Care Home: Westerham Place

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What the care home does well People benefit from an assessment before they decide to move into Westerham Place. This ensures that the home is suitable to meet their needs. Residents enjoy living in a comfortable, clean, attractive, well decorated and furnished environment. They benefit from suitable facilities and equipment, which help to maintain their independence. Their privacy is valued. People are treated with dignity and respect. They are recognised as individuals and are able to exercise choice over their lives. Individuals changing personal, health and social care needs are met. All current residents benefit from support from staff to manage their medication. Residents benefit from a well established, supported and supervised staff team who care for, understand and anticipate their needs and wishes. The views of residents and their representatives are listened to and receive appropriate consideration. People benefit from their views being sought about how the home is run. Residents are protected by the system in place for safeguarding their finances. Their health and safety is promoted by the testing and maintenance of systems and equipment in the home. People feel suitably occupied and can choose to take part in group activities or pursue their individual interests; they enjoy keeping in contact with their relatives and friends. Residents are provided with good quality and varied meals. What has improved since the last inspection? Residents spoken with continue to enjoy living at Westerham Place and to value the care they receive. What the care home could do better: During our visit of 10th July 2009, we found residents were put at risk and not safeguarded by the homes procedures for staff recruitment. This is an enforceable offence. Not all recruitment records were available for inspection and we required information to be sent to us. This was received on 6th August 2009 together with confirmation from the Responsible Individual that appropriate recruitment procedures are now in place. It was not possible to fully assess whether staff are provided with up to date training appropriate to meet the needs of residents, as on the day of our visit, not all records were complete, up to date or available for inspection. We requested this information to be sent to us. It was not possible to assess whether people thinking about moving into Westerham Place are given appropriate written information, as on the day of our visit, none was available for inspection. We requested this information to be sent to us. Residents safety may be enhanced by some replacement carpet and a review of the procedures in place for reducing the risk of scalding from hot water. Residents choice of whether to lock their rooms or not, is not reflected in writing. The way the home meets residents changing needs could be better reflected in care plans and may be enhanced by additional staff qualification. The systems in place for the administration of medication may be enhanced by a review of some procedures. Choices about the main meal of the day may be easier for some residents to make, if more information was available to them. Key inspection report Care homes for older people Name: Address: Westerham Place Quebec Square Westerham Kent TN16 1TD     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: Helen Martin     Date: 1 0 0 7 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 35 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 35 Information about the care home Name of care home: Address: Westerham Place Quebec Square Westerham Kent TN16 1TD 01959565805 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Yewcare Limited 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 to be accommodated is 24 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Westerham Place is a care home providing personal care and accommodation for up to twenty four older people. The home is located just outside the small town of Westerham, which has a variety of shops, pubs, a post office and churches. There is a local bus service and bus stops are nearby. The home consists of a large detached two storey building with a newer purpose built two storey extension. All the homes bedrooms are single with en suite facilities, including a WC, wash hand basin and bath. In addition there is one assisted bathroom located on the ground floor. There is a large lounge surrounded by a conservatory and a separate dining room. The garden is well kept and attractive. All areas of the home are accessible to people who have Care Homes for Older People Page 4 of 35 Over 65 24 0 1 0 0 2 2 0 0 9 Brief description of the care home limited mobility; there is a lift to the first floor. The home employs care staff twenty four hours a day; the majority of the care staff have worked there for some time and there is low staff turnover. The weekly fee range for the service is 750.00 to 850.00 Full details about the service provided and the fees charged are available from the Manager. Care Homes for Older People Page 5 of 35 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: Westerham Place provides care and accommodation for up to twenty four older people. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This Key Unannounced Inspection included a visit to the home in Westerham on 10th July 2009, where one owner, who is also the Responsible Individual, the Head of Senior Care, one Care Worker, the Chef and three Service Users were spoken with. The second owner, who is also the Registered Manager, was not present at the time. Some judgements about the quality of the service provided were taken from observation and conversation. Some records and documents were looked at together with the premises and facilities of the home. In addition, subsequent to this visit, four telephone conversations took place with, one letter was sent to and two received from the Responsible Individual. Care Homes for Older People Page 6 of 35 The last Key Inspection was undertaken on 10th July 2007 and an Annual Service Review was completed on 25th July 2008. Following information received by us, a random inspection was undertaken on 10th February 2009. An Annual Quality Assurance Assessment, AQAA, was received from the home on 24th April 2009. Any other information received since the previous Key Inspection has been reviewed. All of the above have been included within this inspection process and some of the gathered evidence is mentioned within this report where appropriate. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: During our visit of 10th July 2009, we found residents were put at risk and not safeguarded by the homes procedures for staff recruitment. This is an enforceable offence. Not all recruitment records were available for inspection and we required information to be sent to us. This was received on 6th August 2009 together with confirmation from the Responsible Individual that appropriate recruitment procedures are now in place. It was not possible to fully assess whether staff are provided with up to date training appropriate to meet the needs of residents, as on the day of our visit, not all records were complete, up to date or available for inspection. We requested this information to be sent to us. It was not possible to assess whether people thinking about moving into Westerham Place are given appropriate written information, as on the day of our visit, none was available for inspection. We requested this information to be sent to us. Residents safety may be enhanced by some replacement carpet and a review of the procedures in place for reducing the risk of scalding from hot water. Residents choice of whether to lock their rooms or not, is not reflected in writing. The way the home meets residents changing needs could be better reflected in care plans and may be enhanced by additional staff qualification. The systems in place for Care Homes for Older People Page 8 of 35 the administration of medication may be enhanced by a review of some procedures. Choices about the main meal of the day may be easier for some residents to make, if more information was available to them. 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 35 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 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from an assessment before they decide to move in, which ensures that the home is suitable to meet their needs. On the day of this visit, it was not possible to assess whether prospective residents are given appropriate written information about the home before they move in, as documentation was unavailable for inspection. Evidence: The owner explained that people thinking about moving into Westerham Place are assessed by the home to ensure that their needs can be met. This information is recorded with the aim that care plans for the help that people need are developed from this. The home has a statement of purpose and service users guide, although these were not available for inspection on the day of this visit. Subsequent to this visit, the owner Care Homes for Older People Page 11 of 35 Evidence: stated they had sent us copies but they had not been received at the time of writing this report. A requirement has been made; copies of the homes statement of purpose and service users guide must be sent to us by 10th October 2009. The owner stated that the home does not provide any intermediate care. Care Homes for Older People Page 12 of 35 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. Residents are treated with dignity and respect. Residents changing personal, health and social care needs are met; although they could be better reflected in care plans and risk assessments. There are systems in place for the administration of medication which aim to protect residents, although this could be enhanced by a review of some procedures. Evidence: Individual plans of care for each resident are developed. These aim to identify the action required from staff to meet residents personal, social and health care needs. Three care plans were looked at. These are clear and easy to follow, although not recorded in detail. For example, staff spoken with demonstrated a good understanding of the needs of one resident with dementia and the actions taken by staff; however this information is not reflected in their care plan. Residents changing needs are reflected in notes written by staff on a daily basis. Care Homes for Older People Page 13 of 35 Evidence: Entries indicate AM, PM or night but do not always specify the actual time that events occurred. Staff spoken with demonstrated a good understanding of the risks involved in the care of residents. Although some risks are identified in care plans, not all are recorded. Records do not show detailed information about the action needed to reduce the risk. The provider is strongly recommended to review all care plans to ensure that sufficient information is available for staff to meet the needs of residents; all risks to residents and the action needed to reduce these are recorded; specific times of events and entries are recorded in all daily notes. Residents health care needs are met. These are monitored and recorded in care plans. These show that health and social care professionals are accessed to support staff to meet residents needs including consultation and referral to medical professionals. Systems are in place within the home, which aim to protect residents regarding the administration of medication. Currently no residents manage their own medication and all benefit from support from staff to do so. When the home receives medication from the pharmacy, it is checked as accurate by two members of staff, although this is not recorded. Medication is stored individually in locked cabinets in residents rooms. Administration records seen were completed appropriately, with the exception of one handwritten entry which was not signed by two members of staff as double checked. Staff spoken with demonstrated a good understanding of individual residents medication prescribed on a when needed basis; however guidelines for administration of such are not recorded. Photographs of residents are not kept with medication administration records for identification purposes. It was mentioned that new photographs of residents are in the process of being taken. The Provider is strongly recommended to ensure that all hand written administration entries are signed by two members of staff as double checked; medication received from the supplying pharmacy and individual guidelines for medication prescribed on a when needed basis are recorded; photographs of residents are kept with medication administration records. Residents are treated with dignity and respect. During the visit, staff were observed to be kind and helpful, attend to residents needs in privacy and respond quickly when needed. There is a good rapport between residents and staff. Staff spoken with demonstrated a good understanding of individuals needs and described their roles Care Homes for Older People Page 14 of 35 Evidence: well. Residents spoken with indicated that staff looked after them very well and thought them very good. Care Homes for Older People Page 15 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are recognised as individuals and are able to exercise choice over their lives. Residents feel suitably occupied and can choose to take part in group activities or pursue their individual interests; they enjoy keeping in contact with their relatives and friends. Residents are provided with good quality and varied meals, although choices about the main meal may be easier to make for some, if more information was available to them. Evidence: People move into Westerham Place knowing the nature of the service. The pace of daily life is relaxed. People can choose whether to spend time in their rooms or in the communal areas of the home. More able residents can access local facilities independently or with staff support. Residents spoken with indicated they were happy in the home and with its routines and would not want to change anything. Comments included, I like living here; I am very happy at the home; I have no complaints. Care Homes for Older People Page 16 of 35 Evidence: At the time of this visit some residents were listening to music, reading or watching television in their rooms, whilst others were in the lounge. At coffee time more residents arrive in the lounge and there were various comings and goings throughout the day. Of those spoken with, it is clear residents like to choose to spend time alone and with others. The garden and grounds are attractive, accessible and pleasant for residents to use. One resident described how they liked the view onto the garden, enjoyed the outside and sitting out in good weather. Hairdressing is offered once a week at the home. Residents are able to go to church if they wish and two local ministers visit the home regularly. The home can support residents with different faiths to worship in a manner of their choice. Staff spoken with demonstrated a good understanding of residents likes and dislikes. Discussion took place regarding group activities and events organised by the home, such as music sessions, quizzes and coach trips out. It was said that these are not usually well attended and that residents mainly prefer their own individual pursuits and interests. Residents are encouraged to keep in contact with their relatives and friends if they wish. There is space for residents to see relatives in private away from their rooms and visitors are welcome in the home at any reasonable hour. One resident explained that they enjoyed regular visits from their relative. Residents are supported to make choices about their lives and encouraged to maintain their independence. Meals are varied, good quality and well cooked. People are able to choose what they want in advance. Staff are aware of residents individual likes and dislikes and the home could cater for any special dietary needs, allergies and cultural or religious needs if necessary. Written menus confirm a range of choices for breakfast and supper, although only one option for the main meal at lunch time is shown. The owner explained that residents could request an alternative in advance if they wished. Residents choices are recorded. Residents spoken with were mostly happy with the meals provided and said, I like the food, there are very nice meals and very good home made cakes; where they were less so was due to the main meals not being to their taste, for instance being too spicy, or feeling there was not always a choice. Previous inspection identified that it may benefit some residents for the written menu to be amended to clarify choice Care Homes for Older People Page 17 of 35 Evidence: regarding the main meal and a recommendation was made. This inspection identified the same issue and the provider continues to be recommended to clarify choice regarding the main meal on the written menu. Care Homes for Older People Page 18 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of residents and their representatives are listened to and receive appropriate consideration. During this visit we found residents were put at risk and not safeguarded by the homes procedures for staff recruitment. Subsequent to this visit we received confirmation from the owner that appropriate recruitment procedures are now in place. Evidence: At the time of this visit, it was observed that residents were at ease talking with staff who listened to their views. Staff demonstrated a good understanding of residents. A positive relationship between both staff and residents with a good balance between professionalism and friendliness was observed. Residents spoken with indicated that they enjoyed living in the home; comments included, staff are very good and helpful; I like living here; I am very happy at the home; I have no complaints. There is a written complaints procedure available for residents. Any complaints received are investigated and recorded. Staff spoken with stated that all residents are on the electoral role and most get a postal vote, which they can use if they wish. It was said that staff have undertaken training in the protection of vulnerable adults. Written procedures are available including guidelines from the local authority for safeguarding vulnerable adults. Care Homes for Older People Page 19 of 35 Evidence: During this visit we found areas of concern regarding staff recruitment procedures that needed to be addressed to comply with the law and safeguard the people who live in Westerham Place. Our concern was that a member of staff had been employed, without application for a Criminal Records Bureau, CRB, disclosure and a check against the Protection of Vulnerable Adults, POVA, list. In addition no documentary evidence for any pre employment checks for this individual was available for inspection during this visit. During telephone conversations on 14th July 2009 and 15th July 2009, the owner assured us they had received a full employment history, two written references and photographic identification. They also assured us that the member of staff concerned would not work at the home again until either a satisfactory full CRB disclosure had been received, or until a satisfactory POVA First check had been received, when the individual would return to work under appropriate supervision until the receipt of the full CRB disclosure. In order to further evidence that the home complied with the law and safeguarded the people who live there, we wrote to the owner on 15th July 2009, asking for these assurances to be confirmed in writing with us by 21st July 2009. At the date of writing this report we had not received a written response. A requirement was made for a satisfactory written response by 10th October 2009. If this was not received, we could take enforcement action. Subsequently we have received a letter from the owner confirming that appropriate recruitment procedures are now in place. Care Homes for Older People Page 20 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy living in a comfortable, clean, attractive, well decorated and furnished environment. People benefit from suitable facilities and equipment, which help to maintain their independence. Residents privacy is respected and they can choose whether to lock their rooms or not, although this choice is not reflected in writing. Westerham Place is well maintained, although residents safety may be enhanced by some replacement carpet and a review of the procedures in place for reducing the risk of scalding from hot water. Evidence: Residents enjoy living in a comfortable environment. All areas of Westerham place are maintained to a high standard, clean, attractive, well decorated and furnished. The gardens are well maintained and pleasant. Residents can choose to spend time in their rooms or the communal living areas, which include a lounge and conservatory area. There is also a pleasant small sitting area on the first floor. The dining room is spacious and looks out over the garden. Care Homes for Older People Page 21 of 35 Evidence: There are a few areas of rucked carpet in communal corridors. The owner assured us that these did not pose a risk to residents with mobility problems. The owner stated that all communal areas will be fitted with new carpet shortly when they will be redecorated. Residents rooms are very homely and individually personalised, reflecting their individual taste. People are able to bring some items of their own furniture when they move in. There are pictures, photographs and ornaments that all add to the feeling of home and residents spoken with all indicated that they enjoy their surroundings and living in Westerham Place. Comments included, I like my room; everything is clean and nice; I like the view from my room. At the time of this visit the home was not fully occupied, so a choice of room is available. The owner stated that on moving in, residents are offered the option of having a lock on their door; currently two individuals wish to have this. Previous inspection identified that this choice should be recorded in care plans and a recommendation was made; the last inspection report repeated this recommendation. During this inspection care plans seen did not contain written evidence for this choice. The provider continues to be recommended to record residents choice regarding locks on their doors. All residents rooms are ensuite and there are sufficient communal facilities. Adaptations and specialist equipment is provided where necessary to assist people with their mobility and bathing if necessary. A downstairs bathroom is equipped with a parker bath. Those with mobility problems are accommodated on the ground floor wherever possible. There is a lift to access the first floor with a small stair lift to a room situated above a few additional stairs. There is a staff call system, which residents can use when they need to. Those spoken with said that when they use this, staff always arrive very quickly. Residents have equipment for their own personal use and assistance such as walking frames and wheelchairs. The home is warm, light and naturally ventilated. Staff explained that, in order to protect people from scalding, they always test the water temperature before a resident gets into a bath; this is done by hand, a thermometer is not used and temperatures are not recorded. The owner stated that hot water temperatures from sink outlets in bathrooms and residents rooms are not tested as the boiler has a thermostat. However, hot water outlets do not have pre set Care Homes for Older People Page 22 of 35 Evidence: valves to control any fluctuation in water temperature. During this visit the hot water temperature from the sink outlet in the downstairs bathroom was tested by hand and found to be very hot to the touch. In order to further reduce the risk of scalding to residents, the provider is recommended to test and record temperatures from all hot water outlets regularly. Previous inspection identified that no radiators within the home were covered or of a type to guarantee a low surface temperature; this posed a potential risk to residents from scalding; recommendations were made regarding radiator covers and risk assessments. During this visit the owner stated that risk assessments had been undertaken and recorded; confirmed that all radiators have thermostatic valves; radiator surface temperatures posed no risk to residents. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well established staff team who care for, understand and anticipate their needs and wishes. During this visit it was not possible to fully assess whether staff are provided with up to date training appropriate to meet the needs of residents, as not all records were complete, up to date or available for inspection. During this visit we found residents were put at risk and not safeguarded by the homes procedures for staff recruitment. Subsequent to this visit we received confirmation from the owner that appropriate recruitment procedures are now in place. Evidence: A good rapport was observed between residents and staff, who were attentive and respectful during the visit. Residents spoken with indicated that staff are very kind and look after them well. Comments included were, the staff are very good and helpful; staff are kind; I am very happy at the home; I like the staff, they are very good. There remains very low turnover of staff; therefore the team is mainly well established and very familiar with the needs and personalities of residents. Staff spoken with enjoyed working at the home. Records show that there are sufficient care staff on duty during the day and at night. Contract auxiliary staff are employed, such as a chef and gardener together with staff for cleaning duties. Planned staff shifts are rostered and handwritten. Although the roster does not contain all the full names and times of Care Homes for Older People Page 24 of 35 Evidence: staff on duty, the signing in and out book does. This records the actual hours that all staff work. During this visit the procedures for staff recruitment were looked at. Two staff files were examined, only one of which contained documentary evidence of appropriate pre employment checks. Our concern was that another, more recent member of staff had been employed, without application for a Criminal Records Bureau, CRB, disclosure and a check against the Protection of Vulnerable Adults, POVA, list. No documentary evidence for any pre employment checks for this individual was contained in their staff file or available for inspection during this visit. A requirement was made. Subsequently we have received a letter from the owner confirming that appropriate recruitment procedures are now in place. Discussion with the owner and further information regarding this issue is previously detailed under the Complaints and Protection section of this report. The owner stated that induction training is undertaken for all new staff and described this as including the shadowing of more experienced staff. Of the two staff files seen, only one contained a record of induction training. Although this shows the date on which various topics were covered, it does not include detailed information or signatures of the employee and supervisor. The provider is recommended to review the staff induction procedures in line with Skills for Care guidance. The owner described how ongoing training for staff was provided through a combination of internal and external sources. It was stated that since the last key inspection all care staff have undertaken manual handling training and all domestic staff have undertaken training in the care of substances hazardous to health. The owner said that all care staff are trained in first aid, medication and the prevention of fire; the chef has food hygiene training; professional advice is sought regarding dementia. Staff spoken with confirmed that they had received manual handling and adult abuse training Staff spoken with explained that two staff have obtained a National Vocational Qualification with a further four currently undertaking this. Subsequent to this visit the owner stated that over 50 per cent of care staff have a National Vocational Qualification. Of the two staff files seen, only one contained a record of ongoing training; this showed some courses undertaken between 2005 and 2007 with other entries undated. Although the food hygiene training certificate for the chef was seen, no other certificates for training courses or qualifications were available at the time of this visit. It was not possible to fully assess whether staff are provided with up to date training appropriate to meet the needs of residents, as not all records were complete, up to Care Homes for Older People Page 25 of 35 Evidence: date or available for inspection. Subsequent to this visit, the owner stated they had sent us an up to date staff training matrix but this was not received at the time of writing this report. A requirement has been made; copies of staff training and qualification records must be sent to us by 10th October 2009. Care Homes for Older People Page 26 of 35 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 run by an experienced and qualified manager, although residents are put at risk and are not safeguarded by the management of staff recruitment. Residents benefit from their views being sought about how the home is run. Residents are protected by the system in place for safeguarding their finances. Residents benefit from well supported and supervised staff. The health and safety of residents is promoted by the testing and maintenance of systems and equipment in the home. Evidence: Westerham Place has two owners, one of whom is the Registered Manager and one the Responsible Individual. The former is experienced and qualified to National Vocational level 4. The latter was present at the time of this visit. Issues regarding the Care Homes for Older People Page 27 of 35 Evidence: management of staff recruitment have been detailed previously under the Complaints and Protection and Staffing sections of this report. The home has a system in place which aims to assure the quality of the service provided. Residents are relaxed and at ease when speaking to staff; there are also residents meetings. The owner described a more formal system, which included using questionnaires annually; the results of these are analysed with any action needed taken. Examples of returned questionnaires were seen which contained positive comments about the home. Previous inspection identified that the home no longer managed residents finances. Staff spoken with described the system in place as including the individual storage of small amounts of cash with records maintained largely by relatives; if staff purchase anything on behalf of residents, this is recorded with receipts kept. The owner indicated that staff are supported to undertake their roles through informal discussion, staff meetings, and formal recorded supervision sessions. Staff spoken with and records seen confirmed this. Records of any accidents and incidents are recorded appropriately. Some written policies and procedures designed to help carers complete their duties were seen. Other records looked at as part of this visit have been mentioned elsewhere within this report where appropriate; some of these were not available for inspection or incomplete. Records generally indicate the testing and maintenance of systems and equipment within the home. The home has procedures in place for the maintenance of food hygiene; hot food, fridge and freezer temperatures are tested appropriately; the last Environmental Health Officer awarded the home five stars. Care Homes for Older People Page 28 of 35 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 29 of 35 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 17 The registered person shall maintain in the care home the records specified in Schedule 4. The statement of purpose and service users guide must be available for inspection to evidence that the information reflects the service provided by the home. The registered person must send the CQC copies of the homes statement of purpose and service users guide by 10th October 2009. 10/10/2009 2 18 19 The registered person shall 10/10/2009 not employ a person to work at the care home unless the person is fit to work and the employer has obtained the information and documents specified in Schedule 2. In order to protect and Care Homes for Older People Page 30 of 35 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 safeguard service users, the registered person must undertake all of the required pre employment checks and safeguards for all staff. The registered person must send the CQC satisfactory written evidence that the employment of a new member of staff complies with legislation. This must be received by the CQC by 10th October 2009. If satisfactory evidence is not received by this date, the CQC may take enforcement action. 3 29 19 The registered person shall 10/10/2009 not employ a person to work at the care home unless the person is fit to work and the employer has obtained the information and documents specified in Schedule 2. In order to protect and safeguard service users, the registered person must undertake all of the required pre employment checks and safeguards for all staff. The registered person must send the CQC satisfactory written evidence that the Care Homes for Older People Page 31 of 35 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 employment of a new member of staff complies with legislation. This must be received by the CQC by 10th October 2009. If satisfactory evidence is not received by this date, the CQC may take enforcement action. 4 29 17 The registered person shall maintain in the care home the records specified in Schedule 4. Records regarding pre employment checks for a new member of staff must be made available for inspection in order to evidence that service users are protected and safeguarded. The registered person must send the CQC satisfactory written evidence that the employment of a new member of staff complies with legislation. This must be received by the CQC by 10th October 2009. If satisfactory evidence is not received by this date, the CQC may take enforcement action. 10/10/2009 Care Homes for Older People Page 32 of 35 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 5 30 17 The registered person shall maintain in the care home the records specified in Schedule 4. Records of staff training and qualifications must be complete, up to date and available for inspection in order to evidence that staff are able to meet the needs of service users. The registered person must send the CQC copies of staff training and qualification records by 10th October 2009. 10/10/2009 6 37 17 The registered person shall maintain in the care home the records specified in Schedule 4. The registered person must ensure that all records are complete, up to date and available for inspection in order to evidence that service users are protected and that their needs are met. 10/11/2009 Care Homes for Older People Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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