Care Home: Upsall House

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What the care home does well Upsall House provides people that use the service with a warm, friendly and comfortable environment. The home has a welcoming atmosphere and people that use the service are well looked after. Visitors are made to feel welcome at any time. The home is well managed and run in the best interests of people who use the service. People that use the service are happy with the care that they receive comments made by people spoken to during the inspection and surveys received included, "There is a good deal of kindness and caring here" "I am so glad that I am able to speak well of the home. Staff look after me very well and always listen to what I am saying" "My family made a good choice in picking Upsall House. I have made lots of friends. I have a beautiful room with a beautiful view and I am looked after by staff who care" People said that the food is very good and can make lots of menu choices. Staff are experienced, well trained and knowledgeable about the people they are caring for. What has improved since the last inspection? Since last inspection there has been an extension to the home. The extension has created a new hairdressing room, laundry and treatment room. The corridor areas have benefited from redecoration and new flooring. The results of the surveys that are sent out to seek the views of people that use the service are now available to see. The homes fire risk assessment has been reviewed and updated and those people who use the service and wish to leave their bedroom door open have had "hold open devices" fitted to their bedroom doors. This means that bedroom doors will close in the event of the fire alarms being activated. What the care home could do better: The registered person should ensure that care plans are developed for those people receiving respite care and sooner than at the end of the six week trial period of those people who are to move into the home on a permanent basis. This will help to ensure that care needs are met. Some improvement in the recording of medication is needed. Hand written Medication Administration Charts should be signed and checked by two members of staff to make sure that correct information is recorded and people get their medication as prescribed. Medication carried over from one month to another should be recorded on Medication Administration Records to ensure accurate recording, that people are getting their medication and enable auditing. Staff must keep accurate records of medication administered to people who use the service. Medication Administration Records must be signed after medication has been given. This will help to to account for all medication and ensure safety of people who use the service. The homes complaint procedure should be updated to include timescales for action and contact details of both the director and Local Authority so that people know who they should contact if they have a complaint. Some improvement is needed to help to ensure a robust recruitment procedure is followed. The homes reference request should be updated to ask the referee to confirm dates of employment to allow for the exploration of gaps. The manager should be in receipt of a satisfactory POVA first and Criminal Record Bureau Check prior to staff commencing employment. The homes application form should be developed to enable staff to give a full career history and include space for staff to comment on their experience and suitability for work. The manager should ensure that people provide details in their application of the months and years that they were employed from until to enable exploration in gaps of employment. The home should follow health and safety guidance and monitor water temperatures on a weekly basis to ensure safety of people who use the service. Key inspection report Care homes for older people Name: Address: Upsall House Guisborough Road Middlesbrough TS7 0LD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Katherine Acheson     Date: 0 3 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Upsall House Guisborough Road Middlesbrough TS7 0LD 01642300429 01642321572 upsres@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Upsall House Residential Homes Ltd care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 30 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places: 30 Date of last inspection Brief description of the care home Upsall House is a two storey converted private dwelling set in spacious and attractive grounds with extensive views across to the Cleveland Hills. The home is well appointed with two lounges and a dining room. Accommodation is provided in 30 single bedrooms, 24 of which have an en-suite facility. The home is registered to provide care for thirty older people. Upsall House has a no smoking policy. On the date of the inspection the fees at Upsall House ranged from £387 to £474.86 a week. Care Homes for Older People Page 4 of 29 Over 65 30 0 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 two star. This means that people who use the service experience good quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some regulations from previous inspections reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Before this inspection visit we looked at all of the information that we have received since the last inspection of the service on 7th September 2007, and the last annual service review on 3rd September 2008. This unannounced key inspection took place on 3rd of September 2009. The inspection Care Homes for Older People Page 5 of 29 started at 10:30am and finished at 7:10pm The reason for the inspection was to see how good a job the home does in meeting the national minimum standards set by the Government for care homes. Numerous records were examined including care records of people living at the home, medication records, risk assessments, complaints and staff records. We looked around parts of the home to make sure that it was clean, safe and comfortable. Requirements and recommendations highlighted at the last inspection were revisited to see if improvements had been made. During the visit we talked with people who use the service, their relatives, the manager and staff. Before the inspection surveys for people that use the service and staff were sent to the home for the manager to distribute accordingly. Surveys sent to people that use the service were asked to comment on care received. Surveys sent to staff were asked to comment on what it was like working at the home and training. We received eight surveys from people that use the service and five surveys from staff. Care Homes for Older People Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The registered person should ensure that care plans are developed for those people receiving respite care and sooner than at the end of the six week trial period of those people who are to move into the home on a permanent basis. This will help to ensure that care needs are met. Some improvement in the recording of medication is needed. Hand written Medication Administration Charts should be signed and checked by two members of staff to make sure that correct information is recorded and people get their medication as prescribed. Medication carried over from one month to another should be recorded on Medication Administration Records to ensure accurate recording, that people are getting their medication and enable auditing. Staff must keep accurate records of medication Care Homes for Older People Page 7 of 29 administered to people who use the service. Medication Administration Records must be signed after medication has been given. This will help to to account for all medication and ensure safety of people who use the service. The homes complaint procedure should be updated to include timescales for action and contact details of both the director and Local Authority so that people know who they should contact if they have a complaint. Some improvement is needed to help to ensure a robust recruitment procedure is followed. The homes reference request should be updated to ask the referee to confirm dates of employment to allow for the exploration of gaps. The manager should be in receipt of a satisfactory POVA first and Criminal Record Bureau Check prior to staff commencing employment. The homes application form should be developed to enable staff to give a full career history and include space for staff to comment on their experience and suitability for work. The manager should ensure that people provide details in their application of the months and years that they were employed from until to enable exploration in gaps of employment. The home should follow health and safety guidance and monitor water temperatures on a weekly basis to ensure safety of people who use the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments of people who are to use the service are carried out before they move into the home to ensure all needs can be met. Evidence: The Manager said that people who are to use the service are assessed before coming into the home. They firstly receive an assessment from a social worker. This asssesment is sent to the home for the manager to look at. Once this assessment has been reviewed the manager or another senior staff member then visits the person at home or in hospital to carry out a further assessment. The manager uses these assessments to decide whether the home can meet their needs. If a person is funding their own care an assessment is usually only undertaken by the manager or senior staff working at Upsall House. People are encouraged to visit the home before they move in. This gives people the Care Homes for Older People Page 10 of 29 Evidence: opportunity to meet staff, other people living at the home and have a good look round. People who are to use this service are offered a trial period of up to six weeks. At the end of the trial period a review takes place to make sure that the placement is both successful for the person using the service and the home. A relative spoken to during the inspection visit said, We looked at lots of homes before choosing Upsall House. We turned up unannounced to look round. Staff were extremely friendly. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive good support and are happy with the care that they receive. Some improvement is needed in respect of care planning to help to ensure care needs are met. Some improvement is needed in the record keeping of medication to help to ensure accuracy, enable auditing and safety of people that use the service. Evidence: The files of three people that use the service were looked at during the visit. One file was that of a person who had been in the home for some time. This file contained a detailed assessment of needs, evidence of nutritional screening and moving and handling assessments. Plans of care had been developed for each identified need. Care plans were very detailed and provided clear guidance to staff about how to help to meet the needs of the person. Care plans contained evidence of personal choice, likes and dislikes. Another care file looked at during the visit was that of a person who is receiving respite care. The care records and documentation for people receiving respite care is a shortened version as people who receive respite care often only come into the home for a few weeks. This care file contained detailed assessments, however Care Homes for Older People Page 12 of 29 Evidence: did not contain any plans of care. Examination of records highlighted that this person had been receiving respite care for a number of months. A discussion took place with the manager regarding the need to develop detailed plans of care for those people receiving respite care for a longer period of time. The third care file looked at was that of a person who had been in the home nearly six weeks and was approaching the end of their trial period. Although detailed assessments were available within the care records staff at the home had not developed any plans of care. The manager advised that care plans are developed after the persons six week review. A discussion took place with the manager about developing plans of care sooner. There is clear evidence of the involvement of GPs, District Nurses and other healthcare professionals such as chiropodists. People living at the home confirmed that if they were feeling unwell, the GP would be called. A large number of the people using the service are registered with the same GP. This GP holds two weekly surgeries at the home. During the inspection visit the manager and staff were observed to interact well with people that use the service and visitors. Staff approached people in a supportive and respectful way. People spoken to during the visit and surveys received were complimentary about life in the home and care received. Comments made included, The staff are great and really care. If I go to hospital there is always someone from the home who goes with me The staff are good and always treat me with respect Staff are very attentive. He/she is being as well cared for as they can Good caring staff who are keen to listen and help. Plenty of personal care, i.e. showers, baths, haircuts and nail polishing I am very pleased for my mother who is at Upsall House. It gives the family peace of mind to know that as he is well cared for The staff are very good, I have nothing to grumble about The manager said that it is the responsibility of senior care staff to give out medication. Prior to giving out medication all staff complete a Safe Handling of Care Homes for Older People Page 13 of 29 Evidence: Medication Course and have their competency checked. The manager said that staff who administer medication have their competency checked on a yearly basis basis there after. On a monthly basis staff keep a record of medicines coming into the home and the amount received. The amount of medication received is recorded on the Medicine Administration Record (MAR) of the person using the service. Sometimes a new supply of medication may not need to be ordered as there is sufficient left over from the previous month. When this is the case staff should record the amount of medication carried over to the next month to ensure accurate recording and to enable auditing. It was observed that hand written MAR charts were signed but not countersigned to confirm that two staff had been involved in writing up the medication and checking that it was correct. On the day of the inspection the home were on day seventeen of a twenty eight day supply of medication. An audit of one persons medication highlighted that staff had not signed for one medication that was to be given on a teatime. The deputy manager advised that medication had been given and the remaining supply of tablets were available. Concerns in relation to medication recording were discussed with the manager who demonstrated a commitment to review medication practice particularly in relation to record keeping. The manager advised she would carry out an investigation and look at why staff had failed to sign for medication administered. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service lead fulfilling lifestyles through exercising choice and control over how they spend their day. Food provided is enjoyed by people that use the service. Evidence: The manager said that care staff working at the home are responsible for planning and arranging activities and outings for people who use the service. Activities taking place on a daily basis include dominoes, karaoke, quizzes, games and musical bingo. An exercise class takes place on a weekly basis. The manager said that lots of people get daily newspapers and that the mobile library visits every three months leaving a plentiful supply of books. The home have just purchased some tapes and songbooks so that people that use the service can participate in a sing-a-longs. Some people that use the service enjoyed a shopping trip in April and the home hosted a clothes party in May. A hairdresser visits the home on a weekly basis and was present on the day of the inspection. Comments made by people spoken to during the inspection and surveys received in Care Homes for Older People Page 15 of 29 Evidence: respect of activities and outings included, I like the weekly exercises. They get my muscles working to music. Occasionally I play dominoes. I enjoy talking to the other residents. There is everything that I would want I read a lot, I like the large print library books that are brought for us I enjoy life here. I have made lots of friends. There are five of us who have become good friends. We like to sit in the snug and pass the time of day My father enjoyed the recent clothes party. He was able to make choices about the clothes that he wants to wear Religion plays an important part in the life of some people who use the service. One person spoken to during the visit said, The Rector or a representative from St Nicholas parish visit every Monday morning to give out communion. Once a month the Vicar from Ormesby visits on a evening to do a service followed by the singing of hymns. We look forward to it. I was brought up in the church and I am so grateful to be able to hold onto my religion. Relatives said that they are made to feel welcome at any time, and there was a steady stream of visitors during this inspection. The lunchtime of people that use the service was observed. The lunch time menu of the day was was roast pork, stuffing, parsnips, new potatoes, carrots, green beans and gravy or chicken drumsticks with potatoes and vegetables. There are two options at each meal time, however people can choose something else other than the two main options if they want something different. For example on the day of the visit one person was having curly fries and another having sandwiches. Menus are displayed on a cafe-style menu board in the dining room so people can see what main choices are for each meal time. The meal time of people that use the service was relaxed with people enjoying the food that was provided. Tables were appropriately set and people were offered a cold drink and a cup of tea with their meal. The dining room enjoys beautiful views of the countryside. The homes last visit from Environmental Health in accordance with the Tees Valley Food Hygiene Award Scheme, awarded them with five stars (out of five) for excellent Care Homes for Older People Page 16 of 29 Evidence: standards of hygiene. People spoken to during the inspection and surveys received spoke highly of the food provided comments made included, The food is excellent. I had roast pork today followed by strawberry cheesecake. Staff always ask if you would like second helpings The cook is quite good, if there is something that I dont like she will always do something different. We get plenty of fruit and vegetables The food is always good Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are confident that their complaints would be listened to, taken seriously and acted upon. Staff receive adult protection training which helps to ensure safety of people that use the service. Updating of the homes complaint procedure would help to ensure that the appropriate people are contacted when needed. Evidence: The home has a complaints procedure that informs people that if they wish to raise a concern or make a complaint to contact the manager. The complaints procedure then advises that the second stage of the complaint procedure is to contact the director of the home or if they wish they can contact the Local Authority , however does not give any contact details. The homes complaints procedure should be updated to include timescales for action. In discussions, people that use the service and relatives said that they would feel comfortable in raising any concern/complaint that they may have and felt confident that it would be put right. There has been one complaint made directly to the home in the last twelve months. The home has an adult protection policy/procedure that informs people what to do and Care Homes for Older People Page 18 of 29 Evidence: who to contact if abuse is suspected. The manager said that all staff receive adult protection training on induction and on a yearly basis thereafter. People spoken to during the visit said that they felt safe at the home. One person said, I go to bed feeling very safe. I can talk to anyone of the staff and they always listen. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment is good providing people that live there with an attractive, homely and comfortable place to live. Evidence: Upsall House is a two storey private dwelling set in spacious and attractive grounds. The home enjoys extensive views across to the Cleveland Hills. On the ground floor of the home there are two lounge areas and a dining room. One of the lounge areas is referred to as the snug. This lounge is homely as it contains photographs and personal possessions of people who use the service. One person spoken to during the visit said, I love to sit in the snug and chat with the other residents. There is five of us who have become really good friends. We have a good laugh which always helps to lighten the load. There are thirty single bedrooms, twenty four of which have ensuite facilities, bedrooms are situated both on the ground and first floor of the home. Many of the bedrooms have beautiful views. One person spoken to during the visit pointed at a pheasant that was just outside the window. The same person said, From my bedroom I can see the beautiful fields, horses and deer. Bedrooms of people that use the service that were looked were nicely decorated, had appropriate furniture and were personalised. Since last inspection of the service there has been an extension to the home. The extension has created a new hairdressing room, laundry and treatment room. The manager advised that appropriate consent and approval for the extension has been obtained. Corridors have benefited from redecoration and new flooring. Care Homes for Older People Page 20 of 29 Evidence: The last inspection of the service highlighted that some bedroom doors were held open with wedges that would not allow the doors to close if there was a fire. The manager was informed that any person wishing to have their bedroom door open must have hold opener devices fitted. Since last inspection of the service a number of bedroom doors have been fitted with hold opener devices. The last inspection of the service highlighted that bedrooms were fitted with fluorescent tube lighting which was not domestic in character. Following inspection of the service the manager carried out a survey with people that use the service and relatives to determine if people were happy with lighting within their bedroom area. The outcome of the surveys was that people were happy. Bedside lamps are available within bedroom areas if a person wants lighting to softer. The manger advised that the homes fire risk assessment had been reviewed and updated since last inspection of the service. Appropriate laundry facilities were in place. The standard of cleanliness around all of the home was very good. It is clear that housekeeping staff work extremely hards to keep the home clean, tidy and odour free. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general the homes recruitment procedures are good. The homes application form and reference request would benefit from review and update, which will help to ensure that a more robust recruitment procedure is followed and people are safeguarded. Evidence: Staffing rotas looked at during the visit informed that there are five care staff on duty during the day one of which is either the deputy manager or a senior carer. On an night shift there are three care staff on duty one of which is a senior carer. The manager of the home works five days a week supernumerary. Fifteen out of nineteen care staff at the home have achieved a minimum qualification of NVQ level 2 in Care or equivalent, with some staff also having achieved an NVQ level 3. The remaining four care staff are working towards achieving an NVQ level 2 in Care. Staff had many positive comments to make about working at the home comments made included, Its a pleasure to work in Upsall House. All staff and management work as a team. All residents are cared for in the best way. Enough training is given to everyone Records were examined to confirm that in general the home follows good recruitment Care Homes for Older People Page 22 of 29 Evidence: procedures. Two files of newly recruited staff were looked at during the visit. Files looked at contained evidence that references had been obtained prior to commencement of employment. Reference requests would benefit from being updated to request the referee to confirm dates in employment to allow for the exploration in gaps. Appropriate Criminal Record Bureau Checks had been carried out, however it was noted that on occasions the home were starting staff on receipt of a POVA first check rather than awaiting full CRB. It was noted that the homes application form for staff was extremely brief/short. The application form only contained space for details of the last two employers and did not have space for staff to expand on their experience and suitability for working at the home. It was also pointed out to the manager that she should ask people to provide the month and year in which they were employed from until to to allow for the exploration in gaps of employment. Records were available to confirm that new staff receive induction training. Staff files examined during the visit contained certificates to confirm that staff had recently attended training in Moving and handling, fire, adult protection, first aid, dementia, palliative care and health and safety. The home has a training officer, who is qualified as a National Vocational Qualification Assessor. The training officer plans and delivers most of the training at the home. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the interest of people that use the service. The health safety and welfare of people that use the service is promoted. Evidence: The manager has many years of experience of working in a residential care home setting. She is both experienced and qualified. The manager is responsible for the day to day running of the home. People that use the service, relatives and staff commented on the approachable, open management style. Appropriate quality assurance monitoring systems are in place. Surveys are sent out to people that use the service on a regular basis to make sure that they are happy with the home and the care that they receive. A summary/report of the findings of the last quality assurance exercise was available for inspection. The manager also has meetings with people that use the service and staff. The home does not look after personal money for people that use the service. If Care Homes for Older People Page 24 of 29 Evidence: money is required the home will pay and then an invoice will be sent to the person or next of kin. A sample of health and safety records were examined and in general found to be in order. Records were available to confirm that the homes gas boilers, fire alarm and fire extinguishers had been serviced in the last twelve months. Records examined confirmed that tests of the fire alarm system take place on average weekly. Water temperatures of baths and showers were taken on a monthly basis, however should be taken on a weekly basis to ensure safety of people that use the service. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Staff must keep accurate 23/09/2009 records of medication administered to people who use the service. Medication Administration Records must be signed after medication has been given. This will help to to account for all medication and ensure safety of people who use the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The registered person should ensure that care plans are developed for those people receiving respite care for longer periods of time to help to ensure that care needs are met. The registered person should ensure that care plans are developed for people sooner than the end of the six week trial period to help to ensure care needs are met. Hand written Medication Administration Charts should be Page 27 of 29 2 7 3 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations signed and checked by two members of staff to make sure that correct information is recorded and people get their medication as prescribed. 4 9 Medication carried over from one month to another should be recorded on Medication Administration Records to ensure accurate recording, that people are getting their medication and enable auditing. The homes complaint procedure should be updated to include timescales for action and contact details of both the director and Local Authority so that people know who they should contact if they have a complaint. The homes application form should be developed to enable staff to give a full career history and include space for staff to comment on their experience and suitability for work. The manager should ensure that people provide details in their application of the months and years that they were employed from until to enable exploration in gaps of employment. The homes reference request should be updated to ask the referee to confirm dates of employment to allow for the exploration of gaps. The manager should be in receipt of a satisfactory POVA first and Criminal Record Bureau Check prior to staff commencing employment. The Registered Person should follow health and safety guidance and monitor water temperatures on a weekly basis to ensure safety of people who use the service. 5 16 6 29 7 29 8 29 9 29 10 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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