Inspection on 14/05/10 for Donnington House

This is the latest available inspection report for this service, carried out on 14th May 2010.

CQC found this care home to be providing an Good 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Donnington House 14/12/09

Donnington House 18/11/09

Donnington House 21/08/07

Donnington House 26/06/06

Donnington House 21/09/05

Donnington House 03/05/05

Donnington House 14/10/04

Donnington House 09/06/04

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Fairfields Country Rest Home

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Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Key inspection report Care homes for older people Name: Address: Donnington House 47 Atlantic Way Westward Ho! Bideford Devon EX39 1JD     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: Susan Taylor     Date: 1 4 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 33 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 33 Information about the care home Name of care home: Address: Donnington House 47 Atlantic Way Westward Ho! Bideford Devon EX39 1JD 01237475001 01237424540 donnington@stone-haven.co.uk WWW.stone-haven.co.uk Stonehaven (Healthcare) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Jennifer Mary Burrows Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 36. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: DementiaCode DE- maximum of 36 places Physical disability- Code PD- maximum of 36 places Old age, not falling within any other category- Code OP- maximum of 36 places Date of last inspection Brief description of the care home Donnington House is a large detached property situated in the seaside resort of Westward Ho! It has recently been extended and has increased its registration to 36 Care Homes for Older People Page 4 of 33 Over 65 0 36 0 36 0 36 1 1 0 2 2 0 1 0 Brief description of the care home older adults who may also have dementia or physical disability. The accommodation is on three floors. There is access between the floors by stairs, chairlift and a passenger lift. The majority of residents are accommodated in single occupancy rooms but there are two bedrooms which have shared occupancy. Fees charged ranged from £467.50 to £582.25 per week. Additional charges are made for chiropody, hairdressing, newspapers, private telephone lines and are variable according to individual needs. Care Homes for Older People Page 5 of 33 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: The quality rating for this service is 2 stars. This means the people who use this service experience GOOD quality outcomes. This was a routine unannounced key inspection to find out whether the quality of service people receive has improved. We (the Commission) were at the home with people for 8 hours. We looked at key standards covering;choice of home;individual needs and choices;lifestyle;personal and healthcare support;concerns, complaints and protection;environment;staffing and conduct and management of the home. During this visit we spoke with or observed the majority of people living here. We could not speak with some people because they have communication difficulties such as dementia. We looked closely at the care, services and accommodation offered to 3 people living here. This is called case tracking and helps us to make a judgment about the standard of care, and helps us to understand the experiences of people who live Care Homes for Older People Page 6 of 33 here. We looked at the care and attention given by staff to these people and we looked at their assessments and at their care planning records. We looked at the environment in relation to their needs and how their health and personal care needs are met. We also spoke with visitors to the home, with staff and with the provider. We visited some of the bedrooms of the people we case tracked and saw all service and communal areas of the home. Prior to the inspection the provider sent us their Annual Quality Assurance Assessment (AQAA) which gave us information about the home and its management and about the needs of people living here. This document asks for evidence in relation to what the home does well and what they think they can improve upon. In addition, we sent surveys to 15 people living here and 5 were returned. We sent 15 surveys to staff and 4 were returned. The feedback and comments we received are included in the report. In May 2010, the fees ranged between £467.50 to £582.25 per week for personal care. Additional charges are made for personal telephone lines, chiropody,hairdressing, newspapers and toiletries and these vary. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? The quality of life people experience has significantly improved as a result of a complete overhaul of the management of the home in the last 6 months by the provider. Devon Social Services lifted the suspension of placements to Donnington House in February 2010 as a result of the improvements seen. Decisions are being made with people best interests in mind as a result of training staff have had about the legal requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards. People are treated with dignity and their right to make choices or to be engaged and sociable has been improved as a result of the learning and new skills staff have obtained through training. This means that peoples sense of self and personal identity is better promoted and they are experiencing person centred care. Peoples needs are being assessed in terms of occupation, interest and capabilities, which would ensure that activities are person centred and appropriate for the Care Homes for Older People Page 8 of 33 individual. Staff are in sufficient numbers and now have the support, knowledge and skills they need, to meet peoples needs. Recruitment practices are have been tightened up and are now robust, which means that people are no longer at risk of being cared for by inappropriate staff. Practice is being monitored to ensure that people receive consistent safe care and systems have been introduced to further monitor the quality of the service. These have ensured that staff always follow the correct procedures, for example when dealing with accidents or diffusing inappropriate behaviour so that people are safeguarded. Peoples rights in terms of data protection of confidential information about them is now being met. The provider has changed how peoples records are kept so that they are secure and only certain authorised people see them. The Commission is regularly kept informed in relation to all incidents, accidents and deaths in the home, and is in a better position to make a judgment about the management of these, which has been approriate. Peoples independence is better promoted through the use of equipment such as plate guards. Additionally, the fitting of a prompt board has ensured that people with dementia have the best chance of orientation to the environment they live in. Infection control audits have taken place and practice improved so that people that live in the home and staff that work there are better protected from the risk of infection. Financial management systems are now taking account of the needs of people that lack capacity. Staff are putting their learning into practice to ensure that decisions are always in peoples best interests and are involving advocates in monitoring how money is spent on an individuals behalf. A new manager has been appointed and has been working at the home since March 2010. The overall management of the home has significantly improved and has resulted in peoples health and welfare needs always being assessed and generally met. The assessment, care planning and communicating systems in place are now sufficiently robust to ensure that care staff have the information they need about peoples care needs and how these should be met. Additionally, there has been a shift away from institutional practices towards person centred care. The manager must now register with the Commission and we have extended the timescale of the legal requirement so that this is met and people are confident that this person is accountable to the regulatory body. What they could do better: We have made recommendations about the following: The assessment process needs to take better account of the diversity of people and the relationships they have to ensure that this is an inclusive process that does not marginalise some people, for example individuals in civil partnerships. Direct advice should be sought, as necessary, from the speech and language therapist, Care Homes for Older People Page 9 of 33 to ensure that best practice is always followed for people with swallowing difficulties to ensure that the risk of choking is minimised. Put in place arrangements to make sure that for all medicines prescribed with a direction when required or with a variable dose there is clear, up to date and detailed written guidance available to staff on how to reach decisions to administer the medicine and at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. This will help to make sure that there is some consistency for people in the home to receive medication when necessary and in line with planned actions. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 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. Improvement of the assessment process has ensured that people experience more person centred care. Evidence: Donnington House has a statement of purpose and service users guide providing prospective residents with information about the service. 100 percent (5) of people responding in a survey verified that they had been given this information at the point of moving into the home. We spoke to an individual about their experiences moving into the home and asked them about how well their needs were known and being met by staff. The person told us that the manager came to see me and asked lots of questions. Information about the individual was documented in a detailed assessment and highlighted all of the needs that the person had spoken about. Care Homes for Older People Page 12 of 33 Evidence: We saw that assessment information had also been obtained from the placing authority. Important information had been translated into the risk assessments and care plans completed for the individual. For example, the person had some limitations with their mobility and their care plan reflected this. A manual handling assessment had been done giving detailed guidance about how this person should be moved safely, whilst at the same time promoting the individuals independence. We spoke to a relative of this person who told us that they had been given a statement of purpose and guide about the home - very comprehensive information in comparison to other places visited. The relative verified that the manager met with their relation to discuss his needs and agree a care plan and said that there had been lots of questions finding out all about him, whether he would want to stay at home if he was ill or to go to hospital. It was very good. We read a letter on file confirming that the service was able to meet this persons needs at the point of admission to the home. Contracts had been agreed with the individual and their advocate on admission. This demonstrates that the team involve relatives, when an individual does not have the capacity to obtain information about their life, health and social care needs which is good practice. We spoke to the manager about the assessment process, which could be further improved to recognise the diversity of people. For example, the assessment proforma has a question about marital status that may not prompt the assessor to establish information about other important relationships that people may have. This also has the potential to discriminate people. We have made a recommendation about this. The responsible individual verified that Donnington House does not provide an intermediate care service. Care Homes for Older People Page 13 of 33 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. Improvements have ensured that peoples health and welfare needs are being met. Peoples care is planned in a much more person centred way that treats them as individuals and they are treated with dignity. Evidence: In a survey, 100 percent (5) people responding verified that staff generally listen and act on their wishes. We observed kind and caring interactions between staff and people living in the home. In the AQAA (Annual Quality Assurance Assessment) the provider tells us that all of the staff have either completed or are in the process of doing dementia care training. We observed that staff responded well to people and engaged them in conversation when otherwise they might have been isolated and withdrawn We casetracked 3 people to establish what their experiences of care are like at Donnington House. All of the care plans for these people have been reviewed, since the last inspection, and generally provide care staff with the correct and detailed information that they need to meet peoples needs. Care Homes for Older People Page 14 of 33 Evidence: We case tracked a person with complex physical care needs who was at risk of choking due to swallowing difficulties. There was a detailed care plan about how medication should be handled for this person and records demonstrated that this had been reviewed with the GP so that the individual was now having this in liquid form. The care plan stated that the person should be sat upright when being given their medicine to avoid choking and staff followed this approach. However, some information was missing from the care plan about the type of food and drinks the person should have to avoid the risk of choking. We checked with staff and they told us that on good days they offer this person items of food such as meringue or chips, as was seen on the day we inspected. This may be contrary to the specialist advice and may put this person at risk of choking. We observed that the person needed more help with their food and was fed using a dessert spoon. This was done slowly and at the pace of the individual, however the person started to cough indicating that they might be choking. Staff responded to this quickly and appropriately. We spoke to the manager about this incident and asked whether the person had been assessed by a Speech and Language Therapist. The manager verified that this had been recommended at a recent review and is being followed up. We also spoke to the manager about the training staff have had with regard to nutrition and diet. This is because we had seen that a dessert spoon was used when best practice indicates that a tea spoon should be used when feeding someone. She verified that the training staff have done covers specialist and non specialists feeding techniques, however in light of this feedback would seek further training for staff from the Speech and Language Therapy department and started to do this during the inspection. We casetracked a person whose assessment highlighted that they are at risk of developing pressure sores and needing palliative care. The care team were working closely with a palliative care nurse specialist so that the person was receiving good end of life care. This person had a pressure relieving mattress on their bed and was sat on a pressure relieving cushion, which is good practice. We were told that staff are dressing a wound that had developed as a result of their poor health and condition. Some people are also cared for on adjustable beds which is also good practice. We spoke to a professional who was visiting this person, who told us that the community nursing service visits this person once a month. District Nurses have delegated the task of doing this persons wound dressing to 3 named staff in the home who have been assessed as being competent. Personnel files had written authorisation from District Nurses for staff to do this wound dressing and care records demonstrated that only these 3 staff do the dressing for the individual concerned. The professional told us that the wound was improving and that they are totally confident in the Care Homes for Older People Page 15 of 33 Evidence: staffs abilities to look after this person appropriately. We spoke to staff about pressure area care. They recognised the importance of observing for reddened areas and also measures to prevent sores developing for example moving person from side to side in bed carefully. They also described correct observations of blanching and non blanching skin that is an early indicator of when pressure damage is occuring. We saw pressure relieving mattresses that had just been delivered to the home. The manager said the matresses have been bought by Stonehaven and are for specific people. It is good practice for the provider to have a stock of pressure relieving equipment that can be used as individual needs dictate and will ensure known risks are managed appropriately. We read medley assessments that had been completed for all of the people we casetracked that had been regularly reviewed since we last inspected. This demonstrates that there is a good risk management system in place so that people do not experience developing pressure sores. The same person is also at risk of dehydration. We read records demonstrating that the persons fluid and food intake is being monitored. We saw that this person is eating and drinking well, for example we calculated that the individual had had 1300 mls on 13/5/10 and we saw that they are being offered drinks regularly. Fluids are not totalled up every day, and we recommended that this should be done so that staff are quickly aware of when this person is at risk of becoming dehydrated through minimal fluid intake. We tracked how this persons pain relief is managed. Staff were able to demonstrate through records, their knowledge and skills that best practice is being followed. They are working closely with a palliative care nurse specialist, who visits the individual regularly. We checked controlled medication that is held for the individual and is kept secure. Records demonstrated that staff were responding appropriately to the persons needs so that they were given pain relief regularly as prescribed. We met this person who was comfortable, well cared for and feeling a little better when we visited them. A visiting professional commented that the quality of care people receive is definitely improving. They told us that keyworking is in place and there are clearly identified teams upstairs and downstairs so we always know who to speak to and messages get followed and communication is very good. This is ensuring that people experience person centred care through good partnership working with other professionals. We observed that people are treated with dignity and respect, for example we saw Care Homes for Older People Page 16 of 33 Evidence: one person tell a carer that their dentures hadnt been cleaned that morning. The carer tried to respect this persons dignity by suggesting that they take them to their room so that the dentures could be cleaned. However, the person handed their dentures to the carer before this could be done. These were taken away, cleaned and returned to the individual quickly and discreetly. We observed how medicines are given to people generally. We established that practice has improved and is safe. We saw that the carer doing the medicines completely focussed their attention on the individual they were giving this to, gently encouraging the person to take medicine. We looked at the medication records for this person, which had been signed after the medication was given to the individual. We read that this person is prescribed Codeine Phosphate for pain relief as needed. The carer had a good understanding of this persons needs and observations to look for that would indicate when the individual was experiencing pain as they tended not to tell staff about this. Some of this information was seen on the Mar chart for this person. However, the manager needs to consider if it is safe to highlight particular dose times for pain relief medicines that are prescribed to be used as required as this could lead staff to only offer this treatment at the highlighted times. The way pain relief should be used is that the person is able to choose to have this treament when they need it as long as this is in line with the doctors directions. Care Homes for Older People Page 17 of 33 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 are experiencing a better quality of life as a result of more person centred care. Evidence: In a survey (5) people had mixed views about the availability of activities and whether these met their needs. People felt that an area for improvement was to have more activities. Similarly staff (4) responding in a survey suggested that a better menu and more trips on the bus and activities for people with dementia would improve the quality of life people experience. We decided to focus on this area during this inspection. Information sent to the Commission by the provider (AQAA) tells us that life history information is being obtained for everyone living in the home. They tell us that trips out in the mini bus are being organised, as are more activities and that they plan to appoint an activities co-ordinator this year. We spoke to an individual about their experiences moving into the home and asked them about how well their needs in terms of hobbies and interests were known and whether these were being met by staff. The person told us that manager came to see me and asked lots of questions. Their relative who was visiting told us that XXX said Care Homes for Older People Page 18 of 33 Evidence: no to most things like hobbies, but he likes the radio, papers, books. Mostly reading they have other activities such as outings or events and activities. We looked at this persons care file and saw that the manager has introduced NAPA assessments, so that peoples quality of life is improved through person centred care. For example, this document provided staff with detailed guidance about how this person preferred to dress - casually - and their favourite colour for clothes. We observed that the person was wearing casual clothing in their favourite colour. This document takes account of whether people have capacity to make decisions about their lives and prompts staff to ensure that they always follow procedure where applicable. This means that there is a system in place for ensuring that peoples needs are known within the context of their whole life of preferences, relationships, interests and hobbies. Visitors are encouraged to be part of the community at Donnington House. A relative told us there is always plenty of people about. When I arrive Im always made to feel welcome. Always offered a cup of tea or a meal. We saw a poster on the wall advertising a Residents and relatives meeting on 13th May 2010 and had a discussion with people in lounge about this. This demonstrates that people are being consulted about the quality of life in the home - for example people told us that a person who used to be a bingo caller is going to do this in bingo sessions at the home. All of the staff demonstrated that they have a good knowledge of peoples interests for example, one person said he liked playing the clarinet. Another person said that its very nice here, all very kind. We were told that trips out are happening weekly though sometimes nasty weather has affected when people want to go out. One person told us that they went out a few days ago for a cream tea. We noticed that the lounge layout on the ground floor and Primrose Unit had changed since we last inspected. One of the people in the lounge told us that residents chose to move the lounge around we wanted a change because the sun was shining in peoples faces and the view is better this way round. This demonstrates that people have more autonomy about their life and that their views are listened to and acted upon. Additionally, a prompt board had been put up in the Primrose Unit that had up to date information about the menu choice at lunch time, names of staff, the date, day and weather for people to refer to. This demonstrates that best practice is being followed to ensure that people with cognitive impairment are enabled to be as independent as Care Homes for Older People Page 19 of 33 Evidence: possible with additional prompts in place to orientate them to time, place and person. We saw photographs on the wall in the lounge of the Primrose Unit, showing recent activities that people have been involved in. For example, there had been an event to celebrate St Georges day in which the home had been decorated in the English flag and there had been a party that people had enjoyed. The lunchtime meal was relaxed and we saw that people had plenty of choice. We saw that equipment like plate guards are used for people so that they can continue to feed themselves if they are physically disabled. People that needed help with feeding, received this help at their own pace and staff totally focussed their attention on the person they were feeding so that it was an enjoyable experience for them. Whilst at the same time ensured that the person had sufficient food and drink to prevent them becoming malnourished or dehydrated. As discussed under section 2 of this report, there are some areas such as specialist feeding techniques and assessments that could be improved upon. Care Homes for Older People Page 20 of 33 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. Peoples views are respected and they are safeguarded from abuse. Evidence: We looked at the complaint procedure for the home, which is in every persons bedroom. This provides clear information for people about the process. The contact details for the Commission have been updated. In a survey (5) people living in the home verified that they and or their relatives knew who to speak to if they are unhappy or need to make a complaint. Similiary, in the survey 100 percent of people responding verified that they are listened to and their wishes are acted upon. We spoke to a relative who told us that they are very satisfied with the care their relation receives. Surveys from 4 staff tell us that they all know what to do if someone wishes to make a complaint. The information given to us in the AQAA (Annual Quality Assurance Assessment) tells us that this home has received 1 complaint in the last 12 months about medication procedures not being followed, which the Commission was made aware of. This was thoroughly investigated and the disciplinary procedure followed leading to the dismissal of a member of staff. We spoke with staff about what they would do if they saw or suspected abuse. They told us they would tell the manager or the responsible individual for the company, which is good practice. A training matrix for the staff demonstrates that all of the staff have had training about recognising abuse and the procedures that must be followed. Care Homes for Older People Page 21 of 33 Evidence: We observed many interactions between staff and people living in the home, all of which were kind, caring and respectful. Similarly, people we spoke to described staff as being very kind and very sensitive and treat me well. We observed a very difficult situation, between two people in the sitting room area, with one person constantly shouting at another person and banging loudly on a table. Staff told us this happened frequently and they had sought advice from a Community Psychiatric Nurse about how to manage this behaviour. Staff coped with the situation very well and followed an agreed strategy to deal with the situation, which involved engaging the person in one to one conversation to resolve the situation. This meant that the person quickly became less agitated and the atmosphere of the room quickly returned to being calm and relaxed. Therefore, staff demonstrated that they have the skills and experience to deal with incidents appropriately so that they do not escalate and as a result people are protected from the risk of harm. Some people that live at Donnington House, lack capacity to make decisions about important events in their lives due to cognitive impairment. The team have worked in partnership with Social Services in the last six months to both improve their knowledge of applying the legal requirements of the Mental Capacity Act 2005. Senior care staff had completed Mental Capacity Act and Deprivation of Liberty Safeguards training and had used this knowledge to identify situations that required further assessment to ensure that decisions are being made in a persons best interest. Throughout the safeguarding process, highlighted in the last key inspection report, the provider and staff have been very professional and have used the feedback given in a constructive way that has significantly improved the quality of life people experience at the home. The team are commended for this. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, clean and well maintained home. Evidence: Donnington provides a homely environment for people to enjoy. A maintenance book demonstrated that routine maintenance and renewal of the fabric and decoration of the home is done. Since we last inspected, a protruding internal wall has been removed to make it easier for people to move around the home. We found that call bells are accessible in every room and that there is a lift to assist people when needed, in addition we saw grab rails and other equipment to assist people. We observed that a hoist is used by staff when moving the position of a person. Radiator guards are fitted throughout the home. A stock of pressure relieving equipment has been purchased since the last inspection and had been delivered on the day we visited. Therefore, the equipment in the home is suited to the needs of people that live there. Information sent to the Commission verified that 16 staff has done infection control training. We looked at the laundry and saw that there is a good system in place that ensures clothes and linen and washed separately for infection control purposes. Care Homes for Older People Page 23 of 33 Evidence: Similarly, we observed that linen and clothes are taken to the laundry in receptacles and clean clothing is returned to people the same day after being washed, dried and ironed. People looked well turned out in their own clean clothes. 100 percent of people in a survey commented that the home is always clean. Since the last key inspection, the number of cleaning hours has increased and systems put in place to ensure that equipment like commodes are cleaned regularly. Additionally, soap dispensers and hand towels have been fitted in toilets and bathrooms. We observed that staff follow best infection control practice and that people living in the home are encouraged to wash their hands after using the toilet or before eating a meal. Therefore, people are better protected from the risk of infection as a result of the measures put in place. Care Homes for Older People Page 24 of 33 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. Recruitment practices at Donnington House are robust and therefore protect the people living there. The training and development programme ensures that competent and knowledgeable staff cares for people. Evidence: In a survey (5) people responding verified that staff are always available to them. Their comments about the staff were positive such as they look after me and the carers are very good and they are kind and sensitive. Similarly, people that we spoke to said the staff always come quickly and are very pleasant and understand their needs. A relative said theres always plenty of people about. And a professional told us that keyworking is in place and there are clearly identified teams upstairs and downstairs so we always know who to speak to and messages get followed and communication is very good. We observed that peoples needs were attended to promptly and at the pace of the individual concerned. Other professionals have told the Commission that the atmosphere in the home is much calmer and people living there appear to be more relaxed. Therefore, staffing arrangements have improved and people are benefitting from care and attention that is person centred. We examined the files of 3 of the newest staff. Two satisfactory written references had Care Homes for Older People Page 25 of 33 Evidence: been obtained for all of the staff prior to employment. ISA (Independent Safeguarding Authority) checks had been undertaken and criminal records bureau certificates had been obtained before employment commenced. The home had a written procedure about recruitment and retention of staff and it was clear that these had been followed to protect the people living in the home. Information that the manager had sent us verified that a wide range of training had been provided over the last 6 months. Records demonstrated that 56 percent of the care staff had achieved the NVQ level 2 award in care or above. We saw individual training files, which contained further evidence of specialist training having been provided e.g dementia awareness. Induction records seen demonstrated that training meets the appropriate standards set out by the Skills for Care. We spoke to staff about their experience and training opportunities in the home and people verified that this was regularly offered to them. The training and development plan for the home contained information for the period 2010 -11 and reflected the needs of people currently living in the home so would ensure that staff have the knowledge and understanding to meet these needs. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well run home, where their views count and improvements are made. Health and safety is promoted and ensures that people living and working in the home are protected. Evidence: A new manager has been appointed and has 9 years experience in running a care home. The new manager is dual-qualified nurse (RGN and RMN). She also holds the Registered Managers Award, NVQ Level 4, has a Diploma in Health Education and holds a certificate for teaching and assessing. We observed that she is approachable, friendly and has an open-door policy of management style. The provider and staff tell us that the new manager leads by example and addresses issues at the time rather than letting them go by. We spoke to the manager about the application process for registration. They are currently collating the documents required and would be submitting an application for registration shortly. Therefore, we have extended the timescale on the requirement to Care Homes for Older People Page 27 of 33 Evidence: register a manager so that this is achieved. In the last 6 months the Commission has received comments from professionals who say the overall management of the home has significantly improved as a result of safeguarding processes. Systems have been put in place by the provider to monitor the quality of the service provided and in particular to observe the experiences people have living at Donnington House. This also includes questionnaires and audits of health and safety for example. The Commission was provided with a lot of information in a document entitled AQAA (Annual Quality Assurance Assessment). In it the provider outlined what the home could do better to improve the quality of life of people living there and how it would be done, in addition to explaining what had been improved. The provider was very open about what they had learnt as a result of the safeguarding process and worked in partnership with other professionals to improve the care delivered to people. All of the systems in the home have been overhauled to ensure the home runs efficiently and safely, and that people get the care they need. We found that systems are now robust enough to achieve this. For example we looked at the system for communicating peoples needs and changing needs, and for ensuring that peoples needs are met. Information sent to the Commission told us that this is achieved through the care planning system. We established that all of the care plans are written in a in a way that is consistent and of a satisfactory quality. Professional assessments are taken account of and records provide a good audit trail of how decisions are made for people and meet the legal requirements of the Mental Capacity Act 2005. Recruitment systems that the organisation have in place are being followed and this is ensuring that people are cared for by appropriate staff. The Commission is regularly being notified of all incidents that affect the welfare of people living at Donnington House. These reflect that appropriate action is taken to maintain the health and welfare of people. We looked at how equipment being used for the people we case tracked is maintained. PAT testing was up to date on the equipment we looked at in the rooms of the people we case tracked. Information sent to the Commission by the provider (AQAA) tells us that all of the equipment is regularly maintained. The manager told us that a maintenance person had been appointed who has considerable experience in Health and Safety matters and we were shown certificates that demonstrated this. Care Homes for Older People Page 28 of 33 Evidence: Confidential information about people living in the home is now kept in locked cupboards on each floor, which only staff have access to. Therefore, peoples records are being maintained in accordance with Data Protection Legislation We checked the financial systems for management of money for 3 people who we case tracked. All monies checked tallied with totals recorded. The manager told us that she is the only person with the code to the safe where monies are kept. Therefore, good practice is being followed with regard to management of peoples money. Comprehensive Health and Safety policies and procedures were seen, including a poster stating who was responsible for implementing and reviewing these. In information sent to the Commission, the manager verified that risk assessments are carried out. We saw various examples of this with regard to audits done, which included medicines, fire safety and first aid equipment. As we toured the building we observed cleaning materials were stored securely and used with by staff wearing gloves. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home, and staff told us that the alarm was regularly. A certificate verified that an engineer had checked the fire equipment. First aid equipment was clearly labelled. Nearly all of the staff on duty held a current first aid qualification. Risk assessments for the environment had been reviewed since the last inspection. Maintenance certificates were seen for the heating, electrical and fire alarm systems. The manager had verified in information sent to the Commission that portable electrical appliance checks had been done and we were told by people living there that an electrician had looked at their appliances. Therefore, we concluded that the health and safety of people living, working and visiting the home is maintained. Care Homes for Older People Page 29 of 33 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 31 8 The registered person must ensure that an application is submitted to register a manager for this home. This will help to ensure that people benefit from living in a home that is managed by a suitable person that oversees management systems that help to ensure peoples safety and well being. 31/01/2010 Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 31 8 The registered person must 09/07/2010 ensure that an application is submitted to register a manager for this home. This will help to ensure that people benefit from living in a home that is well managed by a suitable person. 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 2 3 8 The diversity of people and the relationships they have should be acknowledged as part of the assessment process. Direct advice should be sought, as necessary, from the speech and language therapist, to ensure that best practice is always followed for people with swallowing difficulties to ensure that the risk of choking is minimised. Put in place arrangements to make sure that for all medicines prescribed with a direction when required or with a variable dose there is clear, up to date and detailed written guidance available to staff on how to reach decisions to administer the medicine and at a particular Page 31 of 33 3 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 dose, taking into account the provisions of the Mental Capacity Act 2005. This will help to make sure that there is some consistency for people in the home to receive medication when necessary and in line with planned actions. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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