Inspection on 17/09/09 for Sunrise Operations Knowle Limited (Reminiscence Neighbourhoo

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

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for older people Name: Address: Sunrise Operations Knowle Limited (Reminiscence Neighbourhood) 1270 Warwick Road Knowle Solihull B93 9LQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lesley Beadsworth     Date: 1 7 0 9 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 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 33 Information about the care home Name of care home: Address: Sunrise Operations Knowle Limited (Reminiscence Neighbourhood) 1270 Warwick Road Knowle Solihull B93 9LQ 01564732400 01562732401 knowlw.rc@sunriseseniorliving.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sunrise Operations Knowle Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 68 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Age 50 and above. The Maximum number that can be accommodated is 68. The registered person may provide the following category of service only Care Home with Nursing (Code N) To service users of the following gender Either Whose primary care needs on admission to the home are within the following categories Older People (OP) 26 Dementia (DE) 42. Date of last inspection Brief description of the care home Sunrise Senior Living was founded in America and now has services in America, Canada and the United Kingdom. The organisation refers to the care home complex as Care Homes for Older People Page 4 of 33 Over 65 42 26 42 0 Brief description of the care home the Community and each unit as a Neighbourhood. Managers are referred to as coordinators and care staff as care managers. There is a marketing team who deal with accommodation, fees and contracts. The Reminiscence Neighbourhood at Knowle is located on the main Warwick Road from Knowle village to Solihull town centre. The service occupies one of two buildings in the Community called Queen Eleanor House and was completed in March 2009. Services are duplicated on the both the first and second floors and care for people with dementia. The ground floor accommodates people requiring nursing care and is referred to as the Skilled Nursing Neighbourhood. There are communal toilets and assisted spa bathrooms, dining rooms, an activities room, a snoezelen (sensory) room and a communal lounge. All areas are furnished and decorated to a high standard. Two passenger lifts serve all floors. All bedroom spaces consist of suites of varying sizes and combination of rooms and have en suite facilities. They are suitably furnished although peoples own furniture can be used if wished. A call bell system has been fitted throughout the building. The surroundings gardens are landscaped and there is ample parking space. There is a furnished sun terrace on the first and second floors and an enclosed garden on the ground floor. Fees vary according to the size of suite chosen and the level of care required. The Community should be contacted for up to date costs. Additional charges include a one off charge on admission of £5,000 for maintenance of all communal areas; hairdressing; chiropody; ironing; additional glasses to complimentary glass of wine with meals; external telephone line installation and call charges. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection included a visit to Sunrise Operations Assisted Living Neighbourhood. As part of the inspection process the executive Director of the Community completed and returned an Annual Quality Assurance Assessment [AQAA], which is a self assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Surveys were given to family or friends of service users. One was completed and returned to us. Information contained within the AQAA, in surveys, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were case tracked. This involves establishing an individuals experience of living in the care home by meeting or observing them, talking to their families, where possible, about their experiences, looking at residents care files and focusing on outcomes. Additional care records were viewed where issues relating to a residents Care Homes for Older People Page 6 of 33 care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit to this and the adjacent neighbourhood in the same Community took place over two days on 17th September from 09:15am to 5:15pm and 18th September from 09:30am to 09:00pm. A second inspector, Julie Preston, also took part in the visit. There was no registered manager of the Neighbourhood but the Executive Director of the Community was currently managing the service with the Reminiscence and Assisted Living Coordinators managing the care and nursing and care staff on a day to day basis. Care Homes for Older People Page 7 of 33 What the care home does well: All care files looked at included a pre-admission assessment that were in sufficient detail, particularly the mental helath section, for the home to be able to know if they were able to meet the persons needs or not. Each care plan looked at gave the staff the information they required to meet a persons needs and in appropriate detail. They are reviewed regularly and as circumstances change to make sure that they are kept up to date. Appropriate risk assessments are recorded in the care file so that the risk in the areas assessed are minimised. The health and well being of the person is maintained by visits from healthcare professionals and evidence of these was seen in care records. The medication system on the second two floors safeguarded the people living there. There are sufficient, varied and appropriate activities and occupation available each day and evening for the people living at this neighbourhood. Visitors were seen to be made welcome and this was further confirmed by comments made in the surveys. Snacks and refreshnments are free of charge to visitors in the Bistro in the Lady Byron building. Residents are able to make choices in their daily lives including where to spend their time, when to get up and go to bed, what meal to have and what activities they would like to join in with. They are also able to furnish and decorate their room with their own personal belongings and to their own taste. There is wide variety and choice of meals on the menu, which are served three times a day. Those people spoken to about the food said that they enjoyed them and our experience was that the meals provided are nourishing, tasty and well presented and that mealtimes were a social event. The dining areas are attractively decorated and furnished and provide pleasant areas for residents to take their meals. Snacks and refreshments are also available to residents at the Bistro twenty four hours a day, including a social afternoon every day. Staff have the training to give them the knowledge and skills to be able to identify abuse and what to do about any suspicion or allegation of this. Residents are safeguarded from abuseabuse. Any money held by the home is done so whuilst protecting the persons financial interest. Recruitment procedure is extremely robust and therefore minimises the risk of the employment of unsuitable people. The service offers the people living there appropriate, attractive and comfortable surroundings, which are clean, free of offensive odour, safe, and well maintained. The decor and furniture is of a high standard. Residents have access to all areas of their unit. Care Homes for Older People Page 8 of 33 Staff met during the inspection were knowledgable about the service and the people living there. The gave a positive impression of being caring, commmitted to their work and were seen to be caring and cheerful and had an excellent rapport with the residents. All evidence indicated that there are sufficient staff available to meet the needs of the residents. The importance of training is recognised with staff having undertaken induction in line with Skills for Care, 34 of the care staff having achieved the National Vocational Qualification Level 2 or 3 in Care and undertaken mandatory health and safety and welfare related training and training in specialist needs such as dementia. In the absence of a registered manager the executive director is managing the community, with the Reminiscence and Skilled Nursing Coordinators managing the specific units on a day to day basis. other Coordinators that form part of the management team include maintenance, activity and catering coordinators. The What has improved since the last inspection? What they could do better: There is no written information for prospective residents to inform them that pets are allowed in the home or that ther are already dogs living there. This should be included in the Statement of Purpose to help people make an informed decision about living at the home or not. The medication system on the ground floor (Skilled Nursing) had several shortfalls related to storage, administration and recording. Requirements and recommendations have been made related to this. The complaints procedure was available in the service user guide but a copy should also be displayed where it can be seen by residents and visitors. Rotas looked at did not all show the actual hours worked by staff. To address this a key should be used for the codes on the rotas. Second names should also be used on the rotas as a matter of good practice. Although a manager has been appointed this person was not in post at the time of the inspection. The organisation should ensure that application to register with us is carried out as soon as possible. Consideration should also be given to the registered manager having full managment responsibility Care Homes for Older People Page 9 of 33 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information required to make a decision about choice of home is available when needed although with shortfalls. Preadmission assessments are carried out to assess if the needs of prospective residents can be met. Evidence: There is a copy of the Service User Guide and the Statement of Purpose available in the reception area and each person living at the home has been provided with copies. The service has chosen to have two different statements of purpose; one for the two Reminiscence floors and one for the skilled nursing ground floor. The front covers tell us that they are available in Alternative Languages, in tape form or larger print upon request. They are reviewed annually and updated as necessary, the last update being August 2009. There was no mention that pets are welcome, or that there was already a dog belonging to a resident living on the first floor and another dog belonging to the home that comes with the Reminiscence Coordinator on the days she is in work. The presence of animals could be a major deciding factor as to whether a person chose to Care Homes for Older People Page 12 of 33 Evidence: live here or not and needs to be clearly included in the Statement of Purpose. The survey returned to us by a relative of a resident answered Always to the question, Do you and your friend/relative get enough information about the care service to help you make decisions? Both statements of purpose are similar but there is sufficient information to inform prospective residents and/or their representative to enable them to make a decision about whether they would choose to move into the home or not. We looked at three care files, two on the Reminiscence floor and one on the Skilled Nursing floor, as part of the case tracking process. Each had a pre-admission assessment that had been completed prior to admission to the home. These were detailed and gave very clear information to enable the home to make a decision about whether they could meet the persons needs or not. The sections related to mental health were particularly well detailed. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place to assist in the residents needs being met. Residents have access to health care professionals and are cared for in a respectful manner. There are some shortfalls in the medication process that could mean risks to safeguarding the residents well being. Evidence: The care plans of three residents were looked at as part of the case tracking process. The plans were well detailed and gave clear information to the care staff regarding the care required. Mental health needs, particularly on the two floors accommodating people with dementia, were well detailed;patterns of behaviour and records of observations made before and after any specific behaviour were evidenced and information of how staff should manage this behaviour was recorded, enabling staff to support and care appropriately for these residents. Care plans were reviewed regularly and as circumstances changed. Any changes in care needs are recorded on the care plan. Daily records are maintained that reflect the care plans. Care Homes for Older People Page 14 of 33 Evidence: Records of falls, pressure areas, weight, nutrition and nutritional screening were in place within the files looked at. Completed risk assessments for tissue viability in relation to the development of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) were in place and risk assessments for moving and handling (transferring a person from one place to another) and falls were also in place. These would help to minimise any risk in these areas. Individual risks were also assessed, including the use of bed rails. Where a risk had been identified the corresponding risk assessment was in place. Preventative measures such as pressure relieving mattresses and cushions were in use for those people at risk of developing pressure sores. The medication system was inspected on all three floors. The pharmacist supplies most of the medicines in a monitored dosage system (MDS) where each medicine is dispensed in a blister pack from which to administer on a daily basis. On all floors the temperature of the rooms in which the medication is stored is monitored to ensure that the correct temperature of less than 25 degrees Centigrade is maintained. The temperature of the medication fridge was checked and records showed that medication requiring refrigeration were stored at appropriate temperatures. The storage of medication and the Medication Administration Record Sheets (MARS) on the Reminiscence floors were examined and were in good order with only one gap where a person had been away from the home but a code explaining this had not been recorded. A random audit of medication in original packages was carried out and found to be correct. One instruction for indigestion medication was as required but there was no procedure showing staff when and why to give this. This could cause the wrong amount to be given or at the wrong frequency and for the wrong reasons. All As required medication should have a corresponding protocol to safeguard the residents. On the Skilled Nursing floor medication was not in such good order and some errors were noted. Whilst temperatures for storage were satisfactory some external medications were stored with internal ones. These need to be kept separately. Medication Administration Record Sheets (MARS) were inspected and found to have some errors. Handwritten instructions were not double signed. A second person should always sign these to ensure the accuracy of the instructions and they should show the Care Homes for Older People Page 15 of 33 Evidence: source of the instructions. There were some discrepancies in the way medication had been carried forward from the previous MARS to the current one with the amount missing in some cases and in one case the receipt of the medication had been recorded on both. There were several unexplained gaps on the MARS leaving doubt as to whether the medication had been given or not. When we carried out a random audit there were four errors out of eight totals checked, indicating that the medication had not been given but had been signed for when there were more tablets left than had been calculated or the wrong dose had been given when there were less tablets than had been calculated. This indicated that staff had not given the medication as instructed by the prescribing doctor and does not safeguard the well being of the residents. The observations made, discussion with staff and discussion with relatives showed that the staff care for residents with respect and that their privacy is safeguarded. Staff were seen to knock on doors and wait to be called in before entering bedrooms. The AQAA tells us, All care giving team are trained using the Sunrise principles, this ensures they understand how to deliver care in a way to preserve dignity and privacy, independence and freedom of choice. In the philosophy of the organisation as seen in the Statement of Purpose, it says that staff employed are committed to preserving dignity and privacy of the residents and this was apparent when we spent time in the communal areas with staff and residents. Interaction between them was friendly, caring and polite and the attitude of the staff to the residents was commendable. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives. Meals provided are interesting, varied, provide choice and are nutritious. Evidence: The home has an activity coordinator who is part of the management team. There is also an activity assistant and a minibus driver who complete the activity team. They facilitate activity events over seven days a week, including the evenings. To assist in ensuring that activities are the wishes and preferences of the people living at Sunrise there is an activities suggestion box and an activities council made up of residents and the activity coordinator and who meet once a month. There is a calendar of activity and events that are planned for the week displayed, to inform everyone of forthcoming events, which includes evenings and weekends. For the current week the calendar showed several events each day and included a Mexican Theme day which incorporated pertinent decorations and costumes, activity and entertainment and a Mexican food menu. A different theme day takes place each month. Photos were on show evidencing the enjoyment. Other events in the week for the Reminiscence community included, creative activities, a trip to Brueton Park, Care Homes for Older People Page 17 of 33 Evidence: Gentle Exercise (by contracted professionals), a trip to Sarehole Mill, a Call Out Quiz, Sing-along and several activities that are planned for all residents in each neighbourhood such as the afternoon tea or social in the Bistro, Movie Night which took place most evenings and the Sunday night cabaret. Reminiscence and nostalgia items, such as food packaging and pictures of the local areas in previous decades, displayed in communal areas were readily recognisable to the residents and nostalgic clothing was used to prompt and stimulate discussion rather than dressing up. All activities undertaken were recorded in the relevant persons files. Activities take place in a variety of places but there is a designated activity room and a marble topped table in the dining area to use for crafting when it is not being used for meals. An attractive chest of drawers containing craft materials has been provided. A comment in a survey said, Their activity and entertainment programme is excellent. We were told by management that Sunrise is an animal friendly organisation and pets are made welcome in their services. There is already one residents dog living on the first floor. Another dog belonging to the home also comes to the Neighbourhood with the Reminiscence Coordinator on each of her working days. The people living in the Community seemed to enjoy them being around. Visitors were seen to be made welcome and this was confirmed by a comment in a survey, Visitors are made very welcome, even by staff not directly involved in my (relatives) care. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, to join in with activities or not and where to spend their time. We were told that people can bring their own possessions with them, and furnish and decorate their room(s) as they wish, and those rooms visited showed that the occupants had brought small pieces of furniture and photos, pictures and ornaments to personalise their room with familiar things. We met the catering coordinator on the first day of our visit to the Community, who is also part of the management team. He is responsible for all catering matters and was knowledgeable about this and all areas of the services we referred to, and was very helpful and welcoming whilst the Executive Director was advised of our visit. The catering coordinator explained that there are several alternatives to the main choices on the menu available every day such as omelette, sandwiches, salads, or fish of the Care Homes for Older People Page 18 of 33 Evidence: day. Menus are on display in the dining areas with the days menu on the tables. The menus are on a four week cycle which are changed with the season in order to incorporate seasonal dishes and fresh foods. Dinner, served in the evening, is also a three course meal. Breakfast offers hotel type choices of cereals, fruit, fruit juice, and a traditional cooked breakfast. The meals times are flexible - breakfast is available between 7am and 9.30am; Lunch between 12md and 2pm; Evening meal between 5pm and 7pm. Meals are served in attractive dining areas on all floors, which also have a small kitchenette for snacks and drinks. There is a good choice of cold drinks, including fresh orange, available. We joined the residents on one floor for lunch. This was a cheerful social event for the people dining here. Care staff served the meal in a professional manner but with banter, smiles and chatting taking place between them and the residents. Support with meals was available and given sensitively and discreetly. Behaviour that could have been disruptive to others during the meal was managed well and any discord was prevented. The meal was brought to the dining areas in heated trolleys from the main kitchen in the Lady Byron building, as happens at all mealtimes, and then served to the residents after the staff have checked that the temperature of the food is within hygienic limits. The three course lunch was well presented and tasty. Residents were shown the two main choices if they were unable to choose from verbal information given. The statement of Purpose says that a complimentary glass of wine is available with the meal but this was not seen in the Reminiscence Neighbourhood. The Bistro, in the adjacent building, is open 24 hours a day for hot or cold drinks and snacks and has a bread making machine following a request made by people living in the Assisted Living Neighbourhood. The statements of purpose tells us that the use and contents of this facility is free of charge to residents and their visitors. The residents dining committee meets once a month with the chef and catering coordinator where menus and meals are discussed and decisions made. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns are listened to and any suitable action taken. There are appropriate policies and procedures to safeguard residents. Evidence: A copy of the complaints procedure was available in the service user guide, a copy of which was seen in each bedroom visited. However the procedure was not displayed for residents and visitors to readily see. When asked people who we thought would be able to answer the question they said that they knew who to talk to if they had any concerns. The relative returning the survey said that they knew how to make a complaint about the care provided by the home and it usually responded appropriately if concerns were raised. A complaints log was maintained by the Neighbourhood and this showed that complaints had been appropriately addressed and managed. This gives people the confidence that their concerns will be listened to. Staff had attended training related to safeguarding vulnerable people in order for them to have the information they need to identify abuse and what to do if they witness it or suspect it has happened. The organisations robust recruitment procedures and practice safeguard residents against the employment of unsuitable people. Care Homes for Older People Page 20 of 33 Evidence: The financial practices safeguard the financial interests of the people in the Neighbourhood. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers the people living there appropriate, attractive and comfortable surroundings, which are clean, free of offensive odour, safe, and well maintained, with minor concerns related to infection control. Evidence: There is a spacious and welcoming porch area that leads to the reception which is manned by a concierge from 8am to 8pm. The ground floor of the building is Skilled Nursing and is part of Assisted Living registration. The Reminiscence Neighbourhood is on the first and second floors. People living in Queen Eleanor have access to the Bistro on the ground floor of the adjacent Lady Byron building. The Reminiscence Neighbourhood is reached from the ground floor by means of a staircase or by passenger lift. The communal areas are open plan but maintain a homely atmosphere. Decor, furniture and fittings are of an excellent standard and are domestic in appearance, adding to the homeliness. There is a large lounge on each floor and smaller cosy one adjacent to it. Corridors are wide enabling residents who need support with their mobility or wheelchair users to be be able to easily move easily around the premises and giving a feeling of spaciousness. There is discreet shelving along the corridors to be used as hand rails for residents to lean on. Comfortable seating in various points in the corridors enable residents to sit and rest or to get way from the group if they wish. Outside each bedroom is a box framed Care Homes for Older People Page 22 of 33 Evidence: collage containing interesting items of nostalgia. These are intended to be relevant to the occupants but most are still the ones created by staff before the home opened. Some residents or their family have personalised these and can therefore assist the resident to locate their own accommodation as well as identifying what is or has been important to them. There is a dining area on each floor, which are attractive and with decor and furbishment to the same standard as other communal areas. Each has a small kitchenette for serving snacks and drinks. Private accommodation varies and consists of Companion Suites where two people have their own bedroom but share a bathroom and kitchenette facility to One Bedroom Suites which have a separate living room, bathroom and kitchenette as well as a bedroom. An internal phone is provided and residents can have an external phone line installed at their own expense. There are call bells in each of the areas of the suites. The rooms are larger than is required for bedrooms and are comfortable and attractively fitted out. Those looked at had personal possessions that the occupant had brought in with them, including some small pieces of furniture, which helps to feel at home and recognise this is where they live. There is a front door to each suite. As well as ensuite facilities in all private accommodation there are two spa bathrooms, which provide assisted bathing and which the statement of purpose says can be booked for use without any further charge. There are also communal toilets, which are fitted out to a high standard and are close to residents communal living areas. Fabric towels were also hanging in the communal toilets and bathrooms. We were told, and it was apparent, that these were for decoration and would be changed if they were used in error. Whilst they did look attractive and colourful there remains the risk of them being used by residents or visitors unbeknown to staff and become a source of cross infection. Each floor has a terrace that can be enjoyed by residents and visitors, which is suitably furnished. There is also an enclosed garden on the ground floor that can be used by all residents. The statement of purpose tells us that they will be accompanied by a member of the care staff in the garden. A comment made by a relative was that its maintenance could be improved and that many of the raised flower beds seemed unfinished. This was not apparent during our visit but should be monitored to ensure that the gardens always look well maintained. All areas of the neighbourhood visited were clean and apart from a faint odour in one bedroom were free of any unwanted odour. It was thought that the odour was from a Care Homes for Older People Page 23 of 33 Evidence: mattress that is usually placed at the side of the bed as the person occupying this room has a history of falling out of bed. The mattress protects the person from injury and they often choose to spend time lying on this mattress but it was stained and smelt of urine. This needed to be addressed and action taken to prevent the odour and risk of infection in the future. Staff had ready access to protective clothing of disposable gloves and aprons in order to prevent cross infection when supporting residents in their personal care. Hand washing facilities of disposable towels and soap dispensers were also available in communal areas where residents and staff would be expected to wash their hands, which further maintained infection control. However the disposable towels were stored in open wicker baskets and they could be exposed to contamination. We were told that enclosed dispensers were on order. Good infection control practice was seen in the use of disposable slings for the hoists. There is a main laundry room where sheets, towels and soiled linen are laundered. This is spacious and well equipped with machines that have the appropriate programmes to disinfect and sluice the items. Each floor also has a smaller laundry that manages the laundering of personal clothing. Residents are invited to use this themselves although it appeared that not many people wanted or were able to do so. Care staff were therefore carrying out these tasks. A comment made by a relative said that the laundry system needed reorganising but felt it was the system and not the staff that was at fault. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff available to meet the needs of the current residents. Robust recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. Evidence: The Neighbourhood is not fully occupied at present. Staff on the unit were spoken with and showed that they were knowledgeable about the residents, their care and the service. They said that they were happy in the work they were doing, and discussion with some residents and observations of them showed them to be cheerful, committed and caring people. Rotas were made available to us but these did not show the actual hours that people should or had worked. A code had been used, for example E for an early shift. Staff are aware of what the code means but for purposes of inspection and a key to this code should be added to the rota. Only first names were used on rota. It is good practice and for means of identification by others not working at the home, for the surname of members of staff also to be used. Staff rotas show that on most days there are four care staff (known as care managers), including the lead care manager on the first floor in the morning, three in the evening and two during the night. This floor caters for people in the earlier stages Care Homes for Older People Page 25 of 33 Evidence: of dementia. On the second floor, which caters for people with more severe dementia there is a Registered Mental Nurse or Registered General Nurse on duty each day and night, three or four care staff throughout the day and two during the night. In addition to care staff there are ancillary staff of lead housekeeper and housekeepers who are managed by the Maintenance Coordinator, catering staff that are managed by the Catering Manager and the activity team managed by the Activity Coordinator. There is also a Concierge who works on the reception from 8am to 8pm. All evidence indicates that there are sufficient staff to meet the needs of the people currently living there. The Reminiscence Coordinator told us that their own staff try to cover any absences but if they are not able to do so then agency staff are used, in order that there continues to be sufficient staff. Eleven members of care staff (34 ) have achieved the National Vocational Qualification (NVQ) Level 2 or 3 in Care. Another member of staff has commenced the training for this qualification. The required 50 of care staff with the minimum of NVQ Level 2 has not yet been achieved but this is a new service that is working towards this. Training related to specialist needs such as dementia has also taken place. Four staff files were looked at and all contained the appropriate documents and evidence indicated that the recruitment procedure and practice are robust and safeguard the residents from the employment of unsuitable people. Each had proof of the persons identity, at least two written and two verbal verified references, a ten year employment history, a completed health questionnaire, a Criminal Records Bureau (CRB) disclosure and a Protection of Vulnerable Adults First check (that shows whether the person has been placed on this register or not). There was no evidence recorded that any offences on the CRB disclosures had been discussed with the person. This was discussed with the Executive Director who advised us that discussion about any convictions was the usual practice and that the person was only employed if they were satisfied with the persons response. This needs to be recorded to evidence that a discussion took place and whether the response was satisfactory. The staff files included signed agreements to say that staff have received a General Social Care Council code of practice and copies of policies and procedures. All applicants are interviewed twice, which include written exercises. Interview notes were included in the staff files. All staff undertake the Sunrise induction training before they start to work in the home. This consists of nine days of theory training and at least three days of practical supervision in order to give them the knowledge and skills to be able to do their job. Care Homes for Older People Page 26 of 33 Evidence: All CRB disclosures for the home up to this date were seen at this visit. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A person with the appropriate management experience temporarily manages the home but is not yet registered with us. The monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. Health and safety practice not protects residents and staff at the home. Evidence: A person with the appropriate qualification and who has previous management experience manages the Community. This is currently the executive director of the Knowle services whilst the organisation recruits a manager to be registered with us. There is also a Reminiscence coordinator responsible for the Reminiscence floors and a Skilled Nurse Coordinator who is responsible for the Skilled Nursing Neighbourhood on the ground floor. The previous registered manager was the Reminiscence Coordinator. The executive director was present for most of the inspection visit and the Reminiscence Coordinator was present throughout. Both were knowledgeable about all areas of the service and very helpful and cooperative. Discussion with the Reminiscence Coordinator showed that she was fully familiar with the needs of Care Homes for Older People Page 28 of 33 Evidence: residents living on the first and second floors and her leadership was reflected in the care managers. The Skilled Living Coordinator was not present during the visit. The other management team members consist of the Maintenance Coordinator, responsible for maintenance and the housekeeping staff, the Catering Coordinator responsible for the catering and the catering staff and the Activity and Volunteer Coordinator responsible for activities and the activity staff and the volunteers. The usual management system in the Community is an unusual one for care homes as we consider the registered manager to be responsible for all areas of management. Quality Assurance takes place, using the Sunrise programme. Residents and families are able to feedback their opinions and views on the services that are provided at family meetings, in an annual survey and in the various resident committees held each month. Monthly inspections take place by an objective representative of the Responsible Individual and which are audited and action plans formed from the outcomes. Monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. Some money is kept on behalf of residents, which is kept in a secure location. There were appropriate records of all transactions and cash balanced against these records. Receipts for any spending were kept with these records. There was evidence from a random check of records including those for hot water temperatures, the gas boiler, the hoists and the passenger lift, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system and fire drills were up to date. Fire safety training takes place at monthly intervals to ensure that any new staff have undertaken this training. Staff have undertaken other mandatory training related to health and safety issues, such as Moving and Handling and Health and Safety. No health and safety issues were noted during the visit and the health and safety policies, procedures and practices safeguard the people living and working in the Community. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 A quality assurance system 13/11/2009 that assesses the handling of medication competence of the staff must be implemented.Action needs to be taken if these indicate that individual members of staff are not administering medication as prescribed. This is so that staff make sure that residents receive the correct medication at the correct time. 2 9 13 The Medication 13/11/2009 Administration Records must be completed accurately to record if medication has been administered or not. This is to minimise the risk of medication not being given as prescribed. Care Homes for Older People Page 31 of 33 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 1 The Statement of Purpose should include that pets are welcome and what pets already live in the premises in order to help people to make an informed decision whether to live at the home or not. Any handwritten instructions on Medication Administration Records (MARS)should be witnessed by a second person and signed by both members of staff. The source of the instruction should also be recorded on the MARS. Internal and external medications should be stored separately. A protocol should be in place for each medication prescribed as as required. Medication Administration Records should be completed accurately for the receipt of medication, including any medication that is carried forward from the previous cycle. The complaints procedure should be displayed where it can be seen by residents and visitors. Action should be taken to ensure that any source of odour and cross infection are prevented. Disposable towels should be kept in suitable enclosed containers in communal hand washing areas. Fabric hand towels should be removed from communal bathrooms and toilets. The surname of members of staff should be included in the staff rotas. Staff rotas should include the second name of employees. Staff rotas should show the actual hours worked or to be worked or a key included to show what hours the codes represent. The outcome of any discussion regarding Criminal Record Bureau disclosures should be recorded in the staff file. The post of registered manager should be filled as promptly as is possible and consideration should be given to the registered manager having full management responsibility. 2 9 3 4 5 9 9 9 6 7 8 9 10 11 12 16 26 26 26 27 27 27 13 14 29 31 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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