Care Home: Westfield Nursing Home

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What the care home does well People have care plans which explain their needs in an individual way. This helps to make sure that an individual`s care is right for them, and not necessarily the same as others. People can maintain social links with people who are important to them. They are offered social activities which they can choose whether or not to join, and they can make choices about their mealtimes, and what they would like to eat. People`s complaints are listened to and acted upon by the registered manager, who takes these seriously. People are protected by staff who will report any concerns if they think anyone living at Westfield House is being abused. The home can look after people`s personal allowance if they wish. This is kept securely on their behalf. The home is kept maintained so that people`s health and safety is protected. What has improved since the last inspection? Staff now have better systems in place to reduce the risk of them making mistakes when they handle people`s medication. Although there are one or two things which still need to be improved. The recruitment process is now more thorough. This reduces the risk of unsuitable workers providing care to the people who live at the home. The staff training records give a better idea about when staff need updating. This helps to stop training about how to work well, and safely, from falling behind. What the care home could do better: Before people are admitted, staff could make it the rule that they visit them to assess them, so they can be more certain that the home has the resources available to meet their needs. Where this is not possible, they could write down information passed on verbally from other professionals, and share it with other staff. This would help staff to get the person`s care right as soon as they arrive. People and/or their families could be more involved in the upkeep of their care plan, so that they know it reflects properly their individual needs and choices. And care could be taken to make sure that ways to minimise risk to people is always explored, for instance with regards to weight loss, when people choose to look after their own medication, and how they should be moved by staff. Staff could always treat people with the respect that they deserve, by responding quickly and sensitively when they ask for personal care, which must always be provided in a dignified manner. Although staff know they must report any signs of abuse, they could be reminded about the role of the local authority as lead investigators, who they can go to if for any reason they do not wish to approach a member of the company about their concerns about anyone living at Westfield House. Everyone`s en suites could be made warm enough for them to use at night so they don`t have to leave their room to use an alternative toilet. Visiting professionals could be given surveys so they have the opportunity to comment upon how the home runs in the best interests of the people who live there. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Westfield Nursing Home Ripon Road Killinghall Harrogate North Yorkshire HG3 2AY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anne Prankitt     Date: 0 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Westfield Nursing Home Ripon Road Killinghall Harrogate North Yorkshire HG3 2AY 01423506344 01423528185 westfield.house@fshc.co.uk Noneprovided Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): County Healthcare Ltd, a wholly owned subsidiary of Four Seasons Health Care Ltd care home 31 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 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 31 The registered person may provide the following category of service only: Care Home with Nursing - Code N, To service users of the following gender: Either, Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places 31 Physical Disability - Code PD, maximum number of places 31 Date of last inspection 0 31 Over 65 31 0 Care Homes for Older People Page 4 of 31 Brief description of the care home Westfield House is part of County Health Care Ltd, a wholly owned subsidiary of Four Seasons Health Care Ltd. It is situated approximately three miles north of Harrogate on the east side of the main A61 Harrogate to Ripon Road. The building is a large older style stone built house on three floors including a lower ground floor. The building has been adapted and extended to provide accommodation for up to 31 older people requiring residential or nursing care. There is a gravelled area to the front and north side of the home and parking areas provided at the front and back with a lawned area stretching beyond. The registered manager told us on 4 June 2009 that the current weekly fees are £389.92, plus the Free Nursing Care Contribution of £106.30 where people have been assessed as being entitled to this. Additional charges are made for chiropody, hairdressing, personal toiletries, newspapers and magazines and outings. A brochure and financial advice is sent to people who enquire about the home. People can get more information in the service users guide, which the registered manager tries to give people a copy of before they arrive. People can ask the home if they want a copy of the most recent inspection report completed by the Care Quality Commission. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection for Westfield House took place on 20 and 26 June 2008. This key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. A site visit to the home carried out by one inspector over approximately eight hours on 4 June 2009. Care Homes for Older People Page 6 of 31 During the visit to the home, we spoke to some people who live there, some staff, visitor and the registered manager. Two peoples care plans were looked at in detail, and a further two to check on specific things. We also looked at two staff recruitment files, some policies and procedures and some records about health and safety. Care practices were observed, where appropriate. Some time was also spent watching the general activity to get an idea about what it is like to live at Westfield House. The registered manager was available throughout the day, and was given feedback at the end. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: Before people are admitted, staff could make it the rule that they visit them to assess them, so they can be more certain that the home has the resources available to meet their needs. Where this is not possible, they could write down information passed on verbally from other professionals, and share it with other staff. This would help staff to get the persons care right as soon as they arrive. People and/or their families could be more involved in the upkeep of their care plan, so that they know it reflects properly their individual needs and choices. And care could be taken to make sure that ways to minimise risk to people is always explored, for instance with regards to weight loss, when people choose to look after their own medication, and how they should be moved by staff. Staff could always treat people with the respect that they deserve, by responding quickly and sensitively when they ask for personal care, which must always be provided in a dignified manner. Although staff know they must report any signs of abuse, they could be reminded about the role of the local authority as lead investigators, who they can go to if for any Care Homes for Older People Page 8 of 31 reason they do not wish to approach a member of the company about their concerns about anyone living at Westfield House. Everyones en suites could be made warm enough for them to use at night so they dont have to leave their room to use an alternative toilet. Visiting professionals could be given surveys so they have the opportunity to comment upon how the home runs in the best interests of the people who live there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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. More information could be collected and written down about peoples needs before they are admitted. Evidence: In the information provided before the key inspection, the registered manager told us that people are assessed before they are admitted. She also said that people are invited to look round prior to the admission taking place. At this site visit, a staff member said they get information about people before they are admitted by referring to the written assessment. However, in the two care plans looked at, neither person had been visited by the home before their admission, and there was no pre admission assessment completed. Instead, an assessment of their needs had been completed by staff the day each person moved in. Some areas of the assessment had not been filled in. This makes the information less useful when developing a care plan for the person. For instance, Care Homes for Older People Page 11 of 31 Evidence: in one case there was nothing written down to confirm whether their mental health, social needs and spirituality had been assessed. The registered manager explained that one person had been referred to the home by their doctor, who had given information about their needs before they arrived. But this information was not written down on the persons pre admission assessment to share with other staff. In the second, we were told the person had been admitted in an emergency. There was a care plan for staff to refer to, which had been completed by the persons care manager. This gives staff the chance to see what needs the person has before they arrive, and will help staff to get the care right, and consistent, from the offset. It would be good practice for a suitably trained staff member to visit everyone, where possible, before a decision is made as to whether the home has the resources to meet their needs, and before the admission takes place. This would help to reduce the chance of failed admissions. The registered manager was able to show us an example where this had been done, for someone who had not yet arrived. The home does not provide intermediate care. It does however provide one interim bed, which is block purchased by the health authority. People are transferred from hospital into this bed when they become medically stable, until their long term care has been organised. The registered manager relies on the assessment completed by the hospital or care manager when deciding whether the persons needs can be met by the home. If there are issues which she needs to look into further, she told us that she or her deputy visits the person themselves to check the information they have is correct. Care Homes for Older People Page 12 of 31 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. Staff know what peoples needs are. The registered manager has demonstrated that she will take swift action to make sure that identified shortfalls are addressed to make sure that these needs will be met in a dignified and respectful way. Evidence: Staff have undertaken training in person centred care planning to help them to achieve improvements in the way peoples care is described in their care plans. It was evident that peoples admission assessment had been considered when the care plan was written, as well as any information from their care manager. Despite the shortfalls noted in peoples pre admission assessment, the completed areas of peoples care plans described their needs in a very individual way. For instance, one care plan about nutrition explained that the person likes pickles with meals to give taste, because of poor taste buds and Likes a snack at 19:00 hours. In the section about dressing, they had written Likes to buy clothes from small local shops. The care plans had been regularly updated by staff, although people and their families had not been involved in this review. It would be good practice to invite them Care Homes for Older People Page 13 of 31 Evidence: to do so. Areas of risk were also assessed, and action was then taken to keep this risk under control by adjusting the persons care plan as necessary, or by calling upon the advice of the appropriate health professional, such as the district nurse or doctor. For instance, where peoples health put them at risk from getting pressure sores, they were given a special mattress to help prevent skin damage, and a request was made for the district nurse to attend to any ongoing care. However, one person, who has experienced recent weight loss, and who spends most of their time in bed, had not been referred to the dietitian or doctor for further advice. The registered manager agreed to do this straight away. Although this person needs help with moving position when in bed, staff do not record when they have last done this, and to what position. Again, they need to keep a record of this, so that every effort to promote healthy skin is made. Perhaps because they were not discussed in peoples initial assessment, there were still some areas of peoples lives that needed to be understood better, so that a full picture of their overall needs could be established. For instance, one care plan about the persons spirituality and end of life wishes, said that all of the persons requirements were with their solicitor. It is likely that staff will need to know and understand about these needs as a part of the persons every day care. However, staff are trying to get to know more about individuals, and are developing life histories as a starting point. Care staff also write daily entries about how people have spent their day. Some of these were very good, because they showed that the staff member knew the person well, and gave a good account of their day overall, not just focusing on the persons physical needs. Two people who live at the home made comments like The care is excellent in every way, The staff are nice - and there are enough of them. Staff knocked on doors before they entered peoples rooms, and put a sign on the door to warn others that personal care was being provided. This helps to protect peoples privacy. However, some comments were made that the communication between people and some staff could be better. One person living there described these staff as abrupt. The registered manager had already dealt with an issue where she had been made aware that the person concerned was not happy. Another comment was made that a persons dignity had not been upheld when a staff member had entered their room to see if they needed any personal care. The way this was offered did not uphold their Care Homes for Older People Page 14 of 31 Evidence: dignity, or their right to privacy. On the day of the site visit, a persons request for personal care was ignored by the member of staff they asked for help. This is in no way dignified, and the registered manager dealt with the matter straight away. On another occasion, a staff member stood behind a persons chair for some time without communicating with anyone in the room. This could have felt intimidating for the person concerned. It was also a missed opportunity for the people to enjoy some one to one conversation with the staff member concerned. The manager has recently attended training about dignity, and intended to hold a meeting with staff the day after the site visit to tell them about the dignity pledge that the home has signed up to. It is important that staff are instructed through both this training, and one to one supervision, about the importance of maintaining peoples dignity, and their responsibility in protecting this, so that incidents such as those witnessed and discussed do not happen in the future. Staff normally look after peoples medication on their behalf. The medication records were mainly up to date, and the storage temperature of both the room, and the medication fridge, were being satisfactorily maintained. Since the last key inspection, a senior member of staff now checks weekly to make sure that the stock balances are checked, and to make sure that staff are giving people their medication as prescribed. In one case, it was advised that the persons medication was reviewed, and they were not receiving it at the rate prescribed by their doctor. Some people do manage some of their topical creams which have been prescribed by their doctor. The staff need to make sure that a risk assessment is completed where this is the case, to check that these people are safe and happy to manage these properly, and that facilities are provided in their room so that they can be locked away safely. This was not the case on the day. the registered manager said she would address this straight away. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples social needs and choices are understood and efforts are made to meet them. Evidence: People have a range of advertised activities that they are invited to attend. However, many people spend the majority of their time in their bedroom. For instance, on the day of the site visit, only four people spent time in the communal areas, although others chose to go to the dining room for their meals. The activities person therefore has tried to look at more individual activities for those people who want them, such as hand and nails, hairdresser and attending to individual needs. Peoples care plans explained what these individual needs were. For instance, their care plan identified that one person likes to do a crossword each night. Their records showed that they were still doing this activity regularly. There were however some group activities for people to look forward to, such as a quiz, walks out into the garden, and bigger events such as a forthcoming barbecue and cream tea afternoon. The home has also produced a newsletter, although the last one on display referred to Winter 2008/2009. And to help meet peoples spiritual needs, there is a monthly religious service held at the home. Care Homes for Older People Page 16 of 31 Evidence: People can have their visitors when they want them. They can see them in their own rooms if they wish, so they can have some privacy. Staff explained that they try to give people choice in their daily lives. The cook explained that they try to make the mealtimes as flexible as possible to fit in with peoples choice of rising and retiring times. And the care staff said that they get enough time so they can flexible when providing people with their care. One person explained how they like to stay in their room. They said that staff respected this choice, and also about when they got up and when they went to bed. Since the last key inspection, people now get a better choice of menu. The cook said that people were taking good advantage of the choices. One of the cooks attends the residents and relatives meetings, so that they can hear first hand peoples views about the food, and where they would like to see changes made. The dining area was nicely set out, with menus on each table to remind people the choice of menu for the day. The kitchen is open twenty four hours a day so that staff can make people a snack should they become hungry between meals. Snack boxes have also been introduced. These contain crisps and other snacks for people to enjoy as they wish. The cook was aware of peoples special dietary needs, which, they said, the person in charge tells them about when the person is admitted. The cook also tries to visit people themselves in order to establish their likes and dislikes. They confirmed that they get sufficient budget in order to provide people with a nutritious diet. They bake regularly, and there was a supply of fresh fruit in the dining area for people to enjoy. People asked said that they liked the food. The mealtime was unrushed. Care Homes for Older People Page 17 of 31 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. Peoples complaints are responded to and acted upon, and staff know they have a duty to protect people from abuse. Evidence: The registered manager said she has reminded people since the last key inspection about how they can complain. The complaints procedure is now displayed on the back of their bedroom door, as well as in the main hallway. This means they can see easily what they should do if they want to make a complaint. One person said that they had raised a concern with the registered manager, and that this had been dealt with. The registered manager confirmed that they knew about this, although this complaint was not included in the complaints log. However, they could evidence in other ways how they had dealt with the situation. There have been two complaints made to the home in the last year. One of these was about personal care, and the other was about concerns about medication. The action taken by the registered manager appears to have resolved each of these issues. One comment was made that the registered manager has become more receptive to complaints. This is good, because it shows that she is listening to people and taking their concerns seriously. There have been no complaints made direct to the commission. Care Homes for Older People Page 18 of 31 Evidence: The home has an abuse policy which is correct, because it tells staff the right steps to take should they witness or be told that abuse has happened. Those staff spoken with were clear that they would pass on any concerns of this nature to the registered manager. However, not all were clear about the role of the local authority, who take the lead on such investigations, and to whom the registered manager has a duty to report to. they should be reminded of the role of the local authority, and the fact that they can pass on their concerns to them directly if for any reason they do not wish to go to a more senior member of the company. Staff have now received training about abuse awareness. This will make them more alert, and clear about what constitutes abuse. The all knew that if anyone was to make an allegation, they must not keep this information secret. Care Homes for Older People Page 19 of 31 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. Improvements made to the environment make it a more pleasant place for people to live. Evidence: The environment has been improved since the last key inspection. A visitor and staff commented that this had made a pleasant improvement for the people living there. Some of the communal areas, including the dining area, sitting room and hallway have been redecorated and re carpeted. The dining area has also been provided with new heating. In addition, the bathroom which was out of use at the last visit has now been provided with a new hoist. This means that people who live on this floor no longer have to go to another floor in order to have their bath. Action has been taken to protect people from the risk of falling down stairs into the office and laundry area, by fitting key pads to the doors, so that only authorised staff can now enter these areas. A key pad has also been fitted to the main entrance, so that only people who the staff know can get into the building. This will stop intruders from entering without staff knowledge. There is a pleasant garden area outside for people to enjoy in warmer weather. The gardens were nicely maintained, so were pleasant for people to look out onto. Care Homes for Older People Page 20 of 31 Evidence: Peoples rooms looked at were individual to them and contained personal items to make them feel more at home. One persons care plan said that they like to use the communal toilet during the night, because theirs is too cold. This should be put right so they do not have to leave their room during the night unnecessarily. The registered manager said she would look into this. The building is not purpose built. Some of the corridors are long, and quite steeply ramped, which will make it more difficult for people with limited mobility, and for staff who use equipment such as wheelchairs, to get around with ease. The registered manager said that she takes this into consideration when people are first admitted. This is essential, in order for them to retain as much independence as possible when moving around the home. The laundry area is located in the cellar. The laundress was satisfied that they had sufficient equipment. She explained that soiled articles which need to be washed separately are delivered separately by staff. One of the washers also has a sluice facility, and there was a supply of protective gloves and aprons. Supplies of alcohol gel are available at points throughout the home so staff can cleanse their hands in between tasks. All of these safeguards help to minimise the risk from cross infection. The registered manager has followed the advice of the community infection control nurse, who has visited the home, and has given guidance about better ways of storing dressings, which were previously kept in a toilet area. Care Homes for Older People Page 21 of 31 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. Staff at all levels get training to help them work in a caring and consistent way. Evidence: The staffing numbers at the home have decreased at night, because the number of people living there has reduced. However, the number of staff during the day remains the same. This is good practice, because many of the people living at the home are highly dependent. A visitor thought that staff response to people was better as a result. They had noticed that call bells took less time to answer than previously. On the day they were answered promptly. The registered manager said that the company now have their own assessors. As a result, the number of staff who are undertaking, or who have completed a National Vocational Qualification in care has increased, and there is a rolling programme in place which will encourage more staff to complete this award. This is good, because it means that people will be cared for by a higher proportion of staff who have received recent training about current good care practice, which they can use in their daily work. There have been no new care staff recruited in the last year. The files of two ancillary Care Homes for Older People Page 22 of 31 Evidence: staff were looked at. These records showed that sufficient information was collected about these staff before they were deployed to work at the home. One of these confirmed that they had completed an induction when they first started working there which meant that they did not have to undertake any tasks that they were unsure about. Training opportunities are provided for staff. Those spoken to had completed a range of compulsory training. Other opportunities are also offered, such as communication training and customer service. The training matrix showed that trained staff also have opportunities to update their skills. This included training about person centred care, diabetes, nutrition, palliative care and dignity training. Care Homes for Older People Page 23 of 31 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. People and their representatives are consulted about the home, and their views are taken into consideration about how it could run better. Evidence: The manager has held this post for some time. She is a registered nurse, also registered with the commission, and has completed a management course to underpin her skills and knowledge. People say they see plenty of her around the home. Staff say she runs the home well. One said The manager makes it easy for us. Another said I can go to her whenever I want. A third said she was very approachable. The company provides her with a programme of training to help her in her management role. The company sends out surveys to relatives to seek their views about how the home is running. Surveys are also sent out to people who live at the service, where it has been decided that they are able to comment. The registered manager said that last time about five people were given these. It is important that the presumption is not Care Homes for Older People Page 24 of 31 Evidence: made that people cannot complete these. However, the registered manager has found other ways of discussing the home with people living there. She recently held a meeting, where forthcoming social events and the menu were discussed. Visiting professionals are not surveyed. It would be good practice to do so, as their views about how the service is running are also important when deciding whether changes need to be made so that it is running in the best interests of those who live there. The results from the most recent surveys showed an increase in twenty percent satisfaction overall. The total quality score calculated by the company stood at eighty three percent. There were no negative comments made. One representative commented A great improvement following the refurbishment. Another said The home has a very homely atmosphere and the care our relative gets is given with great care and attention. The manager has yet to write to people with collective results of the survey, although this is planned. On the day, a visitor said that the home had improved in the last year. The area manager visits the home monthly to check that it is running smoothly. However, the registered manager said that they are available for her to contact should she ever need advice. The home will look after peoples personal allowance if they wish. There is nobody living there for whom the staff act as appointee. This role is managed by their family or advocate. A small float is kept at the home so people can have ready access to cash should they request it. However, the bulk of peoples money is held in a joint account which does not accrue interest. The administrator keeps good records of what has left peoples individual account, and what has been received. Since the last key inspection, the registered manager now asks before the weekend who would like some money, so they can have this when she and the administrator, who hold the keys for the safe, are not available. The records seen before the site visit identified that the home is kept maintained. Although the registered manager must make sure that the weekly in house fire alarm checks are carried out by someone else when the maintenance man, who normally completes this, is on leave, or not available. The Environmental Health Officer reported after their recent visit to the kitchen a Good standard noted at the time of the inspection. One recommendation made about the way information is filed has been addressed, so it is easier to find. Care Homes for Older People Page 25 of 31 Evidence: Staff receive a range of compulsory training which we were told is updated as required. Trained staff are qualified first aiders, and staff knew that they should go to them should an incident requiring immediate first aid attention occur. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 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 8 14 Professional advice must be sought for the individual identified who has experienced unexplained weight loss. This is so that any underlying cause can be ruled out, and appropriate advice and treatment needed to help maintain good nutrition is obtained. 30/06/2009 2 9 13 People who self medicate 10/06/2009 must have a completed risk assessment which is regularly reviewed, and they must be provided with lockable facilities for the safe storage of this medication. This is to check that it is safe for them to do so, and so that they have somewhere safe to store any medication kept by them. Care Homes for Older People Page 28 of 31 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 3 10 12 Peoples request for personal 10/06/2009 care must not be ignored, and must be provided in a sensitive way. This is so that their right to privacy, dignity and self respect is upheld. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 Wherever possible, people should be visited by staff, and have an assessment completed before they are admitted, so it is clear whether the home has the resources to meet these needs before offering the person a place there. Information passed on verbally by other community professionals should be written down and shared with other staff. This is so that staff can understand where people will need help and support, and begin to provide this as soon as the person arrives. 2 7 People and/or their families should be involved in the regular review of their care plans, so they get the opportunity to comment upon their personal needs and wishes, and how they would like their care to be delivered by staff. Peopes care plans should be completed to cover all areas of their health and welfare, so their needs are fully understood by the staff who care for them. 3 8 Clear record should be kept about how any individual, unable to move independently in bed, has been assisted to change position, and to what position they have been moved to, so that subsequent staff know the best way to encorage the person to lie so that they get good pressure relief. Care Homes for Older People Page 29 of 31 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 4 18 Staff should be reminded about the role of the local authority, as lead investigators, and to whom they can refer any concerns should they not wish to report direct to the company. The heating in the en suite discussed at the site visit should be restored to a suitable temperature for the person who occupies the room, so they are able to comfortably use it whenever they wish. Visiting professionals should be given surveys so they have the opportunity to comment upon how the home runs in the best interests of the people who live there. 5 19 6 33 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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