Care Home: Winters Park

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What the care home does well We found that the service ensures people have enough information about the home to help them in making their decision about moving to Winters Park. There is a good process in place to help ensure people have their care and support needs assessed before they enter the home. This helps to make sure that Winters Park will be suitable and will be able to meet their care and support needs appropriately. The home provides a clean and pleasant environment for people to live in. The home is reasonably furnished and decorated, but is about to undergo some redecoration and refurbishment to further enhance the environment. Some of the people we spoke to told us that the food at the home is usually very good. There are plenty of choices at every meal. People told us that `breakfast is served at different times because people get up when they like,` they added, `we are always asked what we want and if there is something we don`t like they will make us something else.` People told us that the staff are `friendly and welcoming,` another person praised their `commitment and caring`. One person wrote, `although it is nice to see the home clean and tidy and frequently updated it is the people working at Winters Park that make it the pleasant place it is. We cannot praise too highly the staff for their care, kindness and thoughtfulness and in several cases their willingness to go that extra mile.` The manager ensures that we, Care Quality Commission (CQC) and social workers (where appropriate) are notified of any events in the home that adversely affect the health and well being of the people that use this service. This helps to ensure that people are safe and protected from the risks of harm. What has improved since the last inspection? No improvements have been made. What the care home could do better: Although many people praised the staff for their hard work, care and attention, some did say that the amount of time staff now spend with them has reduced. One relative suggested that the home could improve by `having more staff to enable them to spend time with residents as they used to,` whilst one of the residents said the home could do better by `having more games and more staff. Staff don`t appear to have the time as they used to.` Staff also said that residents could be `stimulated more` and `go out more.` We found that the service could make improvements to the way in which some care plans are developed and kept up to date, particularly where people have complex care and support needs. Care plans should guide staff to help ensure people receive a consistent approach to their care and support needs. Similarly, improvements need to be made to ensure risk assessments are up to date, accurate and consistently reflect people`s support needs. This will help ensure that staff work safely and that residents are protected from the risks of injury.Staff do undergo basic training to help ensure they work in a safe way. Many staff have also undertaken National Vocational Qualifications (NVQ). However, training records do not clearly record sufficient information to assess whether staff receive the recommended amount of annual training days. Furthermore, the training records we did see at the home do not demonstrate that staff are provided with specialist training such as dementia care or of the illnesses and conditions associated with ageing. As a result of this visit we have made 5 requirements and 8 good practice recommendations. Key inspection report Care homes for older people Name: Address: Winters Park Pategill Road Penrith Cumbria CA11 8RG     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: Diane Jinks     Date: 0 2 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 34 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 34 Information about the care home Name of care home: Address: Winters Park Pategill Road Penrith Cumbria CA11 8RG 01768867939 01768899044 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 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, Dementia - Code DE. The maximum number of service users who can be accommodated is: 44. Date of last inspection Brief description of the care home Winters Park is a purpose built care home and is registered to accommodate forty-one service users over the age of 65 years. The home is owned and operated by Care Homes First Limited, a wholly owned subsidiary of BUPA Care. The home is situated in a residential area of the market town of Penrith, approximately one mile from the town centre and local amenities and facilities. In addition to private bedrooms, two of which can be used, as double rooms if required, there are two large lounges adjoining each other. There is a lounge at the front of the building that can be used by residents who Care Homes for Older People Page 4 of 34 Over 65 4 44 0 0 Brief description of the care home want to smoke. There are laundry facilities and a large kitchen on the premises. Car parking facilities are provided to the side and front of the building. There are shaded seating facilities in the courtyard. The weekly fees are set according to the level of care required. Written information about the services offered, the fee structure and copies of CQC inspection reports can be obtained directly from the home. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of this service takes into account all of the information we have received since the last inspection. We sent surveys to some of the people that live and work at this home in order to obtain their views about Winters Park. The inspection included a visit to the home. During our visit we looked at a variety of the records that the home is required to maintain. We looked around the home to assess the general environment and living accommodation provided to people that use this service. We spoke to some of the people that live and work at Winters Park, including the manager. The manager and the provider completed an annual quality assurance assessment (AQAA) and returned this to us. The information recorded in the AQAA provides us with information about the service and helps us to check the information we gather during the visit to the home. Care Homes for Older People Page 6 of 34 Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Although many people praised the staff for their hard work, care and attention, some did say that the amount of time staff now spend with them has reduced. One relative suggested that the home could improve by having more staff to enable them to spend time with residents as they used to, whilst one of the residents said the home could do better by having more games and more staff. Staff dont appear to have the time as they used to. Staff also said that residents could be stimulated more and go out more. We found that the service could make improvements to the way in which some care plans are developed and kept up to date, particularly where people have complex care and support needs. Care plans should guide staff to help ensure people receive a consistent approach to their care and support needs. Similarly, improvements need to be made to ensure risk assessments are up to date, accurate and consistently reflect peoples support needs. This will help ensure that staff work safely and that residents are protected from the risks of injury. Care Homes for Older People Page 8 of 34 Staff do undergo basic training to help ensure they work in a safe way. Many staff have also undertaken National Vocational Qualifications (NVQ). However, training records do not clearly record sufficient information to assess whether staff receive the recommended amount of annual training days. Furthermore, the training records we did see at the home do not demonstrate that staff are provided with specialist training such as dementia care or of the illnesses and conditions associated with ageing. As a result of this visit we have made 5 requirements and 8 good practice recommendations. 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 34 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 34 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 using this service are provided with information to help them make their decisions to move to Winters Park. The manager also ensures that health and social care needs assessments are undertaken. Both of these things help to ensure that people will move into a home that understands and is able to meet their needs appropriately. Evidence: The home produces a variety of leaflets and information for people thinking of using this service, including a Statement of Purpose, Service User Guide and a welcome pack. We found that this information is only available in one written format. Consideration should be given to producing it in alternative formats to meet the needs of the people this service is aimed at. However, most of the people that participated in the inspection of this service told us that they received enough information about the home to help them make their Care Homes for Older People Page 11 of 34 Evidence: decision to move to Winters Park. People who are thinking of moving into Winters Park are able to visit the home, stay for a meal or experience a trial stay. People are able to and encouraged to involve their families and friends in this process. The manager at the home ensures that people have an assessment of their health and social care needs before the home agrees to their admission. Assessments are carried out either by the manager, or a social worker where necessary. These assessments help the manager to decide whether the home will be suitable and will be able to meet the needs of the prospective resident. Some of the people using this service told us that they have copies of their terms and conditions of residence (contracts) and this helps to make sure that they know what to expect from the home. During our visit to the home we saw evidence that staff do receive some training to help them meet the needs of the people that use this service. We also noted that there appeared to be a sufficient number of staff on duty to provide the care and support needed by the people who live at Winters Park. However, some of the comments we received indicate that there may not always be sufficient staff on duty or staff with the appropriate knowledge, experience and skills to meet needs appropriately. Care Homes for Older People Page 12 of 34 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. Decisions and details on how care and support are to be provided are not recorded consistently. This means that people using this service may not always receive support appropriate to their needs. Evidence: We looked at a sample of care records for some of the people that use this service. We found that care plans have generally been developed from the care needs assessments obtained during the admission process, with additional input from the person themselves or from family members. We noted that care plans are reviewed at least monthly to help reflect the changing needs of people using this service. This process is not always done with consistency or continuity throughout the care plan. Care plans contain elements of risk assessment, nutritional assessments and special assessments to monitor skin condition to help prevent people developing pressure ulcers. There are plans to help manage peoples care needs throughout the night to Care Homes for Older People Page 13 of 34 Evidence: help ensure people living at Winters Park experience a restful night. Short term care plans have also been developed for the use of some medications such as antibiotics and the treatment of infections or wounds. This is good practice and helps the home to monitor improvements and the effectiveness of treatments. The plans we looked at contain information about end of life wishes of the people that use this service. There was one matter that requires further work to ensure decisions made are in the best interests of the person concerned and are clearly recorded. We found that the detail of information in care plans varies. Some contain sufficient information to help staff provide the support and service expected, particularly where residents are more independent. The care plans of people with more complex needs do not clearly detail their care and support needs nor do they provide sufficient and consistent information as to how those needs will be met. We saw examples of conflicting information in care plans and risk assessments relating to moving and handling people. This could result in residents and staff being harmed or injured due to the use of inappropriate equipment. Another person that we looked at is assessed as having high nutritional needs and is at risk of malnutrition. It is evident that specialist help has been sought from the GP and dietician to help manage this and the care plan states that a food diary is to be kept. There were no detailed records relating to the management of this persons food and fluid intake. We noted from daily records that people have access to a variety of health care professionals including, doctors, community nurses, dieticians, occupational therapists and chiropodists. We received a variety of comments from residents and their families, which indicate that people using this service may not always be supported to access to health care professionals when needed. We received surveys from ten residents, eight of which told us that the home always makes sure that they get the medical care they need. One relative told us; they respond quickly to any problems and always let me know when my mother is not well or has had a fall. Another person said; contact with relatives and carers is very good when people are unwell. However, we also received comments from relatives such as; they dont always call the doctor out for my relative unless I insist, and I would like to be informed promptly when there are problems.......particularly where medical help is needed. During our visit to the home we sampled some of the medication records kept at the home and looked at the way in which medicines were stored. We found that individual medication record sheets had been correctly completed and clearly identified each medicine and when it had been administered. Peoples Care Homes for Older People Page 14 of 34 Evidence: medication records include a photograph of each person to help with identification and include details of any allergies they may have. The home has suitable storage arrangements in place for all types of medication, including controlled drugs and medicines that require cold storage. Where medicines are no longer required, they are returned to the pharmacy. Some people who live at Winters Park are able to take control of some of their own medication such as creams and ointments. There are care plans and assessments in place to help ensure these are managed and stored safely. We did observe some of the morning medication being administered during our visit. We saw that some people sitting in the dining room had been given their tablets, some of which were lying on the table and others were still in pots. There was little staff supervision and other residents were sat at the tables with access to these tablets if they chose to. We discussed this with the manager as this is unsafe practice that could result in medicines being taken in error. People told us that they are generally very satisfied with the care and support either they or their relative receives. They told us that staff were friendly, helpful and caring. People are usually treated with respect and dignity but we were told of some areas where this could be improved, particularly with regard to peoples clothing in the laundering process. We were told that clothes often go missing, are spoiled or clothing is not always returned to the right person. Another person told us of their relatives dentures going missing and that they were not informed for over a week. Care Homes for Older People Page 15 of 34 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 using this service are able to make decisions and choices about their daily lifestyle and are provided with interesting and stimulating activities. Evidence: Most of the people taking part in this inspection told us that there are interesting activities available at the home that they can choose to take part in if they wish. The home employs an activities co-ordinator to help ensure activities and events take place. The manager told us that there is a structured activities programme in place at the home. This includes a variety of entertainment, crafts and games. People living at Winters Park also have access to religious groups and a communion service is held at the home each month. During our visit to the home we observed the activities co-ordinator working with some of the residents. She spoke to them and asked them if they wanted to play some games. People were encouraged to take part or to just go along to watch what was going on. The activities co-ordinator used a large pack of cards making it easier for people to handle and see. A few games of cards were played and then a different game was introduced, remembering items or activities from the past such as wash day and Empire Day celebrations. This activity stimulated interesting conversations Care Homes for Older People Page 16 of 34 Evidence: amongst the residents. Some people preferred to watch what was going on, others watched TV, read books or newspapers as they chose and some people preferred to stay in their own rooms. People living at Winters Park are able to receive visitors when they wish and during our visit we saw people coming and going throughout the day. Staff were friendly and helpful making people feel welcome in the home. One relative told us staff are approachable, friendly and welcoming. The facilities are always well presented. Another said; There is easy access for visiting and staff have a good relationship with residents and their visitors. We are always made to feel welcome. We looked at the menus and the meals served at the home. People living at the home told us that the food is usually very good and that there are plenty of choices. Some of the people we spoke to during our visit said they are always asked what they would like. One person said; we can have meals in our own room if we choose and if there is something we dont like they make us something else. Breakfast is served at different times because people get up at different times. We can have what we like for breakfast, there is cooked, toast, cereal, porridge and fruit juice. The menus we looked at confirmed what people told us. We also visited the kitchen and spoke to the chef. The kitchen was generally clean and tidy but some improvements could be made to the way in which food is stored and labelled. The chef told us that the home has been without a second chef for sometime but that a new one was due to start. The staff shortages in the kitchen has meant that the chef has not been able to update some of her training. She has however undertaken training in the past including; health and safety, infection control, COSHH, manual handling and food hygiene. The chef told us that she is aware of any special dietary requirements that residents may have. She told us of the things she uses for people with poor dietary intake to help ensure they receive a good and nutritious diet. The chef ensures that soft diets are prepared and presented attractively to help maintain appetite and nutrition. We saw the service of the lunchtime meal, staff were mindful of hygiene procedures. They checked with residents about what they had chosen for their meal. The meals were of good portion size and included fresh vegetables. The dining room was set nicely and provided a pleasant environment for people to eat their lunch. Staff were on hand to help people with their meal if needed. Care Homes for Older People Page 17 of 34 Evidence: Some people choose to have their meals in the privacy of their own room. We saw that trays had been laid ready to take meals to the rooms. Care Homes for Older People Page 18 of 34 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. There are procedures in place at the home to help protect the best interests of people using this service. There are some gaps in the processes, which mean that people may not always be properly protected. Evidence: The home has a complaints procedure in place. Most of the people we spoke to told us that they know about this process and who they should speak to if they have a concern, although three people were not aware of the process. The manager told us that the home has received five complaints over the year and that all have them have been investigated, with records kept of the outcome. Relatives and visitors who completed surveys, told us that any concerns they have raised are usually dealt with appropriately. One person said; There is a small thing I have mentioned and I know it will be acted upon. Another person told us of things that had gone missing from their relatives room. They had reported this to staff but this had not been conveyed to the manager for her attention and action. This indicates that staff may not always know the process for reporting such concerns. There is also a procedure at the home for responding to allegations of abuse. The manager is aware of this process and has worked well with other agencies where Care Homes for Older People Page 19 of 34 Evidence: allegations of poor practice or abuse have been made. The manager has a copy of the local authoritys safeguarding guidelines, but this is not the most recent edition. The manager should ensure there is a copy of the most up to date version available at the home. We looked at the way in which staff are recruited. The manager makes sure that all the necessary checks are made before people start to work at Winters Park. We saw that staff are provided with some training on the safeguarding of vulnerable adults (abuse). These measures help to ensure that people using this service are supported by suitable staff. We saw two care files which indicate that decisions have been made that may not be in the persons best interests. There are no records showing how decisions have been made or of who has been consulted as part of the decision making process. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home generally provides a warm, safe and hygeinic environment for the people that live at Winters Park. Evidence: The home provides accommodation for up to 41 residents. All of the bedrooms are single rooms and most of them have en-suite facilities. There are various communal spaces at the home including two dining rooms, lounge areas and toilets, showers and bathrooms. There is a designated area for people who wish to smoke. The home has a maintenance plan and is about to undergo some major refurbishment and redecoration to update the facilities and rooms. Improvements are planned for the smoking area and this will help reduce the risks of smoke being detected in other areas of the home, particularly in the reception area. One of the communal bathrooms has a very badly scratched bath. The manager told us that this is also one of the areas that will be refurbished and the bath replaced. On the day of our visit we found the home to be warm, clean and tidy. There were domestic assistants on duty to help ensure the home is kept in a clean and hygienic condition. Care Homes for Older People Page 21 of 34 Evidence: We looked at some of the personal bedrooms of people using this service. They were also clean and people have been able to add personal items such as photographs, ornaments, televisions, radios and some of their own furniture from home, to help make their rooms more cosy and homely. The home has policies and procedures in place regarding the control of infection and most of the staff have undertaken training in the subject. This helps to ensure people using this service are protected from the risks of cross infections. We looked at the laundry area. This also was clean, tidy and well organised. Laundry is kept in colour coded laundry bags and staff are provided with protective clothing, hand wash and hand sanitiser. These measures help to control the risks of infection. We also visited the kitchen area. We found this to be generally clean and tidy and well organised. The people that live at Winters Park tell us that the home is always clean and fresh. Some of the comments we received via our surveys included the following: Facilities are always well presented, the home provides a warm, friendly and secure environment. Some people thought improvements could be made by ensuring better ventilation in in rooms and lavatories and keeping windows and sinks better. Also toilet is often smelly and dirty. People also told us; the staff are special from all aspects of the people in their care to the clean and safe environment they provide, and although it is nice to see the home clean and tidy and frequently updated it is the people working at Winters Park that make it the pleasant place it is. Care Homes for Older People Page 22 of 34 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. There are some gaps in the training processes, which means that there may times when staff do not have the skills and experience to deliver the services and care that the home offers to provide. Evidence: On the day of our visit to the home, there appeared to be a sufficient number of staff on duty in order to meet the needs of the people using this service. A significant number of staff have left the home in the last year. Recent changes to the staff shift patterns have been made to help ensure there are enough staff on duty to provide support at busy times of the day, such as early morning and in the evenings. The manager told us that she is trying to obtain more staff for these times. The needs of people using this service are changing and some are becoming more dependent on help from staff. We did receive some comments raising concerns about staffing levels at the home. Some people told us that staff work long shifts or extra hours. We discussed this with the manager, who told us that there are some occasions where staff provide extra cover by doing split shifts. This happens when there is staff sickness for example. We spoke to some of the staff and others returned surveys to us. The staff told us that there are usually enough staff on duty to ensure the people that live there are supported properly. Care Homes for Older People Page 23 of 34 Evidence: The surveys we received from people living at the home, told us that staff are always or usually available to provide the care and support they need. Comments from relatives included; given the numbers of staff they care adequately for my mother and one person thought the home could do better by having more staff to enable them to spend time with the residents as they used to. We looked at the way in which new staff are recruited at Winters Park. The records show that prospective employees complete application forms, attend interview with the manager and undergo checks such as criminal records (CRB), safeguarding adults (SOVA) and have references checked with previous employers. We saw that the manager had checked any gaps in the applicants previous employment history too. These checks help to ensure that only people suitable to work with vulnerable adults are employed at the home. We also looked at some of the training records for staff working at the home. The manager told us that there is a training plan in place to help manage staff training. The records showed us that staff do receive the basic core training to help them do their job. Training included induction training, health and safety, fire safety, infection control, basic food safety, safeguarding (abuse) and moving and handling. There are some staff at the home who are trained to provide instruction to staff with regard moving and handling and fire safety. Where staff claim to have completed training prior to working at Winters Park, the manager has obtained some evidence to help verify this. Staff training is undertaken in a variety of ways including attending courses, watching training DVDs and completing questionnaires. The manager has told us that 75 of the staff have completed National Vocational Qualifications (NVQ) in Care to at least level 2. However, there is some doubt whether the organisation will continue to support staff to complete such qualifications or their equivalent. Staff told us that they do receive training and that they feel well supported in their work. We did not see any evidence to confirm that staff receive specialised training to help them understand and meet the needs of older people and people who may have dementia illnesses. From the information recorded about training, it is difficult to assess whether staff receive the recommended amount of training. One member of staff told us; we work well together as a team to meet the needs of residents and their families. Some of the relatives that returned surveys commented that the home could do better by; further staff training on confidentiality and dementia. Another person said; I do not feel that all members of staff have an in depth knowledge or Care Homes for Older People Page 24 of 34 Evidence: understanding of vascular dementia, this is very apparent in some. However, others told us; the standard of care and commitment cannot be faulted, and it is obvious they care very much about every individual. Care Homes for Older People Page 25 of 34 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. The home is generally run in the best interests of the people that live there. There are some gaps in the recording and monitoring processes, which may at times compromise the health and safety of people living and working at Winters Park. Evidence: The manager at Winters Park is not yet registered with us, the Care Quality Commission, although her application is in process. The manager holds relevant qualifications to help her undertake the role of manager. She is supported in her duties within the home, by a deputy manager. The organisation also supports the manager with her responsibilities providing access to a Regional Manager, human resource advice and a team of operational quality consultants. The staff we spoke to during our visit told us that the manager is very good and runs a good home. They say the manager listens and you can talk to her. People using this service were familiar with the manager, we observed her on her morning round of the home and saw a friendly and open relationship between manager and residents. Care Homes for Older People Page 26 of 34 Evidence: There are quality assurance and monitoring systems in place at the home. The manager carries out regular audits of different aspects of the home. Resident and staff meetings are held and these help to provide a forum for people to have their say about Winters Park. We found that staff meet with their manager regularly on an individual basis and have their practice monitored. This helps to ensure that staff work to the policies and procedures of the home and helps to identify areas where further training or support may be required. Supervision also provides an opportunity for staff to give their views on life at Winters Park. The organisation has provided a wide range of policies and procedures to help ensure the home is operated safely and in the best interests of the people that live there. From the information supplied by the manager in the AQAA, it is evident that these documents have not been reviewed or up dated for sometime. It is good practice to review such documents frequently to ensure they meet the requirements of any new legislation and are consistent with current good practice guidelines. During our visit we looked at some of the records that have been maintained in respect of health and safety matters. Comprehensive records are kept of fire safety checks including the regular testing of equipment and fire alarms. Annual services are undertaken of firefighting and fire detection equipment. Staff undergo regular training in fire prevention and evacuation procedures. The home has staff trained to instruct staff on this topic. The manager told us that the fire risk assessment has just been updated and that she is awaiting receipt of the updated assessment. Central heating systems, gas appliances, portable electrical appliances and handling equipment have been maintained and serviced regularly. Where any accidents have occurred, these are recorded in the accident book and the manager has notified other agencies as required. People using this service have risk assessments in place to help ensure they are supported safely. They do not always record clear, consistent information nor are they always dated. This could place people at risk of receiving inappropriate or unsafe support. Care Homes for Older People Page 27 of 34 Evidence: We saw from staff training records that staff are provided with training in relation to moving and handling residents. However, whilst we were at the home we observed staff using both good and poor handling practices. This places both residents and staff at risk of harm or injury. We told the manager about these matters as they need some urgent attention. We noted that most of the staff have completed infection control training. A large proportion have also undertaken food safety training, including both care and catering staff. However, the chef told us that they have been unable to update their food hygiene training due to staff shortages in the kitchen. We visited the kitchen during our visit and looked at the way in which some of the food was stored. The dry stores were well stocked with a variety of provisions. Some of the packets that had been opened were not resealed or closed properly. In the fridge, some of the foods were not properly labelled and some things needed clearing out. The kitchen staff need to ensure that things are thrown away promptly and that all foodstuffs are properly sealed and clearly labelled with dates. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 34 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 7 15 Care plan recordings must 31/12/2009 be more detailed for people with complex and/or specialist needs. Management plans must be developed to guide staff and ensure a consistent approach. This will help ensure that all aspects of the persons needs are met appropriately. Care plans provide the basis to help ensure people receive the care and support they need. 2 9 13 There must be safe 14/12/2009 procedures for the administration of medication. Medication must be secure at all times to help ensure that people using this service receive the medication prescribed by their doctor and as he intended. Care Homes for Older People Page 30 of 34 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 Securely stored medicines help to reduce any risk of errors being made. 3 27 18 Staff must be provided with training appropriate to the work they are to perform and to meet the aims and objectives of the service. Staff individually and collectively, must have the skills and experience to deliver the care and services which the home offers to provide. 4 38 13 Risk assessments must be accurately maintained and up to date, with clear information and safe working strategies for staff to follow. Clear strategies help ensure staff provide people with support in a consistent and safe manner. 5 38 16 Food items must be stored and labelled appropriately. Regular audits of food storage areas must be carried out to ensure food items are stored and disposed of appropriately. 14/12/2009 31/12/2009 28/02/2010 Care Homes for Older People Page 31 of 34 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 The health and well-being of people using this service must be promoted and protected. 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 1 The statement of purpose should be reviewed to ensure it contains up to date and accurate details about the managers and responsible persons qualifications, skills and experience. Where the details for contacting other relevant organisations are listed, contact details should be updated and accurate. Consideration should be given to producing information about the home in alternative formats to help meet the communication needs of the people this service is aimed at. The health of people using this service should be promoted and maintained at all times. People using this service should be supported, without delay, to access health care professionals, such as their doctor or community nurses. People using this service should always be treated with respect and dignity. Personal items should be looked after by staff and where items go missing, a search should be made as soon as possible to help alleviate any anxiety or distress to people using this service. Staff should be reminded of their responsibilities to report concerns and/or complaints to their line manager. This will help ensure that the people they support are properly protected from the risks of harm or abuse. Where decisions are made in the best interests of people using this service, clear and detailed records of how decisions are made and of who was involved in the decision making process should be maintained. The best interests of people using this service should be promoted and protected in line with the requirements of the Mental Capacity Act 2 8 3 10 4 18 5 18 Care Homes for Older People Page 32 of 34 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 2005 and the Deprivation of Liberty Safeguards. 6 30 Accurate and detailed records should be maintained for each member of staff in relation to the training they have undertaken. This helps to identify any gaps in their knowledge or when training updates will be required. Policies, procedures and practices should be regularly reviewed to ensure they reflect current legislation and good practice advice. The chef at the home should undertake their food hygiene refresher training without any further delay. 7 33 8 38 Care Homes for Older People Page 33 of 34 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. 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