Inspection on 30/09/09 for Hawthorn Lodge Care Home

This is the latest available inspection report for this service, carried out on 30th September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hawthorn Lodge Care Home 02/10/08

Hawthorn Lodge Care Home 15/04/08

Hawthorn Lodge Care Home 13/11/07

Hawthorn Lodge Care Home 17/04/07

Hawthorn Lodge Care Home 27/04/06

Hawthorn Lodge Care Home 26/01/06

Hawthorn Lodge Care Home 24/06/05

Hawthorn Lodge Care Home 04/05/05

Hawthorn Lodge Care Home 09/12/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Hawthorn Lodge Care Home Beckhampton Road Bestwood Park Nottingham NG5 5LF     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: Karmon Hawley     Date: 0 1 1 0 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: Hawthorn Lodge Care Home Beckhampton Road Bestwood Park Nottingham NG5 5LF 01159676735 01159671815 managerhawthorn@regalcarehomes.com www.regalhomes.com Regal Care Homes Ltd care home 60 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: Within the total number of beds, a maximum of 30 may be used for the category DE(E) Within the total number of beds, a maximum of 60 may be used for the category OP Date of last inspection Brief description of the care home A copy of the most up to date report is found in both the managers office or the senior carers office. Hawthorn Lodge is a large home registered to provide personal care for up to 60 older people. It has several lounges and one large dining room as well as eating areas in some of the lounges. Some of the bedrooms are ensuite. There is a passenger lift to the first floor, making it accessible to any wheelchair users. The home is set in its own grounds with a pleasant enclosed garden. It is in a residential area with easy access to shops and bus routes. Care Homes for Older People Page 4 of 35 Over 65 30 60 0 0 2 6 0 5 2 0 0 9 Brief description of the care home There are hoists available for people who require hoisting and there are suitable bath and shower facilities available for people accommodated who need assistance with bathing. The fees for the service are dependent upon peoples assessed needs and are discussed at the point of enquiry. 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: The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people living at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service delivery that needs further development. A review of all the information we have received about the home was considered in planning this visit and this helped decide what areas were looked at. Two regulatory inspectors conducted the unannounced visit over 1 day, including the lunchtime period. One inspector then spent a further day at the care home concluding the inspection. The main method of inspection we use is called case tracking which involves selecting Care Homes for Older People Page 6 of 35 the care plans of six people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. As some people living in the care home have dementia care needs this has limited the number of their views and opinions that have been included in this report. We therefore used a specialist tool called Short observational framework for inspection (SOFI) this is a methodology we use to understand the quality of the experiences of people who use services who are unable to provide feedback due to their cognitive or communication impairments. SOFI helps us assess and understand whether people who use services are receiving good quality care that meets their individual needs. Two hours were spent observing the care given to a small group of people. All observations were followed up by discussions with staff and examination of records. The area manager, acting manager and four members of staff were spoken with during the visit. People using the service were also spoken with during the visit to gain their views and opinions of the service. We also undertook a full tour of the care home, which included looking at the bedrooms of those people who we case tracked and communal areas of the home. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? Staff now have a better understanding of safeguarding vulnerable people and the working practices that they must employ to ensure this. Improvements have taken place in respect of the activities and stimulation that are on offer to people using the service, ensuring that they experience a lifestyle that meets their expectations. Improvements in regard to involving people in the care planning process and reviews is taking place giving people the opportunity to be involved should they wish. Plans of care and risk assessments have improved, working towards ensuring that these are in place for specific needs and that they contain enough information to enable staff to support people in meeting their needs and keeping them safe. Staff practices have improved working towards ensuring that that people using the service are treated with respect and their privacy, dignity and right to confidentiality is maintained. Work has taken place to minimise and eradicate poor staff practice so that people using the service are protected. The complaints policy has been updated so that people have the correct information should they need to make a complaint. People using the service now feel that they can voice any concerns or complaints if they should have the need and that these will be listened to and acted upon. An assessment of the staffing levels has taken place working towards ensuring that staff are more readily available to support people using the service. Improvements in regard to the recruitment and selection practices has taken place working towards ensuring that people using the service are protected from unsuitable Care Homes for Older People Page 8 of 35 people being employed. Staff training has been improved upon, working towards ensuring that all staff have completed compulsory training and have the necessary knowledge and skills to support people using the service. Management, communication and documentation within the care home has improved working towards ensuring that peoples health, safety and well being are maintained. Additional checks have been put into place to ensure that the storage of documentation is better organised and more readily available when needed. Staff supervisions have improved, working towards ensuring that staffs training and development are monitored so that they are able to meet the needs of people using the service. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 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. The service is currently not admitting anyone into the care home due to a suspension of contract with the Local Authority, nevertheless processes to ensure that people are assured their needs will be met and that staff can meet these are in place in anticipation that the suspension will soon be lifted. The service does not offer intermediate care. Evidence: The service is currently not admitting anyone to the care home; however we can see that in the past the manager has visited people in the community to carry out a preadmission assessment to make sure that staff are able to meet peoples needs before a decision to move into the care home is made. In addition to this information is sought from a social worker if relevant and family to ensure that in depth information is available. Care Homes for Older People Page 11 of 35 Evidence: We can see that the processes for ensuring that peoples needs are assessed and that staff are able to meet these before they make a decision to move into the care home have been readdressed and improved upon in anticipation of the suspension being lifted. People can also visit the care home and spend time there to get a feel for what it would be like to live at the care home before they make a decision to move in. Staff spoken with offer the following comments; with new residents, we might find out before they come in, sometimes we come in on shift and someone new is here. The manager goes out to see people, we are told if they need one or two people for moving, personal care, if they need hoisting or anything like that. We are told verbally then we go through care plans and see what they need, and the manager assesses all new admissions, unless it is an emergency and they just arrive. They have to come with a social worker assessment. We encourage the staff to read the plans of care and I pass on verbal information. One person using the service tells us that they visited the care home before they moved in to make sure that they would like it. The service does not offer intermediate care. 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. People using the service are experiencing improved outcomes in this area, nevertheless their needs may not be fully met and they may not be fully protected due to the lack of information in plans of care and risk assessments in respect of dementia care needs. Evidence: The area manager and acting manager have spent time developing plans of care, working towards ensuring that these are in place for peoples specific needs such as maintaining a safe environment and diabetes. We can also see that work has taken place to ensure that there is information in regard to peoples life history, their favourite things, preferences and hobbies. This provides staff with personalised information, however this information is not fully used within plans of care to make sure that these are person centred and individualised. Some plans of care are pre generated and whilst they contain sufficient information they are not personalised for the individual to make sure that their individual needs are fully met. Care Homes for Older People Page 13 of 35 Evidence: To ensure that peoples rights and choices are maintained , we can see that the area manager has begun to assess peoples capacity to consent. Within one plan of care examined, we can see that this has been used in areas such as personal hygiene, expressing sexuality, risk taking and maintaining a safe environment to ensure people are both protected as necessary whilst making their own choices and decisions where able. Staff at the care home have been working with the dementia outreach team, a specialist team who work with people that have dementia care needs. This has resulted in plans to explore and develop specific plans of care for people with dementia care needs to ensure that they are fully supported in all aspects of their life. Nevertheless at present the plans of care in place and risk assessments only provide basic information as to how to support people with dementia and behaviour that may be challenging and they do not provide information as to how other people using the service will be protected from behaviour that may be presented. To monitor peoples behaviour staff use a help chart which outlines areas that may help or hinder peoples behaviour and fill in a behaviour chart. These contain brief information as to how people are supported but again do not outline how other people may be protected from their behaviour. Daily records show incidents of behaviour that may be challenging which affect other peoples safety, however they do not state the action that has been taken to resolve issues. Brief risk assessments are in place for highlighted needs such as falls however as mentioned above additional information in respect of behaviour that may be challenging is not available to ensure people are fully protected. We can see that plans of care are reviewed and that people using the service and relatives have been invited to be involved in this process, however the information documented following a review is very basic and is not of a personalised nature in all cases to ensure continuity of care. To improve on communication within the care home, new documentation has been implemented. One such form being a record of untoward incidents, the action that has been taken, who has been informed, specialist attention sought if necessary and the completion of a body map to record any injuries if appropriate. Care Homes for Older People Page 14 of 35 Evidence: Staff spoken with are able to discuss peoples needs and the support that they require, however some staffs knowledge in areas such as diabetes mellitus is limited. Staff are able to discuss how they deal with behaviour that may be challenging and some are aware of their limitations; I think there are people here whose dependency is very high, there is a mixture of people with dementia care needs and physical needs, I try to reassure people with dementia, keep them calm, make them feel comfortable, I feel pretty confident, however some people dont feel confident, they deal with it but their body language or expression says they find it hard, and we can not manage people who are really aggressive. People using the service spoken with feel that their needs are met. We can see that people are supported to access specialist service such as the doctor, district nurse, community psychiatric nurse and occupational therapist as needed to ensure that their medical needs are met. During the tour of the care home we can see that specialist equipment such as mattresses to assist the maintenance of healthy skin and hoists to assist people to move are available for those people who need them. People using the service tell us that they can access specialist services as needed; I can see the doctor when I need to, and the district nurse comes to see me to do my dressings. Staff spoken with tell us; I think peoples physical health is well looked after, most of the time we get reasonable support from the GP and district nurses. We do not have anyone with pressure sores here, it is preventable, most people have specialist mattresses, and we have people that are prone to falls, we cant do much about it, the falls prevention team have said this. On examining medication records we can see that people using the service receive their medication as prescribed, however there are times when medication may be out of stock whilst waiting for this to be delivered from the pharmacy. On examining medication records we did however see that some medication was missing and was not accounted for. This was investigated by the area manager who reported her findings back to us the following day. Staff who are responsible for the administration of medication had popped some tablets by mistake as the person was not in the care home at the time and did not need to have these administered. They Care Homes for Older People Page 15 of 35 Evidence: then proceeded to put these into an envelope, however did not put the persons name on them, nor record this in the drugs returns book, resulting in a loss of the audit trail. The area manager spoke with the members of staff concerned, has arranged updated training and put new policies into place to avoid this happening again. Medication audits are undertaken by the acting manager on a monthly basis, however this had not yet been picked up as it occurred in between the audit dates. Handwritten entries on medication charts are signed by two members of staff to show that these have been checked as correct and people receive the correct medication. Throughout the inspection we can see that staff practices have much improved and staff are now more respectful to people using the service. We did not see any issues of concern with the exception of the minor incidents noted during the specialist observation which are covered in the daily life and social activities section. We did however note that some people had dirty finger nails and their teeth were not clean, this was discussed with the area manager who stated that this was difficult with some people due to their willingness to allow staff to assist them. Staff spoken with are able to discuss how they ensure that peoples privacy and dignity are maintained. People using the service offered no concerns in regard to this area and stated that staff are kind and caring. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are now experiencing a lifestyle that is much more stimualting, however their choices may not always be upheld due to staff availbility. Evidence: An activities coordinator has now been employed who supports people using the service to participate in activities of their choosing. We can see that activities such as Bingo, films and reminiscence are available as well as regular visits from outside entertainers. People using the service tell us that more activities are now available which they enjoy; the activities are better now and there is more to do, which I enjoy, and I enjoy reading the paper and joining in the activities. On the day of the visit, we saw a reminiscence activity delivered by an outside entertainer take place. During this time and at other times during the day we saw people join in activities or spend their time either occupying themselves or sitting in their chairs Staff say that activities are provided nearly everyday now there is an activity Care Homes for Older People Page 17 of 35 Evidence: coordinator and these could be painting, entertainment, music, movie nights or bingo and some trips are planned but they have not been provided yet. Staff also tell us; staff need to have more time to talk with people and have fun with them, it is hard when we are short staffed and if we sit down with people it is thought as being lazy, but to do so increases the quality of life, it is important for them to have fun not just to sit and vegetate. It is sad when people are just left sitting in chairs. During our specialist observation we saw that people paid particular attention to the activities on offer and was watching the slide show attentively. We also saw that people using the service are mainly in a positive or passive state of mind. This means that when in a positive state of mind it is a sign of wellbeing and when passive there are no observable signs of well being but no signs of ill being either. People are awake and alert and may be watching what is happening around them or in their immediate vicinity but they are not contributing actively to this. We saw both good and neutral interaction between staff and people using the service. Staff were seen to be sensitive to peoples needs and offer reassurance and assistance when needed in all tasks. They asked peoples permission before they performed any task that may affect them and offered explanations when asked a question. Poor practice was only briefly noted when staff did not ask peoples permission when putting on protective aprons at lunch time and when one member of staff stood to assist someone to eat for a short period of time. As there are currently no church services held in house the activities coordinator is looking into re-establishing contacts so that people may pursue their religious persuasion should they wish. Also to ensure that people have access to the wider community trips outside the care home are currently being arranged. So that people can maintain contacts with those that are important to them there are no restrictions on visiting and visitors may be received in private. People using the service confirm this and tell us that their family are made welcome and can visit when they want to. Staff confirm that family are made welcome and we can see that good relationships are maintained when they visit. Both staff and people using the service tell us that the routine of the care home is flexible and that people may spend their time as they please. However some staff say that if they are short of staff this does affect peoples choices Care Homes for Older People Page 18 of 35 Evidence: in what they can do as there is a lack of staff available to assist them, one such comment being; people can express their rights and choices, but it depends on what they are asking for and the amount of staff that are in whether they get these upheld or not. One member of staff showed a good understanding of the Mental Capacity Act and Best Interest; we try to offer choice but some can not make that decision, as long as they have capacity we give them choice. If they have no capacity we try and involve the family, social worker, or GP. No one has an independent advocate that I know of. People using the service tell us that they are happy and well settled, they feel that they are well looked after and that the staff are nice and caring and help them when needed; the staff are very good, I spend a lot of my time outside and doing as I please, and the staff are very kind and caring, they look after me well. A wholesome and appealing menu is on offer to people using the service with choices available at each meal and specialist and cultural diets catered for. A new pictorial menu has been devised to assist people using the service to make a choice at meal times. Although we did not see this in use we did see that staff took round several plated up choices for people to see and choose from at the main lunchtime meal. We can also see that fresh fruit and homemade cakes and snacks are available if people wish to have these. People using the service tell us that the food on offer is good and plentiful and that they get choices; the food is nice, I can have what I want at meal times, I tend to ask for a salad, and the food is good, we get plenty to eat. Staff feel that the presentation of food has improved and that the choices are much better now. A new nutritional care plan has been developed with the assistance of the dietician so that it can be ensured that people receive a specialist diet and or supplements if required. We can see that people are weighed regularly and a food and drink intake chart is kept if necessary to monitor peoples wellbeing. Two members of staff spoken with are aware that some people using the service are on a special diet, whereas one member of staff did not, this was discussed with the area manager who tells us that all staff should be aware as this information is readily available in the kitchen. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are assured that their complaints will be listened to and acted upon, however they are not fully protected from abuse due to some staff not reporting concerns about poor practice to the management so that these may be dealt with and resolved. Evidence: To ensure that people know how to make a complaint should they feel the need to, the complaints policy has been made readily available to people using the service and their relatives. The service has not received any complaints since the previous inspection. Staff spoken with are aware of their roles and responsibilities in dealing with a complaint should one be received to ensure that these are dealt with. People using the service tell us, the staff are kind and helpful. I dont have any concerns, but if I did, I feel that I can talk to someone about it, and I have no problems, if I was concerned I would tell the manager, she is my friend it is well run I go to see her everyday. Since the previous inspection there have been more safeguarding referrals in regard to neglect and physical abuse. Whilst some of these have been investigated and resolved others are still under investigation. The area manager and acting manager Care Homes for Older People Page 20 of 35 Evidence: have continued to attend meetings and work with both us and the Local Authority in regard to improving standards within the service. The area manager has downloaded the Safeguarding Adults Guidance, it is intended that all staff will read this and sign to state that they understand the policy and their roles and responsibilities in safeguarding people. Although staff spoken with state that they understand their roles and responsibilities in safeguarding people, it became apparent that some staff are still witnessing poor practice, however they are not alerting this to the acting manager or area manager so that this can be dealt with; I have been unhappy with staff performance, I try and deal with it at the time rather than report it upwards. I have not had to tell staff off for swearing but I have for shouting and not shutting doors, some staff struggle to deal with some challenging behaviour and I have seen some staff act inappropriately, and I feel confident staff are maintaining good standards with the deputies keeping an eye on them, if not something could go wrong, there needs to be more hands on. As some people using the service have behaviour that may be challenging some staff have received training in this area and those spoken with are able to discuss how they would handle behaviour that may be challenging to ensure that people using the service are protected; I learned to deal with people as individuals and to try and understand why they are behaving like that, try to de-escalate the situation. One member of staff states that although there have been quite a few issues of concern in respect of safeguarding, this has made all staff more aware of the importance of their job role and keeping accurate documentation in the event of any concerns. Care Homes for Older People Page 21 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 live in a satisfactorily maintained environment, however the maintenance work that is required detracts from its comfort. Evidence: On arrival at the care home a distinct odour was present in the main entrance and some areas around the care home, this was discussed with the area manager who arranged for carpets to be cleaned and the following day when we visited, the odour had been resolved. The general environment remains unchanged and several areas still require work, such as the outside of the windows and tiled areas in some toilets and bathrooms, the providers are aware of this and have made long term plans to address these issues. During the tour of the care home we saw that infection control standards had not been fully maintained. The waste disposal bins in the toilets and bathrooms were dirty and had no lids and gloves and aprons were not readily available. The area manager showed us evidence to demonstrate that new waste disposal bins have been purchased to address this issue and she stated that arrangements will be made to ensure that gloves and apron dispensers are available in these areas. The area manager also demonstrated that plans have been made to put hand towels and hand washing dispensers in each persons bedrooms. We also saw that the laundry bins Care Homes for Older People Page 22 of 35 Evidence: with dirty linen had been left in the corridor which people using the service have access to. This was pointed out to the administrator who removed the laundry bins. People who smoke tend to do so outside, however arrangements for people to smoke in their rooms or flats should they wish are made, we can see that appropriate risk assessments are in place to ensure that people remain safe during this time, however the control of smoke emitting to other areas of the care home is not currently controlled. This was discussed with the area manager is stated she will look into the fitting of extractor fans. We can see that manual handling equipment such as hoists are available for those people who need it, however staff express that additional manual handling equipment would be beneficial to avoid people having to wait to use this equipment. Some staff spoken with tell us that more bathing facilities are needed, whereas others tell us that there are sufficient as people can use the en suite shower rooms instead of the communal rooms, which is better as they are more private. Two people using the service tell us that they have a nice room and staff keep it clean and tidy for them; I have a nice room and the staff keep it tidy for me, and I have a nice room, I enjoy spending time in there. One member of staff tells us that they think that the home is kept clean and tidy and that they have had training in infection control and they also feel that other staff are ok with infection control practices. Care Homes for Older People Page 23 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. People using the service are supported by staff who are working towards ensuring that they have all the required knowledge and skill to support them appropriately, however if a full staffing compliment is not available and this is not managed accordingly this may affect the quality of care that people are receiving. Evidence: On arrival at the care home the acting manager and area manager were at a meeting with the Local Authority, in addition to this two other members of staff needed to escort people to the hospital, this left the deputy manager and remaining staff low in numbers. Subsequently on our arrival the service was in turmoil and disorganised, which resulted in people arriving at the care home, such as the outside entertainer and district nurses, not receiving prompt assistance as required. One person was also left at the breakfast table with an uneaten meal in front of them until 11am and another was quite distressed trying to find someone to help them. This was discussed with the area manager on her return who stated that it was unfortunate that staff needed to leave the care home, one of which was due to an emergency; however she is in the process of addressing these issues of management concerns with head office. Once the staff had returned to the care home, it became more organised and relaxed and during our specialist observation we did see that staff are available to assist and support people as needed when the staffing numbers are at full compliment. Care Homes for Older People Page 24 of 35 Evidence: A new daily responsibilities chart has been commenced so that the person in charge can delegate jobs to staff and to supplement this a new allocation sheet has also been devised to show staff what jobs they are to do during their shift. People using the service tell us that the staff are kind and caring and available to help them when needed. Staff spoken with all feel that additional staff are required to ensure that there are sufficient for them to perform their job role to the best of their ability and ensure that people using the service receive the support that they require; staffing levels sometimes go below what is needed when people ring in sick. This is not regular but I dont feel numbers are sufficient, I think another 2 people are needed. This is about assisting people safely and at their pace. I think staff rush around to much and residents dont get the care they need, things get missed. I do feel that people have to wait for help. I have know staff ignore requests for help. I raise this with the manager and report them. I have not had to do this many times, we had issues with staffing levels before, it was not good, we are trying to work this out as it was due to sickness, we do sometimes use agency staff, sometimes when you are short staffed you feel pushed but we muck in and help each other, and we have been short staffed due to sickness and people not turning up, this has a lot of effect on work and affects the residents, they do not get the care that they should be getting, this mainly happens at weekends. I feel that lack of team work is what is letting the care home down and people not willing to help if it is not on their list of jobs. These issues of concern were discussed with the area manager who stated that she feels a lot of this is due to how staff spend their time and the general management of each shift, plans have already begun to address these issues and the management will now be working more on the floor. So that people are aware of their roles and responsibilities on commencing employment they undertake an induction which outlines these. The induction that staff now undertake is of a recognised standard and we can see within staff files that new staff undertake these. Staff spoken with confirm that new staff undertake an induction when they first start work at the care home. 17 members of staff have undertaken the National Vocational Qualification (NVQ - a nationally recognised work and theory based qualification designed to enhance peoples knowledge and skills in caring for people) level 2 and 9 are currently working towards this qualification. 3 members of staff have undertaken level 3 and 3 are undertaking this qualification. Staff spoken with confirm that they have or are Care Homes for Older People Page 25 of 35 Evidence: undertaking this qualification and state that it is helping to improve their knowledge and skill in supporting people using the service. On observing staff files we can see that they contain all the documentation required by law, such as a Criminal Record Bureau check and identification is available to make sure that people using the service are protected from unsuitable people being employed. However on examining one member of staffs file the documentation suggests that this person started working before a second reference was obtained. We therefore issued a code B (documentation that allows us to seize evidence under the Police and Criminal Evidence Act) to enable us to look into this matter further. The administrator and the acting manager both state that the reference was obtained before the person started working at the care home, however this was subsequently lost, therefore another reference was sourced which accounts for the date difference. The area manager put measures into place the following day to ensure that documentation is logged into the building to prevent this happening again. Because of the action that has been take a decision has been made not to proceed with further enforcement action at this time. Staff spoken with confirm that they have undertaken a Criminal Record Bureau check before they commence employment at the care home. On examining staff files we can see that staff continue to undertake compulsory training, such as manual handling and managing challenging behaviour, working towards ensuring that they have the necessary knowledge and skills to support people appropriately. To enhance this we can see that further training has been booked in a number of areas such as tissue viability, dementia care, infection control and health and safety for those staff who have not undertaken the training or for those who require a refresher. Staff spoken with tell us that they feel supported in their training and development and offer the following comments; I think we get good quality training here and this is discussed in every supervision and I am starting my NVQ, I have had training in dementia, manual handling, fire and everything and I have had sufficient training to do my job role. Care Homes for Older People Page 26 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. Although the management of the care home has improved significantly there are still times when this is not maintained to ensure that the care home is run in the best interest of people using the service. Evidence: The acting manager has now applied to become the registered manager with the Care Quality Commission. She continues to work with the Local Authority and us in regard to improving standards of care within the care home. She is currently being supported to do so by the area manager. When the acting manager and area manager are not at the care home it is run and managed by either a deputy manager or a senior care assistant. Senior staff spoken with are able to discuss their roles and responsibilities in regard to managing the shift when they are in charge, nevertheless as mentioned previously in the staffing section when the acting manager is not present the service does not always run smoothly. Care Homes for Older People Page 27 of 35 Evidence: Staff spoken with offer the following comments; the manager is alright I get on well with her, I have no problems, she is trying to make the home run well, the managers tend to stay in the office more than what they need to, it depends on the senior, the manager is lovely she is supportive and easy to get on with but she is not out on the floor, I think the manager is alright to be honest, if the management is right everything is right. It is about time spent on the floor and observing. I think a lot of issues are management failures. The area manager stated that the issue of management not being out on the floor is being addressed and changes are to be made imminently. One person using the service tells us that they go into the office everyday to see the manager and that they feel that the service is well run. People using the service and relevant others are enabled to have a say about how they feel that the service is run and managed by way of questionnaires and reviews. We can see that the results from the previous questionnaires offer mainly positive outcomes and comments. The provider has also drawn up a short term action plan to address issues of concern and a long term development programme to work towards improving standards in all areas of service delivery. People may keep their money in the care homes safe should they wish. On checking four of these accounts we found that all of them are correct and that receipts are available for all transactions. We can see that audits of the accounts take place on a regular basis to make sure that these are safeguarded. Staff spoken with are able to outline the policy for handling peoples personal finances. To monitor staffs development and practice each has undertaken one or two supervisions since the previous inspection. Staff spoken with have varying comments about supervision sessions in regard to their helpfulness, some feel that they are helpful as they can express what they feel and be honest, whereas others are not sure how often they should have these and feel that they are not very effective as issues will be raised but will end there and are not followed through. One member of staff feels that the manager works with them to check they are doing things right, whereas others do not feel that there are many checks to see if staff are putting their training into practice. Documentation in regard to accidents has been improved upon and a new form has Care Homes for Older People Page 28 of 35 Evidence: been implemented to make sure that the acting manager is kept informed of all events. We can see that when accidents occur people are receiving the specialist help and assistance as needed. Accidents are now also audited to make sure that action is taken quickly if someone is having for instance repeated falls. Liaison is now taking place for people deemed at risk of falls with the Falls Prevention Team so that staff can work with them to managed and reduce these. We can also see that staff are being more mindful should they find a bruise on someone, they are keeping documentation of this and contacting the relevant service as necessary. The fire officer raised several concerns during their last visit to the care home; however the area manager showed us documentation which evidences that they had complied with the requirements set. Working towards ensuring that safe systems are maintained the acting manager carries out monthly audits in areas such as medication, health and safety checks, laundry and infection control. An appropriate area has now been designated for the storage of equipment so that the communal areas are free from hazards. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 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 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 13 You must ensure that risk 12/11/2009 assessments are in place for all highlighted risks. This requirement has been part met, however further development is required to ensure that full compliance is achieved. This will ensure that people using the service are protected and risks are managed. 2 7 15 Plans of care must be in place for peoples specific needs and these must be reviewed when changes occur. This requirement has been part met, however further development is required to ensure that full compliance is achieved. 12/11/2009 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 people are supported as required and their needs are met. 3 14 12 You must ensure that staff 13/11/2009 have sufficient time to respond to peoples requests at all times. This will ensure that peoples rights and choices are upheld. 4 18 13 You must ensure that staff 30/10/2009 report concerns in respect of poor practice. This will ensure that this can be eradicated and that people using the service are protected from abuse. 5 30 18 You must continue to ensure 27/11/2009 that staff complete all compulsory training. This requirement has been part met, however further achievement is required to ensure that full compliance is achieved. This will ensure that staff have the necessary knowledge and skill to support people using the service appropriately. Care Homes for Older People Page 32 of 35 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 Further develop plans of care to make these more person centered so that people always received care in their preferred way. Consider including more specialist training such as diabetes mellitus in the staff training programme so that all staff have knowledge in this area. Make sure that medication is not out of stock resulting in people having to miss their medication until a new stock is received. Where people are reluctant to receive assistance in regard to their personal care, such as manicures, ensure that this is documented within plans of care. Ensure that staff seek permission to put on protective aprons at meal times to ensure that peoples right and choices are maintained. Ensure that all staff are aware of peoples specialist diets so that these can be mainatianed. Ensure that staff are seated when assisting people with thier meals to ensure that their dignity is maintained. Address the maintenance work that is in need of being addressed to ensure that people using the service live in a comfortable and well maintained environment. Assess and address any issues in regard to the amount of cigerette smoke that is being emitted from peoples rooms to ensure that the rights of others are not infringed upon. Arrange for an independent infection control audit to highlight any outstanding areas of concern so that these can be addressed. Further discuss and explore staffs concerns in respect of the staffing numbers so that it can be ensured that sufficient staff are available to meet peoples needs and staff do not feel under pressure affecting the care that they offer. Continue to audit staff files to ensure that all the required documentation is in place before people commence employment. Monitor the effects of the management team working on the floor to ensure that the service is run and managed in Page 33 of 35 2 7 3 9 4 10 5 15 6 7 8 15 15 19 9 19 10 26 11 27 12 29 13 31 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 the best interests of people using the service at all times. 14 36 Carry out more frequent supervisions with staff until the issues of concerns have been fully resolved. 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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