Care Home: Wyndthorpe Gardens

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What the care home does well People in the home are provided with a warm, safe and comfortable place to live that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well. What has improved since the last inspection? The way that staff give out medication and record this has got better, which helps keep people safe and well. Storage of medication at the correct temperatures is better and this means staff know that medicines are safe to use when needed. The way that the home responds to safeguarding issues has got better with staff receiving training and the service working closely with the Doncaster Social Services Safeguarding Team. Repairs and redecoration of the home have improved the living environment for people using the service, so they now have a safe and comfortable place in which to live. Evidence from this visit shows that the manager and staff have worked extremely hard to improve the service and meet the requirements and recommendations from the last two reports. This has provided people who live in the home with a better service. What the care home could do better: The home has worked hard to meet the standards within this report. We have made two recommendations around good working practices relating to staff training and one around registration of the manager. These will be followed up at the next visit to the home. Key inspection report Care homes for older people Name: Address: Wyndthorpe Gardens High Street Dunsville Doncaster South Yorkshire DN7 4DB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Eileen Engelmann     Date: 1 2 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Wyndthorpe Gardens High Street Dunsville Doncaster South Yorkshire DN7 4DB 01302888141 01302882189 Wyndthorpe.gardens@fshc.co.uk www.fshc.co.uk Four Seasons Homes (No 6) Limited (A wholly owned subsidiary of Four Seasons Healthcare) Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Pamela Glover Type of registration: Number of places registered: care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: One named service user under 65 years of age, on variation (V37384) dated 11th December 2006, may reside at the home. Two specific service users under the age of 65 named on variation applications dated 30th May 2003 and 27th May 2004 may reside at the home. Date of last inspection Brief description of the care home Wyndthorpe Gardens is a purpose built care home for up to 38 older people with dementia or mental disorder. The service provides care for people with nursing needs. Care Homes for Older People Page 4 of 31 Over 65 38 38 0 0 0 1 0 9 2 0 0 9 Brief description of the care home The home is within the same grounds as Wyndthorpe Hall in the village of Dunsville near Doncaster. There is ample car parking space to the front of the home. Accommodation is on two floors, accessed by a passenger lift and stairs. All bedrooms have en-suite lavatories. There are communal rooms on both floors. On the ground floor the doors from communal areas open on to a large terrace with access down a slope into a walled garden with paths and seating. Information regarding the service is available from the home in the form of a pack containing a brochure, and the latest CQC inspection report is available from the manager on request. The manager confirmed that as of the 12 May 2010 the fees ranged from £435.93 to £650 per week including the nursing care component. Hairdressing, chiropody and newspapers are not included in the fees and are charged extra. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Information has been gathered from a number of different sources over the past 10 months since the service had its last key inspection visit on 27 July 2009, this has been analysed and used with information from this visit to reach the outcomes of this report. We carried out an unannounced visit to the service on 1 September 2009. This was done by our Pharmacy Inspector to follow up concerns about medication storage arrangements and record keeping identified at the key inspection on 27 July 2009. The outcomes of this visit were, improvements had been made since the key inspection visit on 27 July 2009 and that people using the service could expect to receive their prescribed medications correctly as intended. Some further changes in medication storage arrangements and record keeping would provide further evidence of the efforts made in the home to maintain peoples health and well being through the safe and correct use of prescribed medications. Care Homes for Older People Page 6 of 31 Since our last key inspection visit on 27 July 2009 there has been a change in management for the service. The new (acting) manager is not currently registered with the Commission for Quality Care (CQC), but will be called the manager within the text of this report. This unannounced visit was carried out with the manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and peoples files, and records relating to the service. Informal chats with a number of staff and people living in the home took place during this visit and comments, where appropriate, have been put into this report. The manager completed an Annual Quality Assurance Assessment (AQAA) and returned this to us within the given timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We have received one formal complaint about the service in the last 12 months. This was about the care of a person using the service; it was investigated by the provider and resolved. There have been two safeguarding referrals made to Doncaster safeguarding team in the last 12 months (this is where someone raises concerns about the safety of a person using the service). The safeguarding allegations were around care practices and moving and handling practices. The safeguarding team have looked at both allegations, one has been investigated and resolved and the other is still being investigated at the time of our report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. We would like to thank everyone who spoke to us during this visit. Your comments are very important to us and ensure this report includes the views of people who use the service or work within it. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wanting to use the service undergo a needs assessment and are given sufficient information about the home and its facilities prior to admission. This helps them to be confident that their needs can be met. Evidence: Four peoples care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the person or their representative. Each person has his or her own individual file and the funding authority or the home, before a placement is offered to the individual, completes a need assessment. The home develops a care plan from the assessments, identifying the individuals problems, needs and abilities using the information gathered from the person and their family. Care Homes for Older People Page 10 of 31 Evidence: Information from the AQAA and discussion with the manager indicates that people in the home are of White/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. The home is able to offer a choice of staff gender to people who express preferences about care delivery, as they employ 4 male care staff in addition to a number of female care staff. The information about peoples preferences is recorded onto their care plan. Information from the training files and training matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, and have access to a range of more specialised subjects that link to the needs of people using the service. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of the care given on a daily basis. The home does not have any intermediate care beds and therefore standard six does not apply to this service Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of the people living in the home are being met by the service and staff. The medication at the home is well managed promoting good health. Evidence: As part of our visit we looked at the care and documentation for four people. On the whole the care plans detailed the needs and abilities of individuals and set out the actions required by staff to ensure peoples wishes and choices are respected and their care needs met. The plans looked at have been evaluated on a monthly basis and any changes to the care being given is documented and implemented by the staff. People and relatives are able to input to their plan and changes to their care is discussed with the individual where possible. In addition to this information there are risk assessments to cover daily activities of life, behaviour management plans where a risk to the person or others has been identified, and clear information about health and input from professionals and the outcomes for people. Care Homes for Older People Page 12 of 31 Evidence: At the time of our visit there was an ongoing safeguarding investigation about moving and handling practices in the home. The home has been asked to improve the moving and handling risk assessments for individuals as part of the investigation process. We found that this has been done and the moving and handling risk assessments and care plans for individuals included information on what type of hoist to use for different tasks, what size sling each person requires and the loop configuration for each sling. This will make the moving and handling of people safer. Entries in the care plans specify where individuals have dietary needs, including supplement drinks and specialist diets. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. The nurses within the home carry out specialist tasks such as catheter care and wound dressings. Pressure areas are monitored carefully and proactive measures include risk assessments and special mattresses/beds and seat cushions. The service has made a start on assessing individuals as to their capacity to make their own choices and decisions around care with regard to the Mental Capacity Act legislation. Discussion with the manager indicated that at the moment no-one using the service requires a deprivation of liberty assessment doing for restriction of liberty or facilities. People said that they have good access to their GPs, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. We found that one person whose care we looked at has specific moving difficulties. This individual has been seen by the Occupational Therapist and has been supplied with a specialist shower chair and armchair to make their life more comfortable. In our last key inspection report of 27 July 2009 and the random inspection visit of 1 September 2009 we made four requirements around medication Ensure correct prescription and administration of all medication. Ensure safe and correct recording of as required medication. Arrangements must be put in place to ensure that medication records are made in an accurate and timely manner. This will help to make sure peoples health and well being is maintained by the correct use of prescribed medicines. Care Homes for Older People Page 13 of 31 Evidence: Arrangements must be put in place to ensure all medication is stored correctly and securely at temperatures recommended by the manufacturer. This will make sure that staff know medicines are safe to use when needed. Deep clean and tidy the medication room and trolleys. Checks at this visit found all the requirements have been met. Checks of the medication showed the home is using Boots the Chemist as their pharmacy supplier and the medication system in use is a Monitored Dosage System (MDS) where tablets are supplied in a pop out sheet. Since the random inspection visit on 1 September 2009 the home has made changes to the way it stores and keeps its medication. The medication room is now only used for the storage of medicines and is supplied with sufficient cupboards and locked cabinets to keep these safe and secure. Staff are recording the temperatures of the medication room and fridge. This ensures that all medicines are stored correctly at the temperatures recommended by the manufacturer. Checks of the medication records showed these are up to date and accurate, including those for controlled drugs and refrigerated items. Chats with people revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Our checks of the care plans showed that the home completes risk assessments for activities of daily living to ensure people are kept as safe as possible, whilst accommodating their decisions and choices around their day to day care. Observation of the service showed there is good interaction between the staff and people; with friendly and supportive help being given to assist individuals in their daily lives. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are provided with choice and diversity in the activities and meals provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. Evidence: The home employs an activities co-ordinator who works Mondays to Fridays (30 hours in total). There is some flexibility in their hours to accommodate trips out, evening events and the occassional weekend activity. There are a range of activities taking place over the week, but these are decided on a daily basis and are dependent on the choice of the people using the service. The manager has arranged for an activities committee to meet every two weeks to discuss events taking place in the home. At the moment it consists of the manager, staff and the activity co-ordinator, but people using the service and relatives are being encouraged to participate in the meetings. The activity co-ordinator keeps a record of things that people have taken part in. We found that there is a range of different sessions which cater for both gender types, Care Homes for Older People Page 15 of 31 Evidence: these include hairdressing and hand massages, football games, reading, quizzes, music, dominoes and bowling. The home does not have its own transport facilities, but can arrange to hire vehicles when it wishes to take people on outings. One recent activity that has taken place was a visit by a pet therapy group, who brought a number of guinea pigs in for people to hold and interact with. Discussion with people using the service indicated that they had enjoyed this. A number of photographs taken by the staff indicated that it was an enjoyable day for everyone who took part. Information from the manager indicates that at the moment there are no in-house church services, but people can attend outside services as wished. One person living in the home attends Jehovah Witness meetings each week in the community. The home provides special meals and cakes for birthdays and helps people celebrate all major Christian festivals such as Easter, Harvest Festival and Christmas. Information from the care plans indicates that people have good contact with their families and friends. Staff told us that the manager has an open door policy for staff, relatives and visitors which works well and ensures people can talk about any issues they may have. Discussion with the manager indicated that she and the nurses have attended formal training on the Mental Capacity Act (MCA) and Deprivation of Liberty Standards (DOLs), and understood how these affected individuals within a care home. We were told that this training would be cascaded down to other staff members as part of their training programme. When we spoke to the nurses we found that they would like further sessions on the MCA and DOLs to ensure they understood fully what the legislation was about and how to use it in the workplace. This was fed back to the manager who said she would take this on board and see what other training was available. Leaflets with information about the current legislation and how to access advocates is on display in the home and copies are available from the manager. Staff who have completed or are doing their National Vocational Qualifications in care have received some training around equality and diversity matters, and disability discrimination legislation. This type of training ensures that staff have sufficient knowledge about human rights legislation, so they understand individual rights within the care home and out in the community. We recommended that the registered person should ensure that all staff receive training on equality/diversity and disability Care Homes for Older People Page 16 of 31 Evidence: discrimination. In our last key inspection report of 27 July 2009 we made a requirement The support people get when eating must be safe and dignified and meet the persons needs. Checks at this visit found the requirement has been met. An Environmental Health visit took place in the home in October 2009. There were a few areas for action highlighted on the report and evidence shown to us, during our visit, indicated these have now been met. The home has a 3* rating from the Environmental Health Team (the highest rating is 5*). We observed the lunch time meal on the downstairs unit. Meals are prepared by the kitchen staff and plated up by in the kitchen before being sent in a hot trolley to the units. Discussion with the kitchen staff indicated that they have peoples individuals likes and dislikes recorded in the kitchen so know what meals to prepare. Menus were seen in the dining rooms on wipe clean boards, as well as paper menus being available. The manager told us that work has been taking place to provide the menus in a pictoral format, which helps people with communication difficulties and memory problems make their choices known. Observation of the lunchtime meal showed that there are at least two different options of meals given out to people, including soft diets and those for diabetics. Staff told us that if someone did not like what was on the menu then there are always alternatives that they could have. Presentation of the meal was acceptable and specialist cutlery and plate guards are available. Staff were seen to be sat helping individuals with their lunch time meal. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that people feel that their views are listened to and acted upon. Evidence: The home has a complaints policy and procedure that is found within the statement of purpose and service user guide, it is also on display within the home. The policy and procedure are available in a variety of formats such as easy read, large print, audio and different languages, these can be provided on request. Information provided in the AQAA completed by the manager on 11 March 2010 states that there have been four complaints dealt with in the last 12 months. Checks of the the complaints records show that these are clearly documented and people have been responded to in writing. At our last key inspection on 27 July 2009 we made a requirement The home must put safeguards in place to minimise the incidents between people, who live at the home, which puts them at risk of harm or distress. Checks at this visit found the requirement has been met. The home has policies and procedures to cover adult protection and prevention of Care Homes for Older People Page 18 of 31 Evidence: abuse, whistle blowing, aggression, physical intervention and restraint and management of peoples money and financial affairs. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. There have been two safeguarding referrals made to Doncaster Safeguarding Team in the last 12 months (this is where someone raises concerns about the safety of a person using the service). The safeguarding allegations were around care practices and moving and handling practices. The safeguarding team have looked at both allegations, one has been investigated and resolved and the other is still being investigated at the time of our report. The home has worked closely with the safeguarding team to improve practices within the home, and taken action where needed to make changes. The staff training matrix given to us on 12 May 2009 indicated that the majority of staff have received training in safeguarding of adults from abuse. Additional training sessions are booked for July 2010 and this subject is part of the homes rolling programme of development/learning for staff. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment provides people with safe, comfortable and homely surroundings in which to live, that meet their individual needs and lifestyles. Evidence: At our last key inspection on 27 July 2009 five requirements were made The home must be kept clean and tidy. To ensure that people live in a safe and hygienic environment, that respects their dignity. Make bathrooms accessible, safe and fit for purpose. The home must improve all decor, maintenance, furniture and fittings that are worn, stained, dirty and of insufficient quality to meet peoples needs. This includes communal areas, bathrooms and bedrooms. The home must make sure the environment is kept in a safe state of repair, with adequate decor, furniture and fittings suitable to meet peoples needs. This includes the communal areas, bathrooms and bedrooms. Deep clean the servery and make it safe and fit for purpose. Care Homes for Older People Page 20 of 31 Evidence: Checks at this visit found the requirements have been met. Wyndthorpe Gardens is a purpose built home. It has two storeys and access to the upper floor is via a passenger lift or stairs. There are ten bedrooms provided on the ground floor and twenty five on the upper floor; all bedrooms are single rooms and have en-suite toilets. People using the service have access to a range of communal areas including three lounges/dining rooms and a quiet room. On the ground floor there are double doors from the dining room opening out onto a large terrace/patio area furnished with tables and chairs for sitting out in the good weather. A slope down to the lower walled gardens is provided with handrails, and both the terrace and garden areas are securely enclosed. This means that individuals who like to walk around the gardens can do so and remain safe. Since our last inspection on 27 July 2009 there has been a lot of refurbishment within the home. The lounge/dining rooms have been fitted with new carpets, curtains, comfortable armchairs and new dining tables. The ground floor shower room has been refurbished. The shower room on the first floor now has new blinds to the window and a privacy curtain across the inner doorway. There is a rolling programme of maintenance for the bedrooms and the home has its own maintenance person and access to further resouces from the companys regional estates personnel. There has been a moving around of facilities in the home in the last 10 months, the nurses have a new office which has been created from the old servery area. This office has a locked door and provides a secure site for documentation. A new, open plan breakfast area has been provided in the downstairs dining room. The medication room, which used be the nurses station as well, is now kept for storage of medication and associated paperwork. All areas that we saw were clean, tidy and free from odours. The laundry facility in the home is sited within a large, spacious room that is provided with clean and dirty areas for care of clothing and linen. There are three washers and three tumble driers in use, and all machinary is in working order. The home shares its laundry facility with its sister home Wyndthorpe Hall and Court, which is in the same grounds. The laundry staff told us that they use the laundry in the morning for the sister homes washing and in the afternoon the washing is done for Wyndthorpe Gardens. This helps stop laundry getting mixed up. Infection control policies and procedures are in place, and staff have access to good Care Homes for Older People Page 21 of 31 Evidence: supplies of aprons and gloves for use in personal care. The staffing matrix supplied to us on 12 May 2010 indicates that thirty-two percent of staff have attended infection control training in the last 12 months. This training is part of the rolling programme and information given to us during our visit indicates that the home plans to introduce an E-Learning programme on infection control for all staff, in July 2010. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff have a good understanding of the support needs required by the people using the service. This is evident from the positive relationships, which have been formed between the staff and people using the service. Evidence: Checks of the staffing rotas and observation of the service showed that the home employs nine staff from overseas. Discussion with the manager indicated that the home is an equal opportunities employer and there is a diverse mix in the staffing group. Discussion with the staff indicated that they work as a team to cover any sickness or leave and that on the whole there are sufficient staff on duty to meet the needs of the people they look after. At the time of this visit there were twenty-five people in the home and the staffing levels were as follows, in a morning there is one nurse on duty and five care assistants, in an afternoon there is one nurse and four care assistants and at night from there is one nurse and two care assistants. Information from the staffing rotas about the number of staffing hours provided, and information gathered during the visit about the dependency levels of the people using the service, was used with the Residential Staffing Forum Guidance and showed that the home is exceeding the minimum hours asked for in the recommended guidelines. Care Homes for Older People Page 23 of 31 Evidence: Fifty seven percent of the care staff at the home have an NVQ 2 or above in care and all new starters have to complete an induction which meets Skills for Care criteria. Staff have access to a mandatory training programme, as well as a range of other subjects which reflect the diverse needs of the people using the service. Training booked for this year includes Moving and handling refresher in May 2010, Safeguarding of Vulnerable Adults (SOVA) in July 2010, Fire Safety Awareness in May 2010, Safe handling of Medicines in August 2010 and Equality and Diversity in May 2010. The E-Learning programme is due to start in the home in July 2010 and subjects that can be accessed through this include Health and Safety, First Aid, SOVA, Infection Control, Fire and Food Hygiene. At our last key inspection on 27 July 2009 we made a requirement The home must ensure that staff have training in care needs specific to peoples needs, such as dementia training. Checks at this visit found that action has been taken to improve dementia care training in the home. We have put a recommendation in this report for the training to be developed further. Discussion with the manager indicated that the home has a training programme entitled Person Centred Care. This subject includes care and understanding of individuals with dementia. The majority of staff attended this training in 2009 and it is part of the ongoing staff development and training programme. Nurses who work at the home are registered for general nursing, but none have a Mental Health qualification. One person told us that she had attended additional training on dementia but would like to incease her knowledge around this subject. The manager told us that three staff are trained in Dementia Care Mapping, which is observation and understanding of interactions with people with dementia. The manager does not have a Mental Health qualification or background training in this specialism, and whilst we were informed that the deputy manager should have this qualification the post is currently vacant. The home is registered to take individuals with dementia or mental health needs, but Care Homes for Older People Page 24 of 31 Evidence: is lacking in staff with this specialist training/qualification. The registered person should ensure that new, qualified staff have a background or qualification in Mental Health and that further dementia care training is made a priority within the service. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. Evidence: Since our last key inspection visit on 27 July 2009 there has been a change in management at the home. The manager is in the process of applying to be registered with the Commission for Quality Care and this should be completed by August 2010. The manager has previously been registered with the Commission in another care home and has experience of working with older people. The manager is a Registered Nurse and has an active registration with the Nursing and Midwifery Council. She has completed her Registered Managers Award has support from the Four Seasons Regional Management team. At our last key inspection on 27 July 2009 we made a requirement Care Homes for Older People Page 26 of 31 Evidence: The home must have a system in place that monitors the quality of the services and environment people receive and live in. The home must take action when quality checks identify areas that need improving. Checks at this visit found the requirement has been met. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager and senior staff complete in-house audits of the home and its service on a monthly basis, and the nominated individual does spot checks and completes the regulation 26 visits. Feedback is sought from the people living in the home and relatives through regular satisfaction questionnaires, and the manager produces a development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. Checks of the finance systems within the home found that computerised records are kept for peoples personal allowances; the administrator on a weekly basis up dates these, and they are checked regularly by the provider company. Information from the administrator indicates the majority of people have their families looking after their financial affairs, and checks of the system show their relatives top up the persons individual allowance account on a regular basis. People who have asked the home to look after their personal allowances are able to access their money on request, and receipts are kept for any transactions. All monies are kept safe and secure; only the administrator or manager has access to the funds. At our last key inspection visit on 27 July 2009 we made three requirements The home must make sure staff safe practice training is up to date. So people receive care and support that promotes their health, welfare and safety. The home must make sure staff practices and the environment adhere to safe working practices at all times. So that people live in a safe and well maintained service. Make sure the hoist is safe and fit for purpose. So staff know the equipment they use is safe and suitable. Care Homes for Older People Page 27 of 31 Evidence: Checks at this visit found the requirements have been met. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding moving and handling, bed rails and daily activities of living. A health and safety management system is in place. There are weekly and monthly audits conducted, ensuring the home is fit for purpose. There is a rolling programme of maintenance and the maintenance person undertakes statutory tests as needed and contractors are used when required. Comprehensive service documentation and records are kept and reflected the information given in the AQAA (11 March 2010). Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 14 The manager should ensure that all staff attend training around equality and diversity, the mental capacity act and deprivation of liberty safeguards. So staff have the knowledge and skills to make sure that peoples choices and human rights are maintained and that any limitations on facilities or personal choice are only made following assessment, best interest meetings, risk assessments and discussion with the person concerned or their representative. The registered person should ensure that new qualified staff have a background or qualification in Mental Health and that further dementia care training is made a priority within the service. So that staff feel confident in their knowledge and skills to meet the specialist needs of people using the service. The registered person should ensure that the manager is registered with CQC by the end of August 2010. 2 30 3 31 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. 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