Care Home: Victoria Care Home

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What the care home does well People that are admitted to the home have their needs assessed prior to admission, which means staff, will be able to plan for their individual needs and know how to care for them. People are offered information about the home prior to moving in so that they can decide if it is the right place for them. The home has exhausted all areas to find training in caring for people with Alcohol Related Brain Injury (ARBI) and so they have complied their own training package which is covers a wide range of knowledge sets for staff to know how to care for people with ARBI with all staff set to complete this training. Staff were friendly, aware of the homes policy and practices. They were available to assist with dignity and respect of people living in the service as required. What has improved since the last inspection? When we inspected the home in February 2009, prior to this acting manager being in post, we found a number of concerns particularly in relation to the medication systems in the home. Since that time the acting manager and the clinical manager have worked well with us and have developed an improvement plan and put the required improvements in place. The home now operates an improved process in the standard of management of medication. As a result of these improvements and their regular assessment of competency of staff the requirements around medication standards made following the inspection in February 2009 were assessed as met during this inspection. The acting manager has also introduced new ideas to the home, such as proactive systems for maintaining peoples nutrition and ways of making sure people living in the home, their relatives and the staff are involved in the way it is run. New themed rooms have been introduced and are still being developed, promoting the different interests of people living in the home. We asked relatives to tell us what the home does well and we received lots of positive comments about the new acting manager. These comments included, "The home is undergoing many changes since the new acting manager was appointed. Many things are improving and she is listening and acting quickly where there are concerns", "Communication between relatives and and the home has vastly improved". "There were many problems last year but in the short time Maggie has been the acting manager many improvements have been made" and "The manager and her deputy are welcoming and approachable". What the care home could do better: There are still some improvements that need to be made with regard to recording information in care plans. Further improvements could be made in maintaining appropriate storage of medication according to the manufacturer`s storage specification. Activities being offered could still be developed further, particularly activities focusing on people with dementia. Some areas of the home need some refurbishment. We asked people to tell us what the home could do to improve and one relative said, "There have been too many managers and so there is no continuity. The owners should take more interest and be more involved". Key inspection report Care homes for older people Name: Address: Victoria Care Home Memorial Avenue Worksop Nottinghamshire S80 2BJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lynda Dyer     Date: 1 5 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 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 30 Information about the care home Name of care home: Address: Victoria Care Home Memorial Avenue Worksop Nottinghamshire S80 2BJ 01909476416 01909476089 victoriacarehome@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dukeries Health Care Limited care home 93 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 93 The registered person may provide the following category of service only: Care home only - Care PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling in any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Victoria Care Home is a care home providing personal care and accommodation for 93 older people. The current registration categories are older people, dementia and people with dementia bought about through alcohol related brain injury (Korsakoffs syndrome). There are three units accommodating residents over 65 years old (Lancelot for people with dementia, Guinevere and Camelot for old age not falling within any other category), one unit for people with Korsakoffs syndrome (Champion Crescent) and one unit for people who started out on the Champion unit but are not responding to rehabilitation (pheonix). The home provides short and long term care and will accept Care Homes for Older People Page 4 of 30 1 2 0 2 2 0 0 9 93 0 Over 65 0 93 Brief description of the care home emergency admissions. A respite service is available if required. The home is owned by Dukeries Health Care, which is run as a small business. The home is located in a residential area of Worksop close to shops, pubs, the post office, library and a church. There is also a park opposite. The home was opened in 1996 and was purpose built. The home is split in to five separate units. All of the homes bedrooms are single and have en-suite facilities. Bedrooms are located on 2 floors and there is a passenger lift. The home has 2 gardens that are easily accessible, one of which is enclosed. There is ample car parking available. The acting manager told us on the day of the inspection that the fees range between £369 and £850 depending on needs. There are additional charges for hairdressing and chiropody. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last time we visited this service was February 12th 2009. After this visit we asked the home to provide us with a plan of how they planned to improve the service due to our concerns in some areas of service delivery. The home produced the improvement plan and worked well with us and we looked at the areas identified in the improvement plan as part of this inspection. We, as it appears throughout the Inspection Report refers to The Care Quality Commission. Care Homes for Older People Page 6 of 30 Two inspectors and a pharmacy inspector carried out an unannounced site visit to the home, which took place over a period of eight hours. The Clinical manager, the acting manager and the deputy manager assisted us during the site visit to the home. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service, this is called an AQAA (Annual quality assurance assessment). We received the AQAA back from the manager in good time. The form was completed well and gave us all the information we asked for. We also sent out surveys called, have your say, to people who use the service, staff that work there and relatives. This meant we could get an idea of what people thought about the way the home was run. We had 25 completed surveys back and we have included some of the comments in this report. We have not included comments that could identify the writer as we want people to feel they can be open about the way they feel the service is run. We also reviewed all of the information we have received about the home since we last made a visit to them and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking, which involved us choosing four people who use the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We spoke with the acting manager , four members of staff, two relatives (one over the telephone) and nine people who live in the home to help us to form an opinion about the quality of the service being provided to people. We read documents as part of this visit and looked at the environment and facilities of the home to form an opinion about the health and safety of people who use at the service. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: There are still some improvements that need to be made with regard to recording information in care plans. Further improvements could be made in maintaining appropriate storage of medication according to the manufacturers storage specification. Care Homes for Older People Page 8 of 30 Activities being offered could still be developed further, particularly activities focusing on people with dementia. Some areas of the home need some refurbishment. We asked people to tell us what the home could do to improve and one relative said, There have been too many managers and so there is no continuity. The owners should take more interest and be more involved. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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. People that are admitted to the home have their needs assessed prior to admission, which means staff will be able to plan for their individual needs and know how to care for them. People are offered information about the home prior to moving in so that they can decide if it is the right place for them. Evidence: The acting manager told us in the Annual Quality Assurance Assessment (AQAA) that they ensure that people have a comprehensive assessment prior to moving into the home and that they encourage people to view the home before admission. Prior to us visiting the home, people living there had told us that they had the right information about the home before they decided to live there. In the main reception of the home there was a copy of the last inspection report from the Care Quality Commission along with a variety of other information about the Care Homes for Older People Page 11 of 30 Evidence: services offered in the home. One person living in the home told us, I was given a booklet when I moved in and had a six week trial period to see if I liked it. We looked at the care plans of four people living in the home and they all contained a full needs assessment that was completed prior to them moving into the home. When we asked staff what the home did well, they told us, We care for service users and make sure all care needs are met, Good communication with medical teams involved in the service users care, The home always takes into consideration the service users wishes, Person centred care which takes into account all aspects of a persons care and includes their family and The standard of care is good and all residents are treated with respect. The home does not offer intermediate care and so standard 6 does not apply. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has improved the care planning and medication systems but more improvements in the recording of information in care plans would make sure people had the right care delivered. People living in the home have their privacy and dignity respected. Evidence: The acting manager told us in the Annual Quality Assurance Assessment (AQAA) that new care plans that have been put in place are more comprehensive. They also said that a new comprehensive medication assessment has been put in place to ensure the staff are competent to administer the medication. We looked at the care plans of two people on Lancelot unit. Both plans contained information that was important to the person it was written for with a range of risk assessments in place along with a care plan telling staff how to manage that risk. The care plans also contained evidence of regular nutritional screening, referrals to external health professionals when needed and information relevant to the Mental Capacity Act 2005 and the new Deprivation of Liberty Safeguards. We could not find Care Homes for Older People Page 13 of 30 Evidence: evidence in the care plans that we looked at that the person it had been written for and/or their representative had been involved in their preparation or any reviews. One care plan that we looked at contained conflicting information about whether the person living in the home it was written for was at risk of pressure sores. Another care plan contained information that was inconsistent with the palliative care that they were currently receiving There was no temporary care plan in place, with the persons care needs being detailed so that staff would know how to care for them. This being said, we spoke with two members of staff regarding the care needs of both of these people living in the home and they demonstrated verbally that the care being delivered was appropriate. There were also records in the bedroom of the person who was receiving palliative care which showed that the appropriate care was being given and there were records to show that a referral had been made to external health professionals for a recognised care pathway to be introduced to this person. Although bathing records are now much easier to follow, there were some gaps in one of the persons records we viewed with no reason detailed on the bathing record of why the person had not received a bath. We looked at the care plan of a person living on Champion unit, a dedicated unit for the rehabilitation of people with alcohol related brain injury. This care plan was mostly in the same format as the care plans for the elderly people living in the other units. There were assessments around this person completing cooking and laundry tasks but they were not specific in what task had been completed and so did not give a clear picture of that persons abilities. There were times when there were gaps in the assessment dates and staff told us that this was when this person had refused to take part in the assessment but this had not been documented. The care plan also didnt identify any goals for that individual to aspire to and despite there being written evidence that the person had requested to be involved in the writing and reviews of the care plan, there was no evidence that this had taken place. We looked at the homes medicine management practices by sample examination from five medicine units. This involved the sample audit of the medicines, medicine charts, Monitored Dosage System and storage facilities. We also observed a small part of a lunch-time medication round in the home. The home has recently put a system in place to ensure medication administration competency including assessment of competency of medication management. We found staff members and had followed their medicine policies and best practice. Care Homes for Older People Page 14 of 30 Evidence: However some of the quantity of nutritional supplement drinks received and the number of signatures did not correlate and although fridges contained several medicines including creams with the majority stored correctly, some creams did not require refrigeration and the staff were made aware to follow manufacturers storage temperature specification. The sample controlled drug (CD) balances were correct and these reflected accurately in both the appropriate CD register and medicine chart. We found a dispensing label on a bottle of liquid to be un-readable possibly due to the type of ink print on the label. Staff were able to inform us to which bottle this belongs to which person living in the service, however this was no longer in use as the best before date written by staff has now expired. We asked people living in the home if they felt staff respected their privacy and their dignity and they said that they felt they did. We observed staff on the day of the inspection speaking to people living in the home in a kind and caring manner and we also observed them knocking on peoples doors before entering their room. When we asked people what the home did will, one relative said, It treats everyone as an individual, gives care and support and respects the rights, dignity and privacy of individuals. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some activities are offered to people living in the home but this area is still being developed especially for people with dementia. The dietary needs of people living in the home are being met and people are encouraged to maintain links with their family and friends. Evidence: The acting manager told us that she has made improvements in this outcome by introducing the use of tabards with front pockets, which can be used to assist people who eat little and often with the pockets being filled with healthy snacks in an attempt to encourage people to eat some of the snacks. They also state that they have revamped the activity plan and also now have the use of a mini bus which can be used for outings, and shopping trips. We looked at the care plans of four people and saw evidence of them being asked about their preferences around daily living and we spoke with two people living in the home and they told us that they could choose what they wanted to do during the day, such as spending time in their bedroom and choosing the time they went to bed and got up. Care Homes for Older People Page 16 of 30 Evidence: Although care plans are now more person centred there were some questions recorded that do not take into account peoples diverse needs and lifestyle around daily living. One question people on Champion unit are asked is, Did you marry and What was your husbands/wifes name. This may not encourage people to feel able to express their sexuality. People on Champion unit are generally younger adults and a generic question that they are asked is, When did your mother and father die. This is not an appropriate question as some people living on this unit have living parents and could be upset by this question being asked. We looked at the homes newly implemented newsletters and there was evidence of people being asked to comment on the new pictorial menus that had been implemented as well as references to events taking place such as, a summer fayre, a weekly relaxation session with hand and foot massages, a sponsored staff talent show and party with people living in the home being invited to judge the competition a trip to skegness and a 100th Birthday party. The home employs full time activity coordinators who work with groups and individuals living in the home during the week. On the day of the inspection, we saw people enjoying a game of dominoes in the morning and there was a activity timetable on display on the unit. The newsletter spoke of the home having to put some trips out on hold due to staffing levels but went on to inform people that this had now been rectified and that a new activities co-ordinator was due to commence employment in the home. When we asked staff in surveys what the home could do better some staff said, Offer more choices of daily activities and group activities and They could offer more group activities and trips out. On the day of the inspection we asked staff if they felt there were enough activities offered, particularly to people with dementia and they told us that there could be more but this was an area that was being developed by the acting manager and the activities organisers. Some lounges have been developed with themes around areas of interest and stimulation for people living in the home. So far this includes lounges with themes around music, the safari, films, a tea room, a nursery and a miners room is being developed with plans for a reminiscence room. These rooms have allot of detail in them to stimulate people in different ways and we observed some of the rooms being used in a positive way. A visitor told us, My Aunty loves it in the music room, it seems to calm her when she gets anxious. Care Homes for Older People Page 17 of 30 Evidence: When we asked what they thought the home could do better, one relative said, More social activities and more of a selection for the evening meal. We observed lunch being served to people in one unit and they were given a choice of two different meals. Staff were available to assist people that needed help and the meal looked appetising and nutritious lunch was relaxed and unhurried. We spoke with five people living in the home during the meal and they told us that the meals were always good. One person told us, I have been here for four years and in all that time I have only had one meal that I didnt think was good and another said, We can now have hot meals like egg on toast in the evening which is nice. We spoke with a visitor and they told us that they were always made to feel welcome and that could visit any time. 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. People using the service feel able to raise concerns and complaints and can be confident that the manager will act on them. Staff know how to safeguard people living in the home from abuse. Evidence: The manager told us in the Annual Quality Assurance Assessment that staff at the home take residents opinions seriously and strive to respond to their issues. Complaints books are located in all units and the acting manager ensures that these are checked every month. They also told us that each complaint made is fully investigated and staff are trained in safeguarding adults and will always refer to the relevant authorities if they suspect a safeguarding adults issue. We have received two complaints about the home since the last inspection and both have been looked into appropriately by the acting manager and a response received within the specified timescale. We received surveys back from people living in the home, their relatives and staff working in the home and the information in these told us that people know how to raise a concern or make a complaint and staff know how to respond to them. We asked relatives what the homes does well and one person told us, The home is undergoing many changes since the new acting manager was appointed. Many things Care Homes for Older People Page 19 of 30 Evidence: are improving and she is listening and acting quickly where there are concerns When we asked what the home could do better, one person told us, I have picked up on a few issues but I feel I can raise these at the resident and family meeting. The home has the current local safeguarding adults procedures in place and the acting manager has made one referral since the last inspection. We looked at the training files of three members of staff and they contained evidence that staff are being trained in safeguarding vulnerable adults. We also spoke with the three members of staff and they verbally demonstrated that they had a good understanding of the procedures in place to safeguard people living in the home. 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. Good housekeeping procedures provide people with clean, pleasant and homely surroundings in which to live. Further development will enhance the environment. Evidence: The acting manager told us in the Annual Quality Assurance Assessment (AQAA) that the environment within the units is now age appropriate for the most part and that they will continue to develop this. They told us that the nursery on the dementia unit has been revamped and this is used to assist the residents to relax. They also told us that they work closely with the infections control nurse at the local hospital and that the company has a robust infection control policy which staff are aware they must adhere to. On the day of the inspection we viewed dining areas, other communal areas and five bedrooms and we found these areas to be free from odours and it was generally clean and hygienic. One of the bedrooms we viewed would benefit from being decorated and the acting manager told us that this was in the homes development plan. There was a complaint made to the Commission that included information that the dining room carpet on one unit was deeply stained and had areas of ingrained food. We examined this carpet and we found that this information was accurate and the carpet needed attention to ensure it was hygienic. Care Homes for Older People Page 21 of 30 Evidence: One relative told us, The home provides a clean, safe and caring environment. Another told us They keep the building clean and fresh smelling There was evidence in minutes of meetings and information received by the home and by the Commission that people feel that there should be smoking shelters in place for people living in the home. We discussed this with the clinical manager and the director on the day of the inspection and they told us that they had looked into various options but that they had not found a viable conclusion. We looked at the garden areas and found that these were no longer cluttered with cigarette ends which was an issue at the last inspection. When we asked staff what the home could do better they said, Refurbish the home with new carpets, bedding and curtains and The furnishings could be updated. The acting manager showed us the work that was currently being carried out to improve areas of the home and so far this included some very pleasant areas such as a nursery, tea room, a safari room, a films room and a music room. These areas have been developed to give people a choice of room that suits them. We observed some of these rooms being used in a positive way and a visitor told us, My Aunt loves it in the music room, it seems to calm her when she gets anxious. The home is also developing a miners room and has plans for a reminiscence room. We viewed the files of three members of staff and found evidence that staff are being trained in infection control procedures and we spoke with a member of staff who demonstrated a good knowledge of the procedures to prevent the spread of 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. The home operates a safe staff recruitment process and staff are trained effectively in supporting people living there. Evidence: The acting manager told us in the Annual Quality Assurance Assessment (AQAA) that the required safety checks carried out on staff prior to employment are central to the homes employment policies. They also said that new staff are placed on a buddy system until they have completed their Induction which takes around 12 weeks and that the induction involves the completion of an e-learning programme with new staff then commencing a recognised qualification if they do not already have one. We viewed the files of three members of staff and we found that they contained evidence that the required safety checks had been completed prior to employment commencing. The files also contained evidence of staff completing training in areas of health and safety and health care, including caring for people with dementia and we received completed surveys, which told us that staff felt they had sufficient training to help them to meet the needs of people in the home. The most recent members of staff to be employed have commenced a new induction Care Homes for Older People Page 23 of 30 Evidence: package and this is going to be provided to all staff regardless of the length of service due to the lack of a formal induction in the past. The home has exhausted all areas to find training in caring for people with Alcohol Related Brain Injury (ARBI) and so they have complied their own training package which is covers a wide range of knowledge sets for staff to know how to care for people with ARBI with all staff set to complete this training. We spoke with people who live in the home and staff who work in the home and they felt that there is generally enough staff on duty to meet the needs of people living there. One member of staff told us that care needs could be met more effectively if there was a further member of staff allocated to Phoenix unit. However this is a small unit and the acting manager told us that a third member of staff is available to be called from the Champion unit should the need arise. We asked staff what the home does well and they said, They offer training and We work well as a team and the training is good. When we asked what the home could do better one member of staff said, There could be more appreciation for staff and what they do and more confidentiality between staff. The last time we inspected this home we found staff moral to be low but at this inspection we found the atmosphere to be much more positive and a member of staff told us, Staff moral is much higher now and we feel we are listened to. On the day of the inspection we found an appropriate number of staff on duty. we spoke with spoke with several of them and they demonstrated a good knowledge of the homes procedures and we found them to be very friendly, helpful and caring. One relative told us, There could be better communication between staff. Another said, The staff are friendly, pleasant and helpful. They look after the residents very well. One person living in the home told us, The carers really do care. We spoke with people living in the home and with a visitor and they told us that staff had a good knowledge of health care and that they were caring and patient. 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. There is evidence that the home is run in the best interests of the people that live there and the acting manager is developing the home with improvements to safeguard the people living there. Evidence: The current acting manager has been in post since March 2009. She has prior experience of managing a care home and is currently going through the registration process with the Care Quality Commission. When we inspected the home in February 2009, prior to this acting manager being in post we found a number of concerns particularly in relation to the medication systems in the home. Since that time the acting manager and the clinical manager have worked well with us and have developed an improvement plan and put the required improvements in place. On the day of the inspection we found that the acting manger has worked hard to make changes to the home and a number of improvements have taken place. Care Homes for Older People Page 25 of 30 Evidence: We asked relatives to tell us what the home does well and we received lots of positive comments about the new acting manager Maggie Blower. These comments included, The home is undergoing many changes since the new acting manager was appointed. Many things are improving and she is listening and acting quickly where there are concerns, Communication between relatives and and the home has vastly improved. There were many problems last year but in the short time Maggie has been the acting manager many improvements have been made and The manager and her deputy are welcoming and approachable. Surveys that we received from staff told us that staff felt they were supported and listened to by the acting manager and staff that we spoke to on the day of the inspection supported this information. Staff told us that they had formal supervision with the acting manager and we saw evidence of this in staff files. The home has visits from the provider each month and we saw the records of these visits along with any action taken as a result of any issues raised on the visits. There is also an annual quality audit completed by the clinical manager and this is a thorough audit comprising of looking at records, speaking with people living and working in the home and again an action plan is compiled to address any issues raised. The acting manager told us that there is an annual survey sent to people living in the home and their relatives and we saw the minutes of meetings held by a relatives committee and separate minutes of meetings held by people living in the home. We looked at the personal spending money managed by the home for three people living there and these were being managed appropriately. We looked at some health and safety systems in the home and found that these are being maintained with equipment maintenance now up to date. We saw evidence that staff are trained in health and safety practices and we observed staff putting this training into practice. At the last inspection we identified an area of concern around security with regard to the front entrance to the home. The acting manager has assessed the risk around this and has installed a self closing device to the door, which has minimised the security risk. Care Homes for Older People Page 26 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 27 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 1 7 15 Care plans must contain information that is relevant to the current needs of the person it was written for. This will ensure peoples needs are recorded for staff to deliver the appropriate care. 01/12/2009 2 7 15 People living in the home and/or their representative must be involved in the preparation and review of their care plan. This will ensure people receive care in the way they wish. 01/12/2009 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 If a person does not receive a bath then staff should document the reason why this did not happen on the Care Homes for Older People Page 28 of 30 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 individuals bathing record. 2 7 If a person refuses to take part in an assessment or does not take part for any other reason then this must be documented in the assessment records. Information contained in care plans should take into account peoples race, gender disability, age, sexual orientation and religion or belief, and human rights. Care plans for people living on the Champion Unit could be developed around their specific needs, goals and progress achieved rather than being a more generic care plan that is used in the rest of the home. A dedicated record sheet could be introduced to care plans where a service user and their relative, if appropriate, could sign to say that they agree with the information written in their car plan. To action that staff are aware of storage temperature of medicines and stored under appropriate environmental conditions in compliance with their product licence to maintain their stability. This will ensure the quality of medicines in use and protect residents from harm. Activities should be further developed, particularly for people with dementia. The identified bedroom should be decorated to provide a more homely feel for the person living in there. The carpet in the downstairs unit needs attention to ensure it is free from stains and ingrained food. Now that call bell positioning has been assessed and action taken, a regular audit of this should be undertaken to ensure any movement of furniture does not place the call bell out of reach of people living in the home. 3 7 4 7 5 7 6 9 7 8 9 10 12 26 26 26 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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