Inspection on 09/10/08 for Culm Valley Care Centre

This inspection was carried out on 9th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Culm Valley Care Centre 15/04/08

Culm Valley Care Centre 09/08/07

Culm Valley Care Centre 26/10/06

Culm Valley Care Centre 01/06/06

Culm Valley Care Centre 13/09/05

Culm Valley Care Centre 26/04/05

Culm Valley Care Centre 23/11/04

Culm Valley Care Centre 30/06/04

Culm Valley Care Centre 25/03/04

Culm Valley Care Centre 13/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Culm Valley Care Centre 10 Gravel Walk Cullompton Devon EX15 1DA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Fleet     Date: 0 9 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Culm Valley Care Centre 10 Gravel Walk Cullompton Devon EX15 1DA 0188433142 0188432846 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ashdown Care Limited Type of registration: Number of places registered: care home 56 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: On the termination of the placement of any of the named service users the Registered Person will notify the Commission and the particulars and conditions of this registration will be altered. Registered for up to 6 people Intermediate Care (50 years and above) The maximum number of placements including those of the named service users will remain at 56 To admit one named persons outside the categories of registration in the category DE[E] as detailed in the notice dated 31st July 2006 Date of last inspection Brief description of the care home Culm Valley Care Centre is a 56-bedded home, with accommodation over three floors, which provides nursing care for people over 65 years of age. This includes Care Homes for Older People Page 4 of 37 Over 65 56 56 0 0 Brief description of the care home convalescent, respite and continuing care. The home can also offer accomodation to people who need care but who do not have nursing needs. It is a few minutes walk from Cullomptons high street amenities, being situated just behind St Andrews Church. Besides a car park at the entrance to the home, there is parking elsewhere on site. Each floor has a lounge with a dining area. Of the 44 single bedrooms, most are en-suite. There are also 6 double rooms. Some rooms overlook the spacious and level landscaped garden, with patios accessible from the first floor corridor and some residents rooms. There is a shaft lift between floors, and level access on each floor. The cost of care was 350-700 pounds per week at the time of this inspection, depending on the needs of each individual. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers. Our previous inspection reports are available in the reception area. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Date of the last Key Inspection: 15 April 2008. This Key Inspection took place as part of our usual inspection programme. Our unannounced visit to the home took place over ten hours on a weekday. Teresa Anderson, Dee McEvoy and Rachel Fleet, Regulatory Inspectors, undertook the inspection. A CSCI questionnaire (the Annual Quality Assurance Assessment, or AQAA), sent to the home ahead of our site visit, was returned by acting manager Paula Burtoft and Marlene Butler, Operations Manager for the company that own the home. This included the homes assessment of what they do well and any plans for improvement, as well as Care Homes for Older People Page 6 of 37 information about the people living at the home, staffing, policies in place, and maintenance of facilities. We had also sent surveys to the home for them to give to 10 people living at the home and to 10 staff. We received surveys back from 5 people living at the home (all women, who were were helped by relatives to complete the survey) and from 4 staff. Two healthcare professionals returned surveys, of six provided. Responses were generally positive, with people noting improvements at the home in recent months. During this visit, two of us looked at care matters and one dealt with administrative matters such as health and safety, staff recruitment and training, and quality assurance systems. We spoke with 10 of the 29 people who lived at the home, and met other people who were unable to give their views because of their frailty. We also spoke with 5 family visitors, and 2 visiting doctors. We found out what it was like living at the home from them, as well as by talking with 9 staff (ancillary staff, nurses, and care assistants), and by looking around the home. We case-tracked 6 people, which meant we looked in more depth at their care. They included men and women, people new to the home, people who were assessed as needing residential care only (i.e. not needing nursing care from the homes staff), people with complex or changing needs, and people at the home for a short stay. We read their care records and other relevant information - medication records, personal monies records, etc. We met them, observed some of the support they received, spoke to staff about their care and other matters, and looked at the accommodation with regard to their needs. We also checked information on staff recruitment and training, and looked at records relating to health and safety, such as accident logs and evidence of maintenance or servicing. We ended the visit by discussing our findings with Paula Burtoft and Marlene Butler, who had assisted us fully through the day. An unannounced Random Inspection was carried out on 21 May 2008, to follow up requirements made at the homes previous Key Inspection in April 2008 and information received just after that inspection. A Statutory Enforcement Notice was subsequently issued, relating to meeting peoples health and welfare needs. The home was asked to provide an improvement plan, to address all requirements made. A second unannounced Random Inspection was carried out to check compliance of the Statutory Notice, on 28th July 2008. Although some requirements and recommendations were made following that inspection, it was felt that the requirements from the Statutory Notice had been met. Information included in this report is from all these sources, and from communication with or about the service since our last inspection. What the care home does well: What has improved since the last inspection? What they could do better: Keeping the written information about the home up-to-date would help people to make a fully informed decision when choosing a care service. By assessing prospective residents needs more fully, and using such assessments to inform care planning, staff can be enabled to provide person-centred care for each person living at the home. Some social activities are provided, but social events and recreational activities should be based on the views and preferences of individuals living at the home, to ensure their particular social and leisure needs are met on a more regular basis. Improving certain medication practices would promote peoples welfare in the longterm, as would further action on infection control measures and better monitoring of the safety of the environment. Care Homes for Older People Page 8 of 37 Staff are caring, but more consideration for privacy when talking about certain matters would ensure peoples dignity is not compromised. People would benefit if some staff had further training, so the various and changing needs of individuals will be met and met safely. The home as a whole would benefit from the appointment of a registered manager to provide longterm stability and direction. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 37 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some information about the home is not up-to-date, so prospective service users may not be able to make a fully informed decision when choosing a care service. Assessment of prospective residents needs has improved but is still not always sufficient to ensure that people will receive person-centred care if they move into the home. The home does not currently provide intermediate care. Evidence: Four of five surveys returned from people living at the home confirmed they had received a contract from the home. All said they had received enough information prior to moving in. We found the Statement of Purpose and Service User Guide in the bedroom of someone new to the home were out-of-date (referring to a previous registered manager, the Health Authority as the regulatory body, etc.). Senior staff Care Homes for Older People Page 11 of 37 Evidence: said they would address this. Since our last key inspection, the service has taken action to ensure assessments of prospective residents needs are reviewed, to ensure that individual needs can be met before the person is offered a place at the home. We saw that the Operations Manager had checked assessments carried out by other staff. We spoke with a relative of someone new to the home about the admissions process, since we were unable to speak with the individual themselves. They were happy with the way the admission had gone, confirming they had previously received enough information about the home. They had also visited another nursing home, to have something to compare with. They told us, I was impressed with this place. There was no smell and it seems like a 5 star hotel...Staff gave us a very friendly reception, we felt welcome when we came to look around. We saw a letter had been sent to them confirming that the home could meet the persons assessed needs. We looked at pre-admission assessments for two people recently admitted to the home. One persons assessment included their medications, some of their likes/dislikes, their mental health needs, and problems with pain. There was little information under Social contact (clubs, etc.). Some information in this assessment had not then been used in subsequent care planning. For example, the persons care plan said Needs some assistance to wash and dress without referring to their preference for showering, or how restricted limb movement affected their independence (which we saw detailed in the assessment). The home had information about the second person from health and social care professionals, although some of this was out-of-date or lacked detail. An Admissions enquiry form for the home reflected very well that the person had several and varied needs. The acting manager and operations manager told us they had visited the person in hospital to complete an assessment. We saw this included a full medical history and generally covered the activities of daily living. There was some good detail - about the persons weight loss and risk of developing pressure sores, for example. It lacked detail elsewhere, such as about their individual continence needs and the emotional and psychological support needs stated in the Social Services care plan. Social interests, hobbies, religious and spiritual needs were not been mentioned despite psychosocial problems being identified, nor any special diet needed in view of their medical history and current problems. The persons care plan reflected this lack of personal information. Care Homes for Older People Page 12 of 37 Care Homes for Older People Page 13 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in care and medication management are promoting peoples welfare. However, care planning and monitoring is not yet sufficient to ensure that peoples needs are met consistently and safely, in a person-centred way. Staff are caring, but an occasional lack of consideration for privacy compromises peoples dignity. Evidence: Surveys from people living at the home said they usually or always got the care and support - including medical support - that they needed. One added It is getting better. Another said There had been issues in the past. I am pleased to say that things have improved enormously. A GP, asked if the home sought advice and acted on it to manage and improve peoples health care, said that this was much improved. They thought their patient at the home seemed well looked after. A visitor to someone with complex needs said, I have no complaints at all. I am very happy with the care. They are doing their best with my relative. Most people that we met looked well cared for. Care Homes for Older People Page 14 of 37 Evidence: Care plans we saw were generally comprehensive, with aims of care stated alongside the care planned. They were individualised to an extent, although it was not always evident that the person themselves (or their advocate) had been involved in drawing up their care plan. There was some information about peoples past lives - where they were from, their school days, etc. - giving staff a better picture of the person to promote personcentred care. However, some care plans didnt address peoples social, psychological or faith needs as well as their physical needs. Basic information was available on someones preferred activities, but their care plan didnt include how they were to be enabled to continue to enjoy them. The person told us they couldnt remember the last time they had been out into the garden - something they had enjoyed in the past. The acting manager confirmed this was an area needing development. Someone had recently been diagnosed as having dementia with depression, through involvement of a Community Psychiatric Nurse and psychiatrist. A care plan was still to be drawn up for these new problems. Daily notes for another person indicated they could be aggressive, but there was no care plan to guide staff about this. It was positive to see someones Communication care plan identified a cause of their difficulties (although another cause was not included). There was good guidance on using simple questions and props. One staff member did not know what the props might be. We saw staff were unsuccessful when trying to engage with the person. The Arrangements for mealtime section of their care plan was blank but staff on duty told us the person liked to have their meals in their room. Their poor appetite was highlighted elsewhere and staff said they needed encouraging to eat as they were reluctant. But their Dietary preferences were recorded as nil. A staff member said they were trying to find out their food preferences, although a diet intake chart had been discontinued. During our visit, we saw the person did not eat much despite staff attempts. The possibility that depression might be the cause of the persons reluctance to engage with staff or to eat had not been explored, it appeared. Some information in daily notes or monthly evaluations had not been used when two care plans had been re-written recently. But staff felt that overall they were receiving more accurate information and were positive about changes at the home. One said, There is better communication within the team. They felt improvements could still be made, especially in relation to night staff. Care Homes for Older People Page 15 of 37 Evidence: Staff told us they used profile care sheets rather than the care plans. These gave peoples physical care needs rather than their social needs. We saw little information to ensure personalised care - such as peoples preferences or abilities, or the actual assistance a carer should give. Senior staff told us the profiles were a short-term measure, to ensure basic needs were met whilst the staff team was developed One staff member told us, Handover is where most information is passed over. A staff survey said some nurses were better than others at informing the care assistants. The staff handover we listened to informed and explained well about changes to peoples condition and care. Specific care was prioritised - such as for those who hadnt eaten well that day, or who should be offered help to the toilet after the handover. Less information was given about how people had spent their day. Risk assessments had been completed for most people in relation to falls, mobility, nutrition and risk of developing pressure sores, including for someone at the home for a short stay only. There was evidence that staff had been checking one person regularly as a result, and had contacted relevant professionals regarding someones weight loss. Where one person was identified as at risk of getting pressure sores, we saw staff used the recommended equipment at all times, as well as having information to ensure they were as well nourished as possible, to help prevent sores. Good records were kept of bruising or minor injuries noted by staff, through the use of body maps in care records. Records were less clear for one of two people who had pressure sores, so it was difficult to ascertain how their sore had developed. But we saw staff changed the persons position frequently and kept good records of this. Specialist nurses were involved in the persons wound care. One person was prone to get pain, but their relative was very happy with the care they were given, saying staff did all they could to keep the person comfortable and happy. We saw people were positioned properly when being helped to eat and drink. Care records detailed how frailer people were to be positioned at such times. Staff gave several people diet supplements between meals, taking time to do this at a pace suitable to the individual. We noted that someones mouth was very dry, with their drink out of their reach. We informed staff, who told us this person could help themselves if their drink was to hand, as we had also found. We later saw that a cup of tea was cold, untouched and again out of this persons reach. Care Homes for Older People Page 16 of 37 Evidence: Someones care plan clearly informed how staff were to monitor their diabetes. This included their usual blood glucose range, with evidence that staff had contacted medical staff when the persons blood glucose was outside this range. It was positive to see daily notes included evaluations of individuals care plans. Occasional entries were unhelpful (such as analgesia as prescribed without evaluating its effectiveness, and food taken in her room without saying how much the person ate, where there were concerns about someones intake). But most were meaningful, and informed about how the person had been that day. People spoken with were generally happy with the care provided. One told us, I always know there is someone to help. This is a good place. Another said, I am very well here. I have nothing to grumble about. We have good staff. They are there when I want them. Staff were pleased with recent improvements in standards of care. For example, we were told, We used to put pads on people. Now we are offering them the commode or toilet. It is much better. We saw this particular change reflected in someones care records. Medication records included if people had any allergies. Handwritten directions had been signed and dated by two people, to ensure accuracy and accountability. We saw staff had reviewed the effect of a change in someones medication. One person had been refusing a medication, but staff said the GP had not been informed yet. This should be done in a timely way. One person was prescribed varying doses of a medication. The home had requested these changes in writing, from the GP, which is good practice. One person was prescribed variable doses for two medications, but staff had not recorded the dose they had given. Senior staff said they would follow it up with the staff member concerned. Secure storage has been provided for controlled drugs since our last visit, and appropriate records had generally been kept. Stock levels were relatively high, given the prescribed doses, for some items. The manager agreed to monitor this. Three medications had not been dated on opening, so shelf-life as advised by the manufacturer could not be monitored properly. We also noted that the actual dose of one controlled drug was not recorded in the register. Daily fridge temperature records were kept, but fluctuations between the daily readings were not monitored because minimum/maximum readings were not Care Homes for Older People Page 17 of 37 Evidence: recorded. Insulin was being stored, which is made ineffective by very low temperatures. Gaps on medication records related to skin creams suggested some were not given as prescribed. The acting manager felt this probably reflected an omission of signatures by staff. Care staff usually applied creams, but the nurse in charge was responsible for signing the chart. We discussed ways of ensuring a record was kept, such as having separate charts which care staff could sign. We observed staff were friendly and polite in their approach to people. Four people told us that staff were friendly, respectful and treated them well; certain staff were described as gentle and kind. A visitor confirmed that staff always addressed their relative by their preferred name. We saw staff knocking on peoples door before entering, and personal care was provided in private. One person said staff respected that they preferred their own company. On a number of occasions, we heard staff talking indiscreetly. This was reflected back to staff by someone who exclaimed Does everyone know Im going to the toilet now, or is there anyone else we need to tell?! Continence pads were not always stored out of sight in bedrooms, which again does not promote peoples dignity. Care Homes for Older People Page 18 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some social activities are provided, but this does not ensure that peoples social and leisure needs, particularly those with complex needs, are met on a regular basis. People benefit form continued relationships with family, friends and the wider community around them, which are supported by the home. They are offered a balanced diet, taken in congenial settings, which promotes their health and social wellbeing. Evidence: One person told us, The routines are OK for me. I didnt get up until 9am today and that was my choice. I can do what I like, but I cant go out. Another person said they could get up and go to bed when they wanted to, adding, There is no one telling me what to do. Care records for one person included that their bath day had been changed as they requested. Asked if the home supported people to live the life they choose, a GP wrote, I believe this much improved now staff levels are improved. They also thought the home usually responded to peoples diverse needs. Care Homes for Older People Page 19 of 37 Evidence: Four surveys from people living at the home said that there were usually activities arranged by the home that they could take part in; a fifth said always. We saw a poster for a Harvest thanksgiving to be held at the home, and a weekly programme of activity. This included a trolley shop, video club, board games, a visit from a Pets as Therapy dog and a word quiz. A church service was held monthly at the home. We saw staff engaging in activities with several people in the ground floor lounge. A carer played dominoes with one person, and chatted with others in the morning. Another carer was allocated to be there in the afternoon, although some of her time was spent giving out drinks elsewhere. Little activity was provided for people in the first floor lounge or in their bedrooms. One person was nursed in bed and appeared to have very little social contact with staff, except when physical care was given or at mealtimes. Two people in the first floor lounge slept for long periods, with the TV on. Staff popped in to check if everything was alright, but there was little social interaction. Care plans we looked at had little information about peoples past interests or hobbies to help to the home organize person-centred activities. Records showed that people had little diversion regularly. Entries included such as Painted nails, Chat about farming, Seen by hairdresser. A new activities co-ordinator had been appointed, but was currently unable to take up the post. An Activity folder showed one-to-one social interactions led by care assistants. The number of entries varied between individuals, and it was difficult to see if everyone was offered the same amount of time. A visitor wished staff would take their relative outside for a smoke, at the times the person used to have a cigarette. They said She doesnt ask, but if you offer shell be off. One person enjoyed gardening when in better health, but told us they had never been taken into the garden by staff, only going out when family visited. This person told us there was no activity within the home they could take part in and that they were fed up with the TV. We noticed that they spent considerable periods of time alone in their room. We saw someone else being taken out to sit in the Autumn sun. They were really excited about going, and enjoyed the time greatly. The home did not expect to be the appointee for anyone living at the home, leaving people free to choose who helped them with their financial affairs. Information was available from the home about advocacy services. Bedrooms were personalised with peoples possessions, the handyman being available to put up pictures, etc. to make their rooms homely. Care Homes for Older People Page 20 of 37 Evidence: A visitor said the home keeps us informed at all times about my relatives progress, and described the staff as friendly, adding that the family were happy with everything. Two relatives told us they felt very welcome at the home, and that staff were always friendly and offered refreshments. Care records included whether relatives had been informed of healthcare professionals visits to their relative at the home. Surveys from people living at the home said they always or usually liked the meals provided. A visitor told us The food is lovely - Id love to be eating it...she always has a drink - lots of tea rounds, and a jug of cold drink in the room. She gets biscuits, cake or yogurts between meals. One person who needed pureed food thought the meals all looked the same. Their dietary likes were recorded in their care records, but with no reference to any dislikes. Menus in the first floor dining room showed a varied diet was offered, of mainly traditional English dishes and with the main meal at lunchtime. The lunchtime we observed was unrushed. Specialist cutlery and anti slip mats were available to promote peoples independence. People needing assistance were helped sensitively and discreetly, staff sitting with them if necessary. Those who stayed in their rooms were also assisted in an unrushed manner. Food was delivered on a hot trolley and served by staff. We heard staff asking people what they would like, and meals were generally well presented. Pureed meals were also nicely presented, with each part of the meal (potatoes, vegetables and meat) pureed separately. We noted a staff member paid extra attention to how certain individuals were served their meals - checking the meals were nicely presented, that they had had all their courses, etc. Care records reflected that these were people at risk of not eating enough. Care Homes for Older People Page 21 of 37 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. The homes systems and robust safeguarding practices help to ensure peoples concerns are heard and that they are also protected from harm. Evidence: Surveys from people living at the home said they (or their relatives) knew who to speak to if they were unhappy, and how to make a complaint. A GP said the service had usually responded appropriately if they or someone living at the home had raised concerns about care. We have not received any complaints since April 2008. On our visit, no complaints or concerns were raised with us by service users, relatives or professionals we met, apart from two people who commented on standards of ironing. Two people told us they would speak to staff should they have any concerns or complaints. Both felt that staff listened to them, which was also reflected in the surveys returned. Two relatives told us they would take any concerns to the acting manager, and they were confident that she would deal with them. Senior staff agreed to update the written complaints procedure as was required. This was available around the home, as well as in information given to people new to the home. The service had received some complaints since the last inspection (such as a TV not Care Homes for Older People Page 22 of 37 Evidence: working, and regarding someones position in their chair). These were recorded by the home, including the action taken to address them. According to the records, no complaints had been received since August 2008, which the Operations manager confirmed. We noted one complaint that continence pads were not stored discretely, with records stating that staff had been instructed to rectify this. However, we saw pads left out in some rooms and not stored discreetly. We discussed whether it might be useful to audit the outcome of complaints after a lapse of time. People we asked said they felt safe at the home, one adding, Most staff are very nice. People also told us that staff treat them well. One person said, No-one ever shouts at me or hurts me here. Another person said that their spouse could be contrary but that staff were never contrary back. We asked care staff how they might manage aggressive behaviour, and were given appropriate responses. One said they hadnt themselves encountered such behaviour from current residents, but had seen a colleague act appropriately in a challenging situation. Records show that staff are receiving training in safeguarding adults. All staff spoken with had received the training. They demonstrated a good understanding of the different types of abuse, and described the correct action to take should they witness poor practice or have any other concerns regarding peoples safety or wellbeing. They were aware of outside agencies they could contact about any concerns if necessary. Senior staff at the home have made referrals to Social Services safeguarding staff in recent months, following correct procedures. They have co-operated fully in safeguarding investigations carried out since our last inspection. Recruitment procedures are thorough, helping to ensure new staff are suitable to look after people at the home. Care Homes for Older People Page 23 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from homely accommodation that is being improved through ongoing refurbishment and other measures, although better monitoring of the environment would ensure it remains well maintained. Evidence: People we asked were satisfied with their accommodation and said there was enough heating, lighting in the evenings, hot water, etc. They had a call bell within reach. Bedrooms were personalised, reflecting peoples lives and interests. Paintwork and furnishings were generally in good order in areas used by residents, the range of colours used creating a homely feel. There is lift access between floors, and wheelchair-accessible areas outside from which to view the gardens. We were told that the top floor, which was largely unoccupied on our visit, was to be refurbished and that nine bedrooms had already been recarpeted. Other carpets were to be replaced, including a carpet on the first floor where tape covered a frayed area. The local fire authority had inspected the home in recent months, but on our visit we noted that some fire doors were not closing properly. The Operations Manager subsequently asked the handyman to adjust the door closers on certain doors. The laundry door had no closer, which laundry staff said had been reported as broken but Care Homes for Older People Page 24 of 37 Evidence: senior staff were not aware of this. Matters raised in an Environmental Health Officers report since our last visit had largely been addressed. One matter appeared in need of further attention again. We were told that staff regularly ran all taps and showers in unused areas to control risks of legionella, but no records were kept of this. Surveys from people living at the home said the home was always or usually fresh and clean. One added they were pleased with the improvements, and another said Its getting better. The ground floor lounge had a strong odour when we first arrived, which had gone by later in the morning. Communal areas were generally clean, but some bedrooms were not entirely clean. We saw food stains, etc. on furniture in two peoples bedrooms, and one bedroom was not entirely odour-free. Senior staff said they would follow this up. Action had been taken to address some matters raised in an Infection Control Audit, carried out at the homes request in June 2008. The companys Housekeeping Manager was drawing up an action plan and senior staff were rewriting the homes Infection Control policy, to address the outstanding areas. We were told staff had had recent updating on handwashing and use of disposable gloves. We were also told that, in some cases, hoist slings are shared - a potential cause of cross-infection - on a risk assessment basis. Staff described the measures they took to reduce cross-infection, including correct use of disposable gloves and aprons as well as disinfecting skin lotions, which we saw were all available around the home. The laundry area was reasonably organised, with appropriate washing machine programmes for proper cleaning of laundry. Special bags were used for dealing with soiled washing, to reduce cross-infection risks. Care Homes for Older People Page 25 of 37 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. People are looked after by sufficient caring and committed staff, who would benefit from further training to ensure peoples various and changing needs will be met and met safely. Recruitment systems are robust, helping to protect people from unsuitable staff. Evidence: At the time of our visit to the home, there were 29 people living in the home. During the morning there were six care staff and a registered nurse on duty, supported by the Acting Manager and Operations Manager. Ancillary staff included the cook, kitchen assistant, laundry person, and one cleaner. Rotas showed there is always a nurse on duty, but care assistants are reduced in number after lunch to five, then four for the evening, with two on duty overnight. We were told that the nurse cover had recently been reduced after 4pm, from 2 to 1 nurse. The Operations Manager assured us that this would be monitored closely, to ensure standards did not deteriorate. The Acting Manager and Operations Manager currently also work full time at the home. The Acting Manager reported that she often works with carers as a way of monitoring and teaching good practice. Care Homes for Older People Page 26 of 37 Evidence: A GP, asked how they thought the service could improve, said, Maintain current staffclient ratio. A staff member commented, As breakfast is the busiest time of day, we need at least 5 carers to cover residents needs. This has been rectified and is working better. Three care staff told us there was usually enough staff on duty to meet peoples needs; one told us, We have more staff now, before there were not enough. I feel the quality of care has improved here. Someone who had expressed concerns about staff at a previous inspection told us matters had improved greatly. They still felt staff didnt respond quickly to their call bell because they were seeing to so many other more dependent people. One staff was concerned that staffing calculations should fully take into account the layout of the building and how this affected staff time/availability (- if they had to go to people on different floors, for example). We noted the great majority of people were up by 11am, but some people were still eating breakfast at 10.30am. A visitor said Staff appear busy but are never too busy to do things for you. We saw staff had time to sit and assist people at mealtimes, and people generally looked well cared for. Call bells appeared to be answered fairly promptly; one person told us, Youve only got to ring and they are here. Surveys from people living at the home said that staff were always or usually available when they needed them, and that staff listened and acted on what they said. Someone was particularly pleased with the staff who have started in the last few months, complimenting those already here. A relative told us, Things have really picked up since Paula (acting manager) arrived, all staff are pulling together to make things better. She said the staff team seemed stable at the moment so there is continuity now, and that new staff were getting to know Mum and me. Another commented similarly The staff are staying so you dont have to keep getting to know new ones. And they learn the little things about Mum that make the difference. Care staff made similar positive comments also. A GP thought improvements in care were were partly due to the quality of new staff. A new care assistant described their recruitment process, which showed required procedures had been followed.They said the Code of Conduct for social care staff had been discussed with them also. We looked at the recruitment files of four members of care staff. These were well organised and checks undertaken were robust. Contracts and the duty rota show that staff do not start work until references and a satisfactory police check have been received. The nurses registration with the Nurses and Midwifery Council (NMC) had Care Homes for Older People Page 27 of 37 Evidence: been verified, to confirm she was able to practice as a nurse. And there was a system in place to check that nurses had remained registered with the NMC. The homes interview notes showed that some learning needs were identified during applicants interviews. Other records show that relevant training was then given prior to them starting work. New staff underwent a nationally recognised induction (Skills for Care Induction training), as is good practice. Staff told us that when they started work that they were orientated to the building, including being shown what to do in the event of a fire. They then worked with another staff member who familiarised them with the people living here and their needs, as we saw happening during our visit. Records showed that some staff had received other training - such as on caring for people with diabetes, with swallowing difficulties, with dementia and with behaviours which might challenge the service. A new staff member told us they had had training on diabetes, infection control, safeguarding, and manual handling in the two months prior to completing our survey, with more training offered. Some people we case-tracked had particular medical conditions which affected their presentation, daily routine or longterm wellbeing (Parkinsonism and dementia, for example). Care assistants were not always aware of peoples underlying condition or diagnosis, how it might manifest itself, or that it caused certain of the persons problems. But they generally knew the basic care the person required, their special dietary requirements, what help they needed with moving, and some of their wishes or preferences. One staff member said they had printed information on other conditions. The Operations Manager reported that of the 19 care staff working at the home, 2 had successfully completed the National Vocational Qualification (NVQ) Level 2 in care; 8 were currently working towards this qualification, and 3 were about to start. Care Homes for Older People Page 28 of 37 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 being run in the best interests of those who use the service, although it would benefit from the appointment of a registered manager to provide longterm stability and direction. Evidence: At the time of our visit, the home did not have a Registered Manager, with action being taken to recruit someone. Meanwhile, the service was being managed by Paula Burtoft, a registered manager from another home owned by this company, and by Marlene Butler, the companys Operations Manager, both of whom were registered nurses. A visitor said that the manager has really pulled it together, and that the home now had a stable workforce. Staff spoken with felt well supported by the acting manager and operations manager; one said, They listen to us and try to rectify things. Staff surveys included the comment, Management check regularly with me regarding my working environment Care Homes for Older People Page 29 of 37 Evidence: i.e. if I have any issues I am not happy with, etc. The present manger is always willing to listen to any improvements which can be made and to discuss issues I am not happy with. This was reflected by other staff. Records showed that care staff received supervision, including one-to-one meetings with the manager, observed practice, and identification of learning needs. Where incidents had occurred, there were records that these were addressed, with follow-up meetings. One anonymous care assistant wrote in a survey that in their 4 months of employment they had not had one-to-one supervision to discuss their work, but there had been carers meetings with the Operations Manager. On our visit, other staff confirmed these meetings gave opportunities for general discussion, and feedback on the teams performance. An anonymous member of the ancillary staff wrote that whilst they received relevant training, their manager did not meet with them to discuss how they were working. They felt communication between staff, as well as team-working, could be improved. The Operations Manager informed us that the companys Housekeeping Manager visits the home weekly, spending part of her time with individual staff whilst they are working, or meeting with housekeeping staff in small groups. We found evidence that the home had made good progress in line with an improvement plan they sent us after our last inspection. Admissions to the home had been restricted whilst improvements were made, but restrictions had been lifted recently. We discussed with Paula Burtoft and Marlene Butler our concern that the home - having achieved a more stable, more competent care team during a period of low occupancy - might admit people too quickly, outpacing staff recruitment, induction, and specific training needed to meet the needs of any new admissions. We had been told about a reduction in nurse hours. We were assured, on behalf of Mr Arif Pradhan, the Responsible Individual, that admissions would be managed properly, at an appropriate pace, and staff levels would not be reduced further. A new quality assurance system had been designed, which included annual surveys sent by the home to all stakeholders, including relatives and health care professionals. Surveys will be sent direct from the companys head office and will be returned there. Relatives, staff and residents meetings are to be held three times each year. Minutes of a July 2008 Relatives meeting were available, and there had been a Nurses meeting held the week of our visit. Catering and activities were to be reviewed regularly. The home does not hold monies on peoples behalf. Instead, people are billed in arrears for money spent on their behalf. Receipts and records for all transactions were Care Homes for Older People Page 30 of 37 Evidence: kept, with records showing that if anyone paid a bill in cash, two people checked and signed for this. Staff we asked felt they had a safe working environment, with sufficient equipment to do the work asked of them, etc. Records showed that staff receive training on infection control, first aid, manual handling, and food hygiene. The latest food safety guidance was available in the kitchen. We saw records were kept of the food served; food portions were covered and dated. We were told that testing of portable electrical appliances was about to be carried out, and we were sent evidence of a safety certificate for gas appliances. The homes Annual Quality Assurance Assessment (or AQAA, required by us from every registered service), submitted in April 2008, showed other maintenance was up-to-date. We found some fire doors were not closing properly. This has been addressed under the section on Environment. Care Homes for Older People Page 31 of 37 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 32 of 37 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 1 6 You must keep the homes Statement of Purpose and Service Users Guide under review, and revise them where appropriate, notifying the Commission and service users of any changes within 28 days So that people have access to good, accurate information about the service offered by the home. 31/03/2009 2 8 12 You must ensure that the home promotes and makes proper provision for the health and welfare of people living there, especially regarding availability of drinks for people To ensure each person has enough to drink to promote their health and comfort. 10/02/2009 3 9 13 Arrangements must be made to ensure that the actual dose administered is recorded, where variable 10/02/2009 Care Homes for Older People Page 33 of 37 doses are prescribed for medication So that staff can monitor the effectiveness of medication properly. 4 9 13 Arrangements must be 10/02/2009 made to ensure correct storage of all medicines, especially with regard to systems for monitoring their shelf-life once opened, & systems for ensuring correct storage temperatures are maintained (including monitoring of minimum/maximum fridge temperature) To ensure all medications remain effective & safe to use. 5 10 12 You must ensure that the 10/02/2009 home is conducted in a way which respects peoples privacy ( - not fully met from 12/04/08 & 15/06/08), especially regarding conversations that can be overheard So that peoples dignity is upheld. 6 12 16 You must consult people 10/04/2009 living at the home about their social interests and the homes activity programme, making arrangements for them to go out, engage in local events, and enjoy other social or recreational activities, Care Homes for Older People Page 34 of 37 To ensure their life at the home matches their expectations & preferences, and satisfies their social and recreational needs. 7 19 13 You must ensure 10/02/2009 unnecessary risks to the safety of people at the home are identified in a timely way and eliminated where possible, especially regarding environmental fire safety measures To ensure peoples continued welfare. 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 3 Each person living at the home should have a plan of care, for their daily life and longer term outcomes, based on Care Management information and/or the homes own assessment which is sufficiently detailed to ensure that people will receive the person-centred care they need and want. It is recommended that care planning should promote opportunities for people to enjoy their social or recreational interests, so that their social needs will be met. It is recommended that care planning should be more person-centred, promoting individualised health and personal care. You should complete improvement work based on the findings of the Health Protection Nurses audit in June 2008 in a timely way, complying with professional guidance to establish good standards of hygiene. You should have robust systems in place to ensure all areas of the home, including individuals bedrooms and unused areas, are kept clean and free of malodours as well as possible sources of infection such as Legionella, to promote peoples dignity and welfare. 2 7 3 7 4 26 5 26 Care Homes for Older People Page 35 of 37 6 28 It is recommended that a minimum of 50 of care staff should be trained to NVQ Level 2 or above. (Unmet from previous 2 inspections). It is recommended that the staff training and development programme is such as to equip staff to care for people with different conditions (such as Parkinsonism and dementia), so they can fulfill the aims of the home and meet peoples changing needs. You should submit an application to register a manager for the care home, in order to confirm the home will be run by a person fit to be in charge. 7 30 8 31 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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