Care Home: Westwood Park

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What the care home does well The manager is also one of the directors of the company and is a qualified nurse. She is experienced and very committed to meeting the regulations and standards and improving the quality of life for people living at Westwood park. The home is a clean, warm and pleasant environment for people. Residents spoken with were very happy with their home and surveys confirmed that it was clean and fresh. One person wrote, `they keep the home very clean`. There is a refurbishment plan in place that will improve the dining experience and the facilities in the foyer. The home has plenty of space for people to walk around and different rooms for them to sit in. The gardens are well tended. The meals provided were home cooked and used fresh ingredients. People told us they had plenty to eat and drink. The home looked after peoples` finances appropriately and maintained individual records. What has improved since the last inspection? There have been lots of improvements noted since the last key unannounced inspection. The manager and staff team have worked very hard and the home was compliant with the Statutory Requirement Notices. Assessments and care planning has improved, which means that staff have more up to date information about residents needs. Risk assessments also have more detailed information. Recording of monitoring charts has improved, for example nutritional intake and pressure relief. There has been sustained improvements in the management of medication. People receive the medication as prescribed for them, checks are made to ensure this continues and recording is accurate. People are receiving more social stimulation and attention from staff. Staffing numbers increased in line with the numbers of residents in the home but this has been adjusted again due to vacancies. The manager monitors what is required and adjusts staff accordingly. Although residents said that the staff were busy, they were very positive about the care they received. The increase in social activities and occupations means that residents have more choices. The home has not received any complaints about care issues since the last inspection. One concern was raised but dealt with. Staff training needs have been audited so management is aware of what their training needs are and some courses have been booked. Staff told us they felt supported by the manager and formal supervision and observation of practice has improved. Recruitment is more robust and all checks are carried out prior to the start of employment. What the care home could do better: The care plans could be improved further to make them more personalised. Personal preferences have started to be included in some of the care plans but was not consistent throughout. The manager was aware of this and staff members have been asked to put more information in the plans. Staff do need to ensure that risk assessments are updated when needs change so that care plans can be adjusted to inform staff. Although some recording has improved there were still some areas that required attention, for example ensuring there is follow on for important issues in daily reports and care is needed when using specific terminology. There needs to be a photograph of each resident in the home. This helps when administering medication and provides information to relevant agencies should a resident leave the home unescorted. Although the menus met peoples` nutritional needs, some residents commented in surveys that they would like to see more variety in the menus. There are still some staff training needs to meet but the quality assurance manager is aware of this and plans are in place. The monitoring of the quality of the service provided has started and needs to continue with a wide range of surveys to people. The manager needs to apply for registration with the Care Quality Commission. Until this happens we are unable to test their fitness to be the registered manager. Key inspection report Care homes for older people Name: Address: Westwood Park 4 Langholm Close Beverley East Yorkshire HU17 7DH     The quality rating for this care home is:   one star adequate 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: Beverly Hill     Date: 0 5 0 3 2 0 1 0 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 31 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Westwood Park 4 Langholm Close Beverley East Yorkshire HU17 7DH 01482862170 01482888570 info.wp@lhc-group.co.uk www.lhc-group.co.uk Londesborough Health Care Limited care home 51 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Westwood Park is a privately owned care home that is registered to provide care and support for fifty-one older people, including those with dementia. The company own another care home in a nearby town. The home is close to local amenities such as shops, banks, cafes, public houses and transport facilities. Accommodation is provided in forty-seven single bedrooms and two shared bedrooms. There are a number of communal rooms available on both floors. All areas of the home are accessible to people via the provision of a passenger lift, a stair lift and ramps. The garden has been specially designed to meet the needs of the people living at the home and is attractive and easily accessible. There is a car park available for visitors and staff. Care Homes for Older People Page 4 of 31 Over 65 51 51 0 0 Brief description of the care home Fees paid are between £362.04 and £565 per week and there is an additional charge for hairdressing, private chiropody, toiletries and newspapers. Detailed information about fees can be obtained from the manager. Information is also available in the homes statement of purpose and service user guide. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that people that use this service experience adequate quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Unannounced Inspection on 27th October 2009. At the time we were concerned about the home and following the inspection issued three Statutory Requirement Notices and a warning letter to ensure that specific breaches in regulations were addressed. The home sent us an improvement plan within the required timescale. A Pharmacist Inspector Steve Baker completed a Random Inspection on 18th January 2010 and was very pleased with the progress the home had made regarding the management of medication. Care Homes for Older People Page 6 of 31 The site visit carried out for this inspection was to check on the progress made for the other requirements. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Westwood Park and to see what improvements had been made to their quality of life. We had discussions with the manager, who is not registered yet, the quality assurance manager, care staff members and a cook. Information was also obtained from surveys received from seven residents (some of which had been completed with help from their relatives), seven staff members and two relatives. Comments from the surveys and discussions have been used in the report. We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were met while they were living there. Also examined were, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. The providers had returned their annual quality assurance assessment (AQAA) on time. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Westwood Park, the staff team and management for their hospitality during the visit, and also thank the people who completed surveys and had discussions with us. 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 the 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. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? There have been lots of improvements noted since the last key unannounced inspection. The manager and staff team have worked very hard and the home was compliant with the Statutory Requirement Notices. Assessments and care planning has improved, which means that staff have more up to date information about residents needs. Risk assessments also have more detailed information. Recording of monitoring charts has improved, for example nutritional intake and pressure relief. There has been sustained improvements in the management of medication. People receive the medication as prescribed for them, checks are made to ensure this continues and recording is accurate. People are receiving more social stimulation and attention from staff. Staffing numbers increased in line with the numbers of residents in the home but this has been adjusted again due to vacancies. The manager monitors what is required and adjusts staff accordingly. Although residents said that the staff were busy, they were very positive about the care they received. The increase in social activities and occupations means that residents have more choices. The home has not received any complaints about care issues since the last inspection. One concern was raised but dealt with. Staff training needs have been audited so management is aware of what their training needs are and some courses have been booked. Staff told us they felt supported by the Care Homes for Older People Page 8 of 31 manager and formal supervision and observation of practice has improved. Recruitment is more robust and all checks are carried out prior to the start of employment. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed prior to admission, which means that the home has full and up to date information and can be clear about whether their needs can be met in the home. Evidence: We looked at four care files during the site visit, some of which were for people recently admitted to the home. We wanted to check the admission process to be sure the home had full information about people prior to their admission. There was clear evidence that the home obtained assessments of need and care plans completed by care management for people funded by the local authority. The home also completed an assessment, which was a tick box form with scope for comments about each section of need. In addition to the homes assessment staff also completed a, getting to know you document. This covered likes and dislikes, preferences and information about family and friends. Care Homes for Older People Page 11 of 31 Evidence: The information gathering and pre-admission assessment process ensured that staff had full and up to date information about people prior to admission. The manager formally writes to potential residents or their representatives informing them of the outcome of the assessment and that their needs can be met in the home. The home does not provide intermediate care so standard 6 does not apply. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were improvements noted in the way the home planned and delivered care. A more detailed approach to recording, personalising care plans and updating risk assessments will ensure staff have full and up to date information about the way people prefer to be cared for. Evidence: We examined four care plans during the visit and noted improvements since the last key inspection. The care plans reflected the needs identified at the assessment stage and contained guidance for staff on how to support peoples needs. We noted that the care plans which specified health care needs were detailed and reflected the managers nursing skills and knowledge. To improve, each care plan could be more personalised especially regarding personal hygiene and dressing. For example, how people preferred to be shaved, how oral hygiene was carried out and what toiletries they preferred to use. One care plan for general health included nutrition but there was no mention of the need for food supplements. Some care plans did state some preferences for care but this was not consistent throughout. Care Homes for Older People Page 13 of 31 Evidence: Care plans were evaluated on a monthly basis and some of these were quite detailed, for example, regarding one to one support required for a resident. There was evidence of care plan reviews held with the resident, their family and the local authority present. Assessments and care plans did not always have the full date of completion, which may make it difficult when planning care and monitoring changes. The home completed risk assessments for particular areas of risk, such as the management of diabetes, moving and handling, falls, nutrition and other specific areas. These gave staff guidance on how to minimise risk. Again, full dates were missing from the documents. An area for improvement would be the consistent updating of risk assessments when incidents occur. For example, one resident was recorded as having a low risk of falls in November 09, (no full date was recorded), but in February 2010 they were found on the fall and had sustained a skin tear. The accident book stated the person was dizzy and they did see their GP. However, the risk assessment should have been updated, as there was an increased risk of falls and their care plan would need to be adjusted. The same person had epilepsy but there was no risk assessment to manage any risks associated with this condition. There was clear evidence that people had access to health care professionals for advice and treatment. Records in one of the care files seen showed that a dietician had been involved for advice with nutritional needs and a district nurse had visited to dress a skin tear. A physiotherapist and continence adviser had visited another resident. All residents were registered with a GP and some continued to see consultants at out patient appointments. The recording of monitoring charts for nutritional intake and positional charts for pressure relief had improved. The manager advised that each new resident had their nutritional intake monitored for the first two weeks so staff could be sure there were no issues. Some staff were more detailed and consistent with the general recording of care provided than others. For example, a staff member recorded that night staff had covered a small graze with a dressing and stated they would contact the district nurse. However, there was no record in the following days that this had taken place until an entry six days later when a nurse visited and the record stated, checked legs - apply cream as normal. Also care is needed with terminology when recording, for example, one staff member recorded that a resident had a, nappy rash, which is an inappropriate term for the skin condition. Despite the recording deficits, people did receive treatment from health professionals. Care Homes for Older People Page 14 of 31 Evidence: Care staff were aware of peoples needs and residents spoken with were happy with their care. They confirmed care was provided in ways that respected their privacy and dignity, oh yes they always knock on doors before entering, and that they saw the chiropodist and optician when required. Surveys received from residents and relatives confirmed they were happy with the care provided. Comments from relatives were, respect privacy and dignity at all times, good care and attention at all times and they are very caring and proactive regarding the health of residents and welcome advice and support from other agencies. All seven surveys from residents confirmed they received the care and support, and medical attention they required, either, always or usually. The management of medication had been inspected separately by a pharmacist inspector on 18th January 2010. They found that medication administration records were accurate and well maintained and the home supported people who wished to look after and take their own medicines themselves. Prescriptions were checked for completeness and any changes each month before the medicines are delivered. Regular checks were made of all medicines management processes. Some recommendations were made regarding the recording of storage temperatures and more detailed recording of skin preparations. These have been met. A recommendation regarding the need for a photograph of each resident on the medication administration record had not been fully met yet and will remain on this report. 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. There have been improvements in the amount of social stimulation and occupational activity provided, which has enhanced the quality of life for people living in the home. The meals provided meets the nutritional needs of residents, although some people would prefer more variety. Evidence: There have been improvements in the provision of social stimulation, which was evidenced in documentation and discussions with residents and staff. There was a weekly activity programme that included movement to music twice a week, facilitated by a particular staff member, ball and bean-bag games, crosswords, baking and my life stories. Entertainers visited the home monthly, religious services were held, the mobile library visited every few months to exchange books and staff supported residents with a range of activities such as nail care, a large connect 4 game, listening to music and watching television, reading newspapers with discussions about items, dominoes and cards and completing jigsaws. Records were maintained when people participated so staff could see at a glance, if they needed to focus their attention on particular residents for one to one activities. Care Homes for Older People Page 16 of 31 Evidence: Staff commented that activities had improved, the home needs to entertain the residents more, however, this has now changed and the new time table is working out very well and we have daily activities for residents, regular entertainment and occupations involving residents in small work. Residents spoken with confirmed they participated in activities, I do crosswords, exercises to music and see the hairdresser - I also speak to my daughter on the phone, Im very happy here - we have jigsaws, sing-sings, we chat together and do exercises to music and another resident told us they go out to bingo once a week to a local community centre to catch up with friends. Staff spoken with were clear about how they promoted choice and decision making with residents, there are set meal times but people can eat at other times if they want, communication is the key - we need to read care plans and know what residents want and need and people are encouraged to do things. Residents said they had the choice of staying in their own room if they wanted to and there were no set times about rising and retiring. One resident said, I go to bed about 9ish and get up at 7ish but its not enforced. Visitors were welcomed at any time. People spoken with told us they enjoyed the meals, it was very nice today but Im not a big eater, the meals are nice, it was fish and chips today. We have things like pork pie, salad and sausages for tea, the meals are quite good - you get enough to eat and plenty to drink, Im putting on weight - the food is very nice and the meals are good. However, when asked what the home could do to improve, two of the seven surveys from residents stated, better food and one stated, the meals are boring, we need more variety. We discussed the menus with the cook. These rotated over a two week period, which could account for some residents wishing for more variety. In view of the comments in three of the surveys, the residents could be consulted again about the menus and any suggestions incorporated as standard or as an alternative to the main meal. The cook obtains information about residents likes and dislikes, and special dietary needs on a form from staff. She also visits the residents to check out the information and introduce herself. Changes to the menus are made on special theme days such as St Davids day and Mothers day and there was evidence that some residents were having alternatives to the main choice of fish and chips on the day of the site visit. The cook has a national vocational qualification in catering at level 3 and has completed a two day seminar in nutrition that covered the preparation of food for people with swallowing difficulties. She also has an intermediate food hygiene certificate. Care Homes for Older People Page 17 of 31 Evidence: The dining rooms were set out with individual tables and chairs; one dining room on each floor. There was space for approximately sixteen residents in each dining room. Staff stated some residents preferred to have their meals in their own bedrooms. Care Homes for Older People Page 18 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. Staff and residents are much more aware of the complaints process and the manager has created an environment were people feel able to complain. People are protected from abuse by staff training and adherance to policies and procedures. Evidence: The home has a complaints policy and procedure on display and residents have been made aware of how to complain. In discussions staff were clear about how they deal with any concerns or complaints raised with them, we try to resolve it and tell the manager, there are forms in the news room behind reception for people to complete. Residents spoken with stated, you can tell any of the staff, Ive never had any complaints, I would see Meg (manager), none - its lovely here and I would tell someone - I have no reason to complain. We received seven surveys from people that lived in the home and six stated they knew how to make a formal complaint. All seven stated there was always someone available to speak with informally. The home used the multi-agency policy and procedure for safeguarding vulnerable adults from abuse. The manager had completed safeguarding training with the local authority regarding their role in referral and investigation. Most care staff had Care Homes for Older People Page 19 of 31 Evidence: completed safeguarding training and additional courses were planned. The homes induction for new staff covers a section on abuse and neglect. There have been improvements in the home staff recruitment processes so that all checks are completed prior to the start of employment. This helps to ensure only suitable people work with vulnerable adults. Since the last inspection there has been two safeguarding of adults referrals. One related to an incident between residents and resulted in the local authority providing more support for one of them. The second incident was investigated and was unfounded. Care Homes for Older People Page 20 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. The home provides a clean, warm and safe environment for people. Evidence: The provider has produced a, refurbishment and development plan. In the last year lounge windows have been replaced and the timber cladding to the exterior of the building replaced. Most of the communal areas have been redecorated and recarpeted and bedrooms are completed on a rolling programme or when they become vacant. An improved lighting system is being fitted in the car park and external painting has started. The provider told us of plans due for completion over the next twelve to fourteen weeks. These included improving the dining experience for residents by having two smaller dining rooms and developing a central hub area in the large foyer with a coffee bar for visitors and residents to sit together, and a unisex hair salon. A dedicated activities area with internet access is also planned. Sensory areas in the garden and wheelchair access to flower and vegetable beds are planned to encourage participation. A room will be dedicated to religious services and other group activities, a staff training room is to be organised and one of the lounges can be booked by relatives for small family parties. There are also long term plans to reduce the amount of beds to facilitate en-suite bedrooms. Care Homes for Older People Page 21 of 31 Evidence: The home was warm, clean and tidy with no malodours. Domestic staff obviously work hard to maintain standards. Surveys received from people confirmed the home remained clean and fresh. When asked what the home does well, one person stated, keep the home very clean. Communal areas consist of four lounges, two dining rooms and a conservatory plus a seating area in the foyer. There is also a patio area and garden with furniture for use in warmer weather. The home has one shower room and an assisted bathroom with a shower area on the ground floor, and two assisted bathrooms on the upper floor. The bathroom with the shower area is due for refurbishment and is unused at present. There are sufficient toilets throughout the home and seven of the bedrooms have en-suite facilities. Bedrooms seen were personalised to varying degrees dependent on the taste and style of the occupant. Bedroom doors had privacy locks and one of the rooms seen had specialised non-slip flooring. The home is nicely decorated and residents spoken with were happy with their home and told us they could bring in items to personalise their bedrooms, my bedroom is very nice, the home is spotless, I really like it - I love my room and its a very nice home - I like the way it is decorated. The home has a laundry room with commercial washing and drying equipment. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment, induction and training systems are much more organised and a training programme is in place to ensure staff gain the skills and knowledge they require to support people. Evidence: Following the last key unannounced inspection in October 2010 the manager increased the staffing numbers to ensure there was sufficient staff on duty throughout the day. Since then the numbers of residents has decreased and the staffing numbers readjusted to take account of this. The manager confirmed that staffing hours can be increased again as required. Staff rotas indicated there were four carers, sometimes five, and a senior carer on duty during the day and three carers at night. Staff spoken with confirmed this and also that an extra staff member covered an 8am to 5pm shift when there were more residents in the home. The manager advised that they have started to check staffing levels, using the care staffing forum guidance, every two weeks to ensure they have enough staff for the dependency needs of residents. The manager is supernumerary and is assisted by a senior staff member and a designated quality assurance/training manager. There are sufficient ancillary staff for catering and domestic tasks. There were some positive comments about staff from residents and relatives in Care Homes for Older People Page 23 of 31 Evidence: discussions and surveys. These were, the staff are cheerful and helpful, good interrelationship bewteen staff and residents, the office door is always open and I am always made to feel welcome, they work hard maintaining the excellent service they provide and the staff look after us well. One relative also told us that management and staff were very supportive to them during a recent bereavement. Since the last inspection there has been a new induction and staff training programme produced. Individual staff files have been developed and training needs identified. A discussion with the training manager confirmed that plans for mandatory and service specific training were in place. Seventeen staff were due to start a distance learning course on dementia care awareness and courses on medication management and diabetes have been booked. Health professionals have been approached to speak to staff about catheter care, pressure area management and continence promotion, and ten staff have completed both equality and diversity and mental capacity and deprivation of liberty safeguards training. There were gaps noted in some of the mandatory training such as first aid, basic food hygiene and health and safety but the home is making good progress. In surveys staff confirmed they received training suitable for their role. Some staff commented that they would like to have more training related to the health conditions of the residents. As mentioned above some areas are to be addressed, however, the training manager could discuss this with staff at the next team meeting. Nine out of twenty care staff have completed national vocational qualification in care at levels 2 or 3. This equates to 45 and is a good achievement. When those staff members currently progressing through the course complete it, the home will have exceeded the 50 target. Staff recruitment has improved. Application forms are completed, gaps in employment checked and interviews undertaken. Staff members are employed only after references and criminal record bureau checks are returned. Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been improvements in the way the home is managed, which has increased the quality of life for residents and provided guidance and leadership to staff. We have been unable to test the fitness of the manager as they have not progressed with registration with the Care Quality Commission. Evidence: There have been noticeable improvements in the way the home is managed. One of the directors of the company has been managing the home for the last nine months. New documentation, whole ways of working and management systems have been changed, which has improved the quality of life for people living in the home, and provided the staff team with guidance and leadership. The manager has not applied for registration with the Care Quality Commission yet but the process of gathering information for her application has begun. We cannot test her fitness to be the registered manager until the registration process is completed. Care Homes for Older People Page 25 of 31 Evidence: The manager is a qualified registered nurse and has a clear sense of direction for the home. Staff spoken with said she was, firm but fair and friendly and approachable. Another person stated the management support was, excellent. Staff told us that formal supervision had increased and was more frequent at the moment, as there had been lots of changes and information to pass on. In surveys five staff stated they received, regular support and two stated this was, often. Comments were, staff are always updated in how to carry out clinical observations on each individual, the home has improved a lot - better communication and staff management, mentoring staff well and there have been great improvements since the last inspection in general. We examined formal supervision records which were a mixture of observations of practice, for example how staff administered medication or supported a resident using moving and handling equipment, and one to one discussions. The records showed that staff were given information about particular topics such as care plans, the uniform policy, health and safety and reminded about personal accountability. To improve, staff supervision could be more of a two-way process where staff can discuss any concerns about their key worker role, residents care, training and development needs and any issues impacting on their performance. Staff are on track to receive a minimum of six formal supervision sessions each year. Staff completed a selfassessment score sheet for an appraisal, which the manager then added their own score to, and a discussion took place about areas the staff are doing well in and areas for improvement. Staff stated that they felt able to make suggestions and that they would be listened to and changes made. Since the last inspection there has been three staff and two residents meetings, at which people were able to discuss any issues and management shared information about changes. Staff, residents and relatives told us the managers door was always open and they often saw her out and about the home. The quality assurance system has just started and some questionnaires have been sent out with four returns so far. There are plans to send out other questionnaires to range of people such as relatives, visiting professionals and staff. The quality assurance manager stated action plans will be developed to address any issues identified in the surveys. The home also completed a range of audits such as, accidents in the home, staff supervision, residents reviews, medication, the environment, kitchen stores and equipment, staff practices and documentation. As the quality assurance system has just started it will assessed at the next key inspection. How the home managed the residents finances was not assessed at this visit, Care Homes for Older People Page 26 of 31 Evidence: however, the system remains the same and we have not had any concerns raised with us. The home can hold money for safekeeping on behalf of residents for the purchase of toiletries, hairdressing, chiropody or newspapers. Records were maintained for each person and receipts kept for purchases. The home is a safer place to live in, as it is being managed much more effectively. We are always kept informed about incidents affecting the wellbeing of residents. Equipment is serviced and well maintained, fire alarm checks and drills are completed and there is a risk management system in place. There is some outstanding mandatory training to complete as mentioned in the section on staffing. Care Homes for Older People Page 27 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 28 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 13 Risk assessments must be kept under review and updated when needs change. This will help when planning responses to risk and the care required to support people. 16/04/2010 2 30 18 Gaps in the training records for mandatory training such as first aid, health and safety and basic food hygiene must be completed by all staff. This will ensure staff skills are assured in these areas and they understand how to act in emergency situations. 30/06/2010 3 33 24 The quality assurance system must be fully implemented. This will ensure that people are consulted about the way services are provided. 30/06/2010 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 1 7 The date assessments are completed and care plans formulated should be clear on each document. This will help when auditing care and updating documentation when significant changes occur. Care plans should be personalised in a more consistent way. This will provide staff with full and accurate information about the way people prefer to be cared for. Identification photographs and personal information should be permanently fixed to each MAR chart divider. In light of some comments about the variety of meals provided, catering staff should speak to residents to seek out further views, so suggestions can be accommodated. The home should continue to aim for 50 of care staff to gain a national vocational qualification in care at level 2 or 3. Further training courses relating to the health needs of current residents should be investigated and arranged for staff. This will give them a broader knowledge of how to support people with a range of needs. The manager should apply for registration with the Care Quality Commission so her fitness to be the registered manager can be tested. 2 7 3 4 9 15 5 28 6 30 7 31 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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