Care Home: Tudor House Residential Home

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What the care home does well The home provides a relaxed, comfortable and friendly atmosphere where people are treated with respect and in a dignified way. The home makes every effort to provide people with good care to meet their assessed needs following a care plan. The home has a good key worker system and staff supervision system in place. The home communicates well with the families, friends and representatives of people who use the service and welcomes visitors. People who use the service say they are happy and content with living in a homely and caring place. The comments we received via completed surveys included: "The staff look after residents very well, keep residents very clean and very kind to residents". "Everything that I have witnessed up to date is carried out with care and regard to the residents` well being". People who use the service are often vulnerable both physically and emotionally and the Registered Provider and the Registered Manager ensure that staff recruited have the ability to carry out personal care services for people sensitively and tactfully. The recruitment of good caring staff is critical to the running of care homes and the Registered Provider and the Registered Manager at Tudor House undertake this carefully. The home has a good staff training and development programme in place. A majority of staff have received mandatory training in safe working practice topics, safe handling of medication, Adult Protection and safeguarding issues and National Vocational Qualification (NVQ) Level 2. Thus this training will ensure that the staff have improved their knowledge and skills to meet the changing needs of people who use the service. The home provides good standard of accommodation and facilities for people using the service. What has improved since the last inspection? People commented that: "Lots of recent improvements to decor and fittings and I am pleased that all looks good"". "The facilities and the care provided by management and staff is far superior than previous years". The home has an experienced Registered Manager in post and she is managing the care home well. Conversations with staff, people using the service and their visiting relatives, indicated that the Registered Manager is service user focused, leads and supports an enhanced staff team providing them with improved training andsupervision. This style and approach to management aims to pursue future improvements in all aspects of service. One person who lives at the home stated that "This place is a lot more peaceful and better organised now". The home has made some good improvements in their record keeping and care planning. Care Plans seen for people who use the service were informative and gave good indication of how care is to be delivered for each of them. Medication practices have improved and more senior staff have received training in safe handling of medication. The home has organised staff training on Dementia care. A majority of staff have received training in safe working practice topics, abuse awareness and adult protection and that will enable them to expand their knowledge and skills and enhance the care they give to people using the service. What the care home could do better: The home should continue to improve further the detail and quality of daily care recordings. Those members of staff who as yet have not received training in safe working practice topics, including infection control, safe handling of medication, Dementia care, National Vocational Qualification (NVQ) Level 2, Adult Protection and safeguarding issues must do so as a matter of priority. This training would enable staff to improve further their care practices, knowledge and skills. The AQAA submitted at the end of this visit by the Registered Manager stated that "Our service provides a safe caring environment where our serviceusers remain happy and content. We will continue to monitor, assess and update, with ongoing training for all staff". Inspecting for better lives Key inspection report Care homes for older people Name: Address: Tudor House Residential Home Tudor House 6 Park Crescent West Park Wolverhampton West Midlands WV1 4PY     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: Bhag Jassal     Date: 0 9 0 4 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 30 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 30 Information about the care home Name of care home: Address: Tudor House Residential Home 6 Park Crescent Tudor House West Park Wolverhampton West Midlands WV1 4PY 01902429008 01902832709 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Aurora McGarrigle care home 9 Number of places (if applicable): Under 65 Over 65 9 old age, not falling within any other category Additional conditions: 0 Maximum number of residents - 9 persons (OP) category, females over 60 years and males over 65 years of age. Date of last inspection Brief description of the care home Tudor House is a nine - bedded care home currently registered for older people. The home is a three storey Victorian building with parking facilities to the front of the building and a small paved patio to the rear. It is located near the centre of Wolverhampton, close to shops, West park and bus routes. The three - storey building currently has a lounge, dining room, kitchen, two toilets, two bedrooms and a bathroom on the ground floor, with the remaining bedrooms on the first floor along with a toilet and bathroom. The second floor has a small flat that is now being used as office space. Tudor House make their services known to prospective service users in: the Statement of Purpose and service user guide. Care Homes for Older People Page 4 of 30 Brief description of the care home The inspection report is mentioned in these documents and is available in the home. Tudor Houses rates are reviewed annually on 1st April each year and people who use the service are notified one month in advance. The only additional charges to service users are for hairdressing, newspapers and private chiropody appointments. This is clearly laid out in the terms and conditions. Fees for care as of 1st April 2008 are: £353.00 per week. All service users pay monthly by standing order or by cheque. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 Star. This means the people who use the service experience good quality outcomes. This report is on a Key Inspection, part of which included an unannounced visit undertaken on 9th April 2009. This unannounced visit started at 08:45 and lasted 7 hours and 55 minutes. The home had all 9 places occupied. The judgements made within this report are based upon information supplied by the home, from interviews with staff, people who use the service and their relatives. During the course of inspection the assessment information and care plans were case tracked for 3 people who use the service. Medication administration was checked. Staff Care Homes for Older People Page 6 of 30 records were seen to check staff rotas, recruitment procedures and training. Various documents were seen in order to check compliance with health and safety legislation. A tour of premises was also undertaken, and care practices and interaction between staff and people who use the service were observed. Discussions took place with several members of staff on duty and several people using the service and two visiting relatives were spoken to throughout the day of inspection. The Registered Manager - Ms Juliet Douglas was present throughout the Inspection. On this occasion all the key Standards of the National Minimum Standards were assessed - that is those areas of service delivery that are considered essential to the running of a care home. Regulation 37 Notifications, concerns and complaints against the home, and Regulation 26 reports received from the care home and an Annual Quality Assurance Assessment (AQAA), which had been completed by the Registered Manager and submitted to the Commission for Social Care Inspection (CSCI) towards the end of this inspection, offering an overview of the home were considered and discussed with the Registered Manager. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was sent to the home for completion. The AQAA is a self - assessment and a dataset that is filled in once a year by all Registered Providers. It informs us about how Registered Providers are meeting outcomes for people using their service and is an opportunity for Registered Providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed. Tudor House did not return their fully completed AQAA to CSCI within the given timescale. Information within this document demonstrates that the Registered Manager recognises the strengths and weaknesses within the service and are able to plan for improvement. The AQAA provided information to supplement the inspection. We wish to thank the Registered Manager, the staff, people using the service and their relatives for their assistance and co-operation on the day of inspection. What the care home does well: What has improved since the last inspection? People commented that: Lots of recent improvements to decor and fittings and I am pleased that all looks good. The facilities and the care provided by management and staff is far superior than previous years. The home has an experienced Registered Manager in post and she is managing the care home well. Conversations with staff, people using the service and their visiting relatives, indicated that the Registered Manager is service user focused, leads and supports an enhanced staff team providing them with improved training and Care Homes for Older People Page 8 of 30 supervision. This style and approach to management aims to pursue future improvements in all aspects of service. One person who lives at the home stated that This place is a lot more peaceful and better organised now. The home has made some good improvements in their record keeping and care planning. Care Plans seen for people who use the service were informative and gave good indication of how care is to be delivered for each of them. Medication practices have improved and more senior staff have received training in safe handling of medication. The home has organised staff training on Dementia care. A majority of staff have received training in safe working practice topics, abuse awareness and adult protection and that will enable them to expand their knowledge and skills and enhance the care they give to people using the service. 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 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 30 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 30 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. Everyone receives a full assessment prior to admission to the home to make sure that their care needs can be met. Evidence: Tudor House - care home provides detailed and clear information, in the form of a Service Users Guide, to people who will be using the service and their families to enable them to make decisions about whether or not to live at the home. Admissions are not made to the care home until a full assessment has been undertaken. The home is then able to confirm that they can meet the needs of the individual through the service they deliver as detailed in the Statement of Purpose. For people who are self funding and without a care management assessment, they always receive assessment by the Registered Manager. 3 files and care plans of people who use the service were inspected, which contained Care Homes for Older People Page 11 of 30 Evidence: pre -admission assessments of their needs, both from assessments by the homes senior staff and other relevant professionals. Observations and discussions with people using the service, their visiting relatives, the Registered Manager, and staff on duty indicated that the home continues to meet the needs of older people in a satisfactory and sensitive manner. One relative stated in the returned survey that As it is a small home, I feel it suits my mums needs very well, all the staff are very friendly. It was noted from the staff training records that a number of staff have undertaken their training in Dementia care and adult protection and safeguarding issues. The home does not provide a service for those assessed and referred solely for intermediate care, who require help to maximise their independence and return home. Care Homes for Older People Page 12 of 30 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 who use the service have individual plans of care, which ensures that their personal, healthcare and social needs can be met. Medication is administered and stored in a manner that safeguards everyone using the service. People who use the service are treated with respect and dignity and their right to privacy is understood and upheld. Evidence: People who use the service undergo an assessment of their needs prior to admission to the care home. A Care Plan is produced, which is based on the assessment of needs. The home operates a good key worker system, which helps to ensure that the recommendations arising from the care plan reviews are implemented. Three Care Plans of people using the service were inspected and examined in detail. There was evidence to show that the short - term goals and long - term goals, aims and objectives were clearly identified and appropriate interventions required to meet the individual needs of people who use the service were also identified. However, the home needs to improve further the detail and quality of daily care recording. The Care Homes for Older People Page 13 of 30 Evidence: Registered Manager stated that care staff will be closely supervised and supported to achieve this Discussion with people who use the service showed that the home has a good ethos of involving them in all aspects of their life and runing the home. The care plans that were read were clearly written and included an element of risk assessment. Information from the initial assessments had been written into plans of care. The care plans are reviewed on a monthly basis by senior staff. Care Plans demonstrated that the staff actively promoted the rights of people who use the service of access to the health services both within the home and the community. Appointments are planned or arrangements are made for professionals to visit frail people using the service. Whenever possible continuity of care for the declining state of health of people who use the service is assured. District Nurses are called upon to assist with clinical help, equipment and advice where necessary. The Registered Manager promotes the key worker system so that relationships between staff and individuals are enhanced. Visitors are able to meet people using the service in their bedrooms, and in the lounge on the ground floor. It was observed that people who use the service were being treated with respect and staff were working both professionally and sensitively in meeting individual needs. One relatives stated in a returned survey that Tudor House staff have always given love and care to their residents and provide a caring family atmosphere. We spoke at length with several people using the service and all of them commented positively about their care and felt they have everything that they need. Four people who use the service stated that The carers are very good and kind and they look after us very well. Three other people who use the service said The carers are always there to help us. Generally people who use the service appeared to be content and comfortable. They were complimentary regarding the quality of their lives and care they were receiving at Tudor House - care home. There are appropriate policies and procedures in place for the administration of medication. It was noted that the care plans contained a list of current medication. The Registered Manager stated that reviews are carried out on a regular basis of all the care plans to ensure that medication details are up to date. Appropriate records are kept of all medicines received, administered and leaving the home. Random sample of medication and administration sheets were seen at the inspection and there were no Care Homes for Older People Page 14 of 30 Evidence: discrepancies. All the medicines are stored in the medication cupboard and kept under lock and key. Daily checks are taken of the temperature of the medicines in the refrigerator. There are no controlled drugs used at present by any service user at the care home. However, if there is a need to store such drugs securely and safely in a lockable metal cupboard, which is available in the Registered Managers office. Medication rounds were observed during the inspection Senior staff were seen to administer and record when medicines had been given. The Registered Manager stated that all senior staff responsible for administering medication were appropriately trained in safe handling of medication. Care Homes for Older People Page 15 of 30 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 who use the service are able to exercise choice with regard to social and leisure activities at the home. Activities provided meet the needs of the people using the service. Relatives and friends are encouraged and assisted to maintain contact with the people using the service. The food at the home is of good quality and choices are always available. Evidence: The home provides an activities programme in accordance with everyone using the service, their choices, preferences and capacities in relation to social, leisure and cultural interests. People using the service, who were able to give opinion, were very complimentary about the activities provided, and particularly the external entertainers. People who use the service are enabled to enjoy a full and stimulating life style with a variety of options to choose from. A record of activities participated in is kept and photographs of major events displayed in the home. People using the service were seen sitting in the lounge chatting to staff and visiting relatives. Two people who use the service stated that they preferred to sometimes sit quietly in their bedrooms and the staff respected this. After lunch time a number of Care Homes for Older People Page 16 of 30 Evidence: people who use the service were engaged in playing different games or watching television. The homes AQAA stated that The home organises entertainment delivered by external entertainers, craftwork, music and exercise. There have been several outings i.e. West Park, Sea Life Centre, shopping at local ASDA superstore, and NewBridge Pub lunches and also outings with the family members. However, a relative stated in a returned survey that Perhaps there should be more activities for residents for stimulation. Several people using the service spoken to stated that they were in regular contact with their family members and friends, and spoke about their visitors involvement and interest in their care matters. The visitors book kept in the home showed a considerable activity. People who use the service also keep contacts with the local community, for example, church services, pubs, shops and park. Four people who use the service told us that they are happy with the care and social activities offered by the care home. They further added The home provides a good service and the staff are very caring and they are pleasant. The home also provides a variety of indoor activities, including festive and birthday parties, bingo, dominoes, ball games, skittles, karake games and music movements and film DVDs. The Registered Manager stated that the people who use the service were positively encouraged and helped to exercise their choices, and control over their lives and daily living, subject to risk assessments in terms of safety, security and capacity to make certain decisions. The Registered Manager also stated that a close liaison is maintained with the relatives and representatives, where the people using the service are not able to make certain decisions. The relatives of people using the service and their representatives are informed of the availability of Advocacy Service based at the local Age Concern. The information about the Advocacy Service is included in the homes Statement of Purpose and Service UsersGuide. Several people who use the service told us The home is very good and its peace and quiet here. The food was very nice well cooked and tasty. The consensus of people using the service was the range, quality and choice of food provided was very good and the home catered for those people using the service, who have individual preferences and medical needs. The registered Manager stated that the menu is changed regularly in consultation with the people who use the service. This is usually done in accordance with seasonal changes as well. The kitchen is well equipped and kept clean and tidy. The Environmental Health Officers inspection report dated 13th March 2009 identified some issues, which the Registered Provider is appropriately addressing. The staff are trained in food safety and hygiene matters. Care Homes for Older People Page 17 of 30 Care Homes for Older People Page 18 of 30 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. There is clear Complaints Procedure in place, a copy of which is made available to people who use the service and their relatives. This should ensure that any complaints made are listened to and acted upon. The home has an Adult Protection policy and procedure in place to protect people who use the service from all forms of abuse. Evidence: The home has a good Complaints Procedure in place, which is referred to in the homes Service Users Guide and in the Statement of purpose. There is a system of recording concerns and complaints. The AQAA completed by the Registered Manager states We have a comprehensive complaints procedure and ensure that all service users and their families are aware of how to make a complaint. Our complaints procedure and procedures for dealing with abuse are highlighted in the Service Users Guide, which is issued on admission. The Commission for Social Care Inspection (CSCI) has not received any complaint about the care home and there was no adult protection or safeguarding referral made during the last 12 months. People, who use the service, when asked, were certain of how to formally make a complaint but they said they would quite happily talk to one of the staff or the Manager. Care Homes for Older People Page 19 of 30 Evidence: The home has good policies and procedures in place regarding restraint, dealing with aggressive behaviour and prevention of abuse, which includes whistle - blowing policy. The Registered Manager stated that adult protection issues are discussed during induction training and supervision meetings. The Registered Manager stated that the staff will be receiving formal training in protection of vulnerable adults and safegurading issues and Mental Capacity Act 2005 shortly. She also stated that trainers are being approached to set up this training. Several people who use the service stated they are satisfied with the service provision, feel safe and well supported by staff that have their protection and safety as a priority. Care Homes for Older People Page 20 of 30 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 standard of the environment is good providing a homely, clean and secure place to live. Evidence: The home offers a comfortable and well - maintained environment to all people who use the service. The home has ample communal space - a lounge and a dining room. The home has a rolling programme of redecoration to maintain good standards. The small garden and patio areas are well - maintained. The home has provided suitable aids and adaptations in the home to meet the general and specific needs of all the people using the service. There are adequate numbers of bathrooms and WCs in the home. It was noted that the bedrooms are personalised by most of the people using the service. During the day of inspection, the home was found to be clean, tidy and free from any unpleasant odour. The AQAA completed by the Registered Manager states that, Carpets in the lounge and dining room are in need of changing. Six bedrooms have been refurbished. However, during the tour of the premises we identified the following issues :That the hot water supply in a number of bedrooms hot water outlets was noted to be inconsistent and it was either below 35 Degrees C or between 40 Degrees C to 45 Care Homes for Older People Page 21 of 30 Evidence: Degrees C. This needs rectifying as a matter of priority to ensure the safety of people who use the service. That the self - closure mechanism fitted on several bedroom doors in need of adjusting to ensure that the doors fully close to their rebate. This is to ensure the safety of all people using the service. That the cracked ceiling in bedroom 3 is in need of repair; and lights above the mirrors in a number of bedrooms were not in working order and need to rectify these as a matter of priority for the safety of people who use the service; and the carpet in bedroom need thorough cleaning. The home has good policies and procedures in place regarding infection control. However, it was noted from the staff training records that a majority of staff have not undertaken training in infection controlyet, but will do so shortly and as a matter of priority. It was noted that all staff received induction training and they are made aware of the dangers of cross - infection. Care Homes for Older People Page 22 of 30 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. Tudor House - care home is staffed by well-trained and experienced staff to meet the needs of people who use the service. There are robust recruitment procedures in place to protect people who use the service. There is a good training programme in place that ensures staff are competent to do their jobs. New members of receive structured induction training. Evidence: Information provided by the home and available staff rotas for the months of March and April 2009 indicated that the home has sufficient care staff to meet the needs of 9 people using the service at present. There is deputy manager or Registered Manager and two carers on duty in the morning and deputy manager and one carer or just two carers on duty in the afternoon shift. Two carers are on wakeful night duty and a senior member of staff on - call. The Registered Managers hours are not supernumerary. There is no ancillary staff employed in the home to cover catering, cleaning and laundry duties throughout the week. However, it was noted that the carers are expected to undertake these duties in addition to their caring duties, and also one of Care Homes for Older People Page 23 of 30 Evidence: the members of staff on the morning and afternoon shifts have to go into the kitchen and prepare lunch and evening tea. The Registered Manager stated that she will discuss this kitchen and cleaning staff matters with the Registered Provider with the view to getting dedicated members of staff to undertake the catering duties at the lunch and evening teatimes. By doing so, this will enable allocated care staff to remain with and supervise the service users to ensure their welfare and safety is maintained at all times. The Registered Manager also stated that a vacant post of carer (30 hours per week) is to be filled shortly. The AQAA completed by the Registered Manager states that We could employ a domestic staff person for short shift each day. The staff training records showed that a majority of staff have completed their NVQ Level 2 qualification and some members of staff have also completed their NVQ Level 3 training. The home does not employ Agency staff. The staff team is a well - balanced group in terms of age, experience, gender and ethnicity. Four staff files were examined in detail in order to check compliance with the recruitment requirements. All four files contained copies of two written references, and a full employment history. There was evidence on staff files that all four had been subject to satisfactory Criminal Records Bureau (CRB) and (Protection of Vulnerable Adults) POVA checks prior to being appointed. There was evidence on files that staff have received the statements of their terms and conditions of employment. There is a staff training and development programme in place. In addition to the mandatory training (see NMS OP38) staff also would benefit from training in adult protection and safeguarding issues, Mental Capacity Act 2005, equality and diversity, and physical aggression and challenging behaviours. Staff confirmed that training is provided and there are many opportunities to improve themselves for the benefit of the care of people using the service. All new staff received their induction training in accordance with the Skills for Care standards and specifications. People who use the service commented that they feel safe with staff caring for them and they felt that the home employs people that are capable of carrying out their care duties. One relative stated in a returned survey that My mum said the carers are always kind and friendly towards her and me when I visit my mum. All families say how kind and friendly they are. Care Homes for Older People Page 24 of 30 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. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the home is run in their interests. Financial interests of people using the service are safeguarded. The home promotes the health, safety and welfare of people who use the service. Evidence: Tudor House care home has an experienced and well trained Registered Manager in post. Ms Juliet Douglas has completed her Registered Managers Award and NVQ Level 4 in care qualification. She appears to be managing the home well. There are clear lines of accountability within the home and the Registered Manager is well supported by the Registered Provider. The home has a formal staff supervision system in place, and Ms Douglas is implementing the system of supervision of staff and meetings both with staff and people using the service. Observations made and discussions with people who use the service and their relatives Care Homes for Older People Page 25 of 30 Evidence: and staff have indicated that the Registered Manager is very approachable and she operates an open door policy. People who use the service, who could express themselves stated that they are happy to approach the manager and staff with any problems they might have and were confident that they would respond to them appropriately. Equality and diversity for people who use the service were seen to be promoted throughout the home within the assessments, care plans and activities. Equality for staff is promoted through the opportunities for training at all levels. The home has a Quality Assurance monitoring system in place. Quality Assurance takes place throughout the service in both a formal and informal manner. Meetings and day to day contacts all provide records to show that satisfaction is at the heart of the service for people who use the service. Surveys for the year 2009 have been carried out and a report on the result of the feedback from people who use the service and their relatives will be prepared and made available in the home by the end of May 2009. In addition, the stakeholders survey will also be carried out and the feedback result will also be analysed and a report will be made available in the home. The copies of reports of visits made to the service by the Registered Provider under Regulation 26 of the Care Homes Regulations 2001 should be made available in the home and for inspection by the Care Quality Commission. The home does not get involved the management of financial affairs of people who use the service and therefore actively encourages people using the service or their relatives to manage their monies. The home keeps records to show that health and safety of people who use the service is promoted and protected. It was noted that the hot water supply in several hot water outlets was inconsistent and must be maintained at the recommended level of hot water temperature of close to 43 Degrees C at all times to ensure the safety of people who use the service. Several self - closure devices fitted on the bedroom doors were in need of checking and appropriately adjusting to ensure they close properly to their rebate to protect people using the service from the risks of fire. The Registered Manager stated that this matter will be addressed immediately. The Registered Manager also stated that the issues identified in the Fire Safety Officers inspection report dated 30th May 2008 are being addressed by the Registered Provider. The staff training records showed that a majority of staff have received their mandatory training in safe working practice topics, e.g. moving and handling, food hygiene, first aid, health and safety, infection control and fire safety. The Registered Manager stated that all those members of staff who as yet have not received this Care Homes for Older People Page 26 of 30 Evidence: mode of training will do so shortly. They will also receive training in Adult Protection and safeguarding issues, safe handling of medication, Infection Control, NVQ Level 2, Mental Capacity Act 2005 and Dementia care. People who use the service spoken with were very complimentary about the Registered Manager and staff in the home. Many of them knew who they were by name and looked at ease in their presence. Care Homes for Older People Page 27 of 30 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 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 It is recommended that the Registered Manager takes appropriate action to further improve the detail and quality of daily care recording in order to ensure that the staff are aware of the importance of recording all information regarding the well being of people who use the service, and all the entries made by the staff are always cross referenced to care plans. It is recommended that the Registered Provider takes appropriate action to ensure that all staff receive suitable training in adult protection and safeguarding issues and procedures in order to ensure people who use the service are protected from all forms of abuse and harm. It is recommended that the Registered Provider takes appropriate action to ensure that the essential repairs identified in this report are actioned appropriately to ensure people who use the service live in a comfortable and safe environment. 2 18 3 19 Care Homes for Older People Page 29 of 30 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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