Care Home: Windermere Rest Home

Similar services:

• Claremont House
• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home
• Henrietta House

What the care home does well Windermere Rest Home is a small home that may provide people with a more intimate and `family feel` than a larger home. Because the home is small staff can get to know people well, and have more of a feel for their individual needs. People living at Windermere Rest Home have a good relationship with staff. They felt that they were offered "Good personal care and medical treatment." People also felt that staff, "Try to be adaptable and cover all duties." People will always able to welcome their visitors so that they can maintain contact with friends and family. What has improved since the last inspection? The provider has made some improvements to the premises. Odour control has been improved by the replacement of some carpets with vinyl flooring. A cleaner now works more days at the home to provide a more consistent service. Cleaning schedules are in place to guide practice. Care records have been reorganised so that all the information about individual residents can be found in one place. This should provide staff with better and more consistent information enabling them to help people more effectively. Some signage has been developed to help people`s orientation. Menus have been developed so that people will now have a four weekly menu rather than a two weekly menu. This will provide a greater range of foods and interest for people. The home has been made safer through linking exit doors into the fire alarm system to allow quick and safe exit in the event of an emergency. When people wish the home to hold their monies for safekeeping this is now done in an organised and safe way that will protect their interests. Staff training has been ongoing in some areas so that people working at the home keep their knowledge and skills up to date. What the care home could do better: The lack of good management and leadership at the home has impacted on the service in terms of quality and consistency. For example, at the last inspection we highlighted that care planning was inadequate. We saw from files that this had been addressed to a degree by previous management arrangements, but at the time of this visit the situation had deteriorated again. This needs to be addressed to ensure that all aspects of people`s social, physical and cultural needs are fully assessed with plans in place to help staff to meet these needs. The new acting manager is enthusiastic but gaps in their knowledge, particularly in relation to safeguarding need to be addressed in order to ensure that people are cared for safely. We found some issues in relation to the good and consistent management of people`s medicines. This needs to be addressed so that people can have confidence that this aspect for their care will be managed and monitored effectively. Monitoring of standards of practice in general needs to be improved to ensure that people are cared for properly in all respects. The home need to work on finding ways to help people to have real choices in their daily lives, through promoting person centered care with staff. Systems for good staff induction still have not been developed to ensure that new staff develop good knowledge and skills from the start of their employment. Key inspection report Care homes for older people Name: Address: Windermere Rest Home 23/25 Windermere Road Southend-on-Sea Essex SS1 2RF     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: Vicky Dutton     Date: 0 6 0 4 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 30 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 30 Information about the care home Name of care home: Address: Windermere Rest Home 23/25 Windermere Road Southend-on-Sea Essex SS1 2RF 01702303647 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Kumarasingham Dharmasingham & Mrs Mithila Dharmasingham Name of registered manager (if applicable) Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1. The registered person may provide the following category/ies of service only: Care home only Code PC 2. The maximum number of service users who can be accommodated is: 10 Radiator covers to be provided to all remaining radiators. This work to be carried out within one year of registration. Thermosatic controlled values on all hot water taps accessible to residents. This work to be carried out within six months of registration. To provide locks on all bedroom doors enabling access from outside to comply with fire regulations.This work to be carried out within nine months of registration, with Risk Assessment and Fire Department approval of them in the meantime. Care Homes for Older People Page 4 of 30 Over 65 10 10 0 0 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 Dementia Code DE Date of last inspection Brief description of the care home Windermere Rest Home is a small, privately owned residential home providing accommodation and care for ten older people who may also have dementia. Accommodation consists of ten single bedrooms, a communal lounge/dining room, kitchen, two bathrooms, laundry and office. Each bedroom has a call bell facility and a TV point. A shaft lift is available to provide access to both floors. There is a very small, enclosed garden to the rear of the home. The home is situated in a residential area of Southend on Sea within easy access of the seafront, train links, bus services and local shops. The home provides display permits to allow visitors to use a private car park opposite the home. A Statement of Purpose and Service User Guide were available at the time of this inspection. A copy of the last inspection report was available in the hall opposite the office. The current fees at the home were stated to be £395.78 to £439.88 per week. Fees charge depend on needs, room occupied and funding arrangements. There are extra charges are for hairdressing, chiropody and newspapers. 0 9 0 4 2 0 0 9 Care Homes for Older People Page 5 of 30 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: This was an unannounced key site visit. At this visit we (CQC), considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. We spent seven hours at Windermere Rest Home. We looked around the premises to see if it was pleasant and safe for people. We viewed some care records, staff records, medication records and other documentation to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to management and staff. The homes Annual Quality Assurance Assessment (AQAA) was sent in to us when we asked for it. The AQAA is a self assessment tool that providers are required by Law to complete. The AQAA tells us how management feel they are performing against the Care Homes for Older People Page 6 of 30 National Minimum Standards and how they can evidence this. The AQAA for Windermere Rest Home was completed by the provider. It was adequately completed, gave us all the information we asked for and helped us in our assessment of the home. Before the site visit a selection of surveys had been sent to the home for distribution to residents, relatives, involved professionals and staff. We received responses from three people living in the home and five staff. The views expressed at the site visit and in survey responses have been incorporated into this report where appropriate. We were assisted at the site visit by the provider, acting manager and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the staff team, residents, relatives and visiting professionals for their help throughout the inspection process. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The lack of good management and leadership at the home has impacted on the service in terms of quality and consistency. For example, at the last inspection we highlighted that care planning was inadequate. We saw from files that this had been addressed to a degree by previous management arrangements, but at the time of this visit the situation had deteriorated again. This needs to be addressed to ensure that all aspects of peoples social, physical and cultural needs are fully assessed with plans in place to help staff to meet these needs. The new acting manager is enthusiastic but gaps in their knowledge, particularly in relation to safeguarding need to be addressed in order to ensure that people are cared for safely. Care Homes for Older People Page 8 of 30 We found some issues in relation to the good and consistent management of peoples medicines. This needs to be addressed so that people can have confidence that this aspect for their care will be managed and monitored effectively. Monitoring of standards of practice in general needs to be improved to ensure that people are cared for properly in all respects. The home need to work on finding ways to help people to have real choices in their daily lives, through promoting person centered care with staff. Systems for good staff induction still have not been developed to ensure that new staff develop good knowledge and skills from the start of their employment. 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 30 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 30 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 will be given information and assistance to ensure that the home is suitable to meet their needs. Evidence: The home had a Statement of Purpose and Service Users Guide in place that would provide people with good information about the service. These documents were not dated but appeared to provide up to date information including details of current fees charged at the home. On surveys people said that they had received sufficient information about the home. Most of the people living at Windermere Rest Home have lived there for some time. The most recent person to move in has lived at the home for a number of months. We looked at their file to see if their needs had been assessed before they moved in, to ensure that the home would be suitable for them. We saw that a pre-admission assessment format had been completed on the day of admission. The assessment was Care Homes for Older People Page 11 of 30 Evidence: satisfactorily completed. The acting manager was aware of the need to assess peoples needs before they were admitted. They said they were waiting to go to the hospital to assess one person when they were ready for discharge. The acting manager was advised to review the pre-admission assessment format in use to ensure that it covers all the areas advised by the National Minimum Standards. Other files viewed had preadmission assessments in place. Some had information available from social services departments who were funding the placement. Care Homes for Older People Page 12 of 30 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. People will receive basic care to meet their needs. Care offered will not be based on robust planning and understanding of peoples individual and holistic needs. Evidence: On three surveys received people said that they, usually or sometimes received the care and support that they needed, and that staff were usually available to them. At the site visit people looked relaxed and comfortable and told us that that the staff looked after them well. To see how well peoples care is planned for and arranged so that staff are aware of peoples needs and meet them in an individual way we looked at four peoples care records in some detail. We accept that the home is small and that staff have a reasonable awareness of peoples individual needs. However there is not a comprehensive and holistic approach to planning for peoples care to ensure that all their individual social, cultural, health and personal care needs are recognised and met. All the care and monitoring information about individual residents is now kept in one place in individual files which is good practice. Since the previous inspection staff Care Homes for Older People Page 13 of 30 Evidence: have tried to improve on recording and monitoring in relation to peoples care. However information is jumbled with different care assessments and planning formats in use. Information in files includes historical information and assessments, that may no longer be relevant, mixed in with current care planning and other information. This could cause confusion. The care plans that we viewed were not adequate. They did not include sufficient detail for staff to offer person centered care. For example comments such as X requires assistance from two staff for personal care, and X is a very independent person who requires full assistance and encouragement to ensure their personal hygiene is maintained, do not give staff sufficient information or identify the residents individual needs and preferences in relation to personal care. For example what they can do for themselves, times, any preferred toiletries and so on. Care plans viewed did not cover all of peoples identified needs. For example one person with cognitive impairment and other needs only had one entry on their care plan sheet and this related to personal care. Another person had specific medical conditions identified in the pre-admission assessment and correspondence, these were not referred to at all in care planning. It was not clear that care staff make great use of care planning information. When we asked a member of staff to point out to us current care plans they indicated monitoring sheets such as fluid charts, night checks and daily records and activity records. The new acting manager has undertaken recent training in care planning and hopes to improve the situation. Some other staff have undertaken care plan training but this was in 2007 so their knowledge and skills may be out of date. In looking at records and having discussion with the acting manager it was clear that if health issues are identified then professional help is sought. We saw that one person had just seen a physiotherapist, another person had mental health services involved with their care. We saw that referrals were made to the continence advisory service. People have regular eye checks and a chiropodist visits the home on a regular basis. Again however peoples health care may be compromised by poor recording and planning. Care files included a sheet to record doctors and other professionals visits. These did not appear to be being used any more. For example one persons last visit from a doctor was recorded as 15/05/09 but we know from other records that they have recently seen their GP. Risk assessments are undertaken relevant to peoples needs such as moving and handling, falls and the use of bed rails. Peoples nutritional and skin viability needs were assessed using recognised tools. But, where assessments indicated a level of risk this information had not been carried forward into care planning to ensure that remedial actions would be taken to reduce the risk. Nutrition records are maintained and we saw that where possible, (The home only has stand on scales,) peoples weight is monitored to help identify any weight loss that Care Homes for Older People Page 14 of 30 Evidence: might cause concern. No one living at Windermere Rest Home currently manages their own medication. We looked at systems in place to see if this aspect of peoples care was managed in a safe and effective way. We saw that good guidelines were available to staff to promote good practice. Staff undertook medication training in October last year. The medication trolley was tidy and well organised. However we did identify a number of shortfalls and inconsistencies in recording. Although creams supplied are identified on the Medication Administration Record (MAR) sheets, there is no system of recording their use. On a number of occasions the home were not using medicines in accordance with the prescribers instructions. For example one persons inhaler was prescribed as take two puffs twice a day in the morning and at bedtime. Do not stop taking this medicine except on your doctors advice. Over nine days only three doses had been given. The manager said that they were using it on an as required basis. (PRN.) Another person had night medication prescribed to Take one at night. No doses had been administered. The manager said that they were no longer using it. These issues need to be addressed and protocols agreed with peoples doctors and the suppling pharmacist. Where medication is used on a PRN basis protocols should be in place to ensure consistent use. Errors in recording/administration were noted from records. One person was noted to have eight tablets missing from one blister pack, there were only six signatures on the MAR sheet, and, according to the member of staff, only six doses should have been given from 31/03 to 05/04. This could not be explained. Medication had not always been properly booked in to maintain a robust audit trail. On some occasions a carried forward system seemed to be in place but not on all occasions. The acting manager said that they were about to start a system of weekly audits for the medication system to pick up on and deal with any issues. Generally we saw that staff had a good relationship with residents and treated them with respect. However some monitoring is needed. Records made comments such as residents having been good or eaten nicely. There was reference to people refusing to walk or refusing to go to the toilet. This type of terminology is not reflective of person centered care being offered to adults. Also, staff need to ensure that they always show respect for people in the way that they carry out tasks for residents. We saw that beds had not been made properly and left with rucked up bottom sheets or covers not straightened properly. Peoples drawers were not always tidy with peoples clothes put away nicely. Care Homes for Older People Page 15 of 30 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. People will have some opportunities for occupation and activity and will be able to maintain contact with family and friends. Evidence: During the day the acting manager and staff interacted and chatted with residents. Some games were played. The television remained on and loud all day. No variation of channel or alternative entertainment was offered during the times when we were in the living area. We saw that there were games and materials available to enable activities to happen. Minutes of a recent residents meeting showed that people had been consulted about what activities they would like: The residents said overwhelmingly that they wanted to have regular singalongs, they said they enjoyed gentle games like the balloon game. Records of activities are maintained. Peoples preferences with regard to activities has been assessed to some degree, although in some cases the information was probably out of date as peoples needs may have changed. For example one persons activities assessment dated from 28/01/07. On one file we saw that a new document was in place entitled Lifestyle and Social needs. Had it been properly completed it would have provided much useful information to guide staff and let them know about the person, their previous work and life history, their likes and dislikes, interests, preferred routines and so on. It was said that the Care Homes for Older People Page 16 of 30 Evidence: document had been completed by family with responses to most of the questions being none. The manager and provider said that most residents went out on occasions with their families, and that staff took one resident out for walks. Occasional entertainments are organised. Church groups were said to vist the home on occasions such as Christmas. As at the previous inspection management are trying to get church groups involved on a more regular basis, (as stated in the Service Users Guide.) People made their own choices about where they went during the day if they were able. We saw that some staff had completed training in the Mental Capacity Act. The acting manager had undertaken training in deprivations of liberty. Care files included some Best interest assessments to account for some restrictions such as coded doors. People said that they enjoyed having visitors. Minutes of a recent residents meeting showed that families are encouraged to be involved. Since the previous inspection the menus at the home have been changed to provide greater choice. At the moment a three weekly rotating menu is in place and this will become a four weekly menu soon. Although the new menus indicate an alternative at each meal, nutrition records show that usually only one of the choices is cooked and served. One person said that they were offered choice. The manager said that when that person has said what they want everyone else says the same. Another more able resident said that they were not offered a choice, but just had what came up. When we saw afternoon tea being served residents were just given biscuits without any choices being offered or the opportunity to pick their own from the tin. The home needs to work on ways of proactivly promoting and encouraging people to make individual choices. Care Homes for Older People Page 17 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not fully protected as robust procedures are not in place and staffs knowledge is not adequate. Evidence: We saw that the home had a complaints procedure in place that was on display for people. On three surveys received everyone said that they knew who to talk to informally if they had any concerns. One person said that they did not know how to make a formal complaint. The AQAA said that no complaints had been recorded. When we looked at complaints records we saw that since the new acting manager has taken up their post two complaints had been recorded. Both were for relatively minor issues and both had been dealt with effectively. This demonstrated that the manager takes all issues seriously and is listening to peoples concerns. Over the last year a number of safeguarding concerns have been raised in relation to the home. The local authority have been managing these issues, and working with the provider to raise standards. When we visited the new acting manager had been in post for about a month. Although they have undertaken safeguarding training, this was in March 2008 and their knowledge of what to do in the event of an incident was limited. They were unclear of local guidelines and procedures in place. This needs to be urgently addressed to ensure that people are properly protected by appropriate actions being taken when needed. This point was highlighted further by the fact that in spite of all the input at the home over the last year, on one persons file a recent Care Homes for Older People Page 18 of 30 Evidence: body chart had been completed. This identified bruising and redness to shins and red coloured skin on both arms. Neither daily records or other records made reference to this. No actions had been taken. The manager was unaware of the record and unable to explain what had happened as it was prior to them fully taking up their role. A further safeguarding referral was made to the Local Authority in relation to this. Training records showed that four staff at the home have undertaken more recent safeguarding training to keep their knowledge up to date. Care Homes for Older People Page 19 of 30 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. People live in a comfortable home. Evidence: Windermere Rest Home is situated in a residential area. There is no parking available at the home and, during the week especially, on street parking is generally not available. The home have made an arrangement so that any visitors can borrow a parking permit for the private car park opposite the home. There is one communal lounge/dining area where all activity takes place. There is outdoor space for people to enjoy. The garden although small was well maintained. People spoken with were happy with the accommodation provided and said, I am very happy with my room, and My chair is comfortable. Since the previous inspection carpets in some rooms have been replaced with vinyl flooring which has improved odour control. Some areas of the building look tired and could do with attention. A number of radiator covers remain unpainted, furnishings in a number of rooms are looking tatty and are unmatched. The provider said that they intend to continue refurbishing the home as funds allow. Since the previous inspection the home have developed some signage to assist Care Homes for Older People Page 20 of 30 Evidence: residents with orientation. When we visited odour control at the home was acceptable. Training records showed us that most staff have undertaken recent training in infection control so are aware of good practice. We saw that cleaning schedules were in place and in use. Some areas however seem to miss out. The food storage area on the first floor was in need of a deep clean and some equipment such as commodes also needed a thorough clean. On surveys people felt that the home was usually or sometimes fresh and clean. The home has a small laundry area, that provides adequate equipment to meet the needs of the home. Care Homes for Older People Page 21 of 30 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. People are cared for by staff who are kind and have undertaken basic training for their role. Evidence: We received positive comments about staff working at Windermere Rest Home such as, They are all very nice, and, They help me. Residents looked relaxed and comfortable with staff. On surveys people felt that staff usually listened to them and acted on what they said. At a recent residents/relatives meeting a relative wanted it noted that a particular member of staff, Does way above their duties and is always smiling and willing and is to be sincerely congratulated. Surveys, discussion and observation showed that staff are positive about their role. Staff said, There is good staff training and we take good care of residents, and, We ensure that all the residents needs and concerns are met promptly providing a homely and safe place. Staff turnover at the home is relatively low and a number of staff have worked at the home for some time. Agency staff are not used at Windermere Rest Home. This means residents can have a sense of stability and receive care and support from people that they know and are familiar with. On the day of inspection eight people were being accommodated. We looked at staffing rotas and saw that staffing levels were being maintained at a basic level of two care staff during the day, and one awake member of staff with a sleeping in Care Homes for Older People Page 22 of 30 Evidence: member of staff at night. The acting manager, (or another member of staff) provides a third member of staff during the later morning and lunchtime so that there are still two members of staff available to residents whilst lunch is being cooked. A domestic member of staff works at the home for a few hours each week, spread over four days. The home also has access to a maintenance person to undertake routine works and running repairs. So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. Information provided on the AQAA and discussed at the site visit indicated that out of nine permanent care staff six currently hold an NVQ. The home have therefore achieved over the 50 basic target, and show a commitment to maintaining a well trained workforce. The previous inspection found that recruitment procedures and practice at Windermere Rest Home were satisfactory and protected residents. We looked at the files of two members of staff who had most recently started work at the home to ensure that good practice was being maintained. We saw that proper checks had been undertaken. Independent Safeguards Authority first, and Criminal Records Bureau checks had been undertaken (or in one case applied for,) references had been taken up and proof of identification sought. On five staff surveys people said that their recruitment was carried out fairly and thoroughly. On Five staff surveys everyone said that their induction covered the things they needed to know very well. However although rotas indicated induction, and we could see that some basic training had been undertaken, there was nothing on files to show that people had undertaken a detailed and structured induction into the home. This had been in place at the previous inspection but now appears not to be being done. As at the previous inspection the provider confirmed that new staff still not undertaking ongoing induction through Skills For Care based Common Induction Standards. This needs to be addressed so that people are cared for by staff who are developing good skills and practices from the start of their employment. On Surveys and in discussion staff made positive responses to questions about training saying that training offered gave them the skills that they needed. One said, There is good staff training. Training records seen and a training matrix viewed indicated that staff have undertaken a basic range of training. According to the training matrix some staff have yet to complete training in dementia care, for which the home is registered. The acting manager has recently undertaken training in stoma care and pressure area care to increase their knowledge and skills. Care Homes for Older People Page 23 of 30 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. People live in a home that has lacked consistent leadership and management. Evidence: Windermere Rest Home has not had a permanent, competent and registered manager in post for a long time. In spite of the providers efforts to recruit a suitable permanent manager, there has been a succession of managers and stop gap management arrangements in place. This has had a detrimental affect on the overall quality and management of the service offered. When we visited a new acting manager had been appointed and had been in post for about a month. They have been internally promoted to the role so know the home and residents well. They are experienced in care, have some appropriate qualifications, and are planning to commence a management course in the near future. The acting manager is enthusiastic and willing to learn. The provider said that a consultant had been asked to provide support for the acting manager, and and help them to develop the service. Gaps in the acting managers knowledge such as safeguarding and effective person centered care planning do need to be addressed so that they can be effective in their role. Care Homes for Older People Page 24 of 30 Evidence: The provider has some strategies in place to ensure that the quality of the service is kept under review, and that people have the opportunity to express their views about the service. We saw that periodic staff meetings and residents meetings take place. As the home is small residents views can also be sought on a one to one level. Staff felt that there was Good communication between all staff, whatever level. When we last visited a quality audit involving the use of questionnaires had just been undertaken. At this visit the provider said that a quality assurance process will be developed again with input from a new consultant. The provider is very involved with the home, is frequently on the premises and helps to cover on call arrangements. They also undertake a more formal monthly visit as is required by Regulation. This inspection has shown us that closer internal monitoring is needed to ensure that residents receive good and safe care, and that any improvements made are sustained. The AQAA was completed by the provider. The AQAA was adequately completed and showed us that management know what they need to do better, and how they can continue to improve the service for the benefit of residents. People can feel confident that if they or their families ask the home to help them look after their personal monies, this will be done in a way that safeguards their interests. Monies checked were correct, with receipts in place for all transactions. The AQAA completed identified that systems and services within the home are monitored and maintained. A sample of records looked at confirmed this. A partial tour of the premises showed that the home seemed safe from obvious hazards. We did however notice that a keep locked area and the laundry area were not secured. As the home is registered to provide dementia care this could present a hazard for people. These issues were rectified when we pointed them out. We saw that the fire alarm and emergency systems are regularly tested and checked. Since the last inspection fire systems have been improved by providing automatically opening doors in the event that the fire alarm sounds. We saw that the last fire drill took place in November last year. This identified that, Staff seemed to think that it was not real and did not react properly. Further training and input was given, but a further fire drill has not been held to check that they will now follow correct procedures. This could potentially place people at risk. We saw that further fire training was booked and about to take place at the home. The provider reported that when the fire service visited last year they had been quite happy with arrangements, however the letter detailing their visit could not be found. The local fire risk assessment for the home also could not be found. The provider undertook to look for this and confirm that it was in pace. The last environmental health officers visit in March this year found some minor issues Care Homes for Older People Page 25 of 30 Evidence: that needed to be addressed. Training records showed that training is ongoing, but that there are some shortfalls in staff being kept up to date in core areas such as health and safety and first aid. This is planned to be addressed. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 An effective care planning 01/06/2009 system must be in place that reflects peoples current and holistic needs. As fare as possible people receiving the care must be involved with this process. So that people receive good and consistent care from staff who are aware of and understand their needs. Care Homes for Older People Page 27 of 30 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 Peoples medication must be 30/04/2010 managed in a safe and effective manner. So that people are cared for safely, and receive their medicines in the way prescribed for them. 2 18 13 Staff must have good knowledge and robust procedures must be in place to ensure that any concerns are dealt with openly and properly. Sot that residents can have confidence that they will be cared for safely. 30/04/2010 3 30 18 When staff start work at the home they must be supported through undertaking a robust induction programme. 30/04/2010 Care Homes for Older People Page 28 of 30 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 So that staff develop good skills and knowledge from the start of their employment. 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 30 All staff should receive good quality training in dementia care so that they are able to offer residents appropriate care and support. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!