Care Home: Victoria Highgrove

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What the care home does well The service provides ongoing nursing care and a comfortable home for five older people and rehabilitation services with nursing care for a further seventeen older people. Six residents were spoken with; they expressed satisfaction with the nursing care received and the attitude of the staff. "They look after me very well; the staff are kind and polite". "The care here is good, the staff are very helpful and cheerful and the food is fairly good". Residents admitted under the Intermediate Care Scheme (ICS) have a team of physiotherapists and Occupational therapists working to help them with rehabilitation and ongoing medical support. Health care professionals from the ICS team said that the nursing home`s own team worked well with them to help them support the residents and that the nursing home staff `is a great team and communication between us has improved really well recently` and that "The care home staff liaise well with families and other professionals involved". The home has recently taken over its own catering as opposed to it being provided centrally by another of the Victoria homes. Comments about the food were varied but generally good; with residents saying that they have choices at each meal. Routines in the home are sufficiently flexible to ensure that residents are able to make their own decisions over how to plan their day. All staff have received ongoing mandatory health and safety training. What has improved since the last inspection? There have been many improvements in the past twelve months. The standard of care planning generally includes sufficient information about the needs of the residents and how they are to be met. Discussions were held with the manager about how these could be further improved. Activities now take place from Monday to Friday, these are in need of further improvement but the home is going forward with these. All staff now receive regular formal supervision and the home has commenced an induction course compatible with the recognised induction `Skills for Care`, for new staff. Efforts to improve staffing levels have taken place and whilst there is still some scope for further improvement, staff said `There are usually enough staff`. `Staffing levels are improving`. Staff meetings are being held quarterly. The home has recently commenced a survey of the quality of the services it is offering. Past and current residents and their representatives, along with various health and social care professionals have been approached to give their views on the home. The results from these questionnaires are in the process of being collated. What the care home could do better: Three requirements from the last inspection relating to consultation with residents regarding leisure activities and tailoring leisure activities to people`s interests, the safeguarding policy and refurbishment of a bathroom to ensure resident`s safety and infection control require further work to take place. The provider will be expected to commit to specific date for completion of the shower room. The provider will be expected to contact the Health and Safety executive regarding a firm decision over the time scales for repeating the Portable Appliance Testing. Requirements relating to the administration of `as required` medication, compilation of end of life care plans and social care plans, have been made following this inspection. Key inspection report Care homes for older people Name: Address: Victoria Highgrove 59 Dyke Road Avenue Hove East Sussex BN3 6QD     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: Elizabeth Dudley     Date: 1 2 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 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 33 Information about the care home Name of care home: Address: Victoria Highgrove 59 Dyke Road Avenue Hove East Sussex BN3 6QD 01273-562739 01273882818 sueknights.victorianursinghome@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Victoria Nursing Homes Limited care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 23. The registered person may provide the following category/ies of service only: Care home with nursing - (N) 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 within any other category (OP) Physical disability (PD). Date of last inspection Brief description of the care home Victoria Highgrove the Service is registered to provide nursing care and personal care for 23 older people and is situated on one of the major roads into Hove. It is served by public transport and has limited amount of on site car parking. All residents are accommodated in single rooms which have an ensuite facility consisting of washbasin and w.c and in all rooms except one have a bath or shower. A nurse call system is available in each room. A shaft lift provides access to all parts of the home. Communal accommodation consists of a large lounge/ dining room and all residents have access to the garden Care Homes for Older People Page 4 of 33 0 0 Over 65 0 0 Brief description of the care home surrounding the home. The home currently has block contract beds with the Local Authority and Primary Care Trust to admit residents under the Intermediate Care Scheme which provides ongoing rehabilitative care for people that have been in hospital in order to enable them to return home. The range of fees charged currently for each persons residence in Victoria Highgrove runs from £625 to £750 per week, fees do not include other services such as hair dressing and chiropody but do include a daily newspaper and national telephone calls. Care Homes for Older People Page 5 of 33 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: This key unannounced inspection took place on the 12th January 2010 from 10am to 5.30 pm and was facilitated by the appointed manager and the area manager. Methods used to collect information about the home included examination of documentation in the home, observation of staff working with residents, the serving of lunches and conversations with residents, staff and visitors to the home. All residents were spoken with during the inspection, and six residents were spoken with in depth and gave their views on life in the home. Documentation examined included care plans, personnel files, staff training and supervision records, catering records and health and safety files. Prior to the inspection questionnaires were sent out to relatives, residents and staff. Of these three were returned from residents, two from staff members and four from Care Homes for Older People Page 6 of 33 health care professionals. These gave information about the daily life in the home and helped to inform the judgements made in this report. Thanks are extended to those people who responded. The Annual Quality Assurance Assessment, required by the Care Quality Commission which gives an overview of what has been achieved in the home and issues to be addressed, was received by the CQC subsequent to the inspection. It was returned when we asked for it. The AQAA was specific to this particular home and for the most part accurately reflected the situation within the home as found at the inspection. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Three requirements from the last inspection relating to consultation with residents Care Homes for Older People Page 8 of 33 regarding leisure activities and tailoring leisure activities to peoples interests, the safeguarding policy and refurbishment of a bathroom to ensure residents safety and infection control require further work to take place. The provider will be expected to commit to specific date for completion of the shower room. The provider will be expected to contact the Health and Safety executive regarding a firm decision over the time scales for repeating the Portable Appliance Testing. Requirements relating to the administration of as required medication, compilation of end of life care plans and social care plans, have been made following this inspection. 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 33 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 33 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 adequate 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 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 provides sufficient information to ensure that residents are aware of the services the home can offer. Prospective residents admitted for rehabilitation do not have the opportunity to meet the manager and discuss the home. There were some shortfalls around the provision of suitable facilities and staff knowledge in supporting the residents admitted for intermediate care. Evidence: Currently there are twenty three residents in the home, five of whom are permanent and the remainder admitted on a temporary basis under the Intermediate Care Service (ICS). The Statement of purpose and Service User Guide has been reviewed and the majority of the residents have a copy of the Service User Guide. The manager has agreed to give copies of this document to hospital assessors so that they can give Care Homes for Older People Page 11 of 33 Evidence: it to prospective residents to ensure that they have sufficient information about the home. Prospective residents receive a brochure at present. The ICS manager described the choice offered to prospective residents under this scheme as a Limited choice. However three of the people admitted under the ICS stated that they were happy with the choice of home and thought it appropriate for their needs. The manager stated that all residents admitted have a copy of the homes Terms and Conditions of Residence following admission. Prior to coming into the home, prospective residents are assessed by the Intermediate Care Service Assessor. The manager states that these assessments are generally sufficient to enable her to make a decision over whether the home can meet the persons needs, and on two occasions recently she has visited the individual and undertaken her own assessments to assure herself that their needs can be met. Two surveys received from Intermediate care service health care professionals said that they wished the assessments from the hospital included more information. A full assessment is undertaken following the residents admission to the home. Both the home manager and the manager of the ICS gave assurances that written confirmation that the home can meet their needs is being given to residents prior to admission. One resident spoken with about the admission procedure confirmed that they had received the letter prior to their admission. Three residents spoken with about the admission process confirmed that they were made welcome by the home and the process was fairly smooth although two said that it was late in the afternoon when they were discharged, and staff at the home were very rushed, although the manager was still there and took the time to assess them and explain about the home. Relatives of prospective residents can visit home, however under current admission procedures there is generally insufficient time for this between discharge from hospital and admission to the home. The home does not meet all of directives in the National Minimum Standards intermediate care standard i.e. dedicated equipment for rehabilitation for daily living and mobility. However residents are taken into their own homes for daily living assessments. Specific staff, solely for the use of ICS residents, are not employed by the home; but some of the permanent staff have some knowledge of the rehabilitation Care Homes for Older People Page 12 of 33 Evidence: techniques required although there are shortfalls when bank and agency staff work at the home. The ICS supplies two care assistants to promote rehabilitation on a Monday - Friday basis. The home also five residents who live permanently in the home. These people have been in the home for some time therefore the admission process was not discussed with them. The manager gave assurances that for permanent residents a full assessment prior to admission would be undertaken and residents would have the choice over whether they wished to be admitted to the home. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans were generally comprehensive and gave information to care staff on how care for each individual was to be given. Evidence that care was being given as planned was available.Residents spoken with were happy with the care that they were receiving. Some aspects of medication administration need addressing to ensure that medications are administered in a person centred manner. Planning for end of life care and residents wishes is generally not in place which could impact on residents in the case of emergency. Evidence: Four care plans were examined to ensure that residents in the home were receiving the care appropriate for their needs. These care plans belonged to three people Care Homes for Older People Page 14 of 33 Evidence: admitted under the ICS and one belonging to a permanent resident. The standard of care planning was generally good, with care plans addressing individual needs in a personalised manner. Core care plans included wound care, nutritional and continence needs and all had clear directions for care staff. Omissions noted were social care plans; these were incomplete in the one care plan and absent in the ICS care plans. These must be added and show full consultation with the resident as part of the holistic care package. Daily records fully showed the care that had been given over the 24 hours in the day. Risk assessments were in place for bed rails, self medication, use of hoists, pressure mattresses and any other perceived risk to the residents. All parts of the care plan had been reviewed regularly (monthly) and there was evidence that care plans had been formed in consultation with the resident There was evidence of visits by health care professionals in care plan of the resident who lived permanently in the home, and evidence and reports from ICS health care professionals that have attended residents. Charts showing nursing and care interventions were in place in the residents rooms and were up to date and accurate. ICS health care professionals spoken with said that the care given was good and residents appear happy in the home. A health care professional said that most staff contact them appropriately, although some members of nursing staff were reluctant to make decisions, and sometimes did not assess the residents condition sufficiently prior to contacting them. Residents seen looked well cared for and those spoken with were happy with the care given and said that call bells were answered promptly, they had choices around the activities of daily living and most said that they had been consulted on their care plan. They confirmed that their privacy was respected and all care interventions were undertaken in a manner that maintained their dignity. Comments received included I am well cared for, there seems to be enough staff and the bell is usually answered quite promptly They (the staff) look after me very well, they are very nice and cheerful. The care is very good and I am very happy. Care Homes for Older People Page 15 of 33 Evidence: The management of medicines was generally good. Monthly audits have been undertaken on medication storage, recording and other documentation. All MAR charts had been signed following administration of medication. The home is still marking the administration of ointments and creams with a tick. Application of external medication delegated to a care assistant must hold the signature of the accountable registered nurse. Care plans for as required medications are not currently available in the medication records. All residents currently have a self medication risk assessment in place although few wish or are able to self medicate. This is not necessary as ability should be assessed under a mental capacity assessment on admission or patients wishes noted in the care plan assessments. If the home wishes to continue to maintain risk assessments for all residents these should be reviewed in line with the care plan on a monthly basis. The home needs to have permission for the administration of homely medicines from medical practitioners in place. One of the care plans examined had an end of life care plan in place. Discussions were held with the manager relating to the need for comprehensive planning including resuscitation to be put in place for all residents admitted to the home. This was also discussed with the manager and general practitioner from ICS. Whilst accepted that the majority of residents in the home are in for rehabilitation, should there be any issues in relation to end of life care being needed, the home needs to be aware of the residents wishes and actions to be taken. Staff in the home have not undertaken recognised courses such as the Liverpool Care Pathway for end of life care. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is no care planning for social care or sufficient evidence to show that residents preferred interests or wishes for leisure activities have been discussed in a robust manner. Discussion with the manager showed that the variety of leisure activities available at the current time is limited. Whilst the majority of residents said that they enjoyed the food, some residents would have preferred the supper meal to be hotter. Evidence: Whilst social care needs are addressed to a degree in the initial assessment of residents needs, there is no substantial social care planning in place. Care planning for social needs, following consultation with the individual, requires to be further developed. There are currently two activities organisers who visit the home over the Monday to Friday week. Neither of these hold a qualification in provision of activities. This is an Care Homes for Older People Page 17 of 33 Evidence: increase in both the amount of activities offered and members of staff supplying these in the past twelve months. There is no formal activities programme in place although the manager said that they have quizzes and other interactive activities and one to one sessions. No specific group outings are currently offered but individual outings take place. The home brings in outside entertainers three monthly and had a choir come in to sing carols before Christmas. Residents participation in activities was not documented in the care plans. None of the surveys received by residents mentioned the activities provided, but three of the residents spoken with said that they do participate in the quizzes. The manager said that most residents come to the lounge for the activities and appear to enjoy them. Staff must ensure that residents are given the choice of whether they wish the television in their rooms to be left on There is scope for developing the provision of activities taking into account residents preferences and their current and past interests. The previous requirement made at the last inspection was not fully complied with and the manager and area manager gave assurances that further work will take place. This will be checked at the next inspection. There is an open visiting policy, and residents said that their visitors are made welcome. Ministers of religion visit the home as required. The manager said that ministers of religion could be accessed for most of the mainstream religions Residents spoken with confirmed that routines around the home met their personal preferences and that the menu held sufficient choices for their tastes. The home provides a varied menu which offers options at each meal. The home now provides meals cooked in house rather than a specific Victoria Home providing centralised catering. Pureed meals were presented well and residents that require these now have a choice from the main menu at each meal. Most of the comments received from residents about the meals were generally good: I usually enjoy the food. Most meals are very good but sometimes they are rather large portions for me. Food not bad for an institution, I always enjoy the meals. Care Homes for Older People Page 18 of 33 Evidence: One resident found that the timing of the last meal was too early and also said that their hunger was not always satisfied with the food provided. The manager is addressing this. Three residents said that the evening meal is not always hot enough, the home takes food round on unheated trolleys and although only a few meals are being taken at a time, this does not seem to have addressed this ongoing problem. It was noted that the trays of food given to residents in their roomsa do not include salt and pepper and this should be addressed. The kitchen had adequate supplies of fresh, dried and frozen food and fruit is provided at some meal times and provided in the lounge. The cook said that residents are not currently able to have a cooked breakfast but the manager disputed this. Staff take menus around during the day to enable people to make their choices, and although the cook does not have a list of people who require fortified food, this is indicated on the list by staff. Care Homes for Older People Page 19 of 33 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 experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was evidence that complaints received were dealt with in a satisfactory manner. Staff have received adult safeguarding training and are aware of their responsibilities towards the residents in their care. Further work on the adult safeguarding policy is required to ensure that all staff are familiar with the procedure to follow in the event of an adult safeguarding issue. Evidence: Whilst the Service User Guide contains details of how to make a formal complaint, one resident and their representative were not aware of how to do this and two surveys identified that residents were not aware of how to make a complaint. Other residents, who were aware of the complaints policy, stated that they would feel more comfortable speaking with the manager and indicated that they believed this would be sufficient to ensure the matter was adequately addressed. The home has had two complaints since the last inspection which have been addressed satisfactorily and there have been no adult safeguarding issues. The manager has received adult safeguarding training from the local authority and Care Homes for Older People Page 20 of 33 Evidence: other staff receive this training delivered by the in house trainer and provided at regular intervals. Further work is required on the Adult Safeguarding policy to ensure that all staff have sufficient information on the procedure following the discovery of an adult safeguarding issue. The area manager gave assurances that this will be done and this will be checked at the next inspection. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the 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 establishment is clean and well maintained and provides a pleasant home for residents. Lack of attention to the ground floor shower room could affect residents health and wellbeing. Evidence: The home is generally well maintained; and communal facilities include a large lounge and a garden, which is accessible to residents. All parts of the home are served by a shaft lift. Residents accommodation is in single rooms with an en-suite bathroom. All en-suite facilities with the exception of one have either a bath or a shower provided. Residents rooms are pleasant, with some of the upper rooms having views over the sea. All have a lockable drawer. Water temperatures in areas used by residents are monitored on a regular basis. Records showed that these were within recommended parameters. All windows seen had restricted opening and the manager gave assurances that regular checks take place to ensure patency of the restrictors. Care Homes for Older People Page 22 of 33 Evidence: The home also provides assisted bathing facilities. The ground floor bathroom has had new flooring over the past year but the tiling and equipment has not been maintained, is difficult to keep clean, and puts residents at risk of injury and infection. A requirement was made at the last inspection regarding this room, this has not been completed and is still unsatisfactory and the provider will be expected to provide a clear timscale for completion of the work. The manager is the infection control champion for the home, and as such, liaises with the Health Protection Agency and ensures that infection control measures are in place. All areas of the home with the exception of the ground floor shower room were in a clean condition. The home has provided sufficient equipment to ensure the safety of residents and to enable residents to maximise their independence. Care Homes for Older People Page 23 of 33 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 adequate 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 experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst there are generally sufficient numbers of staff on duty to meet the needs of the residents, the regular use of bank and agency staff unfamiliar with residents needs leads to lack of continuity of documentation and care. Staff training is starting to emphasise training in care matters rather than solely concentrating on health and safety, this will improve the staffs understanding of the care required in the diverse situations encountered in the home and benefit residents. Evidence: Duty rotas and staff spoken with confirmed that the numbers of staff have been increased to ensure that there are two registered nurses during the morning and a registered nurse and the manager until 4 pm. However staff appeared hurried in their work although those spoken with said that there were generally a sufficient number of staff on duty. Staff also have to help out in the kitchen before, after and during meal times, they also have to do laundry work. This takes them away from the care of the residents which is their primary duty. Care Homes for Older People Page 24 of 33 Evidence: A health care professional who visits the home said Staffing is fine until after 4 pm then when there is only one member of registered nursing staff on duty it goes a bit mad. Staff and residents spoken with, surveys received and comments from health care professionals identified that there was a heavy use of bank staff and agency staff, particularly at weekends. They said that this impacted on both the care of the residents and the quality of the care planning. Subsequent to the inspection an agency nurse working at the home was spoken with who said that she was not familiar with the care of the residents in the home but Can manage for one shift, whilst this is appreciated that agency nurses may only do one shift and therefore not be familiar with the residents, we have been informed that agency nurses are often on duty with other agency nurses particularly at weekends. A survey received from a member of permanent staff described some weekends and shifts during the latter part of the day as Chaotic. The home has just commenced an induction programme in line with the Skills for Care recognised induction course. Registered nurses have a local induction course. Two of the seven members of care staff employed at the home have the National Vocational Qualification level 2 in care with three other members of staff in the process of studying for this qualification. Staff have the opportunity to undertake other training from a variety of sources such as the local authority, the nursing home support team and also from the in house trainer. Concerns have previously been raised with the provider that the in house training days concentrated too much on mandatory training and not sufficiently on care matters. Comments from surveys from other health care professionals included Could give more training to care staff and involve staff in rehabilitation. Three personnel files relating to newly employed members of staff were examined. Whilst generally these contained all employment checks to comply with regulation and ensure the safety of residents, one set of references which had been supplied by a member of staff did not show records of having being checked, although this was confirmed verbally during the inspection by the administration staff. The area Care Homes for Older People Page 25 of 33 Evidence: manager gave assurances that this would not reoccur and that referees would be asked to respond in writing. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems in the home generally ensure the safety and well being of residents who live there. Policies and procedures have not been reviewed and therefore could impact on whether residents are receiving care and services which are in line with current practice. Evidence: The appointed manager has been in post for twelve months; she is a registered nurse (Level 1) and holds a management qualification. She is not yet registered with the commission. This must be addressed as soon as possible to comply with the new registration process coming into force. Care Homes for Older People Page 27 of 33 Evidence: Concerns were raised with the manager over the lack of sufficient management time given by the company for her to complete management duties. A health care professional said There is considerable room for improvement in the time allocated to management. The manager has recent deprivation of Liberty Safeguarding (DOLS) and Mental Capacity Act training. The registration certificate correctly reflected the current status of the home. The AQAA was received when we asked for it. The timescales of the AQAA being requested and received resulted in this document not being due until after the inspection. This was well written and represented this specific home. However, it was noted that the findings of the inspection showed that some of the statements in the AQAA were aspirational rather than factual i.e. activities and end of life care planning. However given that the AQAA was written following the inspection it may well be that actions have already taken place to address matters raised. The atmosphere in home is good, and positive comments were received from the ICS staff and included: Great team and good communication Warm and caring atmosphere. Staff employed by the home said that the manager communicated well with them and that all management throughout the company were approachable. Residents described the staff as being Good humoured and willing. Very polite and caring. The home is undertaken quality monitoring and has recently sent out questionnaires to past and present residents, representatives and health and social care professionals. However these had not all been received back at the time of inspection and had not been collated. Some examples of previous questionnaires seen and comments were constructive and often positive. The ICS have undertaken own survey and the ICS manager said that the majority of the surveys received made positive comments about the home and the care received. No residents meetings are currently taking place but staff meetings have been held quarterly. The provider has been undertaking Regulation 26 visits (visits and reports required by Care Homes for Older People Page 28 of 33 Evidence: regulation on a monthly basis) but these have not always been regular. The area manager confirmed that she will be taking over these visits and that they would be done regularly. The necessity of the home providing an action plan to confirm that any points raised have been addressed, was discussed. The home does not have any involvement with residents money. Policies and procedures have not been reviewed since 2008 and frequent discussions have been held with the Victoria group regarding the necessity of reviewing these policies which did not reflect researched practice and were not specific to the procedures in specific homes. The area manager has given assurances that these will be reviewed and the commission will be monitoring this. Certificates relating to servicing of equipment were in place but there was no electrical wiring, gas certificate or evidence of recent portable appliance testing in place. Subsequent to the inspection these were sent to the commission. Whilst the electrical wiring and gas certificate were in date, the Portable Appliance Testing was dated 2008, the provider should contact the Health and Safety Executive regarding the timescales required for review of testing, and the commission will expect to see confirmation of this at the next inspection. Risk assessments were in place for all areas of the home and individual residents All staff have undertaken mandatory health and safety training Care Homes for Older People Page 29 of 33 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 30 of 33 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 That care plans are in place 10/02/2010 to ensure that the administration of as required medication relates to the specific needs of the individual. That when any external medication administered, the MAR chart is signed by the accountable registered nurse. That permission is gained from the relevant GP for the administration of homely (medication available without prescription) medication to ensure that service users do not have to wait for homely remedies to be administered. The administration of this medication to be within the timescales as permitted by the Nursing and Midwifery council and pharmaceutical regulation. Care Homes for Older People Page 31 of 33 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 2 11 15 That a robust end of life care 10/02/2010 plan is in place for each service user. To ensure that the care and interventions that they wish to have in place at the end of their life are documented to ensure that their wishes are known. 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 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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