Care Home: Wayfield Avenue Resource Centre

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What the care home does well The admission process ensures that only residents whose needs can be met are admitted to the home. Care staff demonstrated an understanding of the individual needs of residents and was attentive to them on the day of the site visit. Support to residents was observed to be provided in line with information in the residents care plans. Residents make decisions about their lives and are consulted on aspects of life in the home to ensure choice and preferences are accounted for. There is an informal atmosphere with residents free to participate in differing activities. The home has accessibility and promotes the residents to attain maximum fulfilment of life goals and opportunities by fostering community engagement. The home employs a stable and committed team of staff who know, understand and respect the needs of the people who live there. Residents were served at meal times with dignity and promotion of independence, with assistance where and when required. There are systems in place to ensure residents feel free to air their views and know that action will be taken where needed. The physical environment of the home fulfils the home`s stated purpose and the location facilitates freedom for the people who live there and the opportunity for residents to be involved in the local community. The home is managed by an experienced manager Some comments received from residents were: `the food is good and nice`, `the staff are excellent`, `We get the choice to do what we want`, `I can go to bed early or late` and `We can have the home as we like it`. The Experts by Experience reported they found `Wayfield Avenue Resource Centre was found to be of excellent quality in promoting independence, choice and dignity.` What has improved since the last inspection? Two requirements made at the last key inspection have been addressed. This included ensuring that all residents have a written statement of the terms and conditions of residency. A copy of the terms and conditions are also included in the Service User`s Guide. The home has made improvements in relation to fire safety within the home to ensure all people living at and visiting the service are safe so far as is practicable. The ASR undertaken last year identified that we thought the outcome for residents had improved. The findings at this site visit confirmed that improved outcomes are being provided. Other improvements made have been identified as part of the homes own internal quality checks. The AQAA identifies areas that they have improved in the last 12 months and some examples given as changes they have made as a result of listening to residents are: residents have been involved in choosing colours and designs for on going redecoration within the service, including individual rooms and communal areas. Residents chose a new television that has been purchased for the lounge and are involved in planning activities. Other improvements identified in the AQAA to improve the service provided relate to the physical environment of the home. Staff continue to receive appropriate training and new medication policies and procedures have been implemented. What the care home could do better: The home needs to ensure that written confirmation is given to prospective residents, confirming that having regard to their assessment, the care home is suitable for the purpose of meeting their needs in respect of their health and welfare. Whilst the last inspection report and the AQAA identify that robust recruitment procedures are followed, the home must take action to ensure that all information pertaining to recruitment of staff is available for inspection at the home at all times. It is recommended that changes to Medication Administration Record (MAR) charts are signed to identify who made the changes and any hand written prescriptions are double signed by staff who have received medication training. This will further safeguard staff and residents from errors occurring. Whilst two requirements have been made from this inspection, the service has previously demonstrated the commitment to ensuring compliance and improving outcomes for residents. The AQAA identifies that they are committed to making further improvements and ensures the views of residents are included in future plans. We are confident that they have mechanisms in place that are sufficiently robust within the home to identify its own areas for improvement. Any minor shortfalls noted at the site visit, of which no requirement or recommendation has been made have been highlighted throughout the report. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wayfield Avenue Resource Centre 2 Wayfield Avenue Hove East Sussex BN3 7LW     The quality rating for this care home is:   three star excellent 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: Jennie Williams     Date: 2 8 0 5 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 30 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 30 Information about the care home Name of care home: Address: Wayfield Avenue Resource Centre 2 Wayfield Avenue Hove East Sussex BN3 7LW 01273295880 01273295900 Sarah-lines@brighton-hove.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Brighton & Hove City Council Name of registered manager (if applicable) Mrs Sarah Louise Lines Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 24 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: Mental Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home Wayfield Avenue was opened in 1997 and is owned by Brighton and Hove City council and is registered to provide accommodation and personal care for up to twenty-four older people with functional mental health needs. The vast majority of placements are long term with several respite and transitional care beds available. The home is a three story detached property situated in a residential area on the outskirts of Hove. Residents accommodation consists of all single accommodation with Care Homes for Older People Page 4 of 30 care home 24 Over 65 0 24 Brief description of the care home en-suite facilities and are located on the first and second floor. There is a range of communal space including rear gardens and patio areas. In addition there is a day care resource centre based on the ground floor. The homes literature states that they aim to provide empowering care in accordance with the needs and wishes of individuals. The fees for residential care are currently range from 98.60 pounds to 748 pounds per week. There are additional costs for newspapers, hairdressing, chiropody, and toiletries. Full information about additionals costs is available from the home. This information was provided to us on the 11 June 2009. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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: It has been identified that service users prefer to be called people who use services. For the purpose of this report, people who use the service will be referred to as residents. The Registered Manager was not available on the day of this site visit. A senior care officer facilitated this inspection. This unannounced key site visit took place over eight hours on the 28 May 2009. Evidence obtained at this site visit and information that we have received since the last inspection forms this key inspection report. Two Experts by Experience accompanied us for this visit at the home. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the Care Homes for Older People Page 6 of 30 service. Their observations are incorporated into this report. An annual quality assurance assessment (AQAA) was sent to us by the service, completed by the home on the 25 February 2009. 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. The last key inspection was undertaken on the 30 May 2007. An annual service review was undertaken on the 15 May 2008 that identified that we felt the service may have improved since the last key inspection. The Experts by Experience ate lunch with the residents and spoke with staff and residents. A pre admission assessment was viewed and care plans for two residents looked at. Medication procedures were discussed and viewed. Three staff files were viewed, along with training records. Some areas of the environment were looked at. The quality assurance system and procedures for dealing with complaints and Safeguarding Adults were discussed. Procedures for dealing with residents monies were assessed. There were nineteen residents residing at the home on the day of the site visit. What the care home does well: What has improved since the last inspection? Two requirements made at the last key inspection have been addressed. This included ensuring that all residents have a written statement of the terms and conditions of residency. A copy of the terms and conditions are also included in the Service Users Guide. The home has made improvements in relation to fire safety within the home to ensure all people living at and visiting the service are safe so far as is practicable. The ASR undertaken last year identified that we thought the outcome for residents had improved. The findings at this site visit confirmed that improved outcomes are being provided. Other improvements made have been identified as part of the homes own internal quality checks. The AQAA identifies areas that they have improved in the last 12 months and some examples given as changes they have made as a result of listening to residents are: residents have been involved in choosing colours and designs for on going redecoration within the service, including individual rooms and communal areas. Residents chose a new television that has been purchased for the lounge and are involved in planning activities. Other improvements identified in the AQAA to improve the service provided relate to the physical environment of the home. Staff continue to receive appropriate training and new medication policies and procedures have been implemented. Care Homes for Older People Page 8 of 30 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. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre admission process ensures only residents whose needs can be met are admitted to the home. Evidence: The home has a Statement of Purpose and Service Users Guide that provides prospective residents/representatives with information about the facilities and services provided at the home. These documents include a copy of terms and conditions of residency and advices what costs are additional to the fees. A new brochure has also been developed that provides information about the service. The Experts by Experience viewed the information available and found the following it was found to be excellent with full information to services, needs, costs and charges which was exemplary. This detail to information was clear and concise, but it was felt that an easier to read document should be created which provides a more overarching summary to key information in the main booklet, in terms of accessibility. This is for Care Homes for Older People Page 11 of 30 Evidence: the home to assess to ensure information is provided in a format suitable for the residents they accommodate. People are referred to the home through the Care Matching team within the local authority. A senior care officer and Registered Mental Nurse (RMN) will visit a prospective resident to undertake an assessment of the persons physical and mental needs. Complex admissions are discussed with the Registered Manager. There was no evidence that a letter is provided to prospective residents, confirming that following an assessment the care home is suitable for the purpose of meeting their needs in respect of their health and welfare. The facilitator confirmed that people are verbally informed. There was no one residing at the home from any minor ethnic community, social/cultural or religious groups with any specific needs. People are encouraged to visit the home prior to moving in. The Experts by Experience observed that there was a general sense of community between the residents. This ethos is also shared with prospective residents visiting the service prior to admission. This was evident on the day of the site visit. A prospective resident was visiting the service for the day. This provided them an opportunity to meet staff and other residents. They were supported by staff and other residents. The Experts by Experience observed the clarity and vision to the needs of individuals was shown by the staff, as the transition process between coming to stay and visiting for the first time was taken in graduated steps. This promoted choice and pace of engagement, to ensure maximum outcomes for the prospective resident. This reassured them they were in full control of life goals and choices. The home does not have dedicated accommodation to provide intermediate care. The home provides respite if there is a spare place available and three dedicated beds for transitional care for those residents who require some additional care/support prior to living in the community or moving into sheltered housing. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The system of care planning provides staff with a good foundation to support residents in a way that both enables and protects them. Evidence: The last key inspection showed that the care plans sampled provided clear and comprehensive guidance for staff on the assessed needs of each resident and how these needs can be met. Care plans seen were individualised according the needs of each resident, for example some care plans contained a specific mental health plan developed by the Registered Mental Nurse (RMN) and a night time care plan. No changes have been made to this process. There was evidence viewed at this site visit that the systems in place for regularly reviewing care plans ensure changes in needs and preferences are being identified and recorded. This included reviewing risk assessments. Formal reviews are undertaken every six months. There was evidence that residents are involved in their reviews when they wish to be, however the facilitator confirmed that some residents have little or no interest in the involvement of their care plans. Care Homes for Older People Page 13 of 30 Evidence: The Experts by Experience found it was evident through discussion with staff and residents that diary sheets were used, that the residents could access and discuss, which shaped a monthly summary. This in turn led to a monthly review of the care plan which was shaped according to the needs and views of the residents and signed by them. The home was informed that additional information recorded on notice boards in the staff office should be reflected in care plans to ensure all information pertaining to an individual is recorded in the one place i.e. the days that an individual attends clubs outside of the home environment etc. It was recommended that where a care plan identifies that someone should be weighed monthly and the individual refuses, staff should still record they were offered the choice to evidence that they are providing care in line with the care plan. Residents continue to have access to health professionals when needed. Residents access support within the community and a risk assessment identifies if an escort is needed or not. There was evidence of this on the day of the site visit with a resident returning from a GP visit and advising staff on an update of their current health needs and any medicines that may have been prescribed. The facilitator confirmed that due to the illness of some residents, they know when they are becoming unwell and will request a GP visit. Good practices were noted when observing staff administer medicines to residents at lunch time. Medication Administration Records (MAR) charts viewed identified that some improvements could be made to further safeguard staff and residents and to have a clear audit trail of all medicines received into and leaving the home. On checking a random selection of MAR charts with tablets, there were two incidents noted where the amount signed for and the number of tablets remaining did not complement each other. No documentation could be found to identify where the discrepancies occurred. This is for the home to address. As good practice, handwritten amendments or handwritten prescriptions on MAR charts should be double signed by two staff who have received training in administration of medicines. This will further safeguard residents against errors being made and identify who made changes to the MAR chart. Where a medicine is prescribed, administer one or two, some staff were recording how many were administered. This information was not recorded consistently. Clear records were in place for when as needed (PRN) was used. Residents are provided with an opportunity to self-medicate if they wish and a risk Care Homes for Older People Page 14 of 30 Evidence: assessment identifies that it is safe for them to do so. Additional information needed to be included in these risk assessments. It was confirmed by numerous people within the service that policies and procedures for all aspects of dealing with medicines are being re-developed to improve practices within the home. Examples provided are: more detailed risk assessments, clearer information to be provided on PRN medicines and a body map will be used as guidance to identify where creams/lotions are required to be used. These improvements will further safeguard residents and staff. There were clear records being maintained of controlled drugs. Staff were observed to have a good professional rapport with residents. The Experts by Experience observed good practices that were seen as true partnership between the resident and staff in promoting life goals and choices and maintaining dignity and independence. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have opportunities to access the local community and to participate in social and other meaningful activities. Residents preferences are catered for with meals. Evidence: The Experts by Experience spoke with residents and staff and made the following observations. The staff were seen to be flexible and attentive to the needs and aspirations of individuals with a structured activity programme being available on display. There was full choice regarding participation and a general sense of community between the residents was observed, with residents supporting each other in terms of accessing the shops and being conversant with each other. There is an informal atmosphere with residents free to participate in differing activities. The home has accessibility to and promotes the residents to attain maximum fulfilment of life goals and opportunities by fostering community engagement. One resident advised they went to watch local sporting matches and regularly took part regularly in wider community activities. This example is further supplemented by a member of staff who commented that residents have access to support to participate in mainstream community activities through transport or personal assistance when Care Homes for Older People Page 16 of 30 Evidence: required. This was further commented on when it was highlighted by the example of one resident, who when going out shopping sometimes accessed support and sometimes went independently. This was dependent on aspects of their wellbeing and this support helped promote wider social inclusion, at the same time when not being accessed, maintained independent living skills. On examination of the dining area, it was found there was a wide array of information on display, relating to meals and choice and a menu clearly on display. The residents were served at meal times with dignity and promotion of independence, with assistance where and when required. This formal setting with informal, friendly support, was seen by the Experts By Experience as promoting independent living skills and dignity to a high degree. There was care and consideration evident as to seating arrangements and residents wishes at mealtimes, which was fully attentive and responsive to those present. The residents stated the food was excellent quality and so were the staff, with the following quotes, the food is good and nice and the staff are excellent. We get the choice to do what we want and another stating, I can go to bed early or late. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has systems in place to listen to residents views and safeguard them from harm. Evidence: The AQAA identified that there have been two complaints made to the service within the last 12 months, of which one was upheld. Records of how these were dealt with and any subsequent action that may have been taken were not available for viewing at the site visit due to the absence of the Registered Manager. The last inspection report identified that records of concerns and complaints showed that they were dealt with in accordance with the homes policies and procedures. The AQAA identifies that there continues to be processes in place to ensure residents are able to freely express their views at any time and have access to advocacy services when they want. The facilitator confirmed that support is given to residents to make a complaint if they need it. The AQAA states that they need to ensure they are promoting and recording low level comments/complaints appropriately as an area that they could do better. Feedback from monthly visits undertaken by a representative within the organisation and a previous dignity audit identified that residents and carers are aware of how to make comments about the service. Care Homes for Older People Page 18 of 30 Evidence: The Experts by Experience found there to be complaint procedures in place with regular discussions facilitated by a MIND Advocate in order to promote independent choice and debate around living at the home. The facilitator confirmed that staff receive Safeguarding Adults training that includes whistle blowing. Updated training is provided every 18 months. Some senior members of staff are receiving training on undertaking investigations into lower level allegations made. There was evidence of this training being updated in a staff file viewed. There has been one Safeguarding Adults investigation in the last 12 months. This was unsubstantiated and involved an incident between two people residing at the home. It was confirmed that there a policies and procedures in place for staff in relation to restraint. The AQAA identified that there has been no incidents of restraint in the last 12 months. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely environment and are provided with comfortable indoor communal facilities and their private accommodation personalised to suit their taste. Evidence: The home is a large detached purpose built premises in its own grounds. It is located on the outskirts of Hove with some local shops a ten-minute walk away. Bus routes into Brighton and Hove are close by. The home is spread out over three floors, with residents accommodation being on the first and second floor. All rooms are for single occupancy and all provided with en suite facilities. There was evidence noted that areas within the home have been redecorated/refurbished and this work is ongoing. Residents are involved in choice when changes are being made to their home. The AQAA identifies that due to priorities within the council, they do not always get improvement/changes made as quickly as they would like. The Experts by Experience noted that the home presents in good state of decoration and is homely with many features, tailored to the residents needs and aspirations to achieve independence and living. Care Homes for Older People Page 20 of 30 Evidence: Residents are provided with a key to their individual room if they wish to keep it locked in their absence. There are a variety of communal areas that residents are able to access. This includes: dining room, lounges, designated smoking lounge and there is a hairdressing room also provided at the home. There are call bell points in every bedroom and located throughout the home for people to use to access help when they need it. The home appeared clean on the day of the site visit and there are suitable procedures put into practice to promote infection control. Infection control is further promoted by a laundry chute for staff to use so that dirty linen does not need to be carried through the home. In the last 12 months, the AQAA identifies that the housekeeping team have developed new induction standards for housekeeping staff and have developed a new monthly quality assurance system which the complete. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a dedicated and competent team of staff. Evidence: The atmosphere within the home on the day of the site visit was friendly, relaxed and staff appeared to have time to spend with individuals residents when they required their time. The facilitator confirmed that there are suitable numbers of staff on duty at all times and they have the resources to access additional staff at short notice. Staffing numbers on duty provides opportunities for residents to be escorted into the community when they need this level of support. It was evident through observation of interactions between staff and residents that staff had a good understanding of residents needs and provided support in a way to suit the individual. Staffing levels are arranged to ensure that there are additional staff on duty at peak times. General staffing numbers are five staff during day time hours and two staff work a waking night. The Registered Manager works supernumerary during the week. The AQAA identified that 108 shifts in the past three months have been covered by temporary staff or staff from an agency. It was confirmed that the same workers are used wherever possible to help promote continuity. The AQAA identifies that there are 18 permanent care workers employed at the home, Care Homes for Older People Page 22 of 30 Evidence: of with 14 have National Vocation Qualification (NVQ) level 2 or above. Senior care officers are involved in the recruitment of staff. Residents are not involved in the recruitment/selection of new staff. The Registered Manager holds the information in relation to references and Criminal Record Bureau (CRB) checks. Due to her being absent, full recruitment procedures could not be assessed on this occasion. The home must take action to ensure that information pertaining to recruitment is available for inspection in the care home at all times. The home should consider ensuring all information pertaining the recruitment of a staff member is kept together. Of the information that was available for viewing in three staff files, it was observed that ensuring application forms are fully completed will assist in addressing some shortfalls i.e. gaps in employment. The last inspection report identified that there were no shortfalls in recruitment practices and the AQAA identified that all people who have started work in the home in the last 12 months have satisfactory pre-employment checks. There was evidence that new staff undertake an induction programme and staff are provided with training relevant to their roles. The Experts by Experience noted that there is access to a RMN who provides access to support and guidance around emotional wellbeing and on discussion with the staff, provides training and bespoke courses on differing subjects. On discussion with staff they were informed there was also access to outside training on offer and requests for training topics were also taken readily. Training needs are always evaluated with computerised records, logging training undertaken and training needs to be addressed. There was evidence of training being provided in individual staff files. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the home being run by an experienced and dedicated Registered Manager who ensures that the home is run safely and generally in the best interest of residents. Evidence: The Statement of Purpose identifies that the Registered Manager has NVQ level 4 in care and has completed the Registered Manager Award. It was evident on the day of the site visit that the home is well managed in the absence of the Registered Manager. The information provided to us at the site visit evidenced that the home is run in an open and transparent manner. Senior staff are provided with an opportunity to undertake management courses if they wish. Staff were complimentary about the management of the service. The home is currently accessing courses for Deprivation of Liberty Safeguard (DOLS) to ensure they are familiar with new legislation. The home has access to support when Care Homes for Older People Page 24 of 30 Evidence: they need advice on DOLS. Information is available at the home for staff if needed. There was currently no application for authorisation being processed. The last inspection report identified that there are several mechanisms in place for the home to obtain feedback on the quality of the services provided. The AQAA provided no information about internal monitoring they have in place to ensure the homes aims and objectives are met. Monthly visits to the service by a representative of the council were not available for viewing; however it was confirmed that they are regularly undertaken. The AQAA identifies that the views of people using their service are gathered in a variety of ways. Examples provided were: a meeting is held quarterly chaired by an independent advocate from MIND and the information is shared with the manager and staff, however it does not identify to them who was present at the meeting. Information is available to residents regarding advocacy services, regular resident meetings are held, six monthly reviews for all residents take place and views are also obtained from the councils representative who undertakes monthly quality monitoring visits to the service. The AQAA identifies that some of the changes they have made as a result of listening to residents are: residents have been involved in choosing colours and designs for ongoing redecoration within the service, chose the new television purchased for a lounge, involved in planning activities and themed events have taken place at their suggestion i.e. karaoke. It was confirmed by the Responsible Individual that they are currently not actively seeking feedback from health professionals. The council is currently in the process of looking at developing questionnaires. This work is ongoing. General staff surveys are sent to all staff working for the council, however is not service specific. Consideration must be given to ensure feedback regarding Wayfield Avenue can be provided to the Registered Manager regarding any improvements that can be made. Improving the quality assurance system will assist the home in evidencing that they are meeting their aims and objectives. No requirement has been made in relation to their quality assurance systems, however the progress made will continue to be assessed throughout the inspection process. Residents are encouraged and supported to retain control of their own finances for as long as they are able to. Alternative arrangements are made by individuals if they are unable to manager their own finances. The AQAA identifies in what they could do better is to ensure that those residents where the council is the corporate appointee receive accurate information regarding their benefits. This is currently being addressed Care Homes for Older People Page 25 of 30 Evidence: at a senior management level. The home holds small amounts of money securely for individuals if they wish. Money is placed into a Brighton and Hove safe custody account that is a no interest bearing account. Petty cash is given to residents when required and is impressed to the individuals account. Receipts are kept of financial transactions wherever possible. There are regular monitoring audits done to ensure residents finances are safeguarded. The AQAA returned was generally clear and gave us the information we required. It identifies areas in what they could do better, how they have improved in the last 12 months and their plans for improvements in the next 12 months. The Registered Manager was advised of ways some information could be improved the next time we asked for it and to ensure all key standards are addressed. There was evidence of staff receiving appraisals and regular supervision. The AQAA identifies that equipment in use has been tested or serviced as recommended by the manufacturer or other regulatory body and that all relevant policies and procedures are in place. The AQAA identifies that there are some policies and procedures not in place and some have not been reviewed for up to five years. The Registered Manager confirmed that the council is currently reviewing policies and procedures and developing ones where shortfalls have been identified. This improvement is also reflected in the AQAA. The facilitator confirmed that staff undertake fire training and regular fire drills are undertaken. A representative within the council reviews fire practices within the service and the fire risk assessment has recently been updated. The AQAA provides evidence that the home has various systems in place to ensure the health, safety and welfare of staff and residents are promoted. We did not have cause to question the way health and safety is maintained and therefore records in respect of health and safety were not inspected on this occasion. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 17 That all information relating to staff recruitment is available at the home at all times for inspection. This is to evidence that robust recruitment procedures are followed. 31/07/2009 2 3 14 That written confirmation be 31/07/2009 provided to service users confirming that their needs can be met at the home. To confirm that following an assessment the care home is suitable for the purpose of meeting their needs in respect of their health and welfare. 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 9 That amendments to the MAR charts are signed and hand written prescriptions be double signed by two staff who Page 28 of 30 Care Homes for Older People have received medication training. This will further safeguard staff and service users from errors. Care Homes for Older People Page 29 of 30 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). 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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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