Inspection on 17/12/09 for Meadowside & St Francis

This is the latest available inspection report for this service, carried out on 17th December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadowside & St Francis 27/01/06

Meadowside & St Francis 07/09/05

Meadowside & St Francis 07/12/04

Meadowside & St Francis 02/06/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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: Meadowside & St Francis Meadowside & St Francis 5 Plymbridge Road Plympton Plymouth Devon PL7 4LE     The quality rating for this care home is:   three star excellent 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: Clare Medlock     Date: 1 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: Meadowside & St Francis Meadowside & St Francis 5 Plymbridge Road Plympton Plymouth Devon PL7 4LE 01752337938 01752346682 meadowsidestfrances@btopenworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: A J & Co (Devon) Ltd care home 69 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: OP Maximum registered 25 service users (both) PD(E) Maximum registered 69 service users (both) Physical Disability under 65 years of age (10) Service Users aged 65 years and over TI(E) Maximum registered 9 service users (both) Date of last inspection Brief description of the care home Meadowside and St Francis Care Centre is situated in a residential area in Plympton, Plymouth, Devon. The Care Centre is divided into 2 units; one provides nursing care for a maximum of 44 service users (St Francis) the other provides personal care for up to 25 service users (Meadowside). The home caters for people with physical frailty, Care Homes for Older People Page 4 of 34 Over 65 25 69 0 10 Brief description of the care home illness or disability. The accommodation is provided on three floors. Floors are either accessed by a passenger lift or more able people can access the other floors by stairs or stair lift. Each unit has dedicated staff group and communal areas including lounges and dining rooms although people can socialise in either area. Some bedrooms fall below 10 square metres, a formal assessment of individual needs and consideration to choice is given when these rooms are utilised. The home benefits from spacious grounds, which are well maintained and accessible to wheelchair users. People who have an interest in gardening are encouraged and facilitated to continue to help around the gardens. The home is owned by A.J. & Co (Devon) Ltd, who own another care home in Cornwall. There is access to the local shops and amenities. There is a bus stop very near to the home. The fees charged range from four hundred pounds to 600 pounds for residential care (December 2009). People requiring nursing, specialist or continuing care have their fees negotiated by the placing authority on an individual basis. These fees can range from six hundred and seventy pounds upwards. The latest inspection report and brochure/statement of purpose are available in the reception. The contracts issued include name and date of admission and who pays the fee, how the fee is broken down and the total fee, plus the homes terms and conditions of residency. 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three star. This means the people who use this service experience excellent quality outcomes. This inspection was unannounced and consisted of a visit to the home on Thursday, 17th December 2009. We also inspected this service with an expert by experience. The Care quality commission consider an expert by experience as a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service and spoke with six people. This helps us get a picture of what it is like to live in or use the service. During the inspection we spoke with the registered manager and provider, 10 people who live in the home, one relative visiting the home, and a minimum of six staff who Care Homes for Older People Page 6 of 34 work at the home. We case tracked five people who live at the home. Case tracking means we looked in detail at the care these people received. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us or able to provide feedback. We looked at staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means the people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Meadowside and St Francis. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? Despite the excellent rating made at the last inspection, improvements continue to have been made to ensure that the services provided continue to improve and meet Care Homes for Older People Page 8 of 34 the needs of people. Environmentally, outside the home there have been changes to improve safety. Trees under a preservation order have been felled with authority to improve safety of their neighbouring houses. The car park and drives are now safer with level paving and new chippings on footpaths. Extra lighting on a timer switch has improved security and safety. New signs to the home have been installed, with signs indicating directions to the car park. The reception area of the home has been completely revamped. A new desk has been installed along with new carpet lighting and furnishings. Frosted glass has been introduced to a door to increase privacy of the unsightly rubbish bins. A new telephone system has been introduced, which has introduced new telephones including cordless phones with extension numbers to improve the indication with healthcare professionals and relatives . A new computer system is in the process of being installed. This computer system will monitor staffing levels, occupancy levels funding information and information regarding staff recruitment and training practices. This will improve the audit process to ensure checks are performed when necessary. A new lift has been installed within the St Francis unit to improve movement throughout the home. New flat screen televisions have also been purchased throughout the home. New carpets and curtains have been fitted in areas of the home and stairs have been fitted with fluorescent strips to improve safety. New sluices and washing machines with automatic soap dispensers have been installed, and new wet rooms and showers have been installed. An ingenious invention has been introduced in areas throughout the home, which enables people to use oxygen compressors for oxygen use, which run off electricity, generate alot of heat and noise. Very small holes have been drilled into some bedrooms and bathrooms to enable people to continue with oxygen use but protects them from risk of electrocution in bathrooms, and prevent bedrooms overheating and provides noise reduction whilst oxygen is in use. This also provides a more domestic and less clinical environment people to live in. Separate male and female staff changing rooms have been introduced to promote privacy. An additional activities coordinator has been employed to increase the range of activities to meet the needs of people of different ages and care needs. A league of friends committee has been commenced to increase the voice of people who live at the home and relatives and friends who visit. A new minibus has been purchased which has increased trips for people at the home. Care Homes for Older People Page 9 of 34 Some records have been improved at the home including the assessment tool. Additional staffing numbers have been improved including registered nurses and care assistants to ensure the needs of people at the home are being met. 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 10 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 11 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The excellent admission process ensures that people are provided with the information they need and staff have opportunities to assess and prepare for the admission to the home. Evidence: The manager informed us that she assesses each person who is considering to move to the home. The manager added that sometimes heads of care and registered nurses accompany her on this assessment to assess specialised nursing care needs. Each person is issued a statement of purpose/brochure, an 11 page booklet, which contains photographs, maps and information about the service provided. The brochure also contains a letter of introduction information about the home and then map of where the home is located. Other information includes philosophy of care, standards of care, qualifications of staff and relevant information about the services provided, including how to complain. The views of people is also recorded within the brochure. Care Homes for Older People Page 12 of 34 Evidence: Prior to admission, the manager obtains detailed information regarding each person and their needs. An example of this information was provided and contained 75 pages from healthcare professionals and relatives. The manager explained that although each person has a standard assessment performed additional information and equipment is obtained before they are admitted. The manager provided examples of such equipment. The manager explained that she encourages prospective residents, people and their families to come and visit the home before they are admitted, but prefers this to be done by appointment so dedicated time can be provided by staff. When a new resident is due to be admitted they (or their relatives) are invited to visit the previous day to personalise the bedroom with memorabilia and other items thus providing some familiarity for the person on arrival. Examples were seen where staff had been provided with specialist training to meet the needs of people before they are admitted to the home. Examples of this included care for tracheostomy equipment. Feedback from surveys sent to clinical nurse specialists confirmed that staff at the home access specialist training in order that they can meet the care needs of people at the home. A relative wrote in their questionnaire I am very pleased overall with the way the care home and its staff have made my husband welcome and comfortable. The staff do the extras are that make the difference and are always friendly towards visitorswhether family or friends. They work hard at the various fund raising events. I am happy I chose Meadowside and St Francis for my husbands care. Care Homes for Older People Page 13 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care is provided to a very high standard. Additional very minor improvements would improve medication systems at the home. Evidence: The people we saw appeared very well cared for, with the finer details of care provided. This included appropriate footwear, clean fingernails, glasses in place and access to mobility aids. People who are being nursed in bed appeared to be comfortable, pain free, within reach of drinks and call bells. The people we saw appeared clean, dressed in freshly laundered clothes, well cared for and at ease in their surroundings. Everyone spoken with seemed content and at peace with their situation. Others said, It is lovely here, Its fantastic here, The place for me. A relative volunteered, Mum is so safe and happy here, we do hope she can stay - in fact I might reserve a room for myself when the time comes. Another relative wrote in their parents questionnaire The home gives care, support and a great deal of help by all the staff. Care Homes for Older People Page 14 of 34 Evidence: One member of staff wrote in their survey This is a friendly home that supports not only the clients but family as well if needed. We get to know the clients choices needs and carry out to the best of our ability. We treat clients as we would want our family treated if at home. Five care plans were examined in total. All care plans were well written, clear to follow and had been reviewed within the last month. Care plans also contained information regarding risks to that person. Examples of risk assessments included the use of bed rails, a risk of falls and nutritional screening. The information gathered at the assessments, and from these risk assessments is used to generate the plans of care, which provide the basis for the care to be delivered. Additional care charts were seen throughout the home which evidence what personal care had been provided to the more vulnerable, poorly person. These care charts included information regarding change of position, continence care, bowel management, mouth care and fluid intake. The home nominate registered nurses to act as link nurses for infection control, NVQ training, multiple sclerosis, chronic obstructive pulmonary disease and continence care. Feedback from the continence care nurse was extremely encouraging. Two registered nurses are linked basis for the Liverpool Care Pathway (LCP) and end of life strategy and attend steering groups and meetings to promote good practice within Plymouth. Feedback from healthcare professionals and clinical nurse specialists were extremely complimentary. One person wrote from my viewpoint and specialty I could not ask for better care and knowledge offered to all clients in this nursing home. Another comment read I wish all nursing homes would offer this level of continence care to their clients. The staff are well qualified in all aspects of continence care and readily take advantage of the training on offer from Plymouth care trust. Another clinical specialist nurse wrote This service has a good standard of wound care and is ever open to advice and guidance. The referrals are timely and important and relevant. Another comment read Staff stopped me from seeing the patient if they are having their meals -- that tells me there is respect provided. I have always felt accommodated at my visits to the home but not at the expense of the residents wants or requirements. A GP wrote This nursing home is the golden standard for all other nursing and residential homes. Patients and relatives I speak to both in and outside of the home are extremely happy with the high standard of the staff. I find the staff are well-trained, caring and dedicated. My only wish is that other homes would achieve the same standard. Care Homes for Older People Page 15 of 34 Evidence: Care plans, diaries and discussion with staff confirmed that people have access to NHS services in and out of the home. One person had been escorted to the local hospital for an appointment, whilst others were being seen in the home by NHS healthcare professionals. Other examples of healthcare professional input included speech and language therapists, social workers, dietitians, occupational therapists, general practitioners, chiropodist and aroma therapists. Staff explained that people are seen in the privacy of their own rooms and separate health care professional records are completed when they had been seen by a member of the multidisciplinary team. Medications were generally well managed. The pharmacist supplies medicines in blister packs that are kept in separate drugs trolleys throughout the home. This enables registered nurses to administer medicines at the same time on different floors within the home. The disposal of unused and out of date medication is managed well with robust records kept. Creams and lotions were seen with opening dates written on them. All storage areas where medications were kept were clean and well managed. Medication records were also well completed, but it was suggested that hand written entries on the medication administration record was witnessed by two members of staff to reduce any errors. In addition to this it was also suggested that food supplement drinks that were not individually labelled, were marked with the person they were prescribed for to reduce prescribed products being used for another individual in the home. Staff were seen to knock on doors before they entered, and guarded entry when personal care was being provided. Records showed that people were called by their chosen term of address and were wearing their own clothes at all times. Interactions between staff and people at the home were very positive. Light banter were seen and heard between staff and people. There were no negative interactions witnessed during this inspection. Staff were seen to spend time with people at their coffee breaks and told us that sometimes they joined people for lunch. Care Homes for Older People Page 16 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are helped to exercise choice and control over their lives and have access to a an excellent social and activity programme. People also receive a wholesome appealing balanced diet. Evidence: Staff explained that although there are routines at the home these are very flexible and change according to what a person requests or needs. Staff talked about people wanting to lie in or go to bed early after a particularly busy activity session. Staff explained that there is a rota for baths and showers, but again this is flexible and can be adapted to meet the needs of people at the home. The people we spoke with were in agreement of this statement and told us that they rose and retired at a time of their own choosing although this may, in some cases, follow an agreeable set pattern. Staff were seen to knock on bedrooms doors and wait before entering. No evidence was seen of personal care being given with doors open. The kitchen was well managed. The safe food better business programme was in use, Care Homes for Older People Page 17 of 34 Evidence: with additional records kept to evidence fridge and freezer temperatures, delivery temperatures and food probe temperatures. This is seen as good practice. All areas of the kitchen were clean, tidy and well stocked with high-quality food produce. The chef explained that menus were written on a 28 day rota which could be changed if appropriate. Written communication about changes to the menu were seen on the day of inspection. A choice of lunch menu is given to people the previous afternoon and if neither of the items on offer is acceptable an alternative will be selected. Everyone was complimentary about the food saying, Very good food here, I especially like the roasts, I now have to have soft food, it comes in separate lots and I can see the colours and taste the different flavours and The food is really good here. Sherry or wine is served before lunch. One of the Service Providers is a local beef farmer and supplies all the beef. On the day of the visit the lunch was an excellent meal of roast beef with Yorkshire pudding, roast potatoes, carrots and brussel sprouts. A neighbouring farmer supplies fresh seasonal vegetables. Apart from dry goods obtained from national wholesalers, as much as possible is procured locally thus ensuring good quality fresh items. Snacks are available at all times as are fresh drinks. There are separate kitchenettes throughout the home where staff, relatives and in some cases residents are free to make refreshments. Staff informed us that access to the kitchen is possible 24 hours a day so snacks can be provided. Staff informed us that they are encouraged to have a meal at the home if they work a 12 hour shift. If the shift is shorter than this, meals are also provided at a very small charge. Staff informed us that relatives are also welcome to share a meal at the home at a very small charge. The home employ two full-time activity coordinators. Staff explained that there had been an increase from 1 to 2 activity coordinators to increase the amount and quality of activities provided. There is a very full programme for people to join in with including bingo, singing, exercises, visits from entertainers, making craft items and so on and so on. A visitor commented, I now visit my mum in the mornings as her afternoons are so occupied. The parent expressed her delight that there was so much to do. Because there are three lounges, one can be set aside for family gatherings and celebrations without causing disruption to other people. Care Homes for Older People Page 18 of 34 Evidence: The Home has an unmarked people-carrier (or small mini-bus) used for trips to places of local interest such as Buckfast Abbey, The Marine Aquarium and various Garden Centres and Restaurants for lunch. On these occasions the accompanying staff do not wear uniform thus enabling the outing to have the appearance of a family trip. This is seen as good practice. Relatives are invited to join outings. The London Theatre Company recently presented the pantomime Puss in Boots in one of the lounges and a local Folk Group have given a programme of Christmas Carols and Readings. A recent clothing and jewellery party gave the residents the opportunity to buy items for Christmas gifts. Suitable arrangements have been made for people to undertake light gardening duties such as planting bulbs, growing sunflowers and pumpkins using a greenhouse. One of the activity organisers brings her small dog which seems to be appreciated by people living at the home. There is also a budgerigar and a parakeet in one of the lounges, and a fish tank located close to the reception. Other people in the home are encouraged to bring in family pets. A Christmas Fete and raffle raised money for outings by selling items made or donated by people living at the home. Many photograph albums were available showing the past activities and trips out. The home sponsor a donkey from a local donkey sanctuary that visits the home. The provider also added that the home sponsor the local handbell ringers who also visit the home on a regular basis. We were informed that each week a religious service is held, on a rolling basis of Christian denominations. These include Church of England, Roman Catholic, and Methodist. The manager informed us that other people also visit their place of worship if they are able to do so, and staff support best wherever possible. The majority of people at the home from white Caucasian background with Christian based beliefs. The home has a hairdressing salon where a hairdresser visits on Tuesday and Wednesday. Staff also added that should a person wish to continue with their personal hairdresser this can also be supported. Visitors are made to feel welcome and are able to make light refreshments for themselves and their relative in a purpose built kitchen dedicated for this purpose Care Homes for Older People Page 19 of 34 Evidence: located adjacent to one of the lounges. Since the last inspection a residents and friends group has started for support and fund-raising purposes. We were informed that the activities programme has improved since the increase of activities coordinators. We were told that there are men only activities and ladies only activities. Men only activities included a pie and a pint, whilst the lady only activities included cream tea and hand massage. Care Homes for Older People Page 20 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. Systems are in place to protect people from risk, although this could be improved by additional risk assessments when bed rails are in use. Complaints are well-managed and dealt with appropriately. Evidence: We asked people if they felt safe living at the home. Without exception the response was in the affirmative. All of those spoken with said that there had never been an occasion to make a complaint but they did know who to speak with should the need arise. Several stated, I have no complaints. Everyone spoken with were content that the staff listened and dealt with any concerns. Questionnaires were sent to people who live at the home also indicated that people know how to make a formal complaint and have somebody they can speak to in formally if they are not happy. A copy of the complaints procedure is located within the terms and conditions given to people when they arrive at the home. Other copies of the procedure are located within the brochure and displayed within the home. The procedure explains different stages people can follow if they have concerns about the home, including reporting concerns Care Homes for Older People Page 21 of 34 Evidence: to the nurse in charge and then the manager and if they are not satisfied then the Care Quality Commission. A complaint record is kept which showed that complaints are responded to within timescales and managed effectively. Further discussion was held about how informal conversations and action taken could be recorded to improve this process. There were no examples where deprivation of liberties were noted or suspected. Care plans showed the reasons why people were being cared for in bed using bed rails and were transported in wheelchairs using lap belts. Consent had been obtained from the person or their relative. However a risk assessment seen was ineffective and lacked detail. A discussion was held regarding improving a risk assessment and using such documents provided by the Health and Safety Executive (HSE). Care Homes for Older People Page 22 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 excellent 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 safe and well maintained homely environment. Evidence: The home was very well maintained, clean and well organised. Fire exits were kept clear and there were no obvious risks to health and safety. The provider explained that many changes had occurred since the last inspection. This has included the removal of some trees that came under a preservation order. The car park and drive had been cleared to make parking safer. Paving had been levelled. New chippings have been applied to the footpath, and extra lighting has been provided on a time switch for security and safety. New signs to the home have been installed including signs directing people to the car park. The reception area of the home has been revamped including a new reception desk, carpet and lighting. Frosted glass has been introduced on the fire door to provide privacy from rubbish bins. The telephone systems had been changed to introduce new telephones including cordless phones with extension numbers to improve communication with people at the home. Care Homes for Older People Page 23 of 34 Evidence: A new lift has been installed within one unit of the home. Staff questionnaires highlighted a request for lift within the residential part of the home, but comments also indicated that because the building was older there was no where a lift could be installed within this unit. There were stair lifts for access to the first and second floors and the lift within the nursing unit could be used if people were unable to use the stairs or stair lift . New carpets have been installed and stairs have been fitted with fluorescent strips. New curtains have been introduced within the home. A new male and female changing rooms have also been provided. New sluices and washing machines with automatic soap dispensers have been installed. The bedrooms visited were very clean, homely and personalised to a great degree. When a new resident is due to be admitted they (or their relatives) are invited to visit the previous day to personalise the bedroom with memorabilia and other items thus providing some familiarity for the person on arrival. One example was a duvet cover and curtains with the colours and motif of the local football team of which the incoming person was a fan. All of the bedrooms visited had been personalised to good effect. The in-house handymen will fix shelving or repaint walls in a favourite colour to make people feel at home. All bedrooms have telephones and wall-mounted swivel bracket flat-screen televisions. The only rooms without en-suite facilities are occupied by people who (by virtue of their illness) would have no use of such facility. A Wet Room has a specialised mobile shower chair that can also be used to transport the user from and to their bedroom thus minimising the number of times a person is transferred. The home also have specialist baths, to enable people to enjoy a soak in the bath despite having complex medical needs. An ingenious invention has been introduced in areas throughout the home, which enables people to use oxygen compressors for oxygen use. Very small holes have been drilled into some bedrooms and bathrooms to enable people to continue with oxygen use by having oxygen tubing and pipes fed through the holes, whilst protecting them from risk of electrocution in bathrooms and prevent bedrooms Care Homes for Older People Page 24 of 34 Evidence: overheating and providing noise reduction whilst oxygen is in use. New flatscreen televisions have been introduced since the last inspection to meet with the digital switchover needs. The home employ two full-time maintenance man who are responsible for routine safety checks at the home. their roles include carrying out the ongoing decoration, portable electrical testing (PAT), liaising with local tradesmen as necessary, and other maintenance jobs that need attention on the day to day basis. All faults and jobs are written in a maintenance books by staff which are then passed for the attention of the handymen. Despite the need for a variety of medical and clinical equipment to meet the requirements of the highly dependent people at the home, staff continue to take steps to ensure the home maintains a homely feel. Personal protective equipment was seen to be in used throughout the inspection, preventing the spread of infection. Hand wash, hand gels, paper towels were available in communal bathrooms. Care Homes for Older People Page 25 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. People are cared for by a stable group of staff. Systems should be in place to ensure that staffing levels are suitable at all times. Recruitment and training processes must be improved to ensure staff have been subject to satisfactory checks and mandatory training to show they are safe to work with vulnerable people. Evidence: Feedback from staff indicated that there is a low turnover of staff at the home. One questionnaire read all the staff here have been working for over five years, some have been here over 15 and 25 years, which shows what a friendly and caring environment it is. Since the last inspection staffing levels have increased at the home to meet the needs of people. Staff told us that generally there were sufficient staff on duty to meet the needs of people, but short-term sickness and staff absence often threw this into chaos when there was not enough time to book agency staff. Call bell response time was said to be good and usually within a few minutes, however several people said that sometimes when answering call bells staff would explain that there would be a delay saying, There are only two (or three) of us on duty or We are Care Homes for Older People Page 26 of 34 Evidence: short staffed today. On the day of the inspection visit a bedridden patient was overheard at 11.30am to ask a carer When will I get a wash? The response was, We are running late today as we are short staffed but we will get to you soon. Further questioning confirmed this was not an every day occurance but happened when staff were off sick. Off duty records showed that staffing levels on St Francis were maintained at two registered nurses and 10 care assistant in the morning, two registered nurses and eight care assistant in the afternoon, and two registered nurses and four care assistants at night. On the Meadowside unit staff levels were maintained at two or three care assistants in the morning afternoon and evening. We were informed that staff remained on either the St Francis unit or Meadowside unit and did not mix. Within the St Francis unit staff were allocated on each floor to provide continuity to people at the home. Staff files showed that the recruitment process was not as robust as it could be. All staff files contained an application form, health declaration, and two written references. Statement of entries showing registered nurses were registered on the nursing and midwifery Council register were in place, and interview records were kept. One file did not contain a recent photograph. One file contained the Criminal Records Bureau check that had been performed by the previous employer. Criminal Records Bureau checks are non transferable and should be repeated with each employer. Details of next of kin were not always obtained and proof of identity, although it had been obtained for Criminal Records Bureau checks was not maintained on each staff file as per regulations. Staff informed us that they had received some mandatory training but not all. The provider informed us that the new computer system had been purchased where staff details were being inputted to highlight staff who were due for mandatory training or recruitment updates. These preliminary checks had highlighted major gaps in some mandatory training of some staff. During the inspection the provider was in the process of booking training to address the shortfall. This is also reported on in the last section of this report. However, specialist training, and training needed to care for the complex needs of individuals in the home was seen as a priority by the provider. Examples of this included training staff to care for people with tracheostomys. Healthcare professionals had been invited to the home to teach and train care staff and relatives to care for Care Homes for Older People Page 27 of 34 Evidence: peoples specific care needs. Staff within the home are nominated as link nurses to provide a high standard of care. Two registered nurses are linked basis for the Liverpool Care Pathway and end of life strategy and attend steering groups and meetings to promote good practice within Plymouth. The home were nominated to run as a pilot Liverpool care pathway scheme when it was first introduced. The home also nominate registered nurses to act as link nurses for infection control, NVQ training, multiple sclerosis, chronic obstructive pulmonary disease and continence care. Feedback from the continence care nurse was extremely encouraging. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed. Evidence: Staff spoken to were extremely complimentary about the providers at the home. Staff told us that they had worked at the home for many years and felt very well supported. Staff explained that their line manager performs supervision and are available all the time for advice if needed. Staff were clear about lines of accountability and where to go for advice and said that the manager and provider were very approachable. The registered manager is a registered nurse with a registered managers award qualification, but does not work clinically at the home. She explained because of the size of the home she is more effective working with an overview and delegates to the registered nurses on the nursing unit. Additional administrators work at the home and are responsible for administration tasks and maintaining service user money. The administrator informed us that the Care Homes for Older People Page 29 of 34 Evidence: system has been changed and improved to increase security and transparency. Inspection confirmed that the system used is effective. However, it was noted that some people who ran out of money to pay for services such as hairdressing relied on the balances of other people. As soon as this was highlighted to the provider a float of £500 was introduced to prevent this occurring. The provider explained that he and the manager are present at the home on a daily basis to address any concerns and meet with people if this was needed. The manager explained that heads of department meetings are held to ensure the service provided is effective. She explained that heads of nursing, care, kitchen, housekeeping, and maintenance departments meet together to discuss changes and improvements needed at the home. The heads of departments then report down to their corresponding teams to ensure communication is effective. The manager also explained that questionnaires are sent to people 4 to 6 weeks after they had been admitted to ensure the service is still meeting their needs. Other quality assurance surveys are also sent on a regular basis by the receptionist who gathers the information and reports back to the manager who signs to say she has read each questionnaire. The manager explained that once the new computer systems in place regular audits will be easier to achieve. Accidents are well recorded and reported. The manager checks all entries as part of the internal audit process. The fire logbook and accident books are up to date and completed as required. Valid insurance certificates were on display and provider showed copies of income reports to show financial viability. The provider informed us that a new computer system is being introduced at the home which will record information such as staffing levels, funding information and other information regarding staff. At the time of inspection data was being inputted on this computer system. Inspection of training files and the commencement of data being installed on the computer had highlighted major gaps in some mandatory training of some staff. During the inspection the provider was in the process of booking training to address the shortfall. 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 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 18 13 The risk assessment used when bed rails are assessed as appropriate must be improved. This will ensure any physical risk of entrapment and injury when using bed rails identified and minimised. 11/03/2010 2 29 19 Staff must not be employed 11/03/2010 at the home until full and satisfactory information is obtained on them. This must include evidence of proof of the persons identity, including a recent photograph and a Criminal Records Bureau check performed by the employer. This will show that staff working at the home have had satisfactory checks performed to show they are suitable to work with vulnerable people. Care Homes for Older People Page 32 of 34 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 3 30 13 The provider must ensure the mandatory training for all staff is up to date. This will show that staff have adequate skills and knowledge to perform their roles safely 11/03/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 7 9 9 16 Staff at the home should consider writing care plans in a more person centred way to show care provided is holistic. Where medications administration records are hand written two signatures would minimise any errors being made. Systems should be in place to ensure prescribed products (diet supplements) are used only for that person. The manager should keep a record of conversations made when dealing with complaints to show that appropriate action is taken Staffing levels should be monitored to ensure people have their needs met. 5 27 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. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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