judgment about its suitability for them. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care needs are clearly defined in care plans and are met. Improvements to aspects of the medication system will ensure people have the medication prescribed to ensure good health. Evidence: We saw a sample of 3 care plans for people recently admitted and also people who have been resident for sometime. The standard of information was good, giving necessary information for staff to provide support to meet health, personal and social care needs. Improvements in care planning information have been made over the past 2 years. The format and information is good and informative. It was clear that care plans are reviewed on a monthly basis. We saw risk assessments in place relating to moving and handling, self administration of medication and some aspects of daily living. One person smokes outside the building but retains cigarettes and lighter. A risk assessment should be completed in relation to competency and risk in this instance. Care Homes for Older People Page 13 of 28 Evidence: Information relating to health care needs were clear with recorded interventions by a range of health care professionals. The home have established direct referral arrangements to Physiotherapists and Occupational Therapists. District Nurses visit twice weekly in relation to wound care for ulceration of one person and the usual monitoring of bloods. A good service and relationship with the Nursing Service was reported by the home and confirmed in discussion with the District Nursing Manager following the inspection. A person who had previous pressure damage that had been treated by the nursing service and healed, had developed a further pressure sore, noticed by staff the previous day (Sunday) and had been referred to the nursing service on that day. A nurse visited, made and assessment and advised bed-rest with regular turning to avoid pressure on her sacral area. This had been acted upon by staff. The person was in bed and turn-chart was being put into place. The person eats and drinks well but being referred to the GP for vitamin supplements. A pressure releiving cushion had been used at all times whilst seated and an overlay provided for her bed. The Nursing Service are now providing an air-flow mattress as part of treatment and prevention. This person had a recorded weight a month ago of 5 stones 1 lb. People are all weighed monthly but this person had not been weighed for 3 months later in 2009. The home were advised that this person should be weighed weekly to closely monitor her condition. We spoke with the son who visits regularly. He said that he was happy with the care being provided for his mother at Trentside Manor and was fully aware of the previous and recent tissue viability issues. He has regular discussions with the home about his mothers health and progress. We found a completed form signed by a relative in relation to a DNAR (Do Not Attempt to Resuscitate) for a person who does not have capacity. This form is superfluous DNAR elections must be on the prescribed red cards provided by the Primary Care Trust and completed by a doctor who is required to review the election regularly. Paramedics and hospitals are instructed by the PCT only to act upon elections made on the correct forms. The home will pursue this matter with the GP. We looked at the medication system in place in the home and some shortfalls were identified. There were several written entries on MAR (Medication Administration Records) sheets completed by staff. For the sake of clarity and safety it is important that where handwritten entries on MAR sheets are made, that entries are countersigned by another member of staff. These entries did not contain the prescribers instructions - Care Homes for Older People Page 14 of 28 Evidence: an example was alendronic acid given weekly, should be given with water at least 30 minutes before food. These instructions were not included in the handwritten entry. There was no count of medication, allowing an audit of the system at any time. The amounts of medication (tablets and liquid) were not printed on the MAR sheets by the Pharmacy and medication brought forward from the previous medication cycle was not recorded by staff. This must be done to provide an ongoing count of medication available at any time. The recording of variable doses of Warfarin must be more accurately defined and recorded on MAR sheets. There was one instance where a dose had been missed in one week. The home must review and implement a system for accurately recording and administering defined variable dose medication. There was some confusion and poor recording of prescribed creams. Some prescribed creams listed on MAR sheets were no longer used and had been replaced by other creams. Some creams were kept in bedrooms of ease of use. We saw a MAR chart for a cream in a bedroom that was not completed. We saw that night staff had administered creams morning and night but had been signed on the MAR sheet by day staff. There were no instructions for the use of creams. MAR sheets recorded creams as prescribed this must be addressed with the pharmacy. It is quite acceptable for creams to be stored in bedrooms (safely) and MAR sheets located there to be signed by staff, but clear instructions must be available to staff stating which creams are to be used, where, when and how often they are to be applied. Care Homes for Older People Page 15 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. People have choice and control over their lives. People are treated as individuals and they benefit from the broad range of internal and external activities available to them. Evidence: Activities have been developed in the home over the past 2 years. A member of staff works 6 hours on each of 2 days each week to lead on activities. Other staff are also involved and many give support outside their normal working hours, particularly when external activities take place. A very positive committment in this area by all staff has improved quality of life for many people. The AQAA records: We listen to what our residents want, they express their individual preferences. We identified with them that they wanted more physical stimulation and have bought air balls they use to provide gentle exercise to improve movement of limbs and also eye to hand co-ordination. We raise money for them and recently taken them on their choice of trip to Blackpool. They visit the local public house when they wish and this maintains good community links. People join in crafts, bingo. music afternoon and manicures. We are developing allotments on our own land for several people who are keen gardeners. We are still looking to promote more activities based upon individual interests Care Homes for Older People Page 16 of 28 Evidence: This statement was evidenced in discussions with people using the service, staff, visitors and from photographs displayed in the home capturing the enjoyment of people involved in both internal and external activities. Many people are from the local area and there are strong links with the local village community groups who support the home in both social events and fund raising activities. People we spoke with confirmed that the quantity and quality of food provided was good. They gave examples of choice of menu at all mealtimes. Menus demonstrated a varied and wholesome diet. People confirmed that their chosen lifestyles were known and met. At the start of the inspection (8.30 am) few people were in the dining room, most arrived later for breakfast. There was no pressure to rise and they confirmed they retired to their bedrooms when they wished, several either staying up late or retiring to their rooms to watch TV etc. We saw people freely accessing their bedroom during the day of the inspection, to rest, be alone or receive visitors. Care Homes for Older People Page 17 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. People are aware of the procedures for making complaints. Staff training and greater awareness of Safeguarding procedures means people are protected from potential abuse. Evidence: A copy of the complaints procedure is available in the home for people using the service and visitors. There is a copy of the procedure in the Service Users Guide, that all people have a copy of. No complaints have been received by the home or by us since the last inspection. This is a small home and people have access to the Manager on a daily basis and regularly with the provider, there are also meetings held in the home with people using the service - we saw minutes of those meetings and a range of topics were discussed, including the complaints procedure. At the time of the last inspection only half the staff had had training in Safeguarding Vulnerable Adults. A recommendation to provide training for all staff was made and this has now been provided. No safeguarding referrals have been made in relation to this home since the last inspection. Procedures for keeping monies on behalf of people using the service have been strengthened. The Manager or nominated person only, hold a key and all expenditure Care Homes for Older People Page 18 of 28 Evidence: certified with receipts and 2 staff signatures. There is a limit on the amounts that can be held for people. Relatives assist in handling finances for people. The finances for one person without relatives are handled by a solicitor on behalf of the person under Court of Protection arrangements. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is accessible, safe and well maintained to meet the needs of people using the service. The new extension will further enhance the space and facilities available. Evidence: Improvements to the environment have been made during the past 2-3 years by the new providers. Most areas have been redecorated and improvements and some upgrading been carried out. This has improved the general presentation of the home. The home has been limited by one large lounge area and a smaller dining area. Nevertheless the areas have been changed/rearranged to maximise their use. Plans have been in process to provide additional lounge space and some additional bedrooms. This work has recently been completed and is about to be inspected and approved by our registration team. The new build is in 2 phases - the first on the ground floor has must been completed and will provide considerably more communal space with doors leading to the large rear garden. Six additional en-suite bedrooms have been provided with assisted bathing facilities. This will further enhance the facilities and communal space available. The second phase will be to provide 10 additional bedrooms and communal space on the first floor - work due to commence in the Spring. There are plans to make much needed changes to the kitchen area with a total Care Homes for Older People Page 20 of 28 Evidence: refurbishment. This work will be carried out with oversight from the Environmental Health Office, as some disruption of catering facilities are inevitable. The intended start date for this work is February 2010. Inspection of the kitchen area during this inspection confirmed that some of this work is urgent, for example the existing flooring has gaps presenting potential infection control hazards. Standards throughout the home on this visit were generally high indicating good cleaning routines and soap/paper towel dispensers in place in bathroom and toilet areas. Hand sanitising points were also strategically placed throughout the building. We inspected a sample of bedrooms and found them to be comfortably furnished and personalised to reflect the individuality of people. Random tests of hot water outlets in a bathroom area and adjoining bedroom indicated that hot water exceeded the safe limit of 43C. The maintenance person present said that a new pump had recently been installed and was probably the cause of the high temperature. Arrangements were made on the day of the inspection for a plumber to fit a valve to reduce the hot water temperature in the next few days. This also highlights the importance of regular weekly testing of hot water outlets as there are limited numbers of fail-safe valves in place. On this visit the environment was warm, comfortable, homely and well presented to meet the needs of the people living there. Care Homes for Older People Page 21 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. People are supported by a well trained and committed staff group. Evidence: The home remains fully occupied with 15 people. Staffing levels are 3:2:2 throughout the three 24 hour shifts, plus the Manager who works during the week. This means that during the day there are generally 4 people (including the Manager) on duty. There are 2 staff on duty from 5pm - 10pm which the Manager feels is adequate to meet peoples needs. The 2 waking night staff are also adequate to meet the relatively lower demand at night time. Additionally there are catering, housekeeping and maintenance staff. There is a staff training matrix easily identifying the training undertaken and also any shortfalls. Half the staff had not had training in Safeguarding Vulnerable Adults at the time of the last inspection but all have now received this training. The Manager has attended training relating to the Mental Capacity Act and Deprivation of Liberty Safeguarding. A course is arranged for other staff to attend a similar course in January 2010 and also training in Mental Health Awareness. We looked at a sample of two staff files and found that all checks and references had been obtained prior to employment to ensure people were suitable and safe to work Care Homes for Older People Page 22 of 28 Evidence: with people in the home. There was evidence of a good induction programme and access to statutory training. In one staff file there was no photograph or evidence of (NVQ) qualification but these were being sought. Records showed that 2 monthly supervision for staff had commenced following appointment. Annual appraisals are also completed. All staff have completed NVQ training to Level 2, others were involved in or about to complete NVQ3. We were able to speak with the Senior Carer and other care staff on duty. All appeared relaxed and open. We observed good and positive engagement with people using the service in an atmosphere of friendly, supportive and sensitive care. Staff demonstrated good knowledge of peoples needs and their commitment was evident. Care Homes for Older People Page 23 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 home is well run and managed in the interests of the people living there. Evidence: The home changed ownership, with a new Registered Manager 2 years ago. The Registered Manager takes a positive lead in the home and is readily available to people using the service, staff and visitors. She is enthusiastic about the changes that have been made in the past 2 years and equally positive about changes being made for the future including the new extension and facilities. She has been studying the Registered Managers Award and is awaiting written confirmation of the award. Some staff have worked at the home for several years, some are fairly new. There is a good cross-section of staff with differing experience, qualifications and views. Staff meetings are held - we saw minutes of meetings dated February and July 2009 and were told there was a further staff meeting that the providers also attended but minutes had not been completed. Care Homes for Older People Page 24 of 28 Evidence: Minutes of residents meetings were seen, clearly indicating a range of topics that affected them, including food choices, staff, fire regulations, complaints, activities and confidentiality. The home has a system of questionnaires for visitors, these are always available in the reception are of the home and/or given to visitors at particular times. We saw 6 questionnaires that had been completed by visitors, all expressing high levels of satisfaction with the care, support and facilities being provided at Trentside Manor. The home also sends questionnaires to external professionals, but none were seen for the current year. Regular visits (at least monthly) are made to the home by the providers or their representative, this is usually weekly. We asked previously that reports on those visits should be left in the home. There is now a Directors Visits Book that is completed as a summary of those visits. The Manager confirmed that providers could be contacted by phone at any time and made mostly daily phone calls to check on the operation of the home. Improvements have been made in many outcome areas. Unfortunately the weak area is still in medication administration - and that is an important outcome area. Shortfalls were evident on the last inspection and again on this inspection. If these are addressed swiftly and permanently there is no reason why this home should not move to a 2 Star rating. Care Homes for Older People Page 25 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 26 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 2 7 8 A risk assessment should be completed for people who smoke. People should be weighed regularly and where there are concerns about weight loss, this should be weekly. Handwritten MAR sheets should be checked and countersigned to ensure accuracy and there must be an ongoing count of medication to ensure a running balance and audit of the medication in stock. The prescribers instructions must be clear and followed at all times in relation to all medication. This will ensure that people have the medication prescribed to maintain their health. Hot water outlets in resident areas must not exceed the safe limit of 43C. Weekly tests of outlets must be undertaken and actions taken if the safe limit exceeded. This will ensure people are not at risk of possible scalding. 3 9 4 9 5 25 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). 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. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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