Care Home: Welby Croft

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What the care home does well People live in a home that is kept clean and comfortable. It is well maintained and suits their needs, which are overall well accounted for. Including for their health care needs. People enjoy good relationships with staff who approach them in a respectful manner and promote their dignity and privacy. Peoples daily lives at the home usually accord with their known lifestyle preference and choices and they receive nutritious food, which they enjoy. People know who to speak with if unhappy and who to make a formal complaint to. The homes systems and procedures and staff knowledge of these safeguard people from harm and abuse. People are provided with care and support from staff that is effectively recruited and trained and who treat them with respect and promote their dignity. The home is overall run in peoples best interests and their health, safety and welfare promoted and protected. What has improved since the last inspection? We made 11 requirements at our last key inspection. 9 of these are complied with, one is mostly complied with and one was not applicable at this inspection. These have resulted in improvements in staff recruitment procedures, key service information for people, medicines storage, environmental risks and hazards, reporting procedures for accidents and incidents to CQC, servicing and maintenance of specified equipment and in infection control. What the care home could do better: We have made five requirements and a number of quality recommendations at this inspection. We have indicated the areas that these cover below as follows, including where a requirement is made. Specify the range of fees charged to people in the revised service guide and provide a copy of this guide in each persons own room. Requirement. Ensure individual risk assessments are reviewed at least monthly intervals and use a trigger tool in conjunction with the nutritional risk assessment in use to assist in timely referral to outside health care professionals where necessary. Include consideration of individuals mental capacity to consent to their care and treatment within the homes needs assessment format. Develop a related policy and procedural guidance to assist staff in implementing the considerations of the Mental Capacity Act 2005 in their day to day practise.Provide a suitable cupboard for the storage of controlled medicines. Requirement. Review laundry arrangements, including for care staff deployment there. Requirement. Maintain staff induction records in accordance with sector skills workforce training targets. Ensure that the arrangements for the management of the home are openly determined and in accordance with the role and responsibilities expected of a registered manager, with the Commission to be notified accordingly. Requirement. Ensure that monthly visits to the home by the regstered provider are conducted and reported in accodance with requirements as stated under Regulation 26. Requirement. Review and develop their quality assurance and monitoring systems. So as to provide for greater accountability, including in our AQAA return, as to their service provision and compliance with recognised practise, including for their meeting of national minimum standards for care homes. Develop its infection control policy and procedures for staff to follow to ensure these are in accordance with up to date national guidance. Introduce a policy and procedures for staff to follow in the event of emergencies and crises. Key inspection report Care homes for older people Name: Address: Welby Croft Crossing Road Chapel-en-le-frith Highpeak Derbyshire SK23 9RY     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: Susan Richards     Date: 0 9 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Welby Croft Crossing Road Chapel-en-le-frith Highpeak Derbyshire SK23 9RY 01298812797 01298815379 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Argyle Residential Home Ltd care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 24. The registered person may provide the following category of service only: Care Home only - Code PC 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 Date of last inspection Brief description of the care home Welby Croft is a family run converted two storey house with a modern ground floor level extension, providing personal care and support for up to twenty four older persons over 2 floors accessed either by stairs or a chair lift. There is no shaft lift and some areas of the home do not provide level access thereby restricting disabled access. There area twenty two single and one shared bedroom, with eleven of the single rooms each having an en suite facility. The home offers a variety of communal rooms, including a dining room lounge,conservatory, library with central kitchen and separate laundry facilities. There is also a small kitchen dining room for residents use, Care Homes for Older People Page 4 of 32 Over 65 24 0 1 8 1 2 2 0 0 8 Brief description of the care home with facilities to prepare snacks and drinks. A hair dressing salon is also provided. The home located on the north east outskirts of the town of Chapel en le Frith in the High Peak with good access to local facilities and set in attractive landscaped gardens with access, seating and car parking provided. Care and support is provided from a team of care and hotel services staff. A creative therapist provides weeekly sessional support for people to engage in occupation, leisure and social activities in and outside the home. Up to date information about fees charged and what they cover can be obtained directly from the provider Mrs A Andrew by contacting the home. Fees charged are set in accordance with individuals assessed needs and may include assistance with funding from the local authority for those eligible. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use the service experience good quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the Care Homes for Older People Page 6 of 32 service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. The inspection visit included assessing compliance with previous requirements made and the meeting of key national minimum standards. We sent out 10 surveys to people living in the home and received 3 responses. We sent out 10 surveys to peoples relatives or representatives via individual service users and 5 staff surveys. We received 3 responses from peoples relatives or representatives and 0 from staff. There were 18 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. We were assisted by the provider Mrs A Andrew. (Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff). Case tracking was used during our visit where we looked more closely at the quality of care and services received by people 3 living in the home. We did this by speaking to them and/or their relatives, observation, reading their care records, and talking to staff. All of the above was done with consideration to the diversity needs of people accommodated at the home. At the time of our visit (COMPLETE WITH GENERAL OVERVIEW ANY DIVERSITY NEEDS RELATING TO RELIGION OR CULTURE, SEX, DISABILITY). Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: We have made five requirements and a number of quality recommendations at this inspection. We have indicated the areas that these cover below as follows, including where a requirement is made. Specify the range of fees charged to people in the revised service guide and provide a copy of this guide in each persons own room. Requirement. Ensure individual risk assessments are reviewed at least monthly intervals and use a trigger tool in conjunction with the nutritional risk assessment in use to assist in timely referral to outside health care professionals where necessary. Include consideration of individuals mental capacity to consent to their care and treatment within the homes needs assessment format. Develop a related policy and procedural guidance to assist staff in implementing the considerations of the Mental Capacity Act 2005 in their day to day practise. Care Homes for Older People Page 8 of 32 Provide a suitable cupboard for the storage of controlled medicines. Requirement. Review laundry arrangements, including for care staff deployment there. Requirement. Maintain staff induction records in accordance with sector skills workforce training targets. Ensure that the arrangements for the management of the home are openly determined and in accordance with the role and responsibilities expected of a registered manager, with the Commission to be notified accordingly. Requirement. Ensure that monthly visits to the home by the regstered provider are conducted and reported in accodance with requirements as stated under Regulation 26. Requirement. Review and develop their quality assurance and monitoring systems. So as to provide for greater accountability, including in our AQAA return, as to their service provision and compliance with recognised practise, including for their meeting of national minimum standards for care homes. Develop its infection control policy and procedures for staff to follow to ensure these are in accordance with up to date national guidance. Introduce a policy and procedures for staff to follow in the event of emergencies and crises. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The revised service guide should better inform people about the care and services they are to receive and their needs are mostly well accounted for. Evidence: In the AQAA the home did not give us any information about what the home does well specifically relating to this section. In terms of what they could do better, what they have improved and improvements aimed for. Again information they provided was not relevant to the standards in this outcome section and focused on environmental improvements they have made At our visit we found that the home had complied with the requirements we made at our last key inspection by reviewing and updating their Statement of Purpose and service guide to provide up to date key service information for people, including for their complaints procedures therein. This was available in large print format. The provider told us this was to be distributed to service users accommodated and their Care Homes for Older People Page 11 of 32 Evidence: representatives. However, the service guide did not specify the range of fees charged per week, what they cover or arrangements for their payment. People said they received some information about the service to help them choose to live at the home. They said they felt their needs, including medical needs were being met and that staff were conversant with these. Peoples recorded needs assessment information was reasonably well recorded, although did not contain any information as to peoples individual mental capacity to make key decisions about their care and treatment. This was particularly relevant where one service user had signed consent forms relating to some aspects of their care but not for a significant decision, which was signed for by their relative and a witnessing representative, with no indication as to the service users wishes or capacity here. We saw that individually recorded risk assessments, including relating to peoples health status were being recorded at 6 monthly intervals, rather than monthly. We also saw that the home had developed a nutritional risk asssesment tool, which was a requirement that we made at our last key inspection. Although this did not provide for a trigger for any necessary referral to a dietician. Since our inspection the provider has contacted us to advise they have sourced recognised trigger tool, which they intend to review for use in the home. People told us that staff were usually quick to respond to any changes in service users health status, by ensuring medical input where necessary. We did not assess outcomes for NMS 6 in this section, as the home does not provide for intermediate care. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs are suitably accounted for in a respectful manner and their dignity promoted. Evidence: In their AQAA return the home did not give us any specific or measurable information about what they do well, or improvements they have made or aimed for as relevant to the standards in this outcome section. Referring to social activities arrangements, laundry arrangements and meals. At our visit people said their health care needs are usually met, including for their medical needs and that staff treat them with respect and kindness Peoples care plans were reasonably recorded within a combined needs assessment and care intervention document with an overall monthly review record. Each person had an agreed daily living plan and night routine plan for each person signed by them reflecting their wishes and preferences. They also indentifed peoples capabilities and aims to promote their independence in accordance with these. Care Homes for Older People Page 13 of 32 Evidence: Inputs from outside healthcare professionals to each service user were recorded, including for the purposes of routine health care screening, together with any necessary individual physical health observations and monitoring, such as regular weight monitoring. We saw from the homes most recent annual service user and relative questionnaire returns that people are feel they receive the care they need. Comments in these included, Friendly care and attention at all times. All staff give us respect and dignity. For the most part we found the arrangements for the ordering, receipt, storage, administration and disposal of peoples medicines to be satisfactory and accordance with recognised practise. We had made some requirements at our last inspection relating mainly to storage arrangements for these and found at this visit that these are fully complied with except for one area below. We also made one requirement at our last inspection here, to ensure that where any service user chooses to retain and manage their own medicines. That a suitable risk assessment is undertaken for this. At our visit we found that there is no service user choosing to manage their own medicines and people that we case tracked confirmed their choice for staff to retain and adminster these. The requirement not complied with as referred to above, is for the homes storage arrangements for controlled medicines. However, we understand from speaking with staff responsible for peoples medicines that they had received conflicting advice for this from their local pharmacist supplier. We discussed the required arrangements with the staff responsible and also the provider and agreed to allow a further short period of time for this to be rectified. Since our visit the provider has confirmed this has been ordered and that on receipt, will be suitably fixed as per recognised guidance for this. Care Homes for Older People Page 14 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples daily lives at the home usually accord with their known lifestyle preference and choices and they receive nutritious food, which they enjoy. Evidence: In our AQAA the home told us about some of the things they do well here. These include enabling access for people into the local community and to engage in events there, such as the local carnival and well dressings and with monthly trips out. Provision of a dedicated creative therapist for 3 sessions per week, regular fund raising coffee mornings, seasonal celebrations and ensuring residents are able to maintain contacts with the families and friends. They us about some improvements they have made. These include increased invovlements of people in seasonal and calendar events. Re establishing regular church services and supporting individual arrangements for people to worship. However, they tell us, that as a result of feedback from people from their annual satisfaction survey returns. That they aim to improve by further developing activities, including tailored more to the individual. At this inspection we saw that newspapers are regularly delivered to the home for Care Homes for Older People Page 15 of 32 Evidence: people. That their is a visiting hairdresser, with a dedicated hair dressing salon facility provided and also a cosy library room, with comfortable seating, suitable lighting and an extensive choice of books, including for some in large print. Also that people had been out for a Christmas lunch. Most people told us there are usually activities they can choose to join in and that they are consulted and supported in their daily living routines. We saw that each person has a written daily living plan for both and day and night, which was signed by each person and reflected their stated chosen daily living routines and lifestyle preferences. We saw that a weekly activities programme is displayed on the residents noticeboard and people told us about some of these, which include painting and crafts, bingo, games, singalongs, music and exercise. Although one relative said that these do not always occur as indicated on the programme, referring in particular to the Thursday exercise and music. That person also said that the TV is left on a lot despite peoples lack of interest there and that staff do not choose music pertinent to peoples likes. At our visit we found that Christmas Carols were playing in the small lounge area on our arrival which some people were listening to. Others were watching TV in another lounge, with some people were in their own rooms. One person that we case tracked chose to retire to their own room after lunch to listen to their own music there. Two others received visitors from their families. Two people choose to regularly go out into the local community, including one person who attends a local club. Another regularly attends church independently and two people with their relatives. People told us that they usually enjoy the food provided and we saw that lunches were well organised and that people received the assistance and support they needed. Tables were attractively set and menus indicated a varied and nutritious diet. We received many positive comments about the standard of food and peoples experiences of their daily lives at the home. We also saw that such comments had been made by people in the homes most recent satisfaction survey returns. These included, I particulary enjoy the roast dinners and my porridge and tea. Food is good and we have independence and choice in our routines. One person told us they felt it would be an improvement if drinks were left out all the time, so that people could help themselves independantly. Many people said they could have a drink any time they asked and that these were also routinely and Care Homes for Older People Page 16 of 32 Evidence: regularly offered. People said they could receive visitors at any time, although one relative said there are sometimes difficulties gaining access to the home, when staff are busy, which means they often wait for a significant time period to be let in and quoting up to 20 minutes. In the homes most recent satisfaction survey with service users and their relatives. The majority of returns rated activities and food as excellent or good, with two people rating activities as fair. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the homes complaints procedure does not best inform people, they know who to speak with if unhappy and who to make a formal complaint to. The homes systems and procedures and staff knowledge of these safeguard people from harm and abuse. Evidence: In our AQAA the home told us that they operate an open door policy with regard to concerns and complaints. Ensure that people know how to complain. Effectively deal with any received and undertake proper recruitment checks for all staff to ensure they are fit to work at the home. They say they could do better by reducing the number of complaints relating to missing clothing via their laundry system and by providing a post box in house for people to write down and leave any comments they have about the service. They told us in the AQAA they have received four complaints over the last 12 months, all of which were investigated and responded to within 28 days and which are all resolved. At our visit people told us they know who to speak with if unhappy. We saw the complaints procedure displayed in the home, which refers people to Mrs Andrews and Care Homes for Older People Page 18 of 32 Evidence: provides incorrect details of the Commission. People confirmed that they perceive Mrs Andrews to be Mrs A Andrews, the registered provider and that Mrs P Andrews, the registered manager no longer works in the home. We have referred further to this under the management section of this report and made a requirement there. We looked at the complaints records and saw five complaints recorded therein during the last 12 months, including one received since submitting their AQAA return to us. All complaints recorded are minor in nature and confirm action taken and their resolution to the satisfaction of each complainant. Two relate to missing and damaged personal clothing laundry items and two to equipment provision and repairs required. Staff spoken with were conversant with procedures to follow concerned with handling complaints and safeguarding people from harm, including confirmation as to Mrs A Andrew, being the management stage of referral for any complaint received in the home. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is kept clean, comfortable, well maintained and which suits their needs. Evidence: In our AQAA the home told us they provide a safe, warm and clean home with an ongoing programme of redecoration and renewal. They also gave us some examples of areas of improvement relating to their routine programme and their aims for the coming months included in this. At our visit we saw that their programme ensures that the home is kept in a good state of repair and that it is clean, odour free and well decorated and furnished. Set within attractive and well kept grounds, which people can access, with seating and car parking provided. We found that the provider has complied with the requirements we made at our last key inspection here, relating to hand washing procedures and facilities in communal areas and also for specified risk management strategies concerned with the environment, as referred to under the management section of this report. However, we found that their policy and procedural guidance for staff to follow for infection control is not comprehensive or up to date and that there is no policy and Care Homes for Older People Page 20 of 32 Evidence: procedural guidance for staff concerned with emergencies and crises, except relating to fire procedures. We saw recent correspondence from the Fire officer of Derbyshire Local Fire Authority, which report that matters appertaining to fire precaution are satisfactory. Results of the homes most recent satisfaction survey conducted with service users and their relatives told us that people judged their environment to be either excellent or good. Comments made by people, include The home is always clean, comfortable and homely. People told us that the home is always kept clean and odour free and people bedrooms that we looked at were personalised and suitably equipped and comfortable. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with care and support from staff that is effectively recruited and trained and who treat them with respect and promote their dignity. Although care staff deployment into the laundry may not always promote peoples best interests. Evidence: In our AQAA the home told us they operate a suitable staff skill mix and have a low staff turnover and that all staff are well trained and have NVQ level 2 or 3 with two people currently undertaking level 4. They identified some improvements they have made. By ensuring that all proper recruitment checks are carried out and are satifactory before staff commence their employment in the home and for access to training for staff. They told us that they aim to review and improve their staff induction programme to ensure it meets with current national standards. They also gave us some statistical information that we asked for relating to staff employed and their training. Amongst other things, this tells us that the home does not employ dedicated laundry staff, but that care staff undertake this alongside their personal care duties. At our last key inspection here we made a requirement about staff recruitment Care Homes for Older People Page 22 of 32 Evidence: procedures, as we found a large number of staff working at the home without criminal records checks being undertaken. This situation was inherited from the previous registered provider. Immediate action was taken by the current provider to address our concerns and requirement that we made about this. Thereby ensuring the safety of people who live in the home. At our visit people told us that staff is often available when they need them and listen and act on what they say. Although most said that there are regular times when staff are busy doing the laundry and they have to wait for assistance, including for the toilet resulting sometimes in visitors to the home assisting them. Staff that we spoke with described mostly satisfactory arrangements for their recruitment, induction, training and deployment. However, whilst there have been no recent outbreaks of infection in the home, the current practise in redeploying carers into the laundry between personal care duties may not promote best infection control practise. We discussed this with the provider and have referred to their infection control policy and procedure in the management section of this report and made a recommendation there relating to this. We also found that some staff had minimal information recorded in their personal file as to their induction into the home, with others having no record at all. Although staff that we spoke with described a suitable induction process as undertaken by them. Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is overall run in peoples best interests and their health, safety and welfare promoted and protected. Evidence: In our AQAA the home told us that they regularly consult with people who live at or have an interest in the home and with overall postive results. That they ensure peoples health, safety and welfare and with all systems and equipment in the home regulary checked and maintained. They told about some improvements they aim to make in the coming months. Including, in ensuring feedback to people for their satisfaction surveys results, by increasing their frequency for formal staff supervision and in reviewing and improving their adminstration and record keeping systems. They also gave us some other information that we asked for about their arrangements for the servicing and maintenance of systems and equipment at the home, which are satisfactory. Care Homes for Older People Page 24 of 32 Evidence: We discussed the overall completion of the AQAA with the provider, who gave us the information that we asked for in the dataset part of this. However, information provided in part 1 of the AQAA, which concentrates on quality assurance and review was limited, not always relevant to the a particular outcome section and not specific or measurable. From information that we received from people, including at our visit. We found that the registered manager Pauline Andrew no longer manages the home. Although she does have some contact there. However, this is not for the purposes of providing operational management in line with the managers job description there, nor in meeting with the registered managers responsibilities as defined under the Care Standards Act 2000. People told us that they perceive Ann Andrews to manage the home. In respect of staff management and supervision and for any matters that people who use the service or their relatives may wish to raise. Including for any concerns and complaints they may have. All said the home is well managed by Ann Andrews and staff said they are well supported. Contacts that we have had with the home, including our last key inspection have not provided us with any contact with the registered manager. We discussed the current and future arrangements for the management of the home with the responsible individual there, who advised they have been overseeing the management of the home for some time. We asked her as the responsible individual for the company, to provide us with formal written notification as to those changes, interim arrangements for the management of the home and proposal to ensure a registered manager is appointed. Quality assurance and monitoring systems are in place, which include regular and formal consultation with people who live, work at and visit the service and who have an interest there. However, as the provider has identified in their aims for improvement over the coming 12 months. Their systems and approaches to this, including for record keeping require further development in order to provide for greater accountability. And also for their approach to the conducting and reporting of their monthly visits from the registered provider. Results of their most recent annual satisfaction surveys with people indicate their overall satisfaction with the quality of care and services they receive and with most Care Homes for Older People Page 25 of 32 Evidence: nominating an overall opinion of the service as excellent or good. A small number indicated fair in specified areas, being activities and laundry arrangements and with suggestions for improvement. We saw that there is an overall annual development plan in plan displayed in the home, although this does not link to the satisfaction surveys results or any action proposed as a result of these, which is not currently shared with people. We also saw, including from information provided in the AQAA and from inspecting standards under other outcome sections of this report. That the home provides the majority of key policies and procedures for staff to follow and to assist them in performing their role and responsibilities. However, there is no procedure for staff to follow to assist them in applying the considerations of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards 2009. Their infection control policy is out of date and requires development to ensure it complies with recognised guidance for Care Homes and there is no policy for staff to follow in the event of emergencies and crises. We found safe and suitable arrangements for the safekeeping and handling of personal monies on behalf of service users that request for storage purposes only. That the home does not manage monies on behalf of any person and that where people choose to retain and manage their own finances, that they are provided with safe storage facilities. Staff described suitable for their supervision and support and for ensuring safe working practises, including for their training and provision of equipment. Records that we examined and observations that we made confirmed this. We looked at the report from a recent visit from the local authority for the purposes of ascertaining health and safety arrangements in the home. Whilst they recommended that the home develop falls awareness tools and training for staff, their report indicated well managed premises, with good health and safety awareness. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5A The service guide must specify the range of fees charged by the home, what they cove and the arrangements for their payment. So as to ensure people are provided with the information they need to assist them in choosing a home in an open and transparent manner. A cupboard must be installed for the storage of controlled drugs that complies with the Misuse of Drugs Safe Custody regulations. This cupboard must be located and fixed in accordance with those regulations 28/02/2010 2 9 13 28/02/2010 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So as to ensure the safe storage of controlled medicines. 3 27 18 A review of care staff 28/02/2010 redeployment arrangements into the laundry between personal care duties must be undertaken and with action taken as necessary. To ensure that staff deployment arrangements are in peoples best interests. To promote their health and welfare and to provide that their personal care and support needs are most effectively met. 4 31 39 Written notification must be 28/02/2010 provided that the registered manager no longer manages the home. Together with the arrangements for the running of the home in her absence and proposal to ensure the appointment of a registered manager. So as to clarify and formally confirm the management arrangements for the home. To ensure that a registered manager is appointed as soon as possible who is able to fulful the, role, responsibilities and duties Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action that are required of such a person. 5 33 26 Visits to the home by the 28/02/2010 registered provider must be conducted by persons as identified under Regulation 26 of the Care Homes Regulations 2001. Reports of those visits must account for all matters identified under that regulation. So as to ensure that the visits are conducted by a person suitable. So that person undertakes that which is specified under this regulation. So as to inform those identified therein as to the conduct of the home and the standard of care provided there. 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 2 1 3 A copy of the recently revised service guide should be provided to each person in their own room. Consideration as to peoples individual capacity to consent to their care and treatment should be included in the homes recorded needs assessment format. Individual risk assessments should be reviewed at least monthly intervals and a recognised nutritional risk Page 30 of 32 3 3 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 assessment tool should be used such as the MUST score that triggers any necessary referral for professional dietetic advice. 4 16 The homes complaints procedure should be revised and amended to reflect the full name and designation of the person to whom complaints are to be referred to at management level in the home. And to ensure that the correct name and contact details for the Care Quality Commission are provided for people to contact any time they may choose for information and or advice. A record of induction should be kept in respect of each staff member employed at the home and which meets with Skills for Care national workforce training targets. Staff should be provided with written policy and procedural guidance to follow to assist them in applying the principles of the Mental Capacity Act 2005 and to know what steps to take in the event of emergencies and crises. The home should develop its infection control policy and procedures for staff to follow, in line with recognised Department of Health guidance. The home should review and develop their quality assurance and monitoring systems. So as to provide for greater accountability, including in our AQAA return, as to their service provision and compliance with recognised practise, including for their meeting of national minimum standards for care homes. 5 30 6 33 7 33 8 33 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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