Inspection on 07/12/09 for Homebeech

This is the latest available inspection report for this service, carried out on 7th December 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Homebeech 18/11/08

Homebeech 08/01/07

Homebeech 31/01/06

Homebeech 09/08/05

Homebeech 26/01/05

Homebeech 01/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Key inspection report Care homes for older people Name: Address: Homebeech 19/21 Stocker Road Bognor Regis West Sussex PO21 2QH     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: Lesley Webb     Date: 0 7 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Homebeech 19/21 Stocker Road Bognor Regis West Sussex PO21 2QH 01243823389 01243841295 homebeech@saffronland.co.uk www.homebeechltd.co.uk Homebeech Ltd care home 66 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 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 66 . The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Physical disability (PD). Date of last inspection Brief description of the care home Homebeech is a care home registered to provide accommodation and nursing care for up to 66 people in the categories older people and physical disability. Homebeech Limited owns the home and the responsible individual is Rebecca Jane Page. Homebeech is located in Bognor Regis, close to the seafront, shops and other amenities. It is a large extended property. The majority of rooms have en-suite facilities and are for single occupancy. There is a separate unit forming part of the home known as the Daffodil Suite, which is purpose built for the physically disabled. It Care Homes for Older People Page 4 of 34 0 0 Over 65 0 0 Brief description of the care home has its own communal space, living accommodation and staff complement. Catering and laundry facilities are shared with the main home. Homebeech has two passenger lifts. Fees currently charged for living at the home range from £410.00 to £4,000.00 per week. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited this home on Monday the 7th December 2009, arriving at 8.40 am and staying until 6.10 pm. The purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. Since our last key inspection in July 2009 the registered manager has resigned and the home is being managed by the operations manager until a new manager is recruited. The operations manager was present during our visit and assisted us throughout by providing documentation and answering any questions we raised. For the latter part of our inspection the Responsible Individual for the organisation was also present, also offering assistance. During our visit to the home we examined the care records of four residents and recruitment records of two permanent staff and four agency workers. We also looked at other documentation maintained in the home such as training records, medication and activity records. Care Homes for Older People Page 6 of 34 Two Experts by Experience accompanied us for part of our inspection. These are people who have direct knowledge and experience of receiving a care service. Both older persons and people with physical disabilities live at Homebeech. Two Experts came on this inspection in order that the views of both service user groups could be sought. Since our last key inspection of 7th July 2009 two pharmacy inspections have been undertaken on the 15th September and the 9th November 2009 and a statutory requirement notice (SRN) issued for medication on the 16th October 2009. We have also been supplied with an Improvement Plan by the home. Information from these is included in this report. Information from all of the above sources was assessed and used to help us form judgements on the quality of service people living at the home receive. The quality rating for this service is 1 stars. This means the people that use this service experience adequate quality outcomes. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Whilst changes have been made to medication management areas of continued Care Homes for Older People Page 8 of 34 improvement are identified. Records must be put in place that confirm that prescribed creams and ointments have been administered in order that the home can evidence these are being given as per the general practitioners instructions. PRN (as and when required) care plans must be put in place for prescribed creams and ointments in order that staff understand when these should be applied. Arrangements must be made for all staff to receive training in areas including moving and handling, fire and food hygiene in order that they are suitably qualified to care for residents. The home should review bathing facilities to promote the independence of residents with mobility needs. Records of response times to emergency call bells should be introduced in order that management can monitor residents requests for assistance are acted upon in a timely manor. Some residents raised concerns about response times. For example one person said, It can take around 10 minutes as they have to finish with the person they are dealing with first. Activities offered by the home should be reviewed and expanded in order that residents can choose to participate in a wide range of events on a regular basis that meet their individual needs. Some residents expressed a desire for these to be improved. For example one person said, The activities arent interesting. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have their needs assessed so that staff understand what areas people require support. Evidence: The acting manager informed us that no new permanent residents have moved into the home since our last key inspection and that one person is staying at the home as a respite user. We looked at the admission documentation for the respite resident. This had been completed in full and covered all aspects of physical, health, social and emotional needs. One of the Experts by Experience who accompanied us on this visit reports All the people that I spoke to said that they, or their relatives, had received information about the home before they were admitted. Care Homes for Older People Page 11 of 34 Evidence: Intermediate care is not provided at this home. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have care plans in place that instruct staff how to meet their individual needs consistently. Some medication practises continue to place residents at risk. In the main residents are treated with respect and their rights to privacy are upheld. Evidence: We sampled four residents care files finding all to contain care plans that describe individual residents needs, objectives and actions that staff must undertake to meet individual needs. All those sampled had been reviewed on a monthly basis. None of the care plans have been signed by the resident or their representative. After our visit we received additional information from the home informing us that residents sign a separate document acknowledging their satisfaction with the contents of their care plans. Evidence from one of the Experts by Experience also indicates involvement takes place. The Expert by Experience reports Everyone that I spoke to said that they, or their representative had been involved in the initial care planning/reviews and that, as far as they are concerned the care plans are current and do not need changing. Care Homes for Older People Page 13 of 34 Evidence: Risk management forms part of the care planning system that is in place. These include falls assessments, moving and handling and pressure care. The home uses monitoring forms in conjunction with care plans for areas such as nutrition and pressure care. Those we sampled had been completed in full and demonstrated appropriate monitoring of individuals needs. None of the four residents files that we looked at contained evidence that they have been offered or received regular treatment from opticians, dentists, chiropodists or audiologists. The acting manager produced a separate book that the home uses for recording chiropody appointments. For the four people we case tracked this evidenced two residents having received treatment once and two twice in a four month period. The acting manager informed us the dentist and optician are due to visit the home shortly. Residents that spoke with one of the Experts by Experience confirmed that in the main they receive health attention as and when needed. The Expert by Experience reports The chiropodist and hairdresser calls regularly and all the residents I spoke with attend both. One resident told me she sees the hygienist and one time a dentist called to see her. One resident told me nurses change his dressings on his legs. Two of the residents have had problems with wax in their ears. One was left to clear up on its own, which it has done. One of the nurses at their GP surgery was going to syringe the wax out for the other resident but found blood in the ear so left it. The ear is still a problem and has not been seen by a doctor. Two of the residents files we looked at state that cot sides are used when the individuals are in their beds. We discussed the term cot sides being used when referring to bed rails with the acting manager explaining it was not appropriate for an adult. Since our inspection the home have informed us the term bed rails has been applied. One residents file also contained a form titled consent to use restraints for safety that states when in bed - cot sides, when in wheelchair - lap strap. The form has been signed by a representative of the resident. The resident is assessed as having capacity. We discussed the use of equipment, restraint and deprivation of liberty with the acting manager and responsible individual. They said they would review all the homes assessment and care planning documentation to ensure capacity to consent and restrictions on liberty are fully assessed. As a result of our last key inspection on the 27th July 2009 a random visit to the home was undertaken on the 15th September 2009 where medication was examined and four new requirements relating to medication were made. Care Homes for Older People Page 14 of 34 Evidence: A Statutory Requirement Notice (SRN) was issued for medication on the 16th October 2009. We received a written response from the home informing us of actions that had been taken to meet the SRN and requirements. On the 9th November 2009 a second random visit was undertaken to check compliance with the SRN served. The evidence gained at this inspection indicates that steps had been taken to improve medicine management practises in the home and three of the requirements previously made being met however the notice had not been met. A new requirement was also made as a result of this visit. Again we received written correspondence from the home detailing actions taken to address the medication issues. At this inspection we observed six residents being given their morning medication (three on each of the two units that form the home). Two staff on each unit were seen to participate in this task, a trained nurse and a care assistant. All residents were seen to be given their medication before the medication administration records (MAR) were signed by the nurses, medication was handled hygienically and residents were offered drinks to aid swallowing. The care assistants were seen checking that the nurse had given the right medicine to the right person at the right time. Both members of staff then signed a record confirming this. On the day of our visit the communal areas were having new flooring laid. We had received notification of this working taking place before we visited the home. On the day of our visit we were informed that the medication round starts at 8.00 am. The last resident was given their medication at 11.00am. All the MAR charts were signed to say residents received their medication at 8.00 am. We looked at the medication records of nine residents. All included a photo of each resident maintained with their individual MAR charts. One of the nine residents medication records that we looked at states they self medicate inhalers. A care plan was in place for this. A record was in place for all of the nine residents detailing when their medication entered the home and the amount. A record was also in place detailing the amount of medication given when dosages varied. Medication care plans were in place for all nine residents that give generic instructions to staff with regards to administration and recording. The plans also have a section for recording additional information that is specific to the individual resident. An information sheet is Care Homes for Older People Page 15 of 34 Evidence: maintained with each residents MAR chart that includes recording any known allergies. One residents front sheet detailed three items that they are allergic to. Their care records detailed four items. When discussing this with the acting manager we were informed the front sheets are due to be updated. Since our inspection the home has informed us they have taken responsibility for updating allergy information and in now producing information sheets for this. One residents MAR chart that we looked at details that they did not receive a prescribed medication for the management of epilepsy for two days. Hand written notes on the bottom of MAR chart state out of stock due to spillage. Hand written notes have also been recorded on the same MAR chart confirming that new stock was received two days later. We saw a copy of a fax that was sent to the GP on the day the spillage occurred requesting urgent supply of the medication. The home also supplied us with copies of records where the GP was contacted by phone on two occasions to arrange further supply. Another residents MAR chart states that 224 tablets were received by the home on 16/11/09. The MAR chart states that the resident should take two tablets four times a day. On 18/11/09 and 19/11/09 the medication was not given to the resident with a handwritten note on the bottom of the MAR chart stating o/s out of stock - delivered 0900hrs. A signature is in place to say that the resident was given this medication at 9.00am. The MAR chart states 224 tablets were originally received. This should have been sufficient supply for the resident to receive their medication for a 28 day period. No records were in place detailing what had happened to the missing tablets. Since our inspection the home has supplied additional information that 224 tablets were received on 16/11/09. They state that on 18/11/09 the nurse working the night shift emptied the medication trolley of empty containers and put in drugs for the new period. However she did not put the new container into the drug trolley but left them in the storage cupboard. The nurse who conducted the medication round the following morning noted that the new tablets were not on the trolley so wrote out of stock. They did not check the store cupboard first. When the responsible individual arrived at the home for the morning shift she instructed the nurse to check the medication cupboard and the medication was given at 9.00 am. A third resident has a medication care plan that states takes tabs well from a plastic spoon with yogurt or forticrem. We discussed this with the acting manager who informed us the residents medication is given first and then either a yogurt or forticrem given after due to the resident having difficulty swallowing. A record was in place for all nine of the residents detailing that their medication in Care Homes for Older People Page 16 of 34 Evidence: tablet and liquid form had been given as per the prescribers instructions. Two of the nine residents MAR charts include details of prescribed creams and ointments. No signatures were in place on the current MAR charts confirming that these had been administered. For one of the residents signatures were in place on the previous months MAR chart confirming administration three times. Both residents have PRN (as and when required) care plans. Neither contained instructions for use with regard to prescribed creams and ointments. We asked the nurses who had given the morning medication to residents how often the two residents have the prescribed creams and ointments administered. With regard to the first resident a nurse stated, He washes in it, has every day, carers wash him in it and for a second prescribed ointment, for his face, does not use all time. With regard to the second resident we asked a second nurse if the prescribed creams are applied and they stated, No, dont think so. We then asked if the prescribed creams were PRN medication and the nurse stated, dont know. The acting manager informed us that care staff apply prescribed creams and ointments to residents when supporting them with their personal care of a morning and evening and that it had been an oversight that a record of administration is not completed. Due to the continued non compliance to meet the SRN we copied some medication documents under Code b of the Police and Criminal Evidence Act. We will write separately to the responsible individual regarding this. When giving feedback on our inspection findings to the acting manager and responsible individual they produced a sample recording sheet and informed us this was going to be introduced on the evening of our visit for care staff to sign whenever prescribed creams are applied. They also said that prescribed creams and lotions will be added to residents PRN care plans where appropriate. In the main during our visit staff were observed speaking and assisting residents with dignity and respect. As the Expert by Experience reports All of the residents I spoke with received varying degrees of assistance with personal care. There was a general consensus that the care staff perform tasks well and that there was sufficient training. Residents also commented that staff were polite and respectful. They make sure I am covered if someone knocks on the door while they are washing me. The Expert by Experience reports that one resident commented that further attention to promoting privacy could be undertaken stating, when speaking with one resident I witnessed an ex-staff member and a current staff member enter the room without knocking. I was Care Homes for Older People Page 17 of 34 Evidence: told by the resident that they usually do knock and wait to be invited into the room, but the same person commented that they tend to leave the curtains open during transfers. The second Expert by Experience reports One resident likes to make his bed himself and have his cup of tea and breakfast afterwards. He told me. Every Tuesday I take my bath in the morning down the corridor and I take clean clothes with me and when I get back to my room my bed has been changed and they take my dirty clothes to the laundry and they come back the same day. Its wonderful. This routine to him was very important as he told me. I like order in my life. At 8 oclock every evening I retire. Another told me, I go to bed at 3 oclock every day because I have to lie down to take the pressure off my legs. I stay in bed then because its too much trouble to get up again. Some residents who use wheelchairs informed one of the Experts by Experience that they do not have a shower due to environmental factors. This is discussed in further detail in the environmental section of this report. Care Homes for Older People Page 18 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main residents can choose how they want to spend their day and the home arranges activities they can participate in if they choose, however this at times is limited. Residents are able to maintain contact with their friends and families so that they can continue to lead a fulfilling life style for as long as they are individually able to. The home provides a choice of well balanced and nutritious meals. Evidence: Information regarding activities is displayed in the main entrance hallway to the home. This includes posters for music for health sessions that are available for residents to participate in twice monthly, a weekly men only club where board games, beer and banter take place and local church information. An activity programme is also on display that details morning and afternoon activities that residents can participate in Monday to Friday. The programme includes board games, films, gardening, art and craft, quizzes and cookery. We were shown the activity diary that is used to detail activities that residents have participated in. We viewed the recording from 07/11/09 to 29/11/09. These did not include activities having been undertaken that are advertised in the home such as the mens club, gardening, cookery and reminiscence. Care Homes for Older People Page 19 of 34 Evidence: With regard to activities one Expert by Experience reports None of the three residents that I spoke with participate in the activities organised by the home. One person said activities dont run regularly anyway, if there is not enough interest or staff to run them. All three said that they do enjoy and look forward to the quiz nights. I asked why people dont participate and was told The activities arent interesting, there is nothing really for me to do I was interested in the cooking but as the kitchens arent wheelchair accessible we just ended up icing fairy cakes. Two people said winter is the worst time, you cant go out so there is nothing much to do except watch TV in the bedrooms. I asked what activities people would like to do and it seems like more activities away from the home would be popular. One resident says he goes to a day centre once a week for a break. The second Expert by Experience reports I spoke with one of the carers who had been working in the Home since the mid eighties. She now works part time and comes later in the mornings to help with activities. I asked what they had done that morning and she told me We played a group card game which is one of their favourites. I asked her if all the residents normally join in, she said, They like to sit and watch so you have to try and encourage them to take part. One of the residents I visited in his room is confined to an electric wheelchair and he told me he was not interested in the arranged activities such as Bingo or movement to music but preferred to stay in his room where he reads the newspaper which is delivered to him daily and watch TV. I spoke with six residents in the lounge and asked them if they had enjoyed their morning activity only one said emphatically yes, the others were non committal. I asked what happens in the afternoon and one replied, Nothing much, we normally go back to our rooms and watch TV or take a nap. I asked if anything special was happening for Christmas and another lady said, I expect some of the local schoolchildren will come and sing for us. I asked if they went for outings and was told, Not unless someone visits and takes us out. In passing through the Home I noticed there was more activity evidence, drawings, cut out decorations, on the disabled side of the lounge than the elderly side. Just before I left I went into the lounge as there was movement to music taking place. Apart from one disabled resident being pushed around in her wheel chair by the part time carer I spoke to earlier everyone else, both other carers and residents, were watching. As at our previous inspection the people living at the home who we spoke to told us that their visitors could come at any time and were made to feel welcome. One Expert by Experience reports All three residents said that family and friends were allowed to drop in any time they want and that residents are encouraged to go out with them if possible. Residents were not sure if the Home has transport but one relative confirmed that they can book you a cab if you need it. Care Homes for Older People Page 20 of 34 Evidence: On the day of our visit a menu was on display in dining room detailing lunch options for the day of meat loaf and pork curry. A choice of pear crumble or ice cream and supper of ham and eggs or a sandwich of choice was also stated. A four week rotating menu is in place. The menu on display corresponded with that of the four week rota. With regard to meals one of the Experts by Experience reports All three residents said that the food was good There is a good choice of food and enough of it and I have put on a stone since coming here. One resident who had previously had difficulties with finding variety on the menu said that he is now able to arrange his menus a week in advance and they cater for his likes and dislikes. Another resident said my friend does not like custard so they allow her to have ice cream instead. I asked what they thought of the timing of meals and they all said that lunch and dinner were served around the right time. No one seemed sure if they could ask staff to make them a snack if they felt peckish, but one resident said that she is allowed to keep dry foods in her room. One resident said that he doesnt have breakfast and another said that, as breakfast is too early for her they will make breakfast for her whenever she comes down. One resident said that there is more choice of meals in the summer as there is usually a choice of two things but in the summer it is three, as they also have salad on the menu. The second Expert by Experience reports The three residents I spoke to in their rooms all take all of their meals in their rooms. One told me The dining room is too small to take my wheelchair. All three had the same breakfast of porridge and toast, one told me on Sundays he has a cooked breakfast. He said If you ask the day before you can have something different. All three were given a choice for lunch of meat loaf or curry. One said The food is good, they are very generous, but its too much for me I dont have anything too eat after lunch. I have a glass of wine for my tea and a hot drink for supper. Another told me Theres always a sandwich from the kitchen if you ask. On the day of our visit the communal areas were having new flooring laid. A notice was seen to be on display informing residents and visitors of this work and apologising for any disruptions it may cause. One of the Experts by Experience reports In the lounge I observed six residents being placed at the dining table at 11.45 am. Their meals were not served until 12.15 pm. During this time one resident became agitated and refused to sit any longer and was helped back into a lounge chair. When their lunch was delivered it was nicely presented and I observed some had curry and some meatloaf and their meals were in Care Homes for Older People Page 21 of 34 Evidence: proportion to their appetite. One resident who refused her food was given chips which she ate with relish. Cold drinks were provided and a hot pudding. Cups of tea were brought around afterwards. Care Homes for Older People Page 22 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main residents and their representatives know how to make a complaint and have access to a formal complaints procedure. Safeguarding procedures are in place so that people are protected. Evidence: The acting manager informed us that no complaints have been received by the home since we last visited in July 2009. We saw that the complaints procedure is displayed in the home. With regards to complaints one Expert by Experience reports Two people said that they have not had to complain about the service but everyone knew how too and said that they wouldnt be afraid to make a complaint if they thought it necessary. The second Expert by Experience reports One resident told me (with regards to complaints) my daughter sees to all that. There is currently one safeguarding investigation being undertaken by West Sussex Adult Services as a result of an alert raised by the commission after information was received regarding care practises and lack of management. The outcome of this is not yet concluded. Care Homes for Older People Page 23 of 34 Evidence: During our visit to the home one of the Experts by Experience was informed of an incident involving a resident that resulted in other residents being restricted from accessing the lounge area. The home completed a Regulation 37 notification in relation to this incident. Documentary evidence confirms that residents were restricted from accessing the lounge for part of the day but that this was done to stop them becoming distressed by a persons behaviour and language and to ensure their safety. On the day of our visit records were in place that evidence eight of the eleven staff on duty have received protection of vulnerable adults training. Care Homes for Older People Page 24 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have a clean and comfortable environment to live in. They are encouraged to personalise their bedrooms so that they can have familiar things around them. Further improvements to bathing facilities will promote their use and independence of residents with mobility needs. Evidence: During out visit we looked around some of the home and we were able to see communal areas such as the dining room and lounges. We also viewed four bedrooms and bathrooms. As at our previous inspection residents are encouraged to furnish their rooms with personal belongings such as furniture and pictures, to make it feel like home. With regard to the environment one Expert by Experience reports Each resident I spoke to had their own possessions and furniture in their rooms. Each room was as cluttered or as tidy are the resident wanted. The rooms were all painted the same colour but residents told me they were able to repaint if they wanted. Each room had an en suite toilet and a wash hand basin in the room itself. The toilets are not big enough for a wheelchair user to turn in. I can only go in on a commode chair said one resident, another said I have to transfer from my wheelchair, go in using the frame, use the loo and do the whole process in reverse. The fact that there are no showering/bathing facilities within the residents rooms means that they have to go Care Homes for Older People Page 25 of 34 Evidence: downstairs for a bath-shower. All three residents mentioned that it was cold. I have opted to have bed baths as it is too cold to use the bathrooms - I havent had a shower for years. I wouldnt mind having one if you didnt get so cold. Another resident said, I do use the showers downstairs and the staff dry me off as best they can before I come back up to the room to finish drying and dressing. I asked the resident if there was a changing table he could use to get dry and dressed downstairs, he said there wasnt. Each room has a ceiling track above the bed in case any resident needs to transfer with a hoist. Two of the three residents I spoke to do have hoists but, as these are portable they are not wired into the mains and rely on staff charging and changing batteries. Both hoist using residents said I dont understand why they dont have enough hoists or batteries. One service user commented that sometimes staff have to go from room to room trying to find a hoist that works or a charged battery. One resident pointed me to the empty battery charger in his room that was plugged into the electrics even though there was no battery on the cradle. The second Expert by Experience reports One residents room was decorated with photographs and some personal items. Another of the residents is confined to her bed. Her room has lots of photographs of family and her daughter is going to decorate it for Christmas with lights. The third resident I visited in their room had been at the home for four years. His room, in comparison to the other rooms I visited was better decorated and very orderly. It was very pleasant with a large square bay window overlooking the avenue and houses opposite. A side table and two chairs were in the window and they informed me they like to sit and read there and enjoy the comings and goings. He too had photographs and personal belongings. On the day of our visit the communal areas were having new flooring laid. A notice was seen to be on display informing residents and visitors of this work and apologising for any disruptions it may cause. During our visit the acting manager completed a risk assessment regarding this work. Generally the home was seen to be clean throughout. We did note that some walls in areas such as toilets were stained. Staff were seen to wear personal protective clothing when undertaking tasks and liquid soap and paper towels were situated in all of the toilets viewed. Care Homes for Older People Page 26 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Monitoring systems do not ensure sufficient numbers of staff are trained and competent to care for residents. Recruitment practises are safe and protect residents. Evidence: During our visit staff were seen to attend to residents care needs as they arose. With regard to communication between residents and staff one Expert by Experience reports Two of the residents said that sometimes care tasks can be hampered by communication issues with foreign staff once when I slumped over in my chair I asked the care assistant to pull me back by the shoulders she said what are shoulders. Another resident said they used to talk to each other in their own language but this seems to have stopped now. One resident said I have never had any problems personally. I understand them, they understand me. All three residents that I spoke to were easy to understand but one resident did mention that some staff dont understand what other residents are asking so the residents have to explain several times. Staff members I approached did seem confused about why I was asking to speak to people and, as I left the building I made a comment to a care worker It is warm in there isnt it? She replied I dont know. I am unsure if she said this because she didnt feel warm or that she hadnt understood my comment. The staff that I did talk to were polite. The acting manager and responsible individual informed us that staff receive English Care Homes for Older People Page 27 of 34 Evidence: training through Chichester college. We discussed if the training staff receive gives consideration to peoples different accents or the needs of residents whose communication may be impaired due to disability. They said that they would explore this further. Training records on the day of this visit did not include certificates verifying staff having achieved the basic certificate in English (NVQ1). Both Experts by Experience report that some residents commented on staffing levels and response times to emergency call bells. One Expert reports One of the residents confined to her bed told me that during the day when she rings she most often has to wait for someone to attend often as long as 20 minutes and the other Two people said that it takes a long time for call bells to be answered. One said it can take around 10 minutes as they have to finish with the person they are dealing with first. The other person said during the early evening it can be 20-30 minutes as there are less staff and they have an hour long hand over. No records are currently maintained in relation to response times to emergency call bells. The acting manager and responsible individual informed us that the call bell system in place at the home allows for this information to be obtained but that it is currently faulty. They said repair was taking place. Since our inspection the home has informed us that the repair has been completed. A training matrix was not available for us to look at. The responsible individual informed us this is in the process of being updated. We looked at the training records for all eleven staff on duty during the afternoon of our visit. These evidence eight staff having received training in moving and handling, six in infection control, six in fire, eight in food hygiene, four in control of substances hazardous to health and two in first aid. Also of the eleven staff on duty on the afternoon of our visit four had received training in catheter care, three in Parkinsons, two in epilepsy, two in Huntingtons and three in the Mental Capacity Act. We examined the recruitment records for the two newest staff to commence working at the home. All contained the required documentation including completed application forms, references and Enhanced Criminal Records Bureau (CRB) disclosures. Agency staff are used by the home. Written confirmation was in place from the supplying agency confirming that CRB disclosures, two references, Personal Identification numbers (PIN) and training having been obtained and undertaken. This meets a requirement issued at the last key inspection. Care Homes for Older People Page 28 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of this home continues not to meet the needs of residents safely with regard to some medication practises. Quality monitoring systems allow the home to measure if it is achieving its aims and objectives but are not fully effective in identifying any changes required in service provision. Residents financial interests are safeguarded. Evidence: The registered manager resigned from her position in November 2009. A general manager employed by the company is currently managing the home until a new manager is recruited. The general manager was present during our inspection. The responsible individual also was present for part of the visit. The general manager is currently based at the home on a full time basis, is a registered nurse and has over 20 years experience in care settings. As detailed in the health and personal care section of this report evidence gained at this inspection indicates continued failings with regard to some medication practises. Care Homes for Older People Page 29 of 34 Evidence: We will write to the registered provider separately regarding this. The homes statement of purpose informs us that there are facilities for safe storage of residents personal items and money. As at previous visits the views of residents, relatives and staff are sought annually. During this visit to the home we viewed reports that have been completed on a monthly basis by the responsible individual after visiting the home. A new report format has been introduced that allows for greater detail and information to be recorded. In response to our previous key inspection and random visits to the home to look at medication we have received actions plans from the home promptly. However evidence gained from this inspection with regard to medication indicates the homes quality monitoring systems are not ensuring continued safe medication practises without outside agencies interventions. We viewed a number of health and safety related documents when visiting the home, including accident records and service certificates for lifting and handling equipment. All were in good order and up to date. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 In line with regulation 13(2) The registered person must ensure that records are in place detailing when prescribed creams and lotions have been applied and that guidelines are in place that inform staff when these should be used. This must happen in order that records protect residents. 21/02/2010 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 30 18 In line with regulation 21/01/2010 18(1)(a)(c) The registered person must ensure that a system is in place that ensures staff receive training in all required areas. This must include moving and handling, infection control, fire, food hygiene, first aid and health and safety. This must happen in order that residents are supported by suitably qualified staff at all times. Care Homes for Older People Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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