Inspection on 31/07/09 for Catherine House General Nursing Home

This is the latest available inspection report for this service, carried out on 31st July 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Catherine House General Nursing... 02/11/06

Catherine House General Nursing... 13/12/05

Catherine House General Nursing... 21/06/05

Catherine House General Nursing... 18/01/05

Catherine House General Nursing... 05/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Catherine House General Nursing Home Cork Street Frome Somerset BA11 1BL     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: Justine Button     Date: 0 4 0 8 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 35 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 35 Information about the care home Name of care home: Address: Catherine House General Nursing Home Cork Street Frome Somerset BA11 1BL 01373451455 01373455177 catherinehouse@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd care home 67 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommmodated is 67 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Date of last inspection Brief description of the care home Catherine House is a purpose built care home located in the centre of the town of Frome. The home supports three groups of service users; those needing personal care, general nursing and those with dementia care nursing needs. The first floor provides accommodation for people with dementia care needs and the second for those with general nursing needs. The third floor accommodates some people with general nursing needs and others receiving support with personal care only. All rooms are single occupancy with en-suite facilities. Each floor has its own communal space Care Homes for Older People Page 4 of 35 Over 65 0 67 67 0 Brief description of the care home including sitting rooms, dining areas, one smoking room and adapted bathrooms. The dementia care floor has direct access to an outdoor courtyard with seating and raised beds. There is also garden access to the rear of the home that has a ramp and seating. In addition to this there is a large room on the ground floor, which is used for social events, meetings and staff training. The reception, kitchen and offices are also found on this floor. The service provides an in-house laundry service. The lower floor of the service is currently used at times as staff accommodation and is not occupied by service users. The current fee levels at the home are £512 for personal care up to £688 for private nursing care this does not include £106 Funded Nursing Care. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This Key unannounced inspection was carried out over two days by one inspector. In addition a member of the Helath and Safety Executive accompanied us on one day of the inspection. The purpose of this was to enable the individual to obtain an understanding of the inspection process performed by CQC. Agreement from the manager was obtained at the beginning of the inspection for the HSE to accompany us on our inspection. The Manager was available on the day of the inspection. The inspector would like to thank the manager and the duty staff for their time and hospitality shown to the inspector during their visit. The focus of this inspection visit was to inspect relevant key standards under the CQC Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: excellent, good, adequate and poor. These judgment descriptors for the seven chapter Care Homes for Older People Page 6 of 35 outcome groups are given in the report. Records examined during the inspection were care and support plans as part of the case tracking process, medication administration records, maintenance records, the homes Statement of Purpose, staffing rosters, menus, the homes complaints file, staff recruitment files, staff training records, quality assurance processes and staff supervision records. The inspector also conducted a tour of the premises. Prior to the inspection we sent out a number of comment cards/ surveys to people living at the home, some of whom had their relatives support to complete these. In addition we received a number of surveys from staff who work at the home. Comments from the surveys have been Incorporated into the report. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: A number of issues were identified during this inspection. The care planning process needs to be developed to ensure that it adequately reflects the current care needs of the people living at the home. This should include ensuring that risk assessments are up to date. Consideration needs to be given to developing a risk assessment for ingestion of chemicals The management need to ensure that the health care needs of people living at the home are met in all areas. This includes a regular change of position to prevent pressure damage to skin, regular oral hygiene and access to fluids and a nurse call bell. The home is currently without an activities organiser due to staff sickness. As such the provision of social and recreational opportunities is compromised. The management need to ensure that all people at the home have the opportunity to undertake some Care Homes for Older People Page 8 of 35 recreational activities. A large number of people were nursed in bed. The majority of these people did not have access to music or television. Due to this the days must seem very long and unstimulated. The staff must consider the social stimulation of people in these circumstances On viewing the training matrix it was clear that a number of staff have not received up to date training in such areas as moving and handling, dementia care and health and safety. The management need to ensure that all staff have received up to date training as identified in the homes training matrix. During the tour of the building it was identified that some areas had a very strong malodour smell. Te management need to review this as a matter of urgency The health and safety of people living at th home may be compromised by poor systems with regard to moving and handling. The care plans seen did not contain enough detail in this area, staff training was not up to date nor had the hoists been regularly serviced. This now requires urgent attention. People at the home were at risk of the ingestion of chemicals. These were not securely stored for periods during the inspection. There is currently a risk of cross infection due to some staff not using correct protective equipment and the risk that toiletries are used for multiple people. It could not be confirmed if people are protected from the risk of scalding due to lack of hot water checks. 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 35 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 35 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 are considering coming to live in the home can access information that will assist them to make an informed choice. People who come to live in the home benefit from a needs assessment to ensure their needs can be met. Evidence: Staff at the home told us that all admissions, other than emergency admissions are preceded by an assessment by a trained person. The homes capability to meet a persons needs is carefully considered before an admission is made. Emergency admissions are followed by an assessment as soon as possible after admission. People met during the inspection were able to talk about their admission process and one person said she had been visited in hospital. People and their families are welcome to visit the home and the first month in the home is a trial period. The care documents seen contained comprehensive assessments and information from other health professionals. Care Homes for Older People Page 11 of 35 Evidence: Information is available for people before they come to the home and is presented in an attractive and easily understood format. The home also has a web-site that can be accessed. Fees are set out in the Statement of Purpose and all people in the home have a contract stating clearly the circumstances of their admission to home. Additional information booklets are provided to people on arrival at the home. Care Homes for Older People Page 12 of 35 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. Comments from people living at the home and their relatives were very complimentary about the care and support provided at the home. The care planning process needs to be developed to ensure that they reflect the care needs of people living at the home and give clear guidance to staff. The staff need to ensure that all aspects of peoples hygiene needs are met. This should include regular access to fluids, oral hygeine and shaving for the gentlmen who require it. Mediaction is on the whole well managed Evidence: The Feedback forms asked people living at the home Do you receive the care and support you need? and Do you receive the medical support you need ? All people who replied stated that they received good or excellent care. The surveys were very complimentary about the care and support they received from staff. Comments Care Homes for Older People Page 13 of 35 Evidence: included mum is always very clean. Staff are very caring I am always informed of any changes My father has had excellent care throughout his stay. I am very happy with the staff who are excellent patent and calm Two people were case tracked during the inspection and their care plans reviewed. Case tracking involves identifying individuals at the beginning of the inspection and comparing the care and support they receive with the needs identified in the care plan. An additional three care plans were viewed for individuals living at the home. The care plan for one individual on the nursing floor was seen. The care plan for this individual stated that he was at moderate risk from developing pressure ulcers. Pressure ulcers develop when a person spends too long sitting or lying in one position. People who are frail or who have underlying health issues are more at risk of developing these ulcers. The care plan stated that this individual had developed two ulcers. During further examination of the care records and from observation of the individual it became that both these wounds had healed. This is positive for the individual concerned however the care plans need to be updated in more detail to reflect this change. This is particularly important for staff who do not know the individual well for example agency or apart time staff. The development and the healing of pressure ulcers is influenced by the dietary intake of the individual. Staff had completed a nutritional risk assessment. The care plan for the development of pressure ulcers stated that the individual had been prescribed nutritional supplements. The nutritional assessment and associated care plans for nutritional intake did not reflect that nutritional supplements had been prescribed. The care plan did not contain details of the supplements nor extra snacks that the individual should have. In addition the care plan did not contain enough detail with regard to the amount of fluids the individual required. The care plan stated encourage plenty of fluids. The care plan should have stated the amount and frequency that staff should have supported the individual to have fluids. The professional visits documentation showed that the individual had been seen by the dietitian however the recommendations made by the dietitian were not wholly reflected in the care plan. A moving and handling assessment had been completed by staff. It was not made clear in the care plan what equipment the staff should use to support the individual to change position or transfer from bed to chair. The care plan stated that bed rials were used to prevent the individual falling out of bed. The use of bed rails increase the risk of injury caused by entrapment or the individual trying to climb out of the bed. As such the bed rails need to be maintained and checked on regular basis. The care plan and risk assessment for this was ambiguous stating ensure bed rails are in good Care Homes for Older People Page 14 of 35 Evidence: condition regular checks when in bed . The plan should state how staff should check the bed rails and how frequently staff should check the individual when in bed. We observed the individual throughout the course of one day during the inspection. The individual was being nursed in bed. Due to the risk of the risk of pressure damage it would be expected that the individual would be supported to have a regular change of position (two to three hourly). Although staff supported the individual to change position this was only completed on approximately four hourly intervals. This was not in line with the plan of care which also stated that a change of position should be completed two to three hourly. This was confirmed by viewing the charts that were in place in the individual bedroom. It was observed that the individual did have appropriate pressure relieving equipment in place. It was noted on observation that the individual had not been supported to have a shave on the morning of the inspection visits. In addition the charts completed in the individuals room stated that the individual had been supported to complete oral hygiene. Although mouth swabs were available no toothbrush or toothpaste was evident. Dentist recommend that the most effective way of maintaining oral hygiene in frail people is to use a small amount toothpaste and a toothbrush (even if this is a childs soft brush). It was observed that the individual did not have access to fluids of a nurse call bell. It could not be confirmed if the individual had the supplements or extra snacks as recommended by the dietitian. No snacks were available of the morning or afternoon drinks trolley. Supplements were seen in the kitchen area but we did not observe staff giving these to the individual. The care and support plans for a second individual on the nursing floor were viewed as part of the case tracking process. A range of assessments and associated plans were in place. Again the plans were ambiguous and did contain specific details of the care needs of the individual. The plans did not state the likes and dislikes of the individual nor how the individual would like their care to be given. The care plan for continence stated support to go to the toilet regularly. The plan should have stated the frequency staff should support the individual to use the toilet facilities. The individual was at risk of not dehydration as she could not drink independently. As a result of this subcutaneous fluids (a drip) was in place. Due to this the care plan should have been very specific about the amount and frequency that the individual should be supported to have oral fluids. A moving and handling assessment had been completed which stated that staff should use an oxford hoist to transfer from bed to chair. The use of hoists requires a sling to be used. Slings come in different sizes dependent for example on the weight of the individual or underlying health conditions. The moving and handling assessment did Care Homes for Older People Page 15 of 35 Evidence: not state the sling to be used. The care plan for moving and handling stated that the individual was mobile. This clearly contradicted the moving and handling assessment. On observation it was very clear that the individual was frail and would no longer be able to mobilise. The care plans and risk assessments need to reflect the current needs of the individual. It was clear from the nutritional assessment that the individual had experienced some recent weight loss and reduced appetite. The care plan did not clearly explain what action the staff should take in response to this. In addition it was clear that the individual had been refusing to take prescribed medication. It could not be confirmed if this issue had been discussed with the GP. The individual was observed through the course of one day. As the individual was nursed in bed and had a reduced appetite and weight loss the person would have been at risk of developing pressure ulcers. As such a regular change of position would be required. This was not seen on the day of the inspection. The individual however looked clean tidy and well cared for. Staff were observed giving fluids at times through out the day. Staff were observed supporting one person from wheelchair to an arm chair in the lounge. The care plan for this individual was viewed. This care plan stated that the individual could partially weight bear. This was observed during the transfer. The care plan however stated that the individual could be resistive to care and as such this would increase the risk when supporting the individual to transfer. The care plan was not specific in that it did not give staff clear instruction or guidance on how to assess the individuals ability to make the transfer successfully. The plan did not state what alternative equipment should be used in these circumstances. This could place both staff and the individual at risk of injury during the transfer. A number of bedrooms were seen during the inspection. It was noted that a large proportion of people on the nursing floor were frail and as such were nursed in bed. A number of these people did not have access to fluids or a nurse call bell to enable them to summon help and support from staff. A number did not access to tooth brushes or paste to complete oral hygiene. A number rof the gentlemen had not been supported to have a shave. Care plans for people living on the dementia floor were also viewed. On the whole these were completed to an adequate standard. It should be noted that none of the care plans included a risk assessment for ingestion. (See outcome area for environment). The care plans on the dementia care floor contained more details of the Care Homes for Older People Page 16 of 35 Evidence: individuals likes and dislikes and day to day routine. This would enable staff to deliver the care and support in the way in which the individual would like. The care plan for one individual was seen as part of the case tracking process. This individual had had a recent admission to hospital and as such his care needs had changed. The individual had developed a pressure ulcer whilst in hospital. The care plans and assessments had been reviewed on return from hospital and on the whole reflected the individuals current care needs. The individual however had diabetes. The care plan stated the signs and symptoms the individual may experience when having a hypoglycemic attack however did not state what the individuals normal blood sugar. This should be documented. It should be noted that none of the care plans viewed detailed any information with regard to the Mental capacity Act. The Mental Capacity Act 2005 provides a statutory framework to empower and protect vulnerable people who are not able to make their own decisions. It makes it clear who can take decisions, in which situations, and how they should go about this. This is therefore particularly applicable to people who have dementia It was noted that on the dementia care floor the registered nurse in charge communicated well with the care staff. The nurse regularly met with the care staff to ensure that she was updated with any issues that had arisen during the shift and ensuring that she delegated clear instruction to individual staff on what was required. For example it was identified that one person had not been drinking well that morning. The nurse identified one staff member to ensure that they observed the individual every hour and ensured that a drink was given. This would ensure that the needs of the person living at the home were met. All people living at the home are able to remain with their own GP, where possible. An arrangement has been established with the local GP providing regular support and weekly visits to those registered with the practice. All people living at the home have a GP review every three months in addition to community nursing reviews. A number of health professionals visit the home, both privately and through the NHS. The manager has access to a range of local health services and professionals as required via GP referral. Medication was viewed on the nursing floor during the inspection visit. Medication was on the whole well managed. A number of out of date equipment such as needles for taking bloods were found to be out of date. This was highlighted to the nurse in charge who agreed to dispose of these. It was noted that a number of prescribed creams and lotions were stored in peoples bedrooms. These did not have a date of opening. Most creams and lotion have a shelf life once opened. It could not be Care Homes for Older People Page 17 of 35 Evidence: confirmed therefore if the creams and lotions should continue to be used. Staff were observed conducting all personal care needs in private. People liivng at the home told us that staff always treat them with privacy and respect Care Homes for Older People Page 18 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home do not have opportunities for their social and recreational interests to be met. People living at the home are able to meet friends and family. The opportunity to make choices is limited with regard to social and recreational opportunities and with regard to some aspects of personal care. Meals and mealtimes are on the whole a pleasant experience. Evidence: Feedback forms from people living at the home asked Are there activities arranged by the home that you can take part in? The majority of people stated that activities and social opportunities were quite limited. Relatives feedback on the day of the inspection stated that they felt lack of activities was an issue and that this detracted from a sense of wellbeing. Comments included Mum spends too much time alone. Staff do not encourage her to leave her room. and Lack of activities an issue. perhaps someone popping into her room for a chat now and again would help her pass the time, there are limited actives at the moment therefore the days are long. Some Care Homes for Older People Page 19 of 35 Evidence: time could be devoted to just talking to people at the home. As previously stated a number of people particularly on the nursing floor were nursed in bed at all times. It was observed that a number of these people did not have access to radios or televisions. The only interaction or stimulation therefore would be when staff completed personal care or supported people with meals. This may increase the feeling of isolation and boredom. Information in the statement of purpose states that the home provides a structure range of activities There were no/limited social activities during the inspection. One staff member was observed playing ball games with some people who have dementia. This confirms the concerns expressed via the feedback from people living at the home and relatives. It was confirmed with the management during the inspection that there had been no activity organiser in the home for a significant period of time. This was due to staff sickness. Additional care staff had not been provided to undertaken this role. Staff spoken to during the inspection stated that they tried to complete activities but the demand for them to meet the physical needs of the people living at the home did not always allow this to happen. There was limited documentation available which demonstrated activities that had been on offer at the home. The management stated that they are seeking to recruit an activities organiser in the near future in order that social and recreational opportunities are re commenced at the home. Visitors were seen at the home throughout the inspection. People stated that they were made to feel welcome by staff. The home has regualr visits from visiting clergy and communion is held regualrly. Staff were observed interacting with people. These interactions were observed to be good with staff appearing to have very positive relationships with the people living at the home. This was confirmed in the feedabck forms obtained. All the staff are very very good There are always staff members to assisst clients and family nothing is too much trouble People spoken to during the inspection stated that they were able to make choices and decisions with regard to their daily routine including getting up and going to bed. This was documented in some cases in the plan of care but not in all. It could not be confirmed during the inspection if people living at the home had chosen to shower rather than bathe or if staff offered this choice.This was not documented clearly in the plan of care. It could not be confirmed how people made choices with regard to the meals that they recieved. When asked via the feedback forms Do you like the meals Care Homes for Older People Page 20 of 35 Evidence: at the home? All people who replied confimed that they did. People during the inspection visit also confirmed this. Comments included food is presentable and good choice is offered. Lunch was observed during both days of the inspection visit. It should be noted that on one day of the inspection visit fish and chips were served no condiments (salt, vinegar or sauces) were available on the table. Menus were on display on one table only. This was not readily accessible to the people living at the home. The home caters for some people who have dementia and as such they may difficulty in making choices or remembering what choice of food they have made. Addtionally some people living at the home cannot verbally express their choices. Staff could develop a system were they plate up the choices and show these to people who can then make a choice. Alternatively staff could develop pictures and photographs of the food again enabling people to have a greater understanding on what is being offered. One staff member was observed plating up the food from the hot trolly when it arrived from the kitchen. Staff were however not ready to support people with thier meals and so the food could get cold. A number of people required staff support at meal times. Staff sit down when they support people to eat however one staff member was observed to leave an indivdual that they were supporting three times in order to go and support someone else. In addtion it was observed that one staff who was supporting one indivdual It is advised that food is not plated up until staff are available to support one person at a time even if this means that some people do not get thier meal until a later time. This allows staff to ensure that they have the time to spend with people during meals and ensures that meal times are a pleasant experience for all. This time also allows staff to monitor dietary intake more effectively which will promote the general health of people living at the home. The reaming people requiring assistance were aided thoughtfully For one person who did not eat much of their lunch the care staff asked if she wished to have anything different and this was obtained. The home provides a number of specalist meals for those with swallowing difficulties. This includes soft or liquidised diets. The constituent parts of the soft meal are served as seperate portions. This enables people who are having the meals to taste each componate. One staff member was observed mixing all the separate prtion together prior to supporting the indivdual to eat the meal. This is not in line with good practise recommnedations. The staff member did not communicate with the indivdual what they were eating. Another staff member however was observed having good communication with a person liinvg at the home. This staff member for example was saying would you now like some carrots? there is now some meat and potatoes on the fork, would you now like a drink? The management need to ensure that all staff offetr the same level of care and suppor tin this area. As Care Homes for Older People Page 21 of 35 Evidence: previously stated in the report staff need to ensure that people have access to fluids at all times through out the day. The morning coffee trolley and afternoon tea trolley were observed during the inspection. These contained cakes in the afternoon and biscuits in the morning. There was no alternative, on the trolley, for those on specialist diets who may not be able to eat these items. One family did stated however that staff sometimes gave their mum yoghurt in the afternoon. The management at the home stated that alternatives are available for those on specialist diet or for those people who do not want cake or biscuits. The management team need to ensure that staff actively offer an alternative. Care Homes for Older People Page 22 of 35 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 systems and procedures in the home to protect peole from abuse. People living in the home can be confident that their concerns and complaints will be listened to. Evidence: During induction staff receive information about safeguarding adults and must sign to say that they understand this and the Whistleblowing policy. The home has copies of the local authority guidance Safeguarding Adults in Somerset and key staff are familiar with actions to be taken. There is a register kept of any complaints and there was evidence that any issues raised by people who live in the home (or their relatives) are dealt with promptly by the management team. No complaints have been recieved since the last inspection. Often issues are resolved by email or telephone call before a formal complaint is required. This was confirmed by people living in the home. Feedback from people living at the home when asked do you know who to speak to if you are not happy? All people stated that they would speak to a staff member or the manager if they had any concerns. Comments from relatives included A wonderful home no complaints. Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to personalise their bedrooms. The home is fitted with an appropriate range of aids and adaptations. The standard of cleanliness is overall good hwowever some areas required attention on the day of the inspection. The home does not have systems in place to reduce the risk of the spread of infection in all areas. Evidence: A tour of the building was completed during the inspection visit. This included the majority of communal areas and some bedrooms. The home was purpose built 12 years ago and as such is now requiring some decoration and updating. The outside of the building is in need of the removal of some of the ivy and repainting. Some of the communal areas are looking tired with scuffed and marked paint work or damaged wall paper. This was particularly evident in one of the dining rooms where some repair to the plaster work is required. The home employs domestic staff. The standard of cleanliness on the day of this inspection was good in the majority of areas. Some significant malodorous were noted on the first day of the inspection. Cleaning staff had masked the smell via the use of air fresheners however this only added to the Care Homes for Older People Page 24 of 35 Evidence: general over riding smell. This was raised with the home manager at the end of the first day of the inspection. On the second day it was noted that domestic staff were completing some carpet cleaning. Two comment cards received did make comment to the institutional smell in some areas. The management need to consider these comments and ensure that the malodours are kept to a minimum at all times. This may include the replacement of some floor coverings if necessary. Equipment such as adjustable beds have been replaced as required and the manager told us that they have all the necessary equipment to meet the needs of people living at the home. It was noted during the inspection that the servicing of the hoists used for the movement of people was overdue. This may effect the health and safety of both people living at the home and staff. The home does not take appropriate steps to reduce the risk of the spread of infection in all areas. Liquid soap and paper hand towels are appropriately sited throughout the home. Staff have access to a good supply of protective clothing. It was noted however that a number of the domestic staff did not wear the protective clothing provided. This may increase the risk of the spread of infection. During the inspection it was observed that the trolleys used by the domestic staff were left unattended in corridors. These trolleys contained a number of cleaning products that may cause a risk to health if ingested. People with dementia may be at increased risk of ingesting these products. There was no risk assessments in any of the care plans viewed for people with dementia with regard to the risk of ingestion. In the bathrooms it was noted that a number of personal toiletries were insecure. This included shaving foam, deodorant and bar soap. This may increase the risk of cross infection if these products are used for multiple people and again there is a risk of ingestion by people with dementia. To reduce the risk of scalding the homes policy states that staff should check the temperature of hot water in baths and showers before assisting people with personal hygiene. It should be noted that the temperature from the taps was within acceptable limits during the inspection however no thermometers were available in the bathrooms for staff to check this. There was no documented evidence in any of the bathrooms for hot water temperatures. All hot water taps are fitted with thermostatic valves and the maintenance man completes the necessary checks required for these and to reduce the risk of legionella. We sampled a few bedrooms and it was evident that people are encouraged to personalise their private space. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff may not have recieved all necassary training Staffing numbers are sufficant (with the exception of an activies organiser) to meet the needs of peope living at the home. Staff recruitment procedures are adequate Evidence: The home has a training matrix, which was viewed following the inspection. This contains a record of mandatory training. The home has not yet met the 50 target of care staff achieving a minimum level qualification of NVQ 2 in care, but staff are supported to undertake this training award. The training matrix was compared with the duty rotas that were also supplied to us. This showed that four staff who work on the dementia care floor had not received the southern cross dementia care training (Yesterday, today and tomorrow). Seven staff have not received fire training in the last year. Twenty staff have not received moving and handling training. One staff member who is responsible for the maintenance in the home and has therefore a diverse job role has not received recent training in moving and handling, infection control, COSHH and health and safety Eight staff have not received training in infection control, which given the previous comments in this report Care Homes for Older People Page 26 of 35 Evidence: may be relevant. The management now need to ensure that all staff receive all necessary training. Staff induction was viewed in detail at this inspection although staff told us in surveys received that their induction covered ever thing they needed to know to do the job when they started employment. The staff duty rotas were obtained during the inspection. These were viewed following the visit to the home. These showed that the home has sufficient number of staff on duty at all times. The floor providing nursing care has a registered nurse on duty at all times. In addition six care staff are available in the mornings with four being available in the afternoon and evenings. Two care staff are on duty at night. On the floor providing care and support to people with dementia one registered nurse is available at all times. In addition four (this sometimes rises to five) care staff available during day time hours with two being available on nights. A range of other staff including cleaners, cooks and maintenance staff are available. The duty rotas showed that some staff are working a relatively high numbers of hours. Some in excess of sixty hours per week. Staff have however opted out of the working time directive and it was evident that the manager ensures that all staff have two full days off a week. Comments received by staff were very positive about working at the home. A number however did comment on their rate of pay. A number stated that this was not competitive compared to other homes in the local area. The payment of staff is not within our remit however southern cross may like to note these comments. Comments received by people living at the home with regard to the provision of care and support given by staff was extremely positive and complimentary. During the inspection we viewed three staff recruitment files. These showed that on the whole robust recruitment checks including Criminal Record Bureau checks were completed. It was noted that for one person however a second reference was not received prior to the individual commencing employment Care Homes for Older People Page 27 of 35 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 well organised and the manager is competent and pro-active in her management style. Staff are supported and supervised to carry out their work. People living at the home cannot be assured of a safe environment and that systems are in place to rectify problems. Evidence: The Registered Manager, Ann Dawes has managed the home for a significant period of time . The Statement of Purpose confirms that she is a Registered Nurse with qualifications and experience in management. Staff spoken with felt able to approach the manager and felt well supported. One member of staff stated that the home had a good team and the manager is on top of things. Staff meetings are held monthly. Records seen confirmed that these are Care Homes for Older People Page 28 of 35 Evidence: usually well attended by most staff. Staff are issued with a copy of the General and Social Care Council code of conduct, as seen on staff files. The Statement of Purpose states that the manager sets time aside each month to meet with relatives. These meetings are currently not well attended. All surveys answered yes to the question do staff listen and act on what you say. A number of people stated that the home is well managed. and the manager and staff are approachable. Staff receive formal supervision. Staff confirmed this however it should be noted that some supervisions are behind schedule . The nurses supervise a group of care staff each and the manager supervises nurses and senior staff. Accident records were seen and these showed that any accidents or injuries are reported in line with best practice. the manager regularly audits any accidents that have occurred in the home. In addition we are regularly notified of incidents at the home in line with Regulation 37 of the Care Home Regulations. All records seen were very well organised and stored securely. A current Employers Liability Insurance certificate is displayed. During this inspection some concerns were raised with regard to the health and safety arrangements at the home. The care planning process could not confirm what arrangements were in place for all individuals living at the home with regard to the equipment used for moving and handling. In addition it was identified that a number of staff have not had training in this area. This risk is increased by the fact that the servicing of the hoists is out of date. This may place both people living at th home and staff at increased risk of injury. During the inspection the care planning process did not identify if any person living at the home was at risk of ingestion. Chemicals including toiletries, gloves, aprons and cleaning products were insecure and freely available to people living at the home. This may pose a risk particularly to people who have dementia. Issue were also identifed during the inspection with regard to infection control. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15(1) Care plans must be further developed to provide staff with more detailed information to meet individual social and psychological needs. All staff must have training to update in fire safety and moving and handling. 30/11/2007 2 30 18(1)(c)(i) 30/10/2007 Care Homes for Older People Page 30 of 35 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 1 13 systems should be in place to 14/09/2009 reduce the risk of cross infection. This should include the use of protective equipment by staff and ensuring that personal hygiene products are used for one indivdual only. To ensure that the spread of infection is kept to a minimum. 2 26 16 The home must ensure that malodours are kept to a minimum. This may include the replacement of some carpets if required This will ensure that people live in a clean and pleasant environment 13/08/2009 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 The assessments and 14/09/2009 associated care plans should be up to date in order that they reflect the current needs of the people living at the home and give clear guidance to staff. Care Homes for Older People Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that staff meet the needs of the people living at the home. 2 8 12 The health and personal care needs of people living at the home should be met at all times. This should include access to fluids, oral hygeine and a regular change of postion. To ensure that the health needs of people living at the home are met. 3 30 18 All staff need to complete all 13/10/2009 training to enable them to fulfill their job role This will ensure that people living at the home are supported by a well trained and competent staff team. 4 38 12 The management must 14/09/2009 ensure that the health and safety of people living at the home and staff is not compromised by the poor storage of chemicals and cleaning products. This should include a risk assessment for all people with dementia with regard to the risk of ingestion. Consideration should be given to lockable storage 14/09/2009 Care Homes for Older People Page 32 of 35 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 areas on all the cleaning trolleys. This will ensure that health and safety of people living at the home is not compromised 5 38 12 The management must have 14/09/2009 robust systems in place to protect the health safety and well being of people living at the home and staff. This should include the regular servicing of hoists. Staff training in moving and handling and increased information in the care plans with regard to moving and handling. This will ensure that health and safety of people living at the home is not compromised Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The care plans should demonstrate that due consideration to the mental capacity act has been given. The plans should detail if the individual has capacity to make decisions which may effect their lives. If people have been assessed as lacking capacity then the plan should clearly state who will make decisions on their behalf. A system of stock rotation should be implemented to ensure that out of date medical equipment is not used. Page 33 of 35 2 9 Care Homes for Older People 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 3 4 9 12 The date of opening on prescribed creams and lotions should be documented. It is recommended that the home ensure that people who are nursed in bed are not socially isolated. This could include the provision of music and/or television in bedrooms Dependant on personal preferences. Staff need to continue to develop system which enable people living at the home to make choices. This could include the development of pictures and photographs. This should include choices with regard to fluids and meals. It is recommended that meals are not plated up until staff are available to offer support to those who require it. It is recommended that condiments are available at meal times It is recommended that the management consider the upgrading of some of the decor both internally and externally. It is recommended that all staff receive regular supervision in line with Standard 26 of the National minimum standards. 5 14 6 7 8 15 15 19 9 36 Care Homes for Older People Page 34 of 35 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). 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