Care Home: Warneford House Care Centre

Similar services:

• Abbey The
• Snydale Care Home
• Hawkhills
• Larchfield Manor
• Beeches The - North Yorkshire County Council
• Carentan House
• Ravensworth Lodge

What the care home does well People being cared for have good access to professional medical staff and are able to access external services such as dentists, specialist nurses, chiropody and dieticians, so their health is looked after and they are kept well. The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. The people we spoke to are positive about the home and like living there. People living in the home expressed their satisfaction during this visit regarding the care given and the service received. Staff are hard working and do their best to meet the needs of those people living in the home. What has improved since the last inspection? An increase in staffing has contributed to an improvement in both the amount of activities offered and undertaken, and the recording of people`s choices and experiences from these, reflecting an improvement in meeting people`s social needs and involvement in their local community. Staff uptake of training has got better and the training programme includes a good range of subjects that relate to looking after people with dementia and conditions associated with old age. So staff have the skills and knowledge to meet the needs of people living in the home. Repairs and redecoration of the home have improved the living environment for people using the service, so they now have a safe and comfortable place in which to live. Evidence from this visit shows that the manager and staff have worked extremely hard to improve the service and meet the requirements and recommendations from the last report (28 April 2009). This has provided people who live in the home with a better service. What the care home could do better: The home has worked hard to meet the standards within this report. We have made one requirement around medication record keeping and a small number of recommendations around good working practices. These will be followed up at the next visit to the home. Key inspection report Care homes for older people Name: Address: Warneford House Care Centre Warneford House Tenter Balk Lane Woodlands Doncaster South Yorkshire DN6 7EE     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: Eileen Engelmann     Date: 0 6 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Warneford House Care Centre Warneford House Tenter Balk Lane Woodlands Doncaster South Yorkshire DN6 7EE 01302337111 01302337113 warneford.house@ashbourne-homes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashbourne Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home with Nursing - Code N, To service users of the following gender: Either, Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places 25, Dementia - Code DE, maximum number of places 15 Date of last inspection Brief description of the care home Warneford house is a care home situated in a residential area of Adwick-Le-Street and is within a short distance of shops, library and churches. The home comprises of two Care Homes for Older People Page 4 of 33 Over 65 0 25 15 0 2 7 0 7 2 0 0 9 Brief description of the care home units. They are Warneford suite and Adwick suite. The Warneford suite provides personal and nursing care for up to 25 older people, whilst Adwick suite provides personal and nursing care for up to 15 people with dementia. The home is a horse shoe shaped single storey building with easy access to the patio and garden areas. The fees at the time of this site visit ranged from 402.71 GBP to 605.04 GBP per week depending on the type of care required. Additional fees are payable for hairdressing, private chiropody and specified toiletries. A service user guide is available to visitors to the home, which provides information about services on offer at the home. The most recent Commission for Quality Care Inspection report was displayed at the reception area for the visitors to read. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Information has been gathered from a number of different sources over the past 12 months since the service had its last key inspection visit on 28 April 2009, this has been analysed and used with information from this visit to reach the outcomes of this report. We carried out an unannounced visit to the service on 27 July 2009. This was done by our Pharmacy Inspector to follow up concerns about medication administration and record keeping brought to our attention. The outcomes of this visit were, improvements had been made since the key inspection visit in April 2009 and that people using the service could expect to receive their prescribed medications correctly as intended. Since our last key inspection visit on 28 April 2009 there has been a change in management for the service. The new (acting) manager is not currently registered with Care Homes for Older People Page 6 of 33 the Commission for Quality Care, but will be called the manager within the text of this report. This unannounced visit was carried out with the manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and peoples files, and records relating to the service. Informal chats with a number of staff and people living in the home took place during this visit and comments, where appropriate, have been put into this report. The manager completed an Annual Quality Assurance Assessment (AQAA) and returned this to us within the given timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We have not received any formal complaints about the service in the last 12 months, but the home has made three safeguarding referrals to Doncaster Councils Safeguarding Team in this timeframe (this is where someone raises concerns about the safety of a person using the service). The safeguarding allegations were around staff conduct, medication and care practices. The safeguarding team have looked at all three referrals, two required further investigation and at the time of our report one investigation is ongoing. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. We would like to thank everyone who spoke to us during this visit. Your comments are very important to us and ensure this report includes the views of people who use the service or work within it. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: 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 Care Homes for Older People Page 8 of 33 order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wanting to use the service undergo a needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met. Evidence: Four peoples care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the person or their representative. Each person has his or her own individual file and the funding authority or the home, before a placement is offered to the individual, completes a need assessment. The home develops a care plan from the assessments, identifying the individuals problems, needs and abilities using the information gathered from the person and their family. Information from the Annual Quality Assurance Assessment and discussion with the manager indicates that people in the home are of White/British nationality. The home Care Homes for Older People Page 11 of 33 Evidence: does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. The home is able to offer a choice of staff gender to people who express preferences about care delivery, as they employ 3 male care staff. The information about peoples preferences is recorded onto their care plan. The information in the AQAA tells us that staff have received training on individual care delivery and person centred care in the last 12 months. The staffing matrix given to us on 6 May 2010 shows that the uptake of training in the home is improving and there is a range of mandatory and more specialised subjects available for staff to attend. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of the care given on a daily basis. The home does not have any intermediate care beds and therefore standard six does not apply to this service. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of the people living in the home are being met by the service and staff; and people using the service have confidence in the staff looking after them. Evidence: At our last key inspection of 28 April 2009 we made a requirement The care plans must be kept under review and they must reflect the changing needs of the people. Therefore people are able to to receive appropriate care. Some examples are Barrier Nursing of a person, statements of peoples wishes to get up and get ready in the morning, mouth care to those receiving artifical feeds. Checks at this visit found the requirement has been met. Discussions on this visit with people using the service, indicates that individuals are satisfied with the care they receive and enjoy life in the home. People said that they received the care and support they needed, that staff listened and acted on what they Care Homes for Older People Page 13 of 33 Evidence: said and were available when assistance was requested. On the whole care plans detailed the needs and abilities of individuals and set out the actions required by staff to ensure peoples wishes and choices are respected and their care needs met. The plans looked at have been evaluated on a monthly basis and any changes to the care being given is documented and implemented by the staff. Information about the persons social interests, likes and dislikes, spiritual needs and wishes regarding death and dying are included within the individuals care plan. In addition to this information there are risk assessments to cover daily activities of life and clear information about health and input from professionals and the outcomes for people. We found a few areas where the care plans could be improved and these included:Ensuring that the moving and handling risk assessments and care plans for individuals included information on what type of hoist to use for different tasks, what size sling each person requires and the loop configuration for each sling. This will make moving and handling of people safer. Staff have a habit of leaving gaps between the data entries on the daily notes. This is not acceptable practice as records should be contemporaneous. The practice of leaving gaps could allow information to be inserted after an event. The manager took immediate action to ensure that the care plans affected were brought up to date. Discussion with the manager indicated that she has recognised the need to ensure the care plans become more person centred, to reflect each individuals wishes and choices regarding their care. In order to improve this aspect of the care plans the staff have started to update the information in the plans and replace the personal profile documentation with a more descriptive format. People can input to their plans by using picture cards to make personal choices, where verbal communication is difficult. This is done on a 1-1 basis and staff will take a photograph of the cards chosen by the service user and use this within the care plan. The service has made a start on assessing individuals as to their capacity to make their own choices and decisions around care with regard to the Mental Capacity Act legislation. Discussion with the manager indicated that at the moment no-one using the service requires a deprivation of liberty assessment doing for restriction of liberty or facilities. Care Homes for Older People Page 14 of 33 Evidence: At our last key inspection on 28 April 2009 we made a requirement People must be provided with chairs which are fit for purpose. Checks at this visit found the requirement has been met. The service provides a variety of equipment to aid people in their daily lives. This includes the provision of profile beds, wheelchairs, hoists and specialist chairs as needed. Entries in the care plans specify where individuals have dietary needs, and nutrition risk assessments have been completed. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. The manager told us that the home has a good working relationship with the district nurses and local GP services. Pressure areas are monitored regularly and proactive measures include risk assessments and special mattresses and seat cushions. In the random inspection visit of 27 July 2009 two requirements were made All medicines must be stored securely at temperatures recommended by the manufacturerer. This will help staff know that all medicines are safe to use when needed. Medication, including all skin preparation, must be given as prescribed and a record must be made at that time. This will help to make sure that people receive their medicines correctly and that an accurate record of medication usage is maintained. Checks at this visit found the requirements have been met. Checks of the medication showed the home is using Boots the Chemist as their pharmacy supplier and the medication system in use is a Monitored Dosage System (MDS) where tablets are supplied in a pop out sheet. We looked at the medication records and found that on the whole these are up to date and completed to an acceptable standard, but staff need to be vigilant. At the time of our visit the nurse in charge was supervising a student nurse who was completing the morning medication round. The student nurse is not able to sign for the medication given, it is the responsibility of the nurse in charge. We found that the morning medication had not been signed as administered, until we pointed out their error during our checks of the records. Care Homes for Older People Page 15 of 33 Evidence: We looked at the controlled drugs and the register kept for these medicines. The register and controlled drug stock were correct. As an added precaution the nurses sign a talley sheet for each medication to show what balances are in stock at the end of each shift. We found that on two sheets the staff had not written in the name of the medication being checked or the strength of tablet, but had completed the daily audit of tablets. This indicates the staff are doing the checks by rote, and this makes the task meaningless. Discussion with the manager and staff on duty indicated that since the last random inspection, only the trained nurses administer skin preparations/creams to people using the service. Checks of the medication records show these are completed when the creams are applied. Chats with people revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Our checks of the care plans showed that the home completes risk assessments for activities of daily living to ensure people are kept as safe as possible, whilst accommodating their decisions and choices around their day to day care. Observation of the service showed there is good interaction between the staff and people; with friendly and supportive help being given to assist individuals in their daily lives. Information in the AQAA completed by the manager in February 2010 states that staff have received training on privacy and dignity. This aspect of care is also included in the satisfaction questionnaires sent out to people on a regular basis. One area where the home could improve on how it promotes dignity and respect is around its hairdressing service. At the time of our visit people were sat in a corridor under driers and there was a quantity of cut hair all over the corridor carpet, where the hairdresser had styled peoples hair in public view. The hairdresser was using a nearby bathroom to wash peoples hair at the sink. Discussion with the manager indicated that there is a more suitable room which could be adapted into a hairdressing salon and we recommended that this facility be developed as soon as possible. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are provided with choice and diversity in the activities and meals provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. Evidence: At our last key inspection visit on 28 April 2009 we made a requirement The activity programme for people in both units must be improved so it is suitable and specific to individuals needs. Checks at this visit found the requirement has been met. The home employs an activities co-ordinator who works Mondays to Fridays (20 hours in total). There is some flexibility in their hours to accommodate trips out, evening events and the occassional weekend activity. Discussion with the manager indicated that there is a vacant post for 16 activity hours, and she has plans to recruit for a person who will work alternate weekends. At the moment there is a range of group activities and one to one sessions taking place, which reflect the interests of the Care Homes for Older People Page 17 of 33 Evidence: people living in the home and also their gender. There is a programme of weekly activities and outside entertainers visit once a fortnight. One of the regular entertainers is Motivation and Company, they visit alternate sides of the home, doing quizzes, excercise to music and other stimulating sessions. The home had a group of singers from Age Concern visit the day before our inspection. The manager told us that the home has access to a minibus and there are plans for outings later on in the year. One person using the service told us that he organises the weekly bingo sessions, these are well received by others in the home and prizes for the games are donated by staff and visitors. Information from the manager indicates that people have access to a Church of England service held in the home every six weeks, and individuals can attend outside services as wished. The home provides special meals and cakes for birthdays and helps people celebrate all major Christian festivals such as Easter, Harvest Festival and Christmas. Information from the care plans indicates that people have good contact with their families and friends. Staff told us that the manager has an open door policy for staff, relatives and visitors which works well and ensures people can talk about any issues they may have. Information from the manager indicated that the majority of people using the service had family members who acted on their behalf and took care of their finances. Leaflets with information about the Mental Capacity Act legislation and how to access advocates are available from the manager. The manager told us that she has attended training on the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLs), and those staff doing NVQs have done equality and diversity sessions. This knowledge and information is used to ensure that peoples choices and human rights are maintained and that any limitations on facilities or personal choice are only made following assessment, best interest meetings, risk assessments and discussion with the person concerned or their representative. The training matrix given to us on 6 May 2010 shows that the staff in the home have not had training in MCA or DOLs. We recommended that all staff attend training around the MCA and DOLs and that this becomes part of the homes rolling programme of staff development/training. At our last key inspection visit on 28 April 2009 we made a requirement At mealtimes there must be an adequate number of staff available. Therefore people Care Homes for Older People Page 18 of 33 Evidence: who need help with receive the correct level of support. Therefore people are able to receive good nutrition. Checks at this visit found the requirement has been met. Observation of the midday meal showed it to be well prepared and presented. Staff were organised when serving the meal and a number of individuals were seen to offer assistance to people who need help with eating and drinking. People and relatives are pleased with the quality and quantity of the meals served, saying the food is very good and there is always a choice given. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that peoples views are listened to and acted upon. Evidence: Information in the AQAA completed by the manager on 17 February 2010 indicates that the homes complaints policy and procedure is displayed throughout the home. Copies are available in the Service User Guide which is given to people and families on admission to the service. The complaints policy and procedure seen by us was in a clear print format, however it is available in different formats on request. There are comment cards in the entrance hall of the home, these can be used by people if they wish to make a complaint or can be used for compliments about the service/staff. Checks of the complaints record and information from the AQAA shows that the manager has dealt with eleven complaints in the past year. Information from the AQAA says that a number of issues have been about the maintenance and decoration of the building. This has been addressed by the company decorator attending the home to decorate all the communal areas. There are clear records of any investigation undertaken by the manager and where appropriate the written response to the complainant. People we met during our visit, told us that they are confident of raising any issues with the manager or staff and know how to use the complaints policy and procedure. Care Homes for Older People Page 20 of 33 Evidence: At our last key inspection on 28 April 2009 we made a requirement All staff must be trained and deemed competent when dealing with abuse, neglect and discrimination of those whom they care for. Staff must know whether they have had training on protection of vulnerable adults and know what needed to be done if there was to be an incident or abuse, neglect or discrimination. Checks at this visit found the requirement has been met. The staff demonstrated a good awareness of the process to safeguard the people in the home from abuse. There have been three safeguarding allegations referred by the home to the Doncaster safeguarding team for investigation. The safeguarding allegations were around staff conduct, medication and care practices. Only two allegations needed further investigation and at the time of our visit one investigation was ongoing. Information from the staff training matrix given to us by the manager on 6 May 2010 indicates that 83 percent of staff have received training on Safeguarding of Adults from Abuse, and 35 percent of staff have done management of Challenging Behaviour and Dementia Awareness in the last year. Discussion with the manager indicated that she is working on improving the numbers of staff attending and the training is part of the annual rolling programme of training sessions available to staff. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment provides people with safe, comfortable and homely surroundings in which to live, that meet their individual needs and lifestyles. Evidence: Warneford House is a purpose built home with accommodation provided at ground floor level. There are two double bedrooms for couples and the rest are single rooms; none of the bedrooms are en-suite. People using the service have access to a good range of communal space made up of three lounges, one quiet room (on the dementia unit) and two dining rooms. The home has five bathrooms, all are suitable for hoisted (assisted) bathing; one has been out of action for six weeks (shower room) waiting for repairs to the tiles on the walls. We recommended that it is retiled and refurbished as soon as possible. Walking around the home we found that the enviroment is looking tired and in need of decoration and refurbishment. The corridor carpets are stained and there were a number of malodours on the Warneford unit. We recommended that the carpets need a deep clean or replacing. A number of bedrooms that we looked at require new carpets and refurbishment. Discussion with the manager indicated that she is putting together a maintenance renewal plan, which should be done by the end of June 2010. The manager told us that a new maintenance person is due to start as soon as their employment police checks are back and satisfactory. Care Homes for Older People Page 22 of 33 Evidence: The laundry facility in the home is satisfactory and provided with clean and dirty areas for care of clothing and linen. There are two washers and two tumble driers in use and all machinary is in working order. Infection control policies and procedures are in place, and staff have access to good supplies of aprons and gloves for use in personal care. The staffing matrix supplied to us on 6 May 2010 indicates that 48 percent of staff have attended infection control training in the last 12 months. This training is part of the rolling programme and more sessions will take place in 2010. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good progress has been made in addressing the staffing levels in the last year. As a result there are sufficient staff on duty to meet the specific needs of the people using the service and to offer a consistency of care within the home. Evidence: We spoke to two people who use the service during this visit, and they were satisfied with the care they receive and said that they did not have to wait too long for staff to come when they needed assistance. Individuals told us that staff are friendly, helpful and supportive and we enjoy life in the home. At our last key inspection visit on 28 April 2009 two requirements were made Staffing numbers must reflect the dependency levels and therefore the needs of the people living at the home. Additional staff must be on duty at the peak times of activities. To ensure people are receiving the appropriate care in a timely manner. The staffing levels in both the Warneford and Adwick suite must be sufficient to meet the needs of the people living at the home. Checks at this visit found the requirements have been met. Care Homes for Older People Page 24 of 33 Evidence: At the time of this visit there were 38 people in residence (27 with nursing needs and 11 with personal care needs) and the staffing rota showed that the following staffing levels are in use The home has a twelve hour day and night shift pattern starting and ending at 7:30 each morning and evening. The home has two units Adwick and Warneford, which are staffed separately during the day time and staffed as a whole at night. On Adwick day shift there is one nurse and three care staff, on Warneford day shift there is one nurse and four care staff. At night the home has one nurse and three care staff in total. Information from the manager at this visit, about the number of care staffing hours provided (992), and the dependency levels of the people using the home (22 high and 16 medium), was used with the Residential Staffing Forum Guidance and showed that the home is exceeding the minimum hours asked for in the recommended guidance. Discussion with the manager indicated that she is planning to introduce a twilight shift from 7pm to 11pm to ensure people can go to bed when they want. The recruitment process has been completed for this post and the manager is waiting for the employment police checks to come back and be satisfactory before the shift is put into practice. There are currently a number of nurse hours vacant within the service. At the time of our visit the manager was recruiting 38.5 hours for a nursing unit manager, 33 nurse hours on days and 77 nurse hours on nights. These hours are being covered by existing staff, plus bank/agency staff. We did not look at staff recruitment files during this visit. In our last key inspection visit to this service on 28 April 2009 these records were up to date and satisfactory. This standard will be assessed in full at our next visit. Information from the AQAA completed by the manager in February 2010 indicates that the home has a thorough recruitment procedure in place, every new member of staff has 2 references, a satisfactory employment police check (CRB) and Protection of Vulnerable Adult (POVA) check in place. At our last key inspection visit on 28 April 2009 a requirement was made All staff must be competent to do their jobs. The standard of care at the home must reflect the homes aims and objectives. Checks at this visit found the requirement has been met. Care Homes for Older People Page 25 of 33 Evidence: There is an induction course for new members of staff, which meets Skills for Care criteria. Staff have one day moving and handling training and two days supernumerary before starting as a member of the team. Over 50 percent of the staff have achieved a National Vocational Qualification level 2 or 3 in care. The home provides a mandatory staff-training programme and this includes some more specialised training to help staff develop their skills and knowledge around pressure care,nutrition, medication and customer care. Information from the staff training matrix indicates that the staff uptake of training has improved from last year, but the manager is aware that more sessions are needed to ensure everyone is up to date. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. Evidence: Since our last key inspection on 28 April 2009 there has been a change in management for the home. The manager is in the process of applying to be registered with the Commission for Quality Care and this should be completed by August 2010. The manager has previously been registered with the Commission in another care home and has experience of working with older people. The manager is not a registered nurse, but has clinical support from nurses who are managers within the company. The manager told us that she keeps her skills and knowledge up to date with regular training sessions pertinent to her role. At our last key inspection on 28 April 2009 a requirement was made Care Homes for Older People Page 27 of 33 Evidence: An effective Quality Assurance with quality monitoring system must be in place. So that the management will be able to find out how best they are meeting the aims, objectives and statement of purpose of the home. Checks at this visit found the requirement has been met. The home does not have a formal Quality Assurance System in place but there are robust checks in place to ensure the service runs smoothly and meets the aims and objectives written in the Statement of Purpose. The manager carries out monthly audits of the service and this includes analysis of any accidents, incidents or complaints. Personal allowances for people using the service were checked and appropriate records are in place for each individual. The nominated person visits the home each month and completes the Regulation 26 report for the service. The manager sends out satisfaction questionnaires to the staff, relatives, people using the service and healthcare professionals on a yearly basis, as part of the homes quality assurance process. She is aware of the need to produce an annual development plan based on the systematic cycle of planning-action-review, which reflects the aims and outcomes for people using the service. At the last key inspection on 28 April 2009 a requirement was made Staff must be appropriately supervised and there must be records kept to the supervision. The staff supervision helps the staff to feel supported and provides an opportunity to make career progress. It helps the management when auditing the staff skills, development needs and practices. Checks at this visit found the requirement has been met. The manager provided us with a copy of the supervision matrix that she is working to, the supervision sheets are available for inspection. Information in the AQAA states that all staff receive regular supervision and areas discussed are care plans, keyworking, training, policices and procedures, job role, any other areas which the staff member wishes to discuss. All staff have an annual appraisal which identifies training and development needs. At the last key inspection on 28 April 2009 a requirement was made - Care Homes for Older People Page 28 of 33 Evidence: The window restrainers must be fitted to the areas of the home whre people with dementia have access to. Therefore preventing people putting themselves at risk. Checks at this visit found the windows have restraints fitted to the openings and therefore this requirement has been met. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed risk assessments for a safe environment within the home. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 17 The registered person must 01/06/2010 ensure that accurate records are kept of all medicines received, administered and leaving the home or disposed of to ensure that there is no mishandling. This will result in safer medication practices that ensure people using the service receive their prescribed medication on time and in an appropriate way. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The registered person should make sure that staff do not leave gaps between data entries in the daily records, so that records are contemporaneous and not open to misuse. The registered person should review the moving and handling risk assessments to ensure all information about hoists, sling types and loop configurations are included. Page 31 of 33 2 7 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations This will make moving and handling practices safer. 3 10 The registered person should consider creating a hairdressing salon within the available space of the home. This will ensure that peoples dignity and privacy are respected as personal grooming will not take place in public view. The registered person should ensure that all staff receive training on the Deprivation of Liberty Safeguards and the Mental Capacity Act. So staff have a good understanding of peoples human rights and that any limitations on facilities available or personal choices are only made following assessment, best interest meetings, risk assessment and discussion with the person concerned or their representative. The registered person should consider deep cleaning or replacing the corridor and bedroom carpets where these are stained or odourous. The registered person should ensure the shower room is retiled and refurbished by the end of June 2010 so that people have full use of the bathing facilities provided within the service. The registered person should ensure that all staff are up to date with their mandatory training. Staff should attend specialist subjects where they relate to the care being given to the people using the service. The registered person should have a registered manager in place for this service by the end of August 2010. 4 14 5 19 6 21 7 30 8 31 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!