Care Home: Wantsum Lodge

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What the care home does well Each resident has written information about the home that is kept in their bedroom for them to refer to. This includes details of how to complain if they want to. This is important so that people know what to expect from the home and who to speak to if there is anything they are not happy with. People considering moving into the home have their needs properly assessed beforehand. The manager goes out to meet with them and asks them about the support they need, so that things are ready for them when they move in. Each resident has a written plan of care that makes sure they get the support they need and the right health care. Residents say they are well looked after and they have confidence in the staff team. One resident said, "They are excellent, there is a lovely rapport between all of us. I am very pleased with everything." Residents enjoy their mealtimes, which are relaxed and unhurried. The dining room provides a congenial setting and residents again told us that the food is good and they have choices at every mealtime. The environment is clean, comfortable, homely and well maintained. Residents like their bedrooms and a visiting relative commented, "The home is always spotlessly clean." Staff take good precautions to prevent the spread of infection in the home and keep people safe. Staff are suitably trained and competent. They are encouraged to achieve a recognised qualification in care, they like working in the home and there is a good team spirit. Care staff have a good knowledge of residents` needs and they treat them with respect. There are good safety procedures in place to protect people. What has improved since the last inspection? They have acted upon recommendations made at our last visit. They have improved the assessment and care plan documentation to make it easier for staff to follow and to make sure that it contains all the right information. They have made sure that care plans cover everything that staff need to know about the resident. The care plans show different ways of doing things for individuals that are specific to them. This makes sure that people are treated equally, no matter what disabilities they may have.They have changed the medication room since our last inspection, which is clean, spacious and well organised, with all the right equipment to keep medicines safe. They have employed an activities coordinator who spends time with people individually, takes some residents out and does some group activities. They have continued to keep the environment homely and safe, by ongoing redecoration and refurbishment. They have added a heater to the `wet room` to make sure it is warm enough for residents when they shower. They have added a separate washbasin in the laundry for staff to wash their hands and provided a sluicing sink in a separate room, as added measures to prevent the spread of infection. They have increased the numbers of staff on duty throughout the day and night to take account of the increase in resident numbers. This is to make sure that residents` needs are met. They have continued with their staff training programme to help staff develop their knowledge and skills. Residents can therefore have confidence that staff know how to care for them properly. What the care home could do better: The home has more strengths than weaknesses. They have shown that improvements made at the last inspection have been sustained and they have made further developments. We have not made any requirements or recommendations, as they have shown their commitment over the past year to the development of the home. We are confident that the provider can manage the things identified and they have plans for the continued development of the service. Their main area of weakness is that staff files need reorganising in a way to make sure that loose papers do not go astray. They have acted on the requirement made at our last inspection about this, but they need to make sure that written information received when new staff are vetted is kept safely. Following our visit, the manager has acted to address this and there are plans to introduce an administrator post that will help with some of the record keeping. The other thing that needs to be done, is for the manager to submit his application to register with us. This is something that the law requires and should be done without further delay. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wantsum Lodge 32 St Mildreds Road Ramsgate Kent CT11 0EF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christine Grafton     Date: 1 5 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Wantsum Lodge 32 St Mildreds Road Ramsgate Kent CT11 0EF 01843582666 01843852317 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Choicecare 2000 Ltd care home 41 Number of places (if applicable): Under 65 Over 65 41 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 41. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Wantsum Lodge provides residential care for up to 41 older people. It is a detached three storey premises, with a lift access to each floor. The home offers mainly single bedrooms, with all, except two, having an ensuite toilet facility. All bedrooms have a wash hand basin and a call bell system. There are three double bedrooms, two of which are used as singles. There is a choice of communal areas. The home is situated within walking distance of local shops, post office and church. All other community facilities are accessible in the nearby town centre, including public transport links. Parking is on-street. The homes service users guide gives information about the service and a copy is kept Care Homes for Older People Page 4 of 32 Brief description of the care home in each of the bedrooms. The most recent CSCI report is available on request from the home. The fees for support from the home are set during the assessment period and are very individual to the needs of the service user. The average fee levels, as a guide at this time, are between £328:65 and £650:00 per week. Additional charges are made for: taxis, hairdressing, chiropody, newspapers and personal toiletries. 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 report takes account of information received since the last inspection, including a visit to the home. An unannounced visit took place on 17th April 2009 between 09.40 hours and 17.50 hours. The visit included talking to the manager, staff, residents, visitors and observing the home routines and staff practices. Some records were looked at and we looked round parts of the home, including a sample of bedrooms. Information sent to us by the manager prior to the visit, in the form of the homes annual quality assurance assessment (AQAA), has been used and information from the previous inspection referred to. Care Homes for Older People Page 6 of 32 For the purposes of this report, people living in the home will be referred to as residents. At the time of the visit there were 39 residents living at the home. The atmosphere in the home was welcoming and relaxed. At the time of our last inspection, the manager had only recently taken up his post and had the title of acting manager. He has now been in post for over a year, but has not yet submitted an application to be registered with the commission. He told us that this is now in hand. For the purposes of this inspection he will be referred to as manager. What the care home does well: What has improved since the last inspection? They have acted upon recommendations made at our last visit. They have improved the assessment and care plan documentation to make it easier for staff to follow and to make sure that it contains all the right information. They have made sure that care plans cover everything that staff need to know about the resident. The care plans show different ways of doing things for individuals that are specific to them. This makes sure that people are treated equally, no matter what disabilities they may have. Care Homes for Older People Page 8 of 32 They have changed the medication room since our last inspection, which is clean, spacious and well organised, with all the right equipment to keep medicines safe. They have employed an activities coordinator who spends time with people individually, takes some residents out and does some group activities. They have continued to keep the environment homely and safe, by ongoing redecoration and refurbishment. They have added a heater to the wet room to make sure it is warm enough for residents when they shower. They have added a separate washbasin in the laundry for staff to wash their hands and provided a sluicing sink in a separate room, as added measures to prevent the spread of infection. They have increased the numbers of staff on duty throughout the day and night to take account of the increase in resident numbers. This is to make sure that residents needs are met. They have continued with their staff training programme to help staff develop their knowledge and skills. Residents can therefore have confidence that staff know how to care for them properly. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 9 of 32 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 10 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 11 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. People considering moving into the home are given the information they need to decide if it is right for them. They have an assessment that tells staff about them and the support they need. This makes sure that their needs can be met upon moving in. It is not the general policy of the home to admit residents for specialist intermediate care, so standard 6 was judged as not applicable at this inspection visit. Evidence: Each resident has written information about the home, known as a service users guide, which is kept in their bedroom, together with copies of the menus and the complaints procedure. The documents are kept in special pamphlet holders attached to the wall, so that they are easily accessible. We spoke to several residents, one of whom confirmed that they found the guide helpful to refer to when they want to know something about the home. There is also a more detailed document known as the Care Homes for Older People Page 12 of 32 Evidence: statement of purpose that is kept in the office, which people can see if they want. This is something that all homes must have and it has been well written, with everything in it that people need to know about the home. Before a person moves into the home, there is a process whereby the manager goes to visit them to assess their needs. This also provides the opportunity to give them information about the home and tell them what to expect if they decide to move in. At this pre admission visit, the manager asks them about the support they need and want, so that they can decide if the home is right for them and the home can have everything ready for when they move in. If the person has been referred through care management arrangements, a copy of the care management assessment is also obtained beforehand and used to inform the homes pre admission assessment process. We spoke to a resident who had moved into the home during the past three months and looked at their assessment documentation and care plan. We saw that a wide range of information had been gathered, including practical things like how they wished to be addressed, any assistance needed with getting about, things to do with vision and hearing, diet and nutrition and so forth. The care plan contains detailed guidance for staff on what they should do to support the resident in the right way. We saw that the bedroom selected, had been specially chosen in discussion with the resident and their relative, specifically to meet their particular needs. The resident told us they were happy with their room and they were settling in nicely. Particular equipment needed had been obtained. We spoke to two carers about this persons needs and what they said matched with what we had learnt from speaking with the resident and reading the care plan. Both carers had a good understanding of the resident and the care plan and described how they support the person to promote independence and maintain dignity. Care Homes for Older People Page 13 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. People can be confident that they will have a plan of care that has the information needed to make sure they get the right personal care and health care. They can be assured that their medication will be dealt with safely, that staff understand their needs and they will be treated with respect. Evidence: Each resident has a care plan that is individual to them and has all the things recorded so that staff know how to support them. At the time of our last visit, the manager was introducing a new way of writing the care plans to make them easier for staff to follow and make sure that they contain all the right information. This has all been completed now and kept up to date. We looked at five of these plans and saw that they look at all aspects of support and care needed by the residents. At our last visit, some of the care plans we saw had not been reviewed and updated as residents needs had changed. This means that things might go undetected that could Care Homes for Older People Page 14 of 32 Evidence: have important implications for the persons welfare. At this visit, all the care plans that we saw were well completed, had everything properly recorded and had been regularly reviewed and updated. The care plans describe all about the person and their needs. For example, things like the help they need with washing and dressing, moving about, going to the toilet, skin care and eating and drinking. Any medical conditions that staff need to know about are covered, so that they know what to look out for that might indicate the person is becoming unwell and that medical attention is necessary. We saw records of visits by doctors and community nurses that show that such things are properly followed up. Weights are regularly checked, as these also provide an indicator of a change in health. Things are recorded to make sure that the resident is kept safe, for example there is guidance for staff on the use of moving equipment, such as a hoist or stand aid. Equipment is provided to reduce the risk of pressure ulcers developing. Where such risks are identified, the care plans contain detailed guidance for staff on the right way to do things for each different individual. The care plans show that equality and diversity needs are considered, for example, specific things relating to the persons gender, sexuality, religion and disability. This might be by making sure that a persons wishes are known with regard to the gender of carer to assist with bathing. Other examples were seen of specific guidance for individuals about respecting dignity when assisting with personal hygiene in other ways. Staff told us about ways they communicate with blind people and people with hearing difficulties to make sure they are not left out. A good intervention plan was seen for assisting a person with specific needs at mealtimes. At our last visit we saw that medications were being managed safely. At this visit, we observed the lunchtime medication round, which was completed in a competent way. We looked at a sample of records completed each time a medicine is dispensed and saw that these had been correctly completed. Since the last inspection, a new medication room has been brought into use. New non slip flooring has recently been fitted and the room is clean, spacious and well equipped with cupboards, fridge, stainless steel sink unit and two medication trolleys. Staff that administer the medications have undergone specific training and the area manager does monthly medication audits. We spoke to nine residents about the home and the care they receive. They say that the staff are attentive, friendly and respectful, and there is a nice atmosphere. We observed the interactions between residents and staff and saw that this is right. One Care Homes for Older People Page 15 of 32 Evidence: resident praised the staff, saying, They are excellent, there is a lovely rapport between all of us. I am very pleased with everything. Care Homes for Older People Page 16 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. Residents benefit from having opportunities available for them to take part in activities that suit their needs. The home has developed this since last year and has shown that it is responsive to the diverse needs of individuals living in the home. Residents are encouraged and enabled to lead the lives they want. Contacts with families and friends are encouraged and supported. Residents benefit from the relaxed mealtimes and enjoy their food and the choices available to them. Evidence: Since the last inspection, an activities coordinator has been employed. The manager told us in the annual quality assurance assessment that this has meant that they have been able to give residents a lot more one to one time. This could entail just sitting and chatting, taking part in group activities, or going out for walks and visits to the nearby town. Some residents described their daily routines and it was clear that these are flexible and that they can choose what and when they do things. Some of the ladies spoke Care Homes for Older People Page 17 of 32 Evidence: about having their nails done by a manicurist that visits every week, or of enjoying the weekly hairdresser visits. Other residents spoke about the monthly music for health sessions put on by a lady that comes in to provide stimulation through the use of music. Another thing they enjoy is the weekly exercise to music sessions that are provided from another external source. They also have visits from a music man who provides monthly entertainment. All of these things help prevent boredom and provide stimulation. Past occupations and interests are recorded in the care plans and life histories are being developed. This, together with the key worker system that is being introduced, helps to make sure that staff really get to know people as individuals and can make sure that they give person centred care. Training for staff has recently taken place on supporting people with sight loss and this is something that we spoke about at the last inspection. We saw some good examples of things being done to support blind people to be as independent as possible. We discussed with the manager one issue that came to light upon discussion with a resident, where more could be done to improve their quality of life. This persons care plan contained lots of information about specific needs and showed how these needs were being met. The care plan was still in its infancy and being developed, as the resident was relatively new to the home. The manager indicated he would make sure that the appropriate action be taken to address this need that had only just been identified. Residents spoke of having lots of visitors to the home. We spoke with three visitors who commented that they are always made welcome. They all expressed their satisfaction with the home. Their comments included, We cannot fault it. Were always given a cup of tea, we know Mum is happy here and well cared for. They always keep us informed if Mum is not well. We visit three times a week and it is always the same. Staff are very friendly and always welcome us. Residents say that they have good food and have enough to eat. We saw that mealtimes are relaxed and social occasions. There is a choice of dish at each meal and the menu provides a varied diet. Residents are offered a choice of what to have to drink. We saw staff giving discreet assistance with eating, but only after asking the person first if they wanted any help. One resident started one dinner choice and when they did not eat it, was offered another dish. One resident who praised all the meals, commented specifically about the breakfasts, saying, We have brilliant breakfasts, we have a full cooked breakfast at weekends and in the week we can have anything we want from toast, choice of cereals, fruits such as Care Homes for Older People Page 18 of 32 Evidence: grapefruit, porridge and cups of tea. Care Homes for Older People Page 19 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 can be confident that if they have any complaints they will be listened to and their concerns acted upon. They are protected by the homes procedures and practices to safeguard them from harm. Evidence: The manager has recently rewritten the complaints procedure and had laminated copies put up in every bedroom next to the service users guide. This explains how someone can raise a concern and includes details of how to contact the area manager and the commission. The manager explained that most things are sorted out informally, without the need to make a formal complaint. There is a procedure to record any formal complaints and record how they have been investigated and the outcome. There have been no complaints since May 2008 and the record shows that it was promptly sorted out. We asked three people about how they feel about raising a concern with the manager, or with other members of staff. They each said they feel confident to approach the manager, or any of the staff. They said they have no concerns at the moment, as things usually get sorted out quickly if they talk to staff, so they do not usually need to see the manager. Care Homes for Older People Page 20 of 32 Evidence: The manager said he goes round the home every day and tries to talk to as many residents as possible, giving them the opportunity to say if anything is wrong or make suggestions. Staff also confirmed that the manager is approachable and has an open door policy. As well as this, the area manager does regular monthly unannounced visits when she talks to a selection of residents and staff. This provides them with another means to raise their views about anything to do with the home. At our last visit, we saw that six staff had recently received training on safeguarding adults. We were told that following our last visit, the remainder of the staff were trained. Unfortunately eleven of those staff have left, so there are now still twelve staff that need this training. This is currently being arranged and will also be covering the Mental Capacity Act and deprivation of liberties safeguards. We spoke to one staff member that had recently done this training and they had a good understanding of this issue. Care Homes for Older People Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a comfortable and homely environment. The programme of ongoing redecoration and maintenance makes sure it stays safe and suitable for the residents living in the home. Residents are protected by the good practices to maintain hygiene and prevent the spread of infection in the home. Evidence: We looked at the communal areas of the home and a sample of bedrooms. We saw that the home is clean, attractive and well maintained. Residents say they like their bedrooms, which vary in size, are all nicely decorated, well furnished and homely. The majority of bedrooms are spacious with ensuite facilities. There are only four smaller rooms without ensuite toilets, but these are of adequate size and we saw that they suit the needs of the residents occupying them. Bedrooms are individualised with personal possessions and some residents have brought in items of their own furniture. There are adaptations and equipment to help people get about, such as hand rails, toilet aids, bath hoists, mobile hoist, stand aid and lift access to each floor. All bathrooms are spacious, clean and well equipped. Since the last inspection, an electric fan heater has been added to the wet room to make sure it is warm enough for people when they shower. Hot water temperatures are being regularly tested to make sure the anti scald devices are working properly. This helps to reduce the risk of Care Homes for Older People Page 22 of 32 Evidence: scalds. Radiators are either guarded or of the low surface temperature type to reduce the risk of burns. There is an ongoing redecoration and refurbishment programme and we saw where some rooms had recently been redecorated and new carpets have been provided. A recent improvement has been the creation of a new ramp for two stairs in an upstairs corridor, so that a person can move about to different areas of the home in their wheelchair more independently. This has helped to improve this residents quality of life in that they are able to get to the lower ground floor lounge more easily and spend time with other residents there that they have become friends with. A safety procedure has been introduced for this to reduce risks for other people. We saw that good hygiene procedures are in place. All areas seen were clean and there were no odours. There are effective systems in place to keep the home fresh smelling. Since the last inspection, they have acted on recommendations made and have provided a sluicing sink in the first floor cleaners facility and they have added a hand wash basin to the laundry. There are good laundry facilities and procedures for keeping linen and clothing clean. We observed staff following good hygiene procedures and saw that there are good procedures to control the spread of infection. These include plentiful supplies of liquid soap and paper towels in all appropriate areas and protective clothing for staff. A visiting relative commented, The home is always spotlessly clean, Mum has a nice room, which is always lovely and clean. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that there will be enough staff on duty that have the right skills to meet their needs. Recruitment procedures and practices are adequate to protect them. Evidence: We looked at the numbers of staff on duty and saw that these have increased since our last inspection to take account of the higher resident numbers and their needs. We looked at the rotas and saw that these matched details of staff on duty during our visit. We had discussions with the area manager, the manager, two of the carers and some ancillary staff. From this we saw that what the manager stated in the self assessment document (AQAA) about increasing staffing numbers is correct. Care staffing numbers range from six in the mornings, five in the afternoons to three waking staff at night. In addition to this there are staff on duty that work in the kitchen, do housekeeping, domestic, laundry and maintenance duties. There have been a number of staff changes during the past twelve months, but staff that we spoke with said that new staff employed to replace those that had left have brought new skills and they feel there is a good staff team now. All staff spoken to, including care, housekeeping, laundry and maintenance staff, said they like working at the home and demonstrated their knowledge of residents needs and, or, good Care Homes for Older People Page 24 of 32 Evidence: practices in their roles. Residents expressed their confidence in the staff, saying that they like them and feel that they know what they are doing. Residents that we spoke with say they get the help that they need. One person did express that staff are very busy, but added that they are there to help when needed. Staff spoke enthusiastically about their work, saying that they work well together. They also spoke about being enabled to attend lots of training courses and demonstrated good awareness of equality and diversity issues. Care staff are encouraged and supported to achieve their National Vocational Qualification (NVQ) in care level 2 or above. Ancillary staff are also encouraged to achieve the relevant NVQ for their roles. Training records show that staff attend a wide range of short courses including, induction training, mandatory health and safety training courses and a range of other courses relevant to their roles. For care staff, these include courses on diabetes and insulin administration, palliative care, understanding incontinence and dementia awareness. At our last inspection, we made a requirement that staff files must contain all the information that the law requires. This is important to show that people employed have had all the necessary security checks completed to keep residents safe. The files also needed reorganising in a way to make sure that loose papers do not go astray. The manager informed us that action was taken to address the requirement in the timescale set. He stated that all the correct information is obtained when recruiting staff. However, an unannounced quality monitoring visit by the homes area manager in February 2009, identified that staff files needed some order and the manager was asked to audit them within two weeks. This has been done and records show that all but two files contain the correct information. We looked at three staff files chosen at random and found that most of the required information is there, but the files contain loose pieces of information that are not all in order. One file had two missing references, although both the manager and area manager said they had been received and they had seen them. As a result of the recent audit they had looked through all the files but the missing references had not been found. Another file only contained one reference. We discussed that the reference form does not have a place for the referee to date and interview records are not being kept. The manager has plans to start using an interview form. He confirmed in a telephone conversation following the visit that the missing references have been requested again and new files ordered to secure the records properly. Care Homes for Older People Page 25 of 32 Evidence: The manager has made an undertaking to notify us by 31st May to confirm that all files are in order. The area manager stated that they are going to appoint an administrator to help the manager with some of the record keeping and general administration. She confirmed that she will be closely monitoring recruitment at her future monthly monitoring visits, and the company has good procedures in place. In view of the evidence of improvements completed during the past twelve months in all aspects of the service and the good outcomes for residents that we have seen, we believe that this one shortfall identified will be rectified as stated. Therefore we have not made another requirement. Outcomes for three of the four standards in this outcome group have been judged as good and the recruitment standard almost met. It is because the recruitment of staff is so important that the overall judgement for this staffing section is adequate, rather than good. Care Homes for Older People Page 26 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. The home continues to improve and develop the quality of service it provides to residents, so that they benefit from living in a home where their best interests, health and safety are promoted and protected. Evidence: The manager has been in post for fifteen months and has the relevant experience of working with older people. He has completed a wide range of relevant training courses, but has not yet gained a care management qualification. He spoke of his commitment to complete the new Leadership and Management Course, which he hopes to start soon. He also stated that he would be submitting an application for registration with us. The law requires this, so that we can check that people managing homes have the right qualifications and experience, as well as having the necessary security checks. We have seen the difference the manager has made during the past twelve months. He has continued to improve the assessments and care plans so that residents Care Homes for Older People Page 27 of 32 Evidence: healthcare is good, increased the opportunities for residents to take part in activities, which are good and improved the environment, which is now excellent. Staffing numbers have increased and staff training is ongoing and relevant. The manager has continued to ensure good health and safety procedures are in place. Residents, visitors and staff that we spoke with think that the home is good and all said that the manager is approachable and supportive. Quality monitoring systems include regular monthly visits by the owning companys area manager, who prepares a written report on the conduct of the home. The manager makes sure that regular safety audits are carried out and remedial actions taken. The area manager supervises the manager and also conducts monthly medication audits to inform the quality monitoring processes. Questionnaires have been used in the past and the manager spoke of plans to rewrite them to make them more specific for different groups of people, including, residents, relatives, care professionals and doctors. The manager has an open door policy and goes round the home every day to speak with residents. The homes annual quality assurance assessment (AQAA) was completed on time and gave us an indication of how the home is doing. There is some evidence to support comments made, but more supporting information would have been useful in some areas to illustrate more where improvements have been made, or show how it is planning to improve. A number of regular health and safety checks are carried out. This includes fire safety equipment tests and a fire bell test was carried out during the visit. Bed rail inspections have recently been introduced and other checks include window restrictor and wheelchair visual checks. The housekeeper and domestics carry out their own weekly checks. All of this builds into the homes quality monitoring system and makes sure that as things are picked up, remedial action is taken to address them. The AQAA states that they have improved the system for residents to have access to their own money, where this is kept on their behalf. This is something that we discussed at our last visit and the manager confirmed that the system has been reviewed as a result. We saw that staff training on areas such as, fire safety, first aid, food hygiene and moving and handling is given high priority and sufficient staff are trained in these things to keep people safe. There is a system to identify where refresher courses are needed and for new staff to be trained in these important areas. Overall, the home has more strengths than areas for improvement and all but two of Care Homes for Older People Page 28 of 32 Evidence: the key standards are met. The two standards that are almost met, relate to recruitment and the managers qualifications and registration and we have been told that action is being taken to address these. The home has sustained and developed the improvements seen at our last visit and is building a good track record. Where weaknesses have emerged, these have been recognised and acted upon. There are plans to introduce an administrator post to help the manager with some of the record keeping in future. Care Homes for Older People Page 29 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 30 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 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 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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