Care Home: Wellington Park Nursing Home

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What the care home does well Wellington Park Nursing Home has a friendly and relaxed atmosphere. The management and staff are professional and people are treated with respect and their right to privacy is upheld. A large number of residents are very frail and have complex needs. The staff are working very hard to meet people`s needs. People told us they were happy with the care they received. One person commented, "This is the best". Another resident commented, "I think nothing can be improved on as I am very happy living here". Staff were also positive about the service. One staff member commented, "I am proud to work for Wellington Park and very happy and satisfied with my job". The environment is comfortable, safe and clean and contains the aids and equipment needed to support people who live there. Pre assessments of peoples` needs are carried out before the person moves into the home to make sure the home can support the person appropriately. Staff demonstrated a good knowledge of residents needs and consequently an individualised service is promoted. Every resident has a plan of care which gives staff important information about how best to care for them. People who use the service have good access to outside health professionals. Visitors to the home are encouraged and made welcome. The food provided by the home is of good quality and menus are reviewed with residents on a regular basis. Staff understand what constitutes abusive practice in a care home and are clear about the importance of reporting any potential safeguarding matters to the appropriate authorities so that residents are safe from harm. What has improved since the last inspection? Three requirements and three good practice recommendations were issued at the last inspection. The three requirements have now all been complied with. Staff now receive more support to carry out their roles effectively. Residents have better access to dentists and medication administration has improved. One good practice recommendation related to a particular resident who is no longer at the home and so the recommendation is no longer relevant. The recommendation relating to making meal provision more enjoyable has been complied with. The third recommendation related to equality and diversity and has been reissued because it is important to ensure that the home`s brochure is reviewed to ensure that people from different backgrounds and cultures are encouraged. What the care home could do better: Four requirements and eight good practice recommendations have been issued as a result of this inspection. Although medication practices at the home have improved there a still some issues that need to be addressed. Three requirements and three good practice recommendations have been issued in relation to medication and are detailed in the relevant section of this report. There are some gaps in staff training records and a requirement has been issued that all staff at the home are up to date with mandatory training. The five remaining good practice recommendations relate to monitoring call bell times, dementia training for staff, recruitment, supervision and fire drills for night staff. Further details of these recommendations can be found in the relevant section of this report. Key inspection report Care homes for older people Name: Address: Wellington Park Nursing Home 76 Wellington Road Bush Hill Park Enfield Middlesex EN1 2PL     The quality rating for this care home is:   three star excellent 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: David Hastings     Date: 2 8 0 9 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: Wellington Park Nursing Home 76 Wellington Road Bush Hill Park Enfield Middlesex EN1 2PL 02083605977 02083640696 heptonj@bupa.com www.bupa.co.uk BUPA Care Homes (GL) Ltd care home 33 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : 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: 33 The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Wellington Park Nursing Home is owned by BUPA Care Services providing nursing care. The home is registered to care for thirty three older people. The home is purpose built and is situated in a residential area, approximately one mile from Enfield Town. All bedrooms have en-suite facilities, telephone point and a remote controlled television. A number of the bedrooms are double rooms but the policy is for bedrooms to be provided as single unless two people, for example, a couple, wish to share. This means that currently there are 25 places available at the home. The registered manager stated that the current cost of a long stay place in the home is between six Care Homes for Older People Page 4 of 32 Over 65 33 0 Brief description of the care home hundred and fifty pounds and one thousand and one hundred pounds per week depending on the service users assessed needs and the type of room occupied. Information about the service is made available to all prospective service users and a copy of the latest CQC report is kept in reception at the home and the contents fed back to staff when it is received. The homes stated aim is to provide high quality nursing care for the older people who live there using the companys health and care knowledge, specialist skills and values to deliver as individual a service as possible to residents. 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: 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: We carried out this unannounced key inspection of Wellington Park Nursing Home on Monday 28th September 2009. We were assisted by the registered manager who was open and helpful throughout the inspection. We spoke with eight people who use the service, four visitors and six staff members. We observed the interactions between staff and residents. We looked around the home and examined various care records, staff files and health and safety documentation. Records in relation to the receipt, storage, administration and disposal of medication were examined by a CQC pharmacist inspector who visited the home on the same day. Prior to this inspection we sent out surveys to staff and residents. We received four surveys back from staff and fourteen surveys from residents or their relatives. The home also prepared a self-assessment (AQAA) and this was submitted to the Commission. This information was used as part of the inspection. Care Homes for Older People Page 6 of 32 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: Four requirements and eight good practice recommendations have been issued as a result of this inspection. Although medication practices at the home have improved there a still some issues that need to be addressed. Three requirements and three good practice Care Homes for Older People Page 8 of 32 recommendations have been issued in relation to medication and are detailed in the relevant section of this report. There are some gaps in staff training records and a requirement has been issued that all staff at the home are up to date with mandatory training. The five remaining good practice recommendations relate to monitoring call bell times, dementia training for staff, recruitment, supervision and fire drills for night staff. Further details of these recommendations can be found in the relevant section of this report. 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. Prospective residents have accurate information about the home in order to make an informed choice about where to live. The home carries out an assessment of individuals needs so that they know that the home is able to meet their needs before they decide to move in on a trial basis. Evidence: We examined the homes Service User Guide. This document describes the aims and objectives of the home and the facilities available to people coming into the home. This document also informs social workers looking for placements for people. The document contained clear information to prospective residents about what services are available as well as the aims and objectives of the home. This document did not describe how the needs of people from different backgrounds and cultures would be met. This is a shame as the manager was able to give us this Care Homes for Older People Page 11 of 32 Evidence: information throughout the inspection and gave us examples in relation to special cultural diets and religious observance. The manager told us that she will be amending this document to ensure that people from different backgrounds and cultures are encouraged. We examined four assessments of people who have moved into the home. In addition to the information received from the social worker or hospital a qualified person from the home had also visited the prospective resident and carried out an assessment of their needs before they moved in. These assessments were detailed and covered all the elements required by this Standard including the assessment of physical, emotional, social and cultural needs. People who use the service told us that they were involved in this assessment process and, where possible, had visited the home before moving in on a trial basis. In some cases the person had not been able to visit the home as they were too poorly. In these cases the persons relatives had often visited the home. Relatives and residents we spoke to told us that the staff were very friendly and welcoming and that the home was fresh and clean when they visited. They told us that these were two of the reasons why they had chosen this home. 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. Care plans clearly set out residents health, personal and social care needs so that staff know how best to support everyone at the home. Residents have good access to health care professionals and they are treated with respect. Residents get the medication they require, at the right times and by appropriately trained staff. Evidence: We examined eight peoples care plans. Each plan gave clear instructions to staff about how best to care for each person. Care plans outlined each persons strengths as well as care needs, which encourages people to be as independent as possible. Staff that we spoke with had a good understanding of the care needs of residents they supported. Peoples health, personal and social care needs were recorded on each plan. Care plans contained information about how to maintain an individuals privacy and dignity. Care Homes for Older People Page 13 of 32 Evidence: Each persons plan of care included an assessment of the risk of falling and how staff are to reduce this risk. Other risk assessments were seen including moving and handling, pressure care and nutrition. Residents weight is being monitored on a regular basis and action is taken if any problems are highlighted. Where residents have been assessed as having problems with eating and drinking, fluid charts have been put into place to monitor how much people eat and drink. Where possible, a personal history of the individual had been recorded so staff have information about residents lifestyle and interests. Care plans were being reviewed on a regular basis and updated where needed. There was evidence that people were being asked what they thought about their own care plans and records were being maintained about the residents (or in some cases their relatives) views about the quality of the care being delivered. There was evidence from care plans that people have good access to health care professionals such as doctors, chiropodists, dentists and opticians. These visits were being recorded on residents care plans with any action needed as a result. People who use the service confirmed that they had good access to health care professionals. On the day of the inspection people using the service looked well cared for, their clothes were clean and they were appropriately dressed. Although a large number of residents have very complex needs and are quite poorly, it was good to see that people are assisted to the main lounge for meals and activities so they can socialise with others. Our pharmacist inspector carried out an inspection of the medication at the home. These are the findings from his inspection. Although a minority of residents have elected to retain the GP who served them prior to admission to the home, most residents are registered with the homes regular GP. Repeated medication is prescribed every four weeks and dispensed by a local pharmacy using a Nomad 4-week individually blister packed monitored dosage system (MDS) together with printed medication administration record (MAR) charts for each resident. For most residents their current 4-week medication cycle started on 7th September. Medication is transported to the homes residents on 3 floor levels by means of two purpose-built medicines trolleys. When not in use the trolleys are securely tethered in a locked room dedicated to medication storage. The room has adequate ventilation Care Homes for Older People Page 14 of 32 Evidence: and the ambient temperature is monitored using a wall-mounted thermometer. At the time of the inspection the temperature was 270C, this being in excess of the required maximum of 250C. Keys to the medicine trolleys and the Controlled Drugs cupboard are kept with the nurses in charge. Keys to other medicines cupboards and medicines fridge were hooked on a nail in the wall inside the medicines room beside the door. Although the room is locked when not in use it was considered that security of the keys may be compromised when staff are busy within the open room. This issue was addressed by the homes manager during the inspection and installation of a key press in the medicines room was instructed. Keys will then be accessed by designated staff holding a key to the press. Two residents are prescribed insulin by means of pen injectors containing an insulin cartridge. The pens are stored on an open shelf within the medicines room, whereas storage should be either within a locked medicines cupboard or locked medicines trolley. Once a cartridge is in use the shelf life is limited and therefore requires the date of opening to be recorded with the pen-injector and the in-use expiry date indicated. Audit of residents medication indicated two occasions when the quantity found did not meet that recorded on the MAR charts, as follows: For one resident their Loratidine 10mg. tablets, take one daily when required, was dispensed as 30 tablets on 1st September 2009 and 18 tablets recorded as administered in the current cycle to leave 12 tablets, however, 14 tablets remained. Two possible explanations to account for this surplus of 2 tablets could be either recording administration on two occasions when doses were omitted or the original quantity being incorrect. For another resident this involved Paracetamol 500mg tablets, take two tablets four times a day when required. The MAR record indicated that 56 tablets were received for the current cycle and 12 tablets brought forward from the previous cycle providing 68 tablets in total for use during the current cycle. MAR records indicated that 44 tablets were administered to leave 24 tablets remaining, however, 22 tablets were found. Possible explanations to account for this deficit of 2 tablets could be failing to record one dose, or the quantity received/brought forward being incorrect, or misappropriation. Care Homes for Older People Page 15 of 32 Evidence: Three residents are unable to ingest orally and therefore have their medicines administered directly into their stomach through a tube opening on their abdomen (PEG). Most medication is prescribed in forms suitable for administration by the PEG route, however, one medicine in tablet form has to be dispersed in water to allow its administration. As this preparation is not licensed for dispersal prior to administration it is recommended to obtain the prescribers written authorisation to administer by this means. One resident was prescribed Allevyn dressings to be applied as directed, however, there was no record to indicate when dressings had been changed, either on the MAR chart or in the residents care plan. The nurse stated that dressing changes were marked in the diary, however, there was no indication of this method of recording on the MAR chart or in the care plan. The homes manager agreed that recording should be included on the MAR chart. Some medication prescribed on a when needed basis was held in stock but due to not recently being required for administration was not entered on the MAR charts. This included diazepam rectal tubes for 3 residents and Maxolon tablets for one resident. All prescribed medication is required to be entered on the MAR charts indicating its availability for residents. There were two isolated incidents of omission of the record indicating whether medication prescribed for regular administration, had been administered. This being Aveeno cream for one resident at 22:00 on 23/09/09 and Trimovate cream for another resident at 22:00 on 26/09/09. There were a few examples where the receipt or carry forward of medication from the previous MAR chart cycle was either omitted or not completely entered on the current MAR chart. In order to facilitate the audit process to confirm medication is being administered as prescribed, it is necessary to record the quantity, date of receipt/carry forward and the signed initials of the member of staff making the entry for accountability. When staff write information on the MAR charts, such as deletion of a medicine or change to administration, it is required that the date of entry and their signed initials is entered for auditable accountability. A locked medicines fridge was in use in the medicines storage room and temperatures recorded daily. The temperatures were usually within the required range of 2 to 80C., Care Homes for Older People Page 16 of 32 Evidence: however, the maximum/minimum thermometer was only being reset on the rare occasion when the temperature was outside that required. It is recommended to reset the maximum/minimum thermometer after each recording to prevent carry-over of previous days readings thereby ensuring that readings only relate to the current recording. Medical gases were stored in the adequately ventilated medicines room with an appropriate notice displayed on the door. One cylinder of oxygen was currently in store and was supported to prevent it falling. However, another oxygen cylinder was free standing in a residents room and required securing in accordance with health and safety requirements to prevent falling. As a result of this inspection three new requirements and three new recommendations have been issued in the relevant section of this report. We saw a number of examples of supportive staff interactions with people and staff were able to describe to us how they ensure the privacy of people they support. We saw staff knocking on residents bedroom doors before entering. People we spoke with told us that the staff were respectful and kind towards them. One resident told us, All the staff are kind and friendly. Care Homes for Older People Page 17 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. The home provides varied activities for people who use the service. The home encourages visitors, which ensures an interesting and lively atmosphere. Residents are able to exercise choice and control over their lives. The home provides people with a wholesome appealing balanced diet. Evidence: There is an activities coordinator employed by the home. We saw various notices on display informing residents of forthcoming activities and events at the home. The home also employs a companion worker who works with individual residents, spending time with them, talking and listening and assisting with such activities as personal grooming and other one-to-one tasks. Their work was appreciated both by people using the service and other staff who often did not have time to spend long periods with individual residents. In the afternoon a reminiscence activity was taking place and residents were clearly enjoying the slide show and sing-a-long. A number of residents have dementia and are very poorly and mostly stay in their rooms. We discussed with the manager the need to keep these residents suitably occupied and engaged. Although we saw staff visiting residents it would be useful for training to be given to all staff regarding activities for those residents who have developed dementia or are not able to join in communal activities. Care Homes for Older People Page 18 of 32 Evidence: We saw a number of visitors to the home during the inspection. Visitors told us that they could visit at any reasonable time and that they were made welcome by the management and staff. Residents we spoke with confirmed this. One visitor told us that the staff were, Very friendly. Care plans gave examples of how choice is offered to residents in relation to activities, food, clothes and personal care. People told us that they felt they had choice and control over their lives. Staff we interviewed were able to give us practical examples of how they offer choice to people living at the home. This included times that residents wanted to get up in the morning and making sure that residents were able to choose the clothes they wanted to wear. Residents were observed enjoying their lunch in relaxed and pleasant surroundings. Staff were observed offering discreet assistance where required. The menu for the day is clearly recorded on the notice board and people told us there was always a choice. Residents told us they enjoyed their meals and that there was always enough to eat. One resident told us, I always enjoy my meals. We visited the kitchen during the inspection. Freezer and fridge temperatures were being routinely recorded. The kitchen was clean and well maintained and there was plenty of fresh fruit and vegetables available. The chef was interviewed and had a good knowledge of individual residents dietary needs and preferences including cultural or religious needs. The kitchen has recently been inspected by the environmental health department and was awarded five Scores on the doors. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that any complaint will be taken seriously and dealt with in an open manner and within set timescales. People who use the service are protected from abuse by clear policies and procedures and by a well-informed, trained staff group. Evidence: The home has satisfactory policies and procedures in relation to complaints and the protection of residents from abuse. All the residents and visitors we spoke with said they had no complaints about the service but were clear that they would say something if they had a concern. We examined the complaints record. There have been no recent complaints about the service. People we spoke with told us they were confident that the manager would deal with any complaints or concerns properly. Staff were able to describe how vulnerable people could be at risk of abuse in a residential care setting. All staff interviewed were clear of their responsibility to report any suspicions of abuse to the appropriate authorities. Residents that we spoke to said they felt safe and well supported at the home. Records indicated that most staff have undertaken training in the protection of vulnerable people. Care Homes for Older People Page 20 of 32 Evidence: A resident we spoke with told us, I feel 100 safe. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience 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 clean, safe and maintained to a very good standard. The home has the aids and adaptations needed for the care of the people who use the service. People who use the service are protected by clear policies and procedures in relation to infection control. Evidence: We looked around the home with the manager and visited a number of residents rooms with their permission. One resident told us, Its a lovely room. The home was well maintained and decorated to a good standard. There is a full time maintenance person who checks and ensures that the building and equipment are maintained and repaired. There are suitable aids and adaptations throughout the home to ensure that people who use the service have as much independence as possible. There are some drawbacks to the building. Although purpose built the design lacks some of the features usual in a modern nursing home. For example, the lift is relatively small, storage space is limited, the laundry is located on the first floor and deliveries have to go through the front of the building as there is no dedicated side or rear delivery access. Having said that, staff have responded well and managed their work to take account of such matters. The service is not registered to admit people with dementia and the manager told us Care Homes for Older People Page 22 of 32 Evidence: she would not be applying for such a category as the homes layout does not lend itself to dementia care. On the day of the inspection the home was clean, tidy and free from offensive odours. The home employs domestic workers and the residents and visitors we spoke with confirmed that the home was always clean. Apart from its location, the laundry area is well designed and contains the equipment needed to protect people from cross infection. The home has good policies and procedures in relation to infection control and staff have undertaken infection control training. All toilets contained anti bacterial soap and paper hand towels to limit the risk of cross infection. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff at the home work hard to meet the needs of the residents and are provided with good training opportunities to further enhance their knowledge and skills. Recruitment practices are sufficiently detailed in order to protect residents at the home. Evidence: On the day of the inspection there were twenty four residents at the home. The rota showed that there are two qualified nurses and six carers in the morning shift, two nurses and four carers in the evening and one qualified nurse and three carers on duty throughout the night. People who use the service told us they were happy with the staff at the home and we saw good interactions between staff and residents. On the day of the inspection there appeared to be enough staff to meet the needs of the residents. Staffing rotas seen matched the names of the staff on duty that day. One resident we spoke with told us, They cant do enough for you. Comments we received from two residents indicated that staff sometimes took a while to respond to their call bell in their room. We have issued a good practice recommendation that this issue is monitored by the manager. Care Homes for Older People Page 24 of 32 Evidence: Information sent to us prior to the inspection indicated that well over 50 of care staff have completed their NVQ level 2 or equivalent. Staff we interviewed were positive about the training opportunities available to them and records were examined indicated that staff were undertaking the training relevant to their work. We did notice that there were a few gaps in staff training profiles. A requirement has been made that a staff training audit takes place and training is then booked for staff so that everyone in the home has the training they require. Three staff files were examined from staff recently employed by the home. We checked these files to see if the homes recruitment procedures were being followed so that residents are protected from unsuitable staff working at the home. The files examined contained all the information needed to protect residents including two written references, proof of identity and criminal record checks. Some references we examined did not contain a company stamp or letter headed paper to further confirm the authenticity of the reference. A good practice recommendation has been made relating to this issue. Care Homes for Older People Page 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager of the home knows the residents very well and understands their needs. Residents do have opportunities to have a say in how the home is run. Residents financial interests are being safeguarded. Staff are supported in their work. The health and safety of residents and staff are promoted and protected. Evidence: Residents, staff and visitors we spoke with were very positive about the registered manager. Staff told us they appreciated the managers clear approach and high standards of care practice. The manager has the required qualifications for this post and attends regular training as required. The manager keeps in regular contact with us about issues that affect the home and the residents in her care. The service has a number of ways of obtaining feedback from residents about the quality of care provided. This includes a questionnaire for all residents every two months and an annual quality monitoring exercise by the organisation. The manager has recently instigated a newsletter so that residents and their families can be kept up Care Homes for Older People Page 26 of 32 Evidence: to date with whats going on at the home. There was evidence that the staff consult with residents about the menus and activities and outings. The registered provider undertakes monthly visits to the home and obtains residents views about the quality of care they receive. The home does not hold some money on behalf of residents. Instead residents or their representatives are invoiced on a regular basis. A sample of these invoices were examined and found to be accurate and included clear audit trails. Staff supervision records indicated that care staff receive regular support and staff confirmed that they received supervision every two months. It was noted that this was not always the case for domestic or catering staff. A good practice recommendation has been issued. Satisfactory health and safety records were seen in relation to electrical installation, PAT testing, gas safety and equipment servicing such as hoists and lifts. We also checked records in relation to fire safety. Records indicated that staff were undertaking fire drills on a regular basis. However most of these drills were taking place during the day. It is important that night staff have regular fire drills so they understand the action they need to take if a fire occurs at night. A good practice recommendation has been issued relating to fire drills for night staff. Fire training has been given to staff and staff confirmed they have undertaken this training. Records of checks for the fire alarm, emergency lighting and fire extinguishers were also satisfactory. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medical gas cylinders require 30/10/2009 securing to prevent falling. This is to ensure the staff at the home are following the correct procedures with regard to medication. 2 9 13 Medication with a limited period of therapeutic viability when in use is required to have record to indicate its expiry. This is to ensure the staff at the home are following the correct procedures with regard to medication. 30/10/2009 3 9 13 Medication records are required to be complete and accurate to facilitate auditable control of medication. This is to ensure the staff at the home are following the correct procedures with regard to medication. 30/10/2009 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 30 18 The registered person must ensure that a training audit takes place and training is then booked for those staff as required. This is to ensure that all staff at the home are provided with the training they need. 04/12/2009 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 1 The registered person should review the homes Service User Guide with regard to equality and diversity arrangements at the home. This is to ensure that people from different backgrounds and cultures know how the home will be able to meet their particular needs. To reset the medicines fridge maximum/minimum thermometer after recording its readings. To improve the security for the storage and access to the keys to medication storage. To obtain written authority from the doctor when medicines are used outside their licensed conditions. The registered person should ensure that staff receive training in dementia care with particular reference to communication, occupation and engagement. The registered person should ensure that the time it takes for staff to respond to call bells in residents rooms is monitored so that any issues are identified and residents know that their call bell will be responded to in a timely manner. The registered person should ensure that when written references are requested from a previous employer, there 2 3 4 5 9 9 9 12 6 27 7 29 Care Homes for Older People Page 30 of 32 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 is a clear request for a company stamp or letter headed paper from the referee to further confirm the authenticity of the reference 8 36 The registered person should ensure that all staff at the home, including domestic and catering staff receive regular supervision so they can be supported to carry out their jobs effectively. The registered person should ensure that all night staff undertake fire drills at night every three months. 9 38 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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