Care Home: Victoria Oaklands

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What the care home does well The home provides a range of information including a Service User Guide and Statement of Purpose in order to enable prospective residents to determine whether they wish to live at the home. All prospective residents receive a preadmission assessment to ensure that the home can meet their needs and prospective residents are encouraged to visit the home. Residents spoken with said that ` I knew about the home before I came in and then the manager came to see me`. ` My son found out about the home before I came in`. Following admission a care planning process is commenced to ensure that the home will meet all the nursing,social and personal care needs of the residents. These were comprehensive and showed evidence that residents had been involved in their care planning. The standard of medication administration ensures resident`s safety. Residents said " I am pleased with the care they give, the staff are very willing"." They give a good service and they are conscientious". The home has a complaints policy and staff are aware of their responsibilities in safeguarding those in their care. Residents were aware of how to make a complaint although they said that rather than make a formal complaint they would talk to the manager or the owner and " they always sort it out ". Residents generally spoke well of the catering, saying that " meals are generous and there are choices at each meal". " We get a good variety of food, and we have a glass of sherry before lunch". All residents receive a nutritional assessment on admission and this is regularly reviewed with advice from the dietician being accessed as required. Currently there are sufficient staff on duty over a twenty four hour period to meet the needs of the residents in the home. Residents said that ` The bells are usually answered quickly". " Staff have time to talk to you". Staff stated that if there is a shortage of staff this is made up from the home`s nurse `bank`, but they said that shifts are always covered. Health and safety systems are in place to ensure the safety of residents and staff and all staff receive regular health and safety taring. Staff are encouraged to study for the National Vocational Qualification in care and three out of the seven staff have attained this. There is a member of staff who is responsible for monitoring the infection control systems in place in the home and liaising with the Health Protection Agency, and staff practices in infection control were robust. Residents were generally very satisfied with the services provided by the home and the attitude of the staff and management. There was a positive atmosphere in the home and it was evident that staff spent a lot of time on resident`s personal care. What has improved since the last inspection? The home has recently had a new sluice room installed and in the past year has purchased variable height beds to ensure that residents can be nursed without causing them any discomfort. A new care planning process is in place. This has ensured that all aspects of the resident`s care needs are being addressed and that staff can easily find the relevant plan for the care they are about to give. The home has recently invested in new medication trolleys and is in the process of changing over to a ` blister pack` medication system. This will minimise the risk of errors, ensure that residents will always get the right amount of medication and will be easier for staff to use. Requirements made at the last inspection relating to medication, personnel files and a maintenance issue have been complied with. What the care home could do better: The home must ensure that the Statement of Purpose and Service User Guide are regularly reviewed to reflect the current status of the home and that the Service User Guide contains information that resident`s will find useful. One resident said ` it gives no information on what uniform which type of staff wears and its very difficult to know who is the registered nurse and who is the care assistant when you first come in`. The provider should ensure that prospective residents are informed in writing about whether the home can admit them following their preadmission assessment. The manager must ensure that routines in the home are sufficiently flexible to take into account resident`s preferred times of rising and retiring and having breakfast and incorporate these into the care plans. Leisure activities provided do not currently take into account resident`s past and present interests, a programme of activities which reflects these is required. The lift has been out of order for over a month and the provider is required to provide timescales for its repair. Likewise the provider should provide the commission with an timescale for the introduction of the " Common Induction Standards" for new staff. Formal supervision of staff should be commenced. Any adverse events affecting the residents have to be reported to the commission. Key inspection report Care homes for older people Name: Address: Victoria Oaklands 39 Dyke Road Avenue Hove East Sussex BN3 6PA     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 8 0 6 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 32 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 32 Information about the care home Name of care home: Address: Victoria Oaklands 39 Dyke Road Avenue Hove East Sussex BN3 6PA 01273-330806 01273-881627 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 22 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 who can be accommodated is: 22 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 Oaklands (the Service) is registered to provide nursing care and personal care for 22 older people. The premises are a detached three-storey property. The ground floor and the first floor are used to provide the accommodation. The second floor is used mainly for administrative and storage purposes. When full, two of the bedrooms are shared by two people each. The remainder of the people in residence have their own bedroom. All of the bedrooms have a private wash hand basin, toilet and bath. There is a passenger lift that gives step-free access around the accommodation. There is a call bell system. This enables people to contact a member of staff if they need Care Homes for Older People Page 4 of 32 0 22 Over 65 22 0 Brief description of the care home assistance. There are various items of equipment such as hoists to help people who experience reduced mobility. The property stands in its own gardens. It is set back from the main road. There are no shops within easy walking distance. Hove town centre is about one mile away. There is a bus stop just outside the Service and there is some off-street parking.The Registered Provider is a private limited company. It operates four other similar services in the area. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection took place on the 18th June 2009 from 07:30 to 15.30 and was facilitated by the appointed manager and Mr P Burns, registered provider. The appointed manager has been in post for four months and in the process of applying for registration with the Care Quality Commission, throughout this report she will be referred to as The manager. The Annual Quality Assurance Assessment ( AQAA) was received when we asked for it. This is document required by legislation which the registered person is asked to provide on an annual basis. It shows any improvements or goals reached by the service in the past twelve months and what is planned for the next twelve months. The AQAA accurately identified what was happening in the home and what the problems were that had been encountered. This document was used to help inform the inspection process. Care Homes for Older People Page 6 of 32 No resident, relative or staff surveys were sent out prior to this inspection. Whilst all residents were seen during the inspection, five residents were involved in giving their views on living in the home. Methods used to inform the judgments made at this inspection included involvement with five residents, a tour of the home and examination of documentation required for the smooth running of the home and to ensure that residents are receiving care relative to their needs. This documentation included care plans, duty rotas, medication charts, personnel and staff training files, and catering and health and safety files. Five staff and two visitors were met with and discussions were held with them regarding their perspective of the home. The last key inspection of this service took place on the 10th March 2008. Current fees as stated to the commission by the provider on the 19th June 2009 range from six hundred and fifty pounds to nine hundred pounds a week. The fees do not include extra services such as hairdressing and chiropody, and charges for these can be obtained from the manager, but do include the residents choice of newspaper and telephone calls within the UK. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? The home has recently had a new sluice room installed and in the past year has purchased variable height beds to ensure that residents can be nursed without causing Care Homes for Older People Page 8 of 32 them any discomfort. A new care planning process is in place. This has ensured that all aspects of the residents care needs are being addressed and that staff can easily find the relevant plan for the care they are about to give. The home has recently invested in new medication trolleys and is in the process of changing over to a blister pack medication system. This will minimise the risk of errors, ensure that residents will always get the right amount of medication and will be easier for staff to use. Requirements made at the last inspection relating to medication, personnel files and a maintenance issue have been complied with. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of information which includes a Statement of Purpose and Service User Guide for prospective and existing residents, and residents are encouraged to visit the home before making the decision to move there.These documents have not been regularly reviewed and contain out of date information. Not all residents were aware of the Service User Guide. Prospective residents are assessed prior to admission to ensure that the home can meet their needs and expectations. Evidence: Information about the home is provided in the Statement of Purpose and Service User Guide, which is made available to residents on assessment and on their admission to the home. However during discussion with residents it was shown that not all of them were aware of these documents and this should be rectified. Care Homes for Older People Page 11 of 32 Evidence: Some amendments are required in both the Service User Guide and Statement of Purpose to ensure they are factually accurate and reflect the current situation in the home. Since the current manager came into post no new admissions have taken place, however the manager is aware of the need to undertake a thorough preadmission assessment prior to admission, to ensure the home can meet the needs of the prospective resident. Samples of previous preadmission assessment viewed showed that these were sufficiently comprehensive to inform staff and to enable them to be prepared to meet the needs of the person being admitted to the home. The service does not provide prospective residents with written confirmation to state whether or not the home can meet their needs. The home admits residents for respite and permanent care but not for intermediate care. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A comprehensive system of care planning ensures that residents are receiving the care that they require to meet their assessed needs. The standard of medication administration safeguards the residents. Evidence: Each resident has a plan of care which is initially formed from the preadmission assessment. During the inspection four care plans were examined, these were generally comprehensive regarding the care required and how this care was to be given. Some additions to the care plans are required which include a night care care plan, social care plan and end of life care plan, and these were discussed with the manager. Staff must ensure that all care plans are reviewed on a monthly basis. All care plans had risk assessments included, however these require to be more robust. Residents have access to General Practitioners and other health care professionals Care Homes for Older People Page 13 of 32 Evidence: including the tissue viability specialist nurse and the speech and language therapist. The personal care of residents appeared to be completed to a good standard and nursing care of those residents who are being nursed in bed showed that the records of nursing interventions and also fluid charts, were up to date and accurate. Residents spoken with said The service here is very good. They keep us safe and are very conscientious. The bells are usually answered quite promptly, although sometimes at night they can take longer. Discussions were held with the manager relating to the current practice of night staff having to undertake personal care such as showers in the early morning. Due to the levels of night staff employed, this could lead to this care being undertaken in a hurried manner and by taking night staff away from the floor could put residents at risk. The home is still using multi use night bags for residents who are catheterised, this is poor practice in a communal setting as it can increase the risk of infection. A medication round was observed and this was carried out in a manner which ensured the safety of the residents. Due to the lift having been out of order for some weeks, this has added to the time the medication round takes and has resulted in staff having to put in extra efforts to ensure that medications are administered in a safe manner. Records were in place showing the receipt and disposal of medication and these were satisfactory, staff must ensure that all handwritten drugs on the medication charts are signed by the member of staff entering the medication. Controlled drugs were stored and recorded in an appropriate manner. Whilst the clinic room access from the corridor was locked, access from the laundry was freely available. The provider addressed this on the day of the inspection. The home provides terminal care for residents but has not implemented the Liverpool Care Pathway or Gold Standards Framework ( nursing tools for ensuring that the resident receives a standard of nationally recognised care and pain relief), but staff have attended courses in terminal care and the management of syringe drivers (a method of giving continual pain relieving drugs). Whilst the home now has records of residents who wish for interventions such as resuscitation, the home must ensure that residents making these decisions are fully Care Homes for Older People Page 14 of 32 Evidence: assessed under the mental capacity act and also that the decision is made between the resident and the health care team. An end of life care plan should be put in place for each resident, which would include ongoing review of any decisions reached and also residents wishes regarding whether they wish to go to hospital or remain in the nursing home. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the hours available for the provision of leisure activities have increased, there is insufficient planning or recording in place to ensure that residents are receiving the maximum benefit from additional activities personnel employed. Routines in the home are in the process of change to ensure that they are sufficiently flexible to meet residents needs and expectations and to enable them to have choice around all the activities of daily living. A varied and nutritious menu is provided which allows residents to have choice at all meals. Food is attractively presented thereby ensuring that residents appetites are stimulated. Evidence: There are currently two activities organisers employed by the company for the five Victoria Homes, and a further activities organiser in the process of being recruited, with the schedule showing that Victoria Oaklands is provided with an activities organiser for seven hours a week. There was no planned activities programme and it was difficult to ascertain the nature of the activities provided from the records available. Care Homes for Older People Page 16 of 32 Evidence: Residents and staff spoken with said that they had music and movement sessions, occasionally entertainers were brought in and they played board games and did some reminiscence. Varying comments from residents were received: Not very interested as the activities are not particularly demanding. They are a bit infantile. Quite enjoy them it gives you a chance to have a chat with people you dont normally see. Records available showed that the activities person chatted for a few minutes. had a chat with ... but none viewed directly showed what other activities had taken place. The provider and manager stated that an outing by minibus had been organised for the day following the inspection. Records must be kept of residents past and present interests and what opportunities are being offered to the residents to mentally and physically stimulate them. Some residents are able to go out and meet friends unescorted, but it was noted that the absence of the lift was making it difficult for the residents to do this and also to be taken to any activities taking place in the lounge. Residents can have friends or relatives to visit at any time and they can have a meal with the resident. Ministers of religion visit the home. Residents said that they could choose their times of rising and retiring although this was not evident in the care plans. They will ask you what time you want breakfast and you can make your own decision. Seems to me they are always dying to put you to bed. Observation of residents showed that they do have choice in the activities of daily living and are enabled to go out and about if they are able. Night staff stated however that they start the early morning care round at 5.30am. This is very early to commence waking people up and the manager must give thought to residents choices and the flexibility of routines in the home. The home provides a varied and nutritious menu with choices available at each meal, meals were presented in a manner likely to stimulate the appetite. Residents said that they enjoyed the food and described the food as Generous and with choices at each meal. Good food on the whole but sometimes not hot. I like the food but I wish we could have more interesting food embroidered to stir the imagination. Care Homes for Older People Page 17 of 32 Evidence: Lunch consists of three courses preceded by sherry or other alcoholic drinks as requested, one resident said that The lunch is always excellent and I really enjoy the sherry, makes life worth living. At the last Environmental Health Inspection the home was awarded four stars as part of their Scores on doors initiative. Documentation, as required by the Environmental Health Authority, was in place and catering staff have received the training relevant to their role. The home has changed routines and night staff no longer give out the majority of the breakfast. Night staff said that they still give the breakfast to those residents who require assisting with meals. Discussions were held with the manager regarding whether these residents choose to have their breakfast at this time, and whether this needs reviewing to ensure that the routines are sufficiently flexible to meet the individual needs of residents. There have also been changes in the catering routines insomuch that the provider is now putting chefs into all the Victoria homes and therefore, this home,which used to do the catering for all the homes, is now currently catering for two homes only. The cook said that this had made the catering more individual to the home, and that the catering staff had the additional benefit of knowing the people that they are cooking for. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were aware of how to make a formal complaint and were confident that any complaints they may have would be addressed in a fair and transparent manner. Staff have received training in the safeguarding of those in their care, and were aware of the various systems in place to ensure that residents are not put at risk. Evidence: The complaints procedure is readily available to residents, being displayed in the entrance hall and also included in the Service User Guide. Discussions with residents showed that they were aware of the formal complaint processes, but most said that they would talk to the manger or the owner if they had a complaint, and said that they believed it would be dealt with in a fair manner and sorted out. The home has received three complaints in the past year, some aspects of each of these complaints were substantiated and systems have been altered or put in place to prevent recurrence. The complaints policy needs amendments regarding the name of the commission, and to ensure that complaints agencies such as the local authority are included in the policy. There have been no adult safeguarding issues in the home and all grades of staff have Care Homes for Older People Page 19 of 32 Evidence: received training and updating in adult safeguarding and reporting protocols. Staff were able to demonstrate that they were aware of both the issues which are defined as adult safeguarding and the relevant reporting protocols. Guidelines on the prevention and reporting of adult safeguarding issues are available in the home for staff. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well maintained and provides a pleasant environment for residents. Some areas of the home require refurbishment to ensure that residents are encouraged to make use of the communal areas. The lift has been out of order for around a month which has impacted on the quality of life enjoyed by the residents. Evidence: The home is well maintained and provides a pleasant environment for residents. Over the past twelve months residents beds have been replaced with variable height electric beds and the provider is currently assessing the furniture around the home which is in need of replacement. Replacement of lounge furniture is required as there are few chairs and occasional tables have become very sun damaged, this will not encourage residents to use this room. A new call bell system has been put in place, although one resident found this disturbing as they could hear all the call bells at all times of night and day and a survey received in the latter half of 2008 also said that this was noisy and the call bells were always going off. Hot water temperatures to residents outlets are monitored to reduce the risk of a Care Homes for Older People Page 21 of 32 Evidence: resident being scalded and records showed that these were within recommended parameters. The lift is currently out of order and has been so spasmodically for the past four weeks, this has had an impact on residents, staff and visitors to the home. The commission had not been informed of this and the provider gave assurances that the work would be carried out as soon as possible. A requirement has been made for the provider to supply the commission with the anticipated timescales for this work to be completed. Whilst residents rooms have lockable drawers, no resident is provided with a key to their door and therefore unable to maintain either the security of their belongings or their privacy. Residents should be given the option to have a lockable door on admission to the home and this decided following a risk assessment. A window restrictor in one bedroom was broken, the provider addressed this on the day of the inspection therefore no requirement has been made. Currently the company only holds a minimum amount of pressure relieving mattresses, although nursing homes should be providing nursing equipment required. Therefore the majority of residents have to provide their own should they require these, this is not clarified in the Statement of Purpose. This can lead to a delay in treatment and was discussed with the provider. He stated that the home will commence providing these as necessary. The home was clean in all areas and there were supplies of disposable aprons, hand gel and gloves available. The home has an infection control champion who liaises with the Health Protection Agency and ensures that the home is following the correct protocols. A new sluice room has recently been installed. It was noted that the bath seat in the top floor bathroom is limescaled and therefore difficult to clean, this could impact on the spread of infection. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing rotas and discussions with staff and residents show that during the timescales examined there were sufficient staff to ensure that the needs of the residents in the home could be met. Records showed that staff receive a sufficient amount of mandatory training and some training relating to the care of the residents, there was little evidence that some of the registered nurses are meeting their responsibilities in maintaining and updating their skills. Nurses should be vigilant in ensuring they have the training to ensure residents benefit from their updated and expanded skill range. Evidence: Discussion with staff and residents, observation of staff working and examination of the duty rotas showed that there are sufficient staff on duty over a twenty four hour period to meet the current needs of the residents in the home. Staff stated that if staff are off for any reason, then the companys bank staff or agency staff are brought in. Whilst change in routines in the home have assisted night staff to avoid hurrying residents early morning, the management should be aware that if residents needs increase then the amount of staff on night and afternoon duties will need to be changed. Staff have received mandatory training such as moving and handling, fire and safeguarding training, this is undertaken by the companies own trainer. Catering and Care Homes for Older People Page 23 of 32 Evidence: other staff receive additional training according to their role. Night staff spoken with do not generally attend training given by other agencies such as the Nursing Home Support Team, and should be encouraged to do so. The manager should ensure that all registered nurses are continuing with their own study to ensure that their practice is up to date. it was noted that the registered nurses did not have the skills to undertake compression bandaging although a resident with this need had been admitted, this resulted in the use of community nurses. On examining registered nurses personnel files, there was little evidence that those employed for some time had undertaken any recent clinical training, whereas discussion with recently employed registered nurses showed that they had updated themselves more frequently. All staff participate in the companys own induction training on commencement of employment. The company is not yet using the nationally recognised common induction Skills for care although has stated that they intend to commence this. The provider is required to give the commission the approximate timescales when this will be commenced. Three out of the seven members of care staff employed by the home have the National Vocational level 2 in Care. Senior staff have had briefings on the Mental Capacity Act and Deprivation of Liberty safeguarding. This training should be expanded and made available to all grades of care staff. Four staff files were examined and these included all the information and checks as required by legislation. The provider stated that all staff receive a copy of the General Social Care Council Code on commencement of employment. It was noted that one of the residents employs their own private care assistant. Discussions took place with the provider regarding ensuring that parameters were set to ensure that the resident receives the necessary care and to ensure the safety of other residents within the home. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management are aware of systems that need to be put in place to ensure that residents expectations are met. Residents and staff are safeguarded by the managements awareness of health and safety issues. Evidence: The appointed manager has been in post since February 2009 and is in the process of registering with the commission and applying for a place on the Leadership and Management course which commences September 2009. This course replaces the previous Registered Managers Award. Whilst the managers within the group have received a briefing on the Mental Capacity Act and Deprivation of Liberty Safeguarding, more in depth training is required. The manager is applying for the Local Authority course in this subject. The manager is aware of the need for her to update herself on all aspects of the National Minimum Standards and the associated regulations. Care Homes for Older People Page 25 of 32 Evidence: The majority of the residents involved in the inspection said that the atmosphere in the home was good with staff attending to their needs in a willing and prompt manner. Staff said that they enjoyed working at the home and that the standard of training received was good. The Annual Quality Assurance Assessment ( AQAA) was received when we asked for it. This is a document required by legislation which informs us of the improvements made in all areas of the home and the plans for the following twelve months. This is the only quality monitoring process currently taking place in the home. The provider, Mr P Burns, said he was not sure when the last resident and stakeholder surveys had been sent out, although the AQAA stated that they were planning on commencing this. Surveys in the home were not dated and therefore it was impossible to determine when they had been sent. No residents meetings have been held since the new manager has been in post, however staff meetings have been held regularly and minutes of these were seen. Policies and procedures were last reviewed in 2008, however although they were not examined in this home, the companys policies are generic and the policies viewed on a previous occasion showed that these did not reflect either changes in clinical practice or legislation. The home requires a policy on witnessing wills and other financial documents, and the home needs to have a method in place to ensure that staff have read this and other policies. The home does not hold money for residents or act as their appointee. Discussions with staff and the manager identified that no staff are currently having formal supervision. The manager is aware that this needs to be commenced in line with the timescales directed by the National Minimum Standards. Records seen in the home such as care plans, personnel files, medication records and health and safety documents were up to date and accurate. Regulation 26 visits (monthly visits and reports by the provider and required by legislation) were in place. The manager was not aware of the necessity to inform the commission about any events affecting residents ( Reg 37 noticifications), and the provider, Mr Burns, was not well informed about this. Consequently events such as the lift being out of action and two other events which should have been reported, had not been reported. Both the manager and the provider gave assurances that this would be done in the future, therefore no requirement has been made. This will be checked throughout the year. Care Homes for Older People Page 26 of 32 Evidence: All members of staff have up to date mandatory training such as moving and handling and other health and safety training and there were no health and safety issues, other than those reported in previous sections of this report, seen. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 That the Statement of 03/08/2009 Purpose and Service User Guide are regularly reviewed to ensure that the information contained is up to date and accurate To enable existing and prospective service users to receive accurate information about the home. 2 4 14 That the registered person 24/07/2009 confirms in writing that the home is able to admit the prospective service user and meet their needs. To confirm that the service users needs will be met on their admission to the home 3 12 16 That service users are consulted about a programme of activities which takes into account past and present interests and provides physical and mental stimulation. 03/08/2009 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that service users are able to enjoy leisure activities which meet their needs and capabilities. 4 22 23 That the commission is 10/07/2009 provided with the timescales for the completion of the lift repairs To enable service users to enjoy a maximum quality of life 5 30 18 That timescales for the commencement of a recognised induction course are forwarded to the commission. to ensure that staff receive a robust induction course to prepare them to give service users a high standard of care. 6 33 24 That a system is put in place 03/08/2009 to ensure that the quality of care and the quality of services delivered by the home is regularly reviewed. This system should also include the views of residents, staff and other stakeholders such as health and social care professionals. To ensure that the home 20/07/2009 Care Homes for Older People Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action meets the expectations of service users and stakeholders and meets regulation 7 36 18 That staff receive regular 03/08/2009 formal supervision within the timescales as directed by the National Minimum Standards. To ensure that staff are aware of their responsibilities towards service users, can have their training needs addressed and to ensure that services meet the expectations of the service users 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 8 That single use night catheter bags are used for those residents who are catheterised to reduce the likelihood of the spread of infection. That handwritten drug charts are signed by the person writing them and if possible, checked by a witness to ensure that the medication, dosage and timing are correct. That residents are given the opportunity to have a key to their rooms, and if they wish to have one this is provided under the auspices of a risk assessment. That policies and procedures are reviewed and that a policy relating to the witnessing of financial arrangements is put in place and all staff are aware of this. 2 9 3 24 4 33 Care Homes for Older People Page 31 of 32 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. 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