Care Home: Willoughby House

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What the care home does well This home has demonstrated that it has made numerous developments since the last key inspection In July 2009, however, it needs to continue to develop and improve services for people. People who lived at the home had a needs assessment and a detailed care plan file. This helped to ensure their needs were identified and ensures the staff knew how to care and support people in a consistent manner. We asked three people who lived at the home if they felt they were treated with respect and dignity and whether their right to privacy was upheld. This is what they told us, "Oh the staff are polite, they knock on my door before they come in to my room". "The girls are very good to me" and "Staff treat me with dignity and call me by my first name and I like that". We observed that people were supported to maintain contact with their family and friends as they wish. A relative told us they were made to feel welcome by the staff and they could visit at any time. The people who lived at the home confirmed their relatives can and do visit them regularly. People told us and we observed that that they receive a wholesome and appealing diet, in pleasing surroundings at times convenient to them. One person told us, "The food is good", "We always get a choice of our main meal". Another person told us, "The food is ok, but I would like to have an option of a cooked breakfast". This request was fed back to the manager who advised they would ensure this was provided. The menus checked were varied and offered two or more choices at every meal. Snacks and drinks were available at all other times for people. Overall, people who lived in the home were protected by the recruitment and selection policy and procedures in place. People were in safe hands as the staff had been trained in how to keep people safe from harm. People lived in a home which was run and managed by an experienced and trained manager, who has made vast improvement in the service since they joined in July 2009. What has improved since the last inspection? We checked all of the previous requirements made at our last inspection and found that all of them had been complied with. The care plan system had been markedly improved. The care plans checked were detailed and had been regularly reviewed to ensure they met people`s individual needs. Risk assessments were also in place to help protect people from harm. These had also been reviewed on a regular monthly basis. Staff interviewed were aware of the contents of people`s care plans and were knowledgeable about each person`s individual needs. This helped to protect people`s welfare. We checked to see if people and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. This is what we found; One person told us, "The manager is approachable I would feel confident to take any concerns to him". Another person said, "Yes, I know how to make a complaint, I`d just go to the manager". Some relatives told us, "I`ve got no complaints with the home it is fine". The manager`s door is always open". We checked to see whether people were protected by the home`s safeguarding procedures and practices and found that all staff had completed training in this area in September 2009. The staff interviewed were knowledgeable about the procedures and this helps to safeguard people from harm. Staff training records were checked and this showed that the staff team were up to date with all mandatory and some generic and specialist training. This demonstrated a commitment to staff development. People`s financial affairs were being managed appropriately and the manager informed us that a new robust system was in place to protect people from financial abuse. The manager of the service had kept us informed of all significant events at the service, they have worked well with us and this helps to protect people`s welfare. These improvements demonstrated that the manager and the providers have taken steps to improve the services they offer to people. What the care home could do better: Some people said they were satisfied with the activities on offer, other people said they wanted more organised activities and the manager has agreed to look at the range of activities available to people. We took a partial tour of the building with the manager to see whether people lived in a clean, safe and well maintained environment. Overall, the home was clean and tidy and there were no malodours. However, many areas of the home needed to be refurbished. The owners were aware of this and had future plans in place to upgrade the environment. This needs to be done as a priority to ensure people can live in pleasant, homely surroundings. Each person had their own bedroom, but none of the rooms have en suite facilities. People who lived at the home told us, "I like it here, the home is clean, my room is fine". Another person said, "My bedroom is fine, the lights are a bit dim though". This was brought to the manager`s attention to address. A relative told us, "The home is clean and tidy". In relation to staff recruitment practices we found that all of the information required by the regulations to keep people safe was available for inspection. However, on two of the three staff files checked there were no application forms. The manager said these had been misplaced and would action this to ensure staff work histories can be checked to make sure people were supported and protected approriately. For the majority of the time we found that there were adequate numbers of staff on duty to ensure that people`s assessed needs could be met. However, there was a period of time over the tea time, when only two carers were on duty and one of these staff was taken away from directly supporting people to serve the tea time meal. This was discussed with the manager and the owner of the service and an immediate plan was put in place to ensure that for this period of time managers would support the staff to ensure people`s assessed needs were adequately met. A requirement has been made for the registerd person to ensure people`s assessed needs can be met at all times by adequate numbers of staff. This will protect people`s safety. Key inspection report Care homes for older people Name: Address: Willoughby House St Johns Road Cudworth Barnsley South Yorkshire S72 8DE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Shelagh Murphy     Date: 1 7 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Willoughby House St Johns Road Cudworth Barnsley South Yorkshire S72 8DE 01226717152 F/P01226717152 wendy.lovely.willoughby.house@googlemail.co m Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Flagswan Two Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 40 Date of last inspection Brief description of the care home Willoughby House was formerly a vicarage that was adapted and extended to provide accommodation for up to forty service users. The property is in its own grounds and car parking is available. Accommodation is on two levels serviced by a passenger lift. It has 20 single bedrooms and 10 double bedrooms. The home is situated off the main Barnsley to Pontefract road in the village of Cudworth. It is within walking distance of all shops and local amenities in Cudworth. Barnsley town centre is approximately four miles away. Details of the homes current fees, service users guides and statement of Care Homes for Older People Page 4 of 31 Over 65 40 0 Brief description of the care home purpose can be requested from the manager of the service. 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: Shelagh Murphy carried out this unannounced visit to the service over one day and the total time spent on site was 6.5 hours. In the report we make reference to `us and `we. When we do this we are referring to the inspector and the Care Quality Commission. We used a variety of information as well as our findings from the visit to assess the quality of service offered to people who live at this home. Some time was spent with the people who use the service. We spoke to three people who live at the home to gain their views of the service. We took part in and observed a meal being served to people. It gave us some insight into how staff interacted with people, how people are supported by the staff and also Care Homes for Older People Page 6 of 31 an indication of peoples well being. Three staff attended interviews with us and we spoke to two relatives to ensure we had a range of views about the service. Comments and feedback from these stakeholders have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check some of the homes policies and procedures. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection in July 2009. The progress made has been reported on under the relevant standard in this report. 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. The charges for the service were £357.77 per week. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? We checked all of the previous requirements made at our last inspection and found that all of them had been complied with. The care plan system had been markedly improved. The care plans checked were detailed and had been regularly reviewed to ensure they met peoples individual needs. Risk assessments were also in place to help protect people from harm. These had also been reviewed on a regular monthly basis. Staff interviewed were aware of the Care Homes for Older People Page 8 of 31 contents of peoples care plans and were knowledgeable about each persons individual needs. This helped to protect peoples welfare. We checked to see if people and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. This is what we found; One person told us, The manager is approachable I would feel confident to take any concerns to him. Another person said, Yes, I know how to make a complaint, Id just go to the manager. Some relatives told us, Ive got no complaints with the home it is fine. The managers door is always open. We checked to see whether people were protected by the homes safeguarding procedures and practices and found that all staff had completed training in this area in September 2009. The staff interviewed were knowledgeable about the procedures and this helps to safeguard people from harm. Staff training records were checked and this showed that the staff team were up to date with all mandatory and some generic and specialist training. This demonstrated a commitment to staff development. Peoples financial affairs were being managed appropriately and the manager informed us that a new robust system was in place to protect people from financial abuse. The manager of the service had kept us informed of all significant events at the service, they have worked well with us and this helps to protect peoples welfare. These improvements demonstrated that the manager and the providers have taken steps to improve the services they offer to people. What they could do better: Some people said they were satisfied with the activities on offer, other people said they wanted more organised activities and the manager has agreed to look at the range of activities available to people. We took a partial tour of the building with the manager to see whether people lived in a clean, safe and well maintained environment. Overall, the home was clean and tidy and there were no malodours. However, many areas of the home needed to be refurbished. The owners were aware of this and had future plans in place to upgrade the environment. This needs to be done as a priority to ensure people can live in pleasant, homely surroundings. Each person had their own bedroom, but none of the rooms have en suite facilities. People who lived at the home told us, I like it here, the home is clean, my room is fine. Another person said, My bedroom is fine, the lights are a bit dim though. This was brought to the managers attention to address. Care Homes for Older People Page 9 of 31 A relative told us, The home is clean and tidy. In relation to staff recruitment practices we found that all of the information required by the regulations to keep people safe was available for inspection. However, on two of the three staff files checked there were no application forms. The manager said these had been misplaced and would action this to ensure staff work histories can be checked to make sure people were supported and protected approriately. For the majority of the time we found that there were adequate numbers of staff on duty to ensure that peoples assessed needs could be met. However, there was a period of time over the tea time, when only two carers were on duty and one of these staff was taken away from directly supporting people to serve the tea time meal. This was discussed with the manager and the owner of the service and an immediate plan was put in place to ensure that for this period of time managers would support the staff to ensure peoples assessed needs were adequately met. A requirement has been made for the registerd person to ensure peoples assessed needs can be met at all times by adequate numbers of staff. This will protect peoples safety. 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 10 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 11 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. People who use the service had their needs assessed, to try to ensure that the staff can meet their needs before they are admitted to the service. Evidence: The manager showed us the new needs assessments format, which, had recently been introduced to the service. This was detailed to enable a more thorough assessment of peoples full range of needs. We checked three peoples needs assessments. All of them had been completed by managers at the service. The needs assessments were all appropriately completed, to ensure the service could assess whether peoples needs could be met at the home. The registered manager confirmed that this service does not offer intermediate care. 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. People had individual care plans, which contained enough information to ensure staff knew how to meet their individual needs. People were protected by the homes medication policies, procedures and practices. We observed and people told us that they were treated with dignity and respect by the staff. Evidence: The staff told us and we saw evidence, that each person had an in depth care file, incorporating information on admission, assessment, health and care plans and reviews. The care plans checked showed an in depth knowledge of peoples histories, likes and dislikes and preferences in each individual plan. We checked three peoples care plans. We found that each persons health, personal and social care needs were clearly set out in a care plan folder. Since the last inspection it was clear that care plans had improved greatly. Staff told us that a new system of care planning and recording peoples health and care needs had recently been introduced and after discussions with them it was clear they were knowledgeable about the systems in place. The individual plans checked were all detailed and there Care Homes for Older People Page 13 of 31 Evidence: was evidence that all of care plan summaries and monthly reviews had been carried out on a regular monthly basis since September 2009. We checked to see if peoples health care needs were fully met. The care plans we checked showed evidence that people had the opportunity to see the G.P as required. There was also evidence to demonstrate that they had support from other health specialists including community health teams such as district nurses, opticians, chiropodists, dentists, social workers and other specialist geriatric health support services. This helped support peoples diverse health needs. We checked to see whether people had risk assessments in place to protect their health and welfare. These were in place on each of the three care plans checked. The staff told us and we saw evidence that they update risk assessments on a monthly basis to ensure they remained relevant and appropriate. This helped to protect people from harm. We checked to see whether people, where appropriate, were responsible for their own medication, and were protected by the homes policies and procedures for dealing with medicines. The staff told us that currently some of the people who lived at the home were able to manage their own medication. We also saw evidence of risk assessments and consent sheets signed by people for this and then we spoke to a person who managed their own tablets. They were quite happy with the arrangement and had been given a locked facility in their room in which to store the medication appropriately. This practice supported people to maintain their independence. Other people needed staff support to administer their medication to them. Medication was stored in a locked room, in a locked cabinet. The staff responsible for administering medication told us they had completed the relevant training for this. We checked three peoples medication sheets. One MAR sheet had been hand written by staff and some sections had not been fully completed. For example, allergies had not been filled in, even though we found a record in their care plan that this person was allergic to some medications. This was pointed out to the manager immediately. Who then took action to address this before the completion of the inspection. The other MAR sheets checked were completed correctly. The staff had recorded when people had been given medication and there was a system in place to return and reorder medication to ensure people always had a supply to meet their needs. The manager told us that the controlled drugs were stored appropriately and these drugs were recorded in the controlled drugs book and that entries had been signed for by two staff signatures. This helps to protect peoples welfare. Care Homes for Older People Page 14 of 31 Evidence: We observed staff interactions with people and at all times saw that people were treated with positive regard. Staff were professional, yet informal and friendly with people who used the service. People also told us they were treated well by staff. Their comments included, We always receive the care we need and They really look after me. We asked two people who live at the home if they felt they were treated with respect, dignity and whether their right to privacy is upheld. This is what they told us, Oh, the staff are polite, they knock on my door before they come in to my room. The girls are very good to me and Staff treat me with dignity and call me by my first name and I like that. This helped to protect peoples dignity and privacy. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people had opportunities to meet their social and cultural needs, however, more activities need to be organised to ensure other peoples recreational needs can be met. People received wholesome and appealing diets in surroundings, which met their needs. Evidence: Overall, we found that the lifestyle experienced in the home matched peoples expectations and preferences, and satisfied their social, cultural and religious needs. However, although some people told us they were not interested in taking part in activities within the home other people said they wanted more regular organised activities. People who lived at the home told us, I like to do the music and movement with the girl who comes in, but its only every fortnight. I think the activities are fine. We have got a weekly activities sheet, but its not up to much, Bingo and knitting are the main activities. Care Homes for Older People Page 16 of 31 Evidence: Another person said, I would like more entertainers to visit here like they used to. We observed the activities on offer on the day of the inspection, one student working at the home was colouring in a childs picture with one person. This was discussed with the manager as it was not age appropriate materials which were being used. And this did not protect the persons dignity. We checked the weekly activities rota, it was dated week commencing 16 November 2009. It had one activity each morning and afternoon. Activities included, Bingo, Games, Hairdresser, Videos. We discussed this with the manager and advised that the present system was not adequately meeting some peoples needs and that this needed to be reorganised with input from people who lived at the home and who wanted to take part. This would better support peoples recreational opportunities. The manager told us and staff and one person who lived at the home confirmed that local church representatives and a minister came in to the home on a regular basis to visit individuals and once a month conducts a religious service for people. This helped to support peoples spiritual needs and provided companionship. We observed that people were supported to maintain contact with their family and friends as they wish. A relative told us they were made to feel welcome by the staff, they could visit at any time. Two people who lived at the home confirmed their relatives can and do visit them on a regular basis. One couple told us their relatives called in every morning. This helped people to maintain important relationships. We checked to see if people were supported to exercise choice and control over their lives. We observed people to be offered everyday choices, such as choice of meals and drinks, where people wanted to go in the home and where they wished to see visitors. People told us they made everyday decisions about what they did during the day, outings they had and their rising and retiring times. This supported peoples independence. People told us and we observed that that they received a wholesome and appealing diet, in pleasing surroundings at times convenient to them. One person told us, The food is good, We always get a choice of our main meals. Another person told us, The food is ok, but I would like to have an option of a cooked breakfast. This request was fed back to the manager who advised they would ensure this was provided. We checked the last four weeks menus. They were varied and offered two or more Care Homes for Older People Page 17 of 31 Evidence: choices at every meal. Snacks and drinks were available at all other times for people. One concern noted was that the hot water boiler in the kitchen was broken and therefore, staff had been making hot drinks for people using domestic sized kettles. Staff told us this was not ideal and could be time consuming when trying to prepare drinks rounds for 20 people. This was feedback to the manager to address as a priority, who informed us that a new hot water boiler had been ordered. We observed lunchtime in the home, it was well organised. There were two staff supporting people to eat and drink. The meal time was relaxed. Staff were seen to prompt and coax some people to eat. This helped to ensure people received the support they needed. 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. People were able to make complaints and the recent actions taken by the management at the home to train and support staff should ensure peoples welfare and safety is better protected. Evidence: We checked to see if people and their relatives and friends were confident that their complaints would be listened to, taken seriously and acted upon. This is what we found, One person told us, The manager is approachable I would feel confident to take any concerns to him. Another person said, Yes, I know how to make a complaint, Id just go to the manager. Some relatives told us, Weve got no complaints with the home it is fine. The managers door is always open. Weve seen the complaints procedure on the noticeboard. Staff told us that the complaints procedure had been discussed at recent staff meetings and in supervision. We also saw records to evidence this. The staff we spoke to understood the procedures they should follow. The complaints procedure was seen on the notice board in the entrance hall corridor. We asked to check the complaints book held at the home and no complaints or concerns had been made since the last Care Homes for Older People Page 19 of 31 Evidence: inspection in July 2009. It was clear to us from speaking to people, a relative and the staff that the home promoted an atmosphere of open and honest communication and encouraged family and friends to make them aware of any concerns or suggestions they may have as soon as they arise. This will help to protect peoples rights. The manager told us, We also provide family and friends with a copy of the complaints procedure, which is also on display in the reception area. This was good practice as it protected peoples rights and fostered good communication between all interested parties. We checked to see how the people who lived in the home were protected from abuse. We saw a copy of the South Yorkshire area Adult Safeguarding procedures in the managers office, which, staff told us they had access to. From the staff training records we could see that all of the staff had completed adult safeguarding training in September 2009. From interviews with two staff we know that they understood their responsibilities and the procedures to follow should any allegations of abuse be disclosed to them. This helped to safeguard people. There had been two safeguarding investigations at the home over the last year. From these investigations several overarching strategy meetings have been undertaken, chaired by Barnsley Metropolitan Borough Council (BMBC) social services representative, in order to monitor improvements in the home to ensure peoples safety. A further strategy meeting will be held on 25th November 2009. Findings from this inspection will be fedback into this meeting. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lived in a warm and clean home, but many areas of the home need refurbishing to ensure people live in a pleasant environment. To ensure peoples safety some remedial maintenance was needed. Evidence: We took a partial tour of the building with the manager to identify whether people lived in a safe and well-maintained environment. This is what we found. Overall, the domestic staff in the home, were managing to ensure the home was clean and tidy and there were no unpleasant odours. However, the home was in need of refurbishment in many areas. The decor was tired and in most areas the decor was stained or chipped. For example the ground floor hallway decoration was stained, paint was chipped from each doorframe and the floor was uneven in areas, the floor also creaked in many areas. The manager told us that he and the owner were currently working on a programme of refurbishment and improvements throughout the home. This refurbishment needs to progress as soon as possible to ensure that people live in homely and pleasant surroundings. People who lived at the home told us, I like it here, the home is clean, my room is fine. Another person said, My bedroom is fine, the lights are a bit dim though. This was brought to the managers attention to address before the end of the inspection. Care Homes for Older People Page 21 of 31 Evidence: A relative told us, The home is clean and tidy. During our tour of the premises with the manager of the service, we identified some concerns which could place peoples safety at risk. These included several radiators, in bathrooms and toilets, which were not covered. Some had thermostats on to regulate the surface temperature, but one did not. The surface temperature on this radiator was so high it placed people at risk from scalding. Immediate action was taken by the maintenance worker at the home to ensure peoples safety. Some areas of the home were very dimly lit for example, one bedroom and the ground floor dining area was poorly lit and numerus bulbs were not working. Action was needed to remedy this situation to ensure peoples safety. All of these issues were brought to the managers attention to address on the day of the inspection. Staff told us that the home had adequate laundry facilities to meet peoples collective needs and people told us their clothing was returned from the laundry clean and ironed. We checked to ensure that good hygiene practices were in place at the home and found that staff were following good practice by regularly washing their hands, using alcohol gel and wearing gloves and aprons when supporting people with personal care. There were soaps and paper towels in all toilets and bathrooms checked. This will help to protect peoples health. 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. On the day of our visit adequate numbers of staff were not in place and this could mean peoples assessed needs may not be met at all times. People who lived in the home were protected by the recruitment and selection policy and procedures in place. People were in safe hands as the staff were trained in to meet peoples diverse needs. Evidence: We checked to see if peoples needs were met by the numbers and skill mix of staff. On the morning of our visit there were two carers and one senior carer on the morning duty to support 19 people who lived at the home. They were supported by the manager of the home, a cook, a catering assistant, a maintenance worker, and a cleaner. This was observed to be an adequate staffing level to support people. The manager told us that two staff, a senior carer and a carer were on the afternoon and night shifts. We spoke to several staff who reported to us that the two staff on duty to cover the night shift was adequate to meet peoples needs. However, staff told us that sometimes, the two staff on the afternoon shift struggled to support people adequately. They told us this was because they were required to prepare and serve tea, wash up after tea and to support people with personal care and mobilising during this time. This staffing issue was brought to the manager and the owners notice on the day of the inspection. It was agreed they would take immediate action to address Care Homes for Older People Page 23 of 31 Evidence: this issue in order to ensure that peoples assessed needs could be met. We then checked the staff recruitment files to ensure that people were in safe hands at all times. The three files checked included the information required to ensure the staff employed had appropriate records to meet the regulations. However, only one file had an application form. The manager was unsure why these were missing and agreed to take action to address this anomaly. The manager had developed a training matrix to ensure all staff training needs were identified and then met. We checked this. From this we were able to identify that over 80 per cent of the staff had completed the NVQ2 care awards and some staff had completed the NVQ3 care award. This was very positive and demonstrated the providers commitment to training staff. We also identified that mandatory training had been completed for the majority of the staff team. The only area outstanding on the day of the inspection was that the majority of care staff had not completed fire safety training; however, there was evidence that this had been planned for the day after the inspection on 19th November 2009 and the manager confirmed in writing to us that this had been completed after our inspection. This helped to protect peoples safety and welfare. There was also evidence on the training matrix, that some staff had completed other generic and specialist training courses, including, safeguarding adults, bereavement and loss, stroke awareness, understanding Dementia and challenging behaviour. This demonstrated that since the last inspection staff were better trained to support peoples diverse needs. Staff told us, We get lots of training, its really good. And, Any training I need we get. We have had more training over the last six months than Ive ever had in five years. This was very positive and will help to safeguard peoples welfare. From our observations it was clear that staff had the skills to communicate effectively with people who lived in the home. This included both care staff and ancillary staff who come into regular contact with them. Staff showed respect for people and their relationships were informal and friendly at all times. Staff told us, that they now had regular staff meetings and group supervisions and were encouraged to be involved in the development of the service. They told us agendas were developed, minutes were taken and relevant information was made available to staff and people and their representatives. We saw evidence that these records were in place. These systems suport the staff team and help to ensure better Care Homes for Older People Page 24 of 31 Evidence: communication within the home. Care Homes for Older People Page 25 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 were living in a much improved service. People who lived at the home, staff and relatives were more confident in the management of the home and found the manager approachable and professional. People were safer because the manager had made sure that proper health and safety checks were undertaken. Evidence: People lived in a home which had improved a great deal since the last inspection. It was now managed by a trained and experienced manager who was in the process of registering with CQC. The manager had completed the NVQ4 care management award. Staff told us that the manager was, Open and honest, He is approachable, Very good at managing and organising the home and He has made a great difference for the better. It was clear that the manager had made a marked improvements to the staff morale. This will help to ensure people are supported with dignity and respect. Care Homes for Older People Page 26 of 31 Evidence: A relative told us, We can talk to the manager if we have any concerns. People who lived at the home told us, He is good at this job, He is alright you can go and talk to him. We checked to see if the home was run in the best interests of people who lived there. The provider of the service visits the home on a monthly basis to carry out checks to ensure the service is being run and managed appropriately. CQC has been recieving these reports on a monthly basis, since September 2009. We have discussed the content with the manager and the provider and have recommended that more details are incorporated into the reports. We then checked three peoples finances, which were kept by the home. All transactions were recorded by two signatories and receipts given. The finance records maintained were clear and the manager told us, it is regularly audited by the manager and the owner to protect peoples rights. The new system in place no longer allows for peoples debit cards and pin numbers to be kept by the service. The manager confirmed that more secure sytems are now in place to protect people from financial abuse. One person told us their daughter managed their finances, and they managed a small amount of their own money and were quite happy with this. We saw evidence that the service had health and safety policies and procedures in place; to ensure peoples safety and welfare. As part of the site visit we examined some of the maintenance and servicing records. All were up to date. These checks helped to ensure peoples health and safety was promoted and protected. 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 9 13 The registered person must 14/12/2009 ensure that hand written Medication Administration Record (MAR) sheets are adequately completed to include all of the relevant details about whether people have any allergies. This is to ensure peoples safety. 2 12 16 The registered person must consult with people about the programme of activities arranged by or on behalf of the home, and provide facilities for recreation for people who live at the home. To meet their social and recreational needs. 31/01/2010 3 25 23 The registered person must ensure that the lighting in the home is adequate to meet peoples needs. 27/11/2009 Care Homes for Older People Page 29 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 This is to protect peoples safety. 4 25 23 The registered person must 27/11/2009 take action to ensure that all radiators in the home are made safe. This is to ensure people are not scalded. 5 27 18 The registered person must ensure that there are adequate numbers of staff on duty at all times to meet peoples assessed needs. To protect peoples safety and welfare. 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 27/11/2009 1 2 19 29 The refurbishment of the home should contine to ensure people live in pleasant surroundings. The registered person should ensure that staff application forms are completed and then kept on file for inspection. To ensure people are supported by appropriate staff. Regulation 26 providers visit reports, should be more detailed, to better identify the findings from the visit and evidence where action has been taken to address issues. 3 33 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. 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