Care Home: Trippier House

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What the care home does well The service is able to offer people a full and holistic assessment which supports them in ensuring that their diverse needs and preferences are being identified and met. The care planning process is closely linked with the assessment ensuring that people`s needs are transferred on to a plan of care that the care staff are able to interpret and put into practice. During the inspection it was identified that the staff receive the required training and that they are able and competent to do their roles. One person using the service commented that "the staff are really friendly and caring to us all". During the inspection staff were indirectly observed to be engaging with the people using the service in a respectful manner. The management of complaints and compliments ensures that there is an open culture regarding complaints and people fell able to make a complaint. One person using the service commented "I can always talk to the manager if I am unhappy about anything, she always listens". What has improved since the last inspection? Since the last inspection an number of improvements have been made to the service, this includes a refresh of the internal and external decoration. At the time of the inspection improvements were being made to a number of external windows, guttering and fascia`s. Internal works had also commenced with a number of communal areas being repainted. The AQAA tells us that the service has improved the involvement of the people using the service. This was evident as part of the care planning process, where people and their representatives are invited to become increasingly more involved. Improvements have been made to the assessment process where by each persons personal choices and preferences are more detailed ensuring that individuals cultural and diversity needs are identified and met. What the care home could do better: A number of areas of improvement have been identified as part of this inspection process and includes the needs for the service to ensure that where a risk has been identified that person centred risk assessments are implemented to meet the needs of the individual. The provision of activities within the service requires development and the displaying of menu`s so people are aware what is available for their meals on any given day. The service must review the fire risk assessment and add the location of the oxygen cylinders to the zone map and the assessment. Signs used for the location of the cylinders must illuminate, so they are visible in the event of a fire. There were a number of doors which people using the service access frequently. These doors are required to be closed at all times except for access. In order to improve access for all the service must ensure appropriate door devices are available. A number of recommendations have been made to further develop the medication systems and the service must commence in the recording of room temperatures were medication is being stored. Where a carpet has become uneven the service must seek to replace the carpet as this will cause an increase to the risk of trips and falls. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Trippier House 22 Blackthorn Avenue Greenstead Colchester Essex CO4 3PU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Louise Bushell     Date: 0 7 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Trippier House 22 Blackthorn Avenue Greenstead Colchester Essex CO4 3PU 01206860537 01206865416 trippier@southendcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Southend Care Limited Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 36 persons) Date of last inspection Brief description of the care home Trippier House is a purpose built home for older people, situated in a residential area of Colchester. Accommodation is provided on two floors, with a passenger lift providing access to the first floor. Individual accommodation is mainly in single bedrooms, with just two shared rooms. There are a variety of communal lounge areas, and a large dining room. It has appropriate aids and equipment (e.g. mobile hoist, assisted Care Homes for Older People Page 4 of 32 Over 65 36 0 Brief description of the care home bathing facilities, hand rails, through floor passenger lift, etc.) to assist residents with limited mobility. The home does not provide nursing care and is not registered to admit people with dementia; however, a few current service users have developed dementia since coming to live in the home. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspections undertaken by the Care Quality is based on outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting a number of people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The last key inspection took place on the 5th August 2009. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Care Quality Commission. We looked at the last Inspection Report and information on safeguarding and Care Homes for Older People Page 6 of 32 complaints since the last inspection. We also looked at the Annual Quality Assurance Assessment (AQAA) and reviewed what the service has improved in the last twelve months and its plans for the next twelve months. The AQAA is a document that the service must complete and is a legal requirement. During the visit information was gathered directly from the staff, people who use the service and relatives and or visitors to the service. The visit took place between 08:45am and 16:00pm. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and visitors and the manager. What the care home does well: What has improved since the last inspection? What they could do better: A number of areas of improvement have been identified as part of this inspection process and includes the needs for the service to ensure that where a risk has been identified that person centred risk assessments are implemented to meet the needs of the individual. The provision of activities within the service requires development and the displaying of menus so people are aware what is available for their meals on any given day. The service must review the fire risk assessment and add the location of the oxygen cylinders to the zone map and the assessment. Signs used for the location of the cylinders must illuminate, so they are visible in the event of a fire. There were a number of doors which people using the service access frequently. These doors are required to be closed at all times except for access. In order to improve access for all the service must ensure appropriate door devices are available. Care Homes for Older People Page 8 of 32 A number of recommendations have been made to further develop the medication systems and the service must commence in the recording of room temperatures were medication is being stored. Where a carpet has become uneven the service must seek to replace the carpet as this will cause an increase to the risk of trips and falls. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their assessed needs are being met at all times. Evidence: The admission of new people to the service aims to involve the individual as much as possible. The AQAA tells us that an in depth pre admission assessment is carried out by our experienced staff. Where possible, medication confirmation is obtained from the residents GP before admission. The Com 5 is received. A person centred care plan is written on admission. The service has sufficient policies and procedures regarding assessment of need and moving into the service. Part of the inspection process involved case tracking three people. Case tracking is a method used to review a persons care package and reviews the person from the assessment stage to the current stage in their lives, including assessments, care planning, risk management and health issues. Where possible the people case tracked Care Homes for Older People Page 11 of 32 Evidence: are also visited to gain their views directly. Indirect and direct observations also occurred in order to establish if the care being provided was as per the care plan. Three people were case tracked as part of this inspection process. The assessment process sets out each separate area of need and how the service is able to meet the needs of the individual. The service also has internal documents in place to ensure that each of the records are completed to a standardised approach, ensuring that the full needs of the person are accurately recorded. Of the three people case tracked all of the pre assessments formats were completed. Part of case tracking identified a person who had only recently moved into the service. It was observed that whilst this person had been residing in the service for over a week, that there were still some areas of the care plan to be completed. This however did not effect the outcomes for the people using the service. The pre admission assessment does explore some areas of difference and diversity and identifies the persons preferred name, religion, age, ethnic group, language, sexuality, body image and wishes in the event of death or a terminal illness. The form also explores marital status but does not prompt or identify civil ceremony and partnerships. The manager at service is new to post and has recently been reviewing the internal systems and has been pro active in identifying areas within the service where shortfalls have been found. The new management team are suitably skilled to drive for continued improvement and better outcomes for the people using the service. The care plan containing the assessment did not have any photographic evidence of who the person was. The service consults the assessment information to see if they can meet the prospective individual needs before they make the decision to accept the application for admission and offer a place. For all of the individuals case tracked, the service had received copies of the summary and care plans from the assessments carried out by social services (where applicable). For individuals who are self funding the service is able to demonstrate how they have undertaken the assessment. They are undertaken satisfactorily. Staff have the necessary specialist skills and ability to care for individuals who are admitted. Individuals are provided with a statement of terms and conditions or a contract before admission to the service. It gives basic information on what people who live in the home can expect to receive for the fee they pay, and sets out terms and conditions of occupancy. The contract is normally reviewed when the persons circumstances change. The service has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service users guide, which provides basic Care Homes for Older People Page 12 of 32 Evidence: information about the service and the specialist care the home offers. The guide is made available to individuals in a standard format. These documents, were on display within the service. A person using the service commented when I moved into the home the manager visited me to talk about the service available. My daughter also helped with the paper work. Five surveys were returned from relatives of people using the service. It is determined that the people using the service and or their representatives usually or always receive enough information in order for them to make informed choices about the service. In addition to this another person commented Although my family and I had lots of information about the home, the manager also came to visit me to do an assessment. The service does not provide intermediate care. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their medical, care and support needs are being met at all times. Evidence: The care plans of three people living at the service were read to determine how the service supports the needs identified in the persons initial assessments. All the plans seen were completed and followed a format that provided information about the persons abilities and how staff should support these. The care planning format followed the information obtained during the assessment process. Each area of need was identified in a separate care planning tool and covered items such as a safe environment, eating and drinking, personal hygiene, elimination, dressing, communication, mobility, sociability, oral / mouth care and foot care. Each of the care plans detail the identified need for the individual person followed by the individuals need and outcomes for delivery of the care and support. The care plan has a dependency profile in place which is reviewed on a monthly basis to track the improvement or deterioration of an individuals needs. On one occasion this had not been completed and this was brought to the attention of the manager. Care Homes for Older People Page 14 of 32 Evidence: Whilst the care plan then went onto explore the specific needs of the person it did not refer to any associated risk assessments with regards to the management of risks associated with the individual. Instead of individualised risk assessments the files of those people case tracked contained generic risk assessments for infection, poor nutrition and falls, however these had not been reviewed and did not contain a date of commencement of the risk assessment. One person using the service commented the girls are good fun and they are always very respectful to us. They do all they can. A relative commented that the service is good at sorting out medical needs. In addition to this a further relative commented if mishaps occur such as a fall, we are always telephoned immediately. If a doctor visits and diagnosis a problem the staff always phone and advise us. The care practices observed throughout the day were respectful and caring at all times. Overall the plans do give instruction to staff in meeting the needs of people, and from observation and discussions with people living at the home and the staff group there was evidence of knowledge of the individuals and their needs. This is further supported by the AQAA, which states a care plan based on assessment and com 5 centred on activities of daily living, staff trained in care planning. Care plans reviewed by staff each month and also home Acting Manager / Manager or signature of resident to say they were involved in their care planning. We ensure all services and equipment are brought in to meet residents assessed needs. Record in care plan body chart and pressure area completed on admission and when required. Robust reporting in care plans. Staff have personal portfolios which they carry while at work so at any one time they know the basics about every resident and know what to look for. The service maintains records that monitor peoples health and wellbeing such as regular checks on their weight and fluid intake. This provides tools that give indications of changes in the persons wellbeing which may require action by the service. The service uses a number of recognised tools to identifying deterioration in a person specific health area, which in turn alerts the service to other possible health issues associated with the deterioration. Visits made by medical professionals such as GPs or District Nurses were maintained on peoples files, and included the reason and outcome of the visit. Changes made as a result of these visits to the individuals support or medication were transferred to their care plan and medication records. This helps staff understand how the persons Care Homes for Older People Page 15 of 32 Evidence: changing medical needs are to be met. One relative commented that the service tries to give every resident what they need. Each person has individual tastes which they take into consideration. My mother in law was very poorly when she came her and eighteen months later she looks like a new person. The management of medication administration was reviewed as part of this inspection visit. This included the indirect observation of staff administering the lunchtime round, checks on documentation and discussions with staff. A number of areas were highlighted during the inspection conducted on the medication systems with the manager. Whilst in general, a sound system is in place a number of minor areas have been identified where improvements would achieve better outcomes for the people suing the service. . The shortfalls included the bottles and boxs that were in use did not have a date of opening on them, no temperatures were taken where medication was being stored, hand written entries on the Medication Administration Record had not been double signed and there were no tools available to safely count medication to manage the stock and audit the balances. Care staff are the people applying peoples creams as prescribed but the MAR did not show that this had been administered as the staff had not signed. The manager stated that the care staff add this information to the daily records. It was discussed with the manager how this process could be stream lined and consistent showing actual administration in the persons best interest. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service do not always have their prefernces of activity taken account of. Evidence: Generally staff are aware of the need to support people to develop their skills, including social, emotional, communication, and independent living skills. Some people are consulted or listened to regarding the choice of daily activity, but this process could be improved. The service does not currently provide any specifically allocated activity hours and this is covered by the care staff and external entertainers visiting the service. People using the service are given the opportunity to take part in a number of activities both within the service. Where possible, staff gather information on community-based events and try to make individual arrangements for people to attend. However due to the number of people residing at the service, the frequency of community base trips is minimal. The service has an activity programme however at the time of the inspection this was not available and was not on display. The service benefits from a number of small separate lounges, where people sit Care Homes for Older People Page 17 of 32 Evidence: together. During the inspection time was spent observing and chatting with individuals in each of these communal spaces. It was directly observed that acre staff were engaging well and respectfully with individuals however on a number of occasions the people using the service were not attended to for periods of up to fifteen minutes. Some people using the service were unable to move to raise any call bell alarms in the lounge were they were residing and therefore had to wait for a staff member to enter the room to gain their attention. The service has a basic understanding of human rights and how this impacts on people using the service. There is little documentary evidence to support this approach, but staff were directly observed to be respecting and dignifying personal choices and opinions. The service does not document on the person care file restrictions that are imposed upon the person. The initial assessments held on the persons care plan detailed references to a persons life style and interest. The plan also details a section where information is obtained regarding the persons family, working life and what the individual enjoys. There were care plans relating to the social needs of people there were not specific details of how the assessed needs and abilities of people shaped their choices and how staff should support these. Care plans contained an activity sheet used by staff to record the activities which people had participated in. The records although completed were at times rather sparse. One entry sheet showed that a person was engaged in an activity on the 31st July 2009 however no further entries of engaging or refusal had been made since that date. Discussions occurred with the manager regarding this. People using the service stated that they felt they were given opportunities to exercise choices during their day. One person spoke about how they enjoyed spending time in their room and actively chose not to take part in activities provided or outings. They felt that this was respected although staff never forgot to offer the opportunity to take part. One person using the service commented the staff are friendly and very respectful, they do all they can. In addition to this a further individual commented there is chair aerobics, but I dont like to take part, they do sometimes do quizzes in the dining room. It was observed that a number of the television aerials in the small lounges were not digital and therefore the signal was not suitable to obtain a clear picture on the screen. This did not meet peoples needs. One person using the service stated I can only watch number one and there is no Sky sports either. A further person using the service commented we dont get to do much at all really. Care Homes for Older People Page 18 of 32 Evidence: Another person spoke about the choice of meals and felt confident that if they chose something else from the offered menu this would be not be a problem, they said the food has been alright really and we are asked what choices we would like daily. The menu is planned in advance and people are asked for their choice for the following days meals. The menu includes at least two choices at each meal and provides a nutritious and balanced diet. The inspector sampled the food during the inspection and found it to be well presented and tasty. The observation of the lunchtime meal indicated that there was generally a congenial atmosphere where people were given time to eat in a relaxed manner. The staff moved around the dining room serving the meal, encouraging people to eat and offering assistance if required. There were no menus in display on the tables or around the service. A number of people were asked what was for lunch and many replies were received stating that they did not know. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they are safe and supported in order to ensure that they are suitably protected from harm. Evidence: The service has an open culture that allows people to express their views and concerns in a safe and understanding environment. Individuals and others involved with the service say that they are happy with the service provided, feel safe and well supported by an organisation which has their protection and safety as a priority. One person using the service commented I dont like to make complaints, but if I was unhappy I would always speak to the staff. The staff are very kind. The service has a complaints procedure that is clearly written and easy to understand. The procedure is available to in the Statement of Purpose and is on display in the foyer of the building. The AQAA tells us that the service has received four complaints in the last twelve months and it reports that all of these of these have been managed within a twenty eight day period. Individuals and others involved with the service understand how to make a complaint and are clear about what will happen if a complaint is made. The service keeps a full record of complaints and this includes details of the investigation and any actions taken. Unless there are exceptional circumstances the service always responds within the agreed timescale. The manager has responded in the AQAA that the service learns Care Homes for Older People Page 20 of 32 Evidence: from complaints made and the AQAA has detailed that all complaints are recorded and the outcome of each complaint completed. This is kept on file in the main office. Staff training includes safeguarding of vulnerable adults training to ensure the well being and safety of all residents. Whistle Blowing procedure in place and staff made aware. We carryout an in-depth pre admission assessment and medical history from their GPs before residents come into Trippier. Complaints referred to Operations Manager who investigates and reports back. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff working at the service know when incidents need external input and who to refer the incident to. We spoke to three staff as part of the inspection process. All three staff understood what action to take to safeguard people using the service. One staff member commented my induction was over three to five days and I shadowed a trained staff member. Team work is pretty good and really working well. There is a clear system for staff to report concerns about colleagues and managers. Staff confirmed that they are aware of how to report bad practice and one staff member stated I can talk to the manager if there are any problems. The service understands the procedures for safeguarding adults and will always attend meetings or provide information to external agencies when requested. There have not been any referrals made to the safeguarding adults team. Training of staff in safeguarding is regularly arranged by the service and the manager reported on the day of the inspection that a further training session on safeguarding adults is scheduled. The Commission monitors the outcomes of safeguarding referrals and considers how the findings of any investigation indicate the services compliance with the Care Homes Regulations 2001. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to relax and be cared for in an environment suitable to meet their communal and individual needs. Evidence: The service provides a physical environment that is appropriate to the specific needs of the people who live there. The environment provides specialist aids and equipment to meet their needs. The home is a pleasant, homely, safe place to live and the bedrooms and communal rooms meet the NMS or are larger. All bedrooms that were seen, were personalised to the individuals own taste. All the services fixtures and fittings meet the needs of individuals and can be changed if their needs change. One person using the service commented I am very pleased with my room, its quite spacious. In addition to this one person commented I enjoy going to my nice room. The lay out of the service attempts to encourage people to socialise and engage in small clusters rather than all in one area. The service has many different seating areas available with books available to all. The design of the building allows people to move freely throughout with a lift available to move between floors. The environment promotes the privacy, dignity and autonomy of people. This was directly observed during the inspection, where people where seen to be supported to their rooms for personal care and support tasks. Staff were also seen to knock an wait on bedroom and bathroom doors. Care Homes for Older People Page 22 of 32 Evidence: The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who use the service, and are in sufficient numbers. The service is well lit, clean and tidy and smells fresh. The management has a good infection control policy. They seek advice from external specialists, such as NHS infection control staff, and encourage their own staff to work to the services policy to reduce the risk of infection. Discussions occurred with a member of staff working in the laundry. The member of staff confirmed the completion of an Infection Control course and discussed the management of soiled laundry. Gloves and aprons were being used and were visible throughout the building with easy access at all times. The AQAA tells us that the home is always clean and tidy, lounges have been decluttered, weekly homes check for domestics and a weekly homes check for maintenance. Internal and external redecoration was occurring at the time of the inspection. It was noted that the lounge carpet in the Daisy lounge requires replacing as this is a potential trip hazard. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their needs will be met by a trained and competent work force, keeping them safe. Evidence: People are generally satisfied that the care they receive to meet their needs. One person using the service stated I like the staff they are kind and caring. The manager confirmed that they are in the process recruiting new staff. In addition to this the manager is supernumerary. In addition, there are catering, housekeeping and maintenance staff. The manager stated that the numbers of staff required are arrived at by a calculation of individuals needs, discussions with staff about how they work with people living at the service and an allowance of time for the tasks to be undertaken. The rota was also arranged to provide increased staffing levels for the periods where people living at the home require the most support from staff such as early in the morning when people wanted to get up and late in the day when people wanted to go to bed. The recruitment records of the three staff contained documents that supported the Care Homes for Older People Page 24 of 32 Evidence: employment of people who were suitable to work with vulnerable adults. This included full application forms, references, proof of their identify and CRB checks. In each case the staff had commenced their employment with a POVA first request while the full CRB report was waited for. Discussions with staff verified that they undertook a robust recruitment process and were asked to provide supporting documents before they were offered a post. Staff members that completed a survey told us that their employer carried out pre employment checks. The training programme included items such as health and safety, food hygiene, fire safety and manual handling as having being completed so far this year. Further scheduled training included medication, infection control and safeguarding. Staff spoken with said they had enjoyed the training they participated in and felt that there was plenty of training on offer. The AQAA tells us that we have a training programme for Senior staff. We are very much a team of staff who work well together in a friendly atmosphere within the home. We no longer have the need for agency staff on a regular basis as we have been pro-active in recruitment. There are enough qualified, competent and experienced staff to meet the health and welfare of people using the service. Staffing rotas take into account the needs and routines of the people using the service. All staff are clear regarding their role and what is expected of them. People using the service report that staff working with them know what they are meant to do, and that they meet their individual needs in a way that they are satisfied with. One relative commented to me a care home is only as good as the staff make it. I have nothing but praise for the staff there. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a service that is well managed and where systems are in place to keep them safe and protected from harm. Evidence: The service focuses on the individual, takes a basic account of equality and diversity issues, and works in partnership with families or close friends, as appropriate, and professionals. The service has a Statement of Purpose that sets out the aims and objectives of the service. The management team have already identified a number of shortfalls within the service and has shown a pro active approach to its review and implementation. The management team discussed the ways it will be improving and developing systems that monitors practice and compliance with the care plans, policies and procedures of the service. Staff spoken with during the inspection spoke highly of the manager. They said they felt supported by the management team and knew that they could speak to them at any time. This was endorsed by the people who live at the service, who said that they Care Homes for Older People Page 26 of 32 Evidence: thought the service was well run and that they knew they could speak to the manager at any time. The manager reported that the consistent provision of staff supervision had been achieved. There are arrangements in place to spread line management supervision responsibilities across the senior staff. This is further supported by the completed AQAA which states we all work well as a team. Acting Manager attends handovers most mornings and afternoon shift changes and meal times. The Manager keeps files and records up to-date. One to one supervisions with all staff to ensure standards are met at all times. The service has a quality assurance system in operation that consists of the consultation of people who live at the home and their families through the distribution of surveys at the end of the calendar year. The manager reported that they are awaiting a return of the recent report from surveys. Discussions occurred with the management team regarding the quality assurance system place and how they intend to report the findings back to the people that use the service and their families, friends or representatives. The service held certificates in relation to the safe operation and maintenance of equipment according their legislative responsibilities. The certificates that demonstrated this were considered at this inspection and included electrical installation, gas safety soundness test, lift maintenance, moving and handling hoists, water regulations, portable appliance testing, fire extinguishers and emergency lights and fire alarms. The service carries out monthly visual check of the fire safety systems and there was a fire risk assessment in place. The records included the monitoring of staff attendance at fire drills. It was observed that the service uses and stores oxygen to meet the needs of a number of individuals. Although there are paper signs on display within the service these would not illuminate in the event of a fire. The fire risk assessment in place has been reviewed, however this does not show the location of the oxygen cylinders. This was brought to the attention of the manager. Further discussions occurred regarding people using the service, accessing doors that are to remain closed at all times. A number of doors throughout the building did not have automatic door closures or door guards fitted. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments must be in 30/10/2009 place where a need has been identified. To ensure that appropriate risks have been identified and control measures put into place to support and or protect the person using the service at all times. 2 9 13 Room temperatures must be 15/10/2009 taken where medication is being stored. To ensure that all medication is being stored in line with the manufactures guidelines. 3 12 16 Structured activity must be provided for people using the service. To ensure that the social needs of the people using the service are consistently met. 09/11/2009 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 19 23 Replacement of any carpets that have lifted must occur. To ensure that appropriate action has been taken to minimise the risk of trips and falls. 30/10/2009 5 38 13 Signs used to locate oxygen cylinders must illuminate. To ensure that in the event of a fire they are easily detectable. 30/10/2009 6 38 13 Fire doors that need to be kept open to aid free access by people who use the service must be fitted with closing devices for use during emergencies. To ensure that people using the service are supported to move freely but are protected in the event of a fire. 30/10/2009 7 38 13 The location of oxygen cylinders must be noted within the fire risk assessment and the zone maps. To ensure that the location of the cylinders is known in an event of a fire. 30/10/2009 Care Homes for Older People Page 30 of 32 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 3 4 5 6 7 3 9 9 9 12 12 15 Photographs should be taken and held on a persons care file. Hand written entries on the Medication Administration Record should be double signed. Date of opening should be added to all bottles, boxs and containers. A pill counter should be purchased. The service should consider providing additional television channels. The service should provide suitable airal transmition reception to all televisions. The service should consider providing and displaying menus on tables. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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