Inspection on 14/09/09 for Ashmount Residential and Nursing Home

This inspection was carried out on 14th September 2009.

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

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

Other inspections for this house

Ashmount Residential and Nursing... 18/01/10

Ashmount Residential and Nursing... 19/11/09

Ashmount Residential and Nursing... 15/05/07

Ashmount Residential and Nursing... 05/09/06

Ashmount Residential and Nursing... 17/11/05

Ashmount Residential and Nursing... 29/06/05

Ashmount Residential and Nursing... 08/10/04

Ashmount Residential and Nursing... 03/06/04

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The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

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Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for older people Name: Address: Ashmount Residential and Nursing Home 10 Southey Road Worthing West Sussex BN11 3HT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Val Sevier     Date: 1 4 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 32 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 32 Information about the care home Name of care home: Address: Ashmount Residential and Nursing Home 10 Southey Road Worthing West Sussex BN11 3HT 01903528500 01903528502 ashmount@btconnect.com www.guildcare.org Guild Care Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Patricia Hall Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Ashmount is registered to provide personal and nursing care for up to fifty people aged 65yrs and over. It is a large detached property situated in a residential area of the seaside town of Worthing. The sea front and shopping areas are a short walk away. There is a private car park at the front of the home and a garden at the back. Care Homes for Older People Page 4 of 32 Over 65 50 0 Brief description of the care home Accommodation is provided on 3 floors. A passenger lift allows access to all floors. Large communal sitting and dining areas are available on the ground floor. Fees are between #259 and #460 per week. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service 1 star. This means the people that use this service experience adequate quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The visit was carried out on the 14th September 2009 between the hours of 10:10 and 4:50pm Prior to the visit to the home we reviewed, previous inspection reports and information received from the home since it was last visited on 15th May 2007. The Annual Quality Assurance Assessment (AQAA) was returned to the Commission by the due date before we visited the home. The AQAA is a document that we send to a service once a year, in it they are able to comment on improvements they have made, any barriers to improvement to meeting the standards and how they feel the service is Care Homes for Older People Page 6 of 32 meeting the needs of people who live at the home. We met with the registered manager, deputy manager, five staff, three visitors and there were three people who use the service involved in the inspection visit. We looked at four pre admission assessments, five care plans, medication records, staff files and training records and fire prevention testing and training records. We sent out ten surveys to people who use the service, ten staff and five professionals at the time of writing the report we have had ten surveys returned. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: All individuals must have a plan of care related to an identified need for example tube feeding; showing staff what support they must give to the individual. Prescribed Medication must be available for individuals. Records must be kept of when medication is given, reason it is or is not administered and outcome for individuals. The record must show what dosage has been given when a varied dose is available. Records regarding controlled medication must be kept accurately to reflect what is kept in the home. Care Homes for Older People Page 8 of 32 Daily routines in the home must be flexible; when people who use the service are being encouraged to make choices for themselves and exercise personal autonomy, this is not supported. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 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. People that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process, which involves other professionals or family as needed. Evidence: The AQAA for the home said: The provision of information: Regularly updated information packs are available. Residents Agreement: We always provide this on the day of admission for resident and family to peruse together. Needs Assessment: A pre admission assessment is completed by the Care Services Manager prior to admission, unless it is an emergency. This is completed for all residents, if necessary, in conjunction with the Care Management assessment for Social Services. Emergency Admission: Senior staff provide the necessary information to the resident and family held within the admission pack, they would also undertake the initial assessments. They would follow up with the assessment of needs within the required 5 days of admission. Trial visits: Anyone can take the opportunity to visit the home for a trial, Care Homes for Older People Page 11 of 32 Evidence: staying for a meal, joining an activity, chatting to residents. We are just about to embark on a Luncheon Club for all interested residents. A time for them to draw apart and have a special meal of their choice and the little extras that go with it. There have been several admission since we last visited in 2007 we looked at three of them from the past six months. We saw that there was information on individual needs based on their present and past medical history for example, communication issues. The assessment offered choices and space for individual issues to be written. For example needs assistance of one person with personal care, able to carry out some tasks such as cleaning teeth, needs prompting. We saw information from other professionals such as health and social services which described how they saw individuals needs and what support if any they would continue to give the individual. We saw that one assessment had not been signed or dated. It was not clear when people had been admitted to the home, or when the assessment had taken place. Visitors spoken to on the day said they felt they had had enough information when they were looking for a home for their relative. They acknowledged that someone from the home had come to see their relative and they had been able to visit the home. Care Homes for Older People Page 12 of 32 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. The care plans do not always detail the needs of the individual and support staff are to give. The medication records and administration within the home do not always show that this is carried out in a safe manner to protect the people who use the service. Staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. Evidence: The homes AQAA told us that: Include the resident their friends and family as agreed in the care planning process. Care supervisor role further development of this role, which is a hands on, experienced carer, who supports the senior staff and carers with all care related aspects. Relatives are encouraged to be involved in providing personal care, if they and the resident wishes. Where relatives are not local, the named nurse keeps them involved with the changing needs of their relative through telephone calls in writing and via Email, with agreement of resident involved. Good working relations with local GP and Primary Care and Social Care Services. Care Homes for Older People Page 13 of 32 Evidence: Since our last visit in May 2007 there has been a change in the registered manager of the home and an action plan had been sent to the commission outlining areas where they felt they wanted to improve. One of these areas was care planning and we saw on the action plan that the date for revising the style and how care plans were to be written and reviewed was the end of June 2009. The manager explained that as a provider Guild Care wanted to standardise all the care plans across the group and as such the care plan revision had not yet taken place. We looked at four care plans where the individual had moved to the home in the last nine months. The first care plan we saw that the individual had moved to the home in May 2009, for a period of respite. We could not see a photo identifying the person. We saw admission details with the next of kin, GP and social workers contact details. We saw that there was some information to assist staff in caring for the individual for example best method of communication is: speak directly face to face. It had been identified that the individual had a poor appetite and likes bread and butter with marmalade, weight is below average and they needed food supplements high protein and high calorie diet, however the information also said the person had a normal diet and we could not see that supplements were in place or offered. We saw that a nutritional assessment was in place and the risk factors had risen between May 2009 and August 2009. A risk assessment sheet showed all areas where the individual was deemed to be at risk and this had been reviewed regularly. We saw that in July the review stated that the individual was to be reviewed daily with regard to nutrition and food that they had and a record was to be kept and they were to be weighed weekly. We saw that the individuals weight had dropped from 51.3 kg in May to 42.6kg in August although it had been as low as 40.6kg. There was no record of weight for the week ending 11th September. We could not see information for staff on how this was being managed. Under preferred daily pattern we saw that the individual likes to go to bed after lunch, go to bed early at night and get up early. The night assessment care plan was not completed. The next care plan we saw had care plans and documents associated with the individuals care and support including risk assessments. There was brief information for staff on how to support the individual for example nutrition and diet good diet eats large meals. Continence - uses pads. We saw that these plans had been reviewed regularly. We saw risk assessments for pressure area care, nutrition and falls. We noted that the individual is at risk of falls due to epilepsy we could not see how staff could lessen the risk or what action they should take if the person had a fit. In the third care plan we saw that the first piece of information was the manual handling and mobility assessment with information about pressure relieving aids, Care Homes for Older People Page 14 of 32 Evidence: hospital and sling to use and how many staff. There was information on preferred rising and bedtimes and hair care; wash and shampoo twice weekly with special shampoo and brush and comb daily. This individual receives their food and fluids via a tube in their tummy. We saw two pieces of information from the enteral feeding dietician dated February, June and July 2009, the last piece of information where changes had been made was at the back of the file. We could not see any information to inform nursing staff in the care of the feeding tube. The fourth plan we saw the individual also had a tube for their food. We noted that this had become blocked several times in the last month resulting in hospital admissions for the individual. We spoke with staff and they said they had tried several things to unblock the tube; the GP had been consulted and had suggested something which would help and should be available at the chemist. We saw that the staff had contacted the chemist who did not stock the said item. Resulting in the person going to hospital. We also saw that on their return on 13th September the day before our visit, that nursing staff at the home had noted that the area around the tube had an offensive odour. We could not see that any action had taken place about this. We also noted that this individual also did not have a plan of care for staff to follow with regard to care of the tube and the area around it. A record was on the care plans we saw about weekly bathing or showers. For this individual who was admitted on 28th May 2009 the bathing record started in June. The next record was July, there was nothing to say that the individual had been bathed, showered or received a bed bath in August. Their last bed bath was 4th September. This individual it was noted needs the assistance of two people and was to have a shower at least once a week. Due to having dry skin and being prone to pressure areas through immobility the individual was also to have a moisturiser daily after their wash. We could not see evidence of this (see below re medication). We also noted for this individual that on returning from hospital and being assisted to their room, hot water was spilt on them and a cold compress applied and the ambulance called to assess whether further treatment was needed. It was not clear from information we saw why hot water was being carried around the home and how this was split onto this individual. Staff on duty on the day of our visit were not able to comment as they had not been on duty at the time. We discussed this with the manager in the feedback from the day. She told us that a new routine had been given to staff for people to receive two baths and or showers a week and was concerned to hear that no record was available for one individual for a month. Care Homes for Older People Page 15 of 32 Evidence: We looked at the medication storage and administration records (MAR charts). We saw the medication records from the 31st August to the day of our visit. There are two medication trolleys; one on the nursing floor and one downstairs, both were attached to the wall. The home has Temazepam, Buprenorphine and Morphine Sulphate stored as a controlled medication and these were kept locked in cupboard near a small office. We looked at the Controlled Medication book and saw the total number of tablets written in the book did not match the stock for the Morphine Sulphate. A nurse who was helping us with the medication said that a night duty nurse (a member of the homes night staff) had sent all medication from the home with an individual when they went into hospital. The Controlled Medication record indicated that there should have been 14, 10mg Morphine Sulphate tablets in the home, which were not there. There were no records of this missing medication. We discussed this with the manager in our feedback. She said that the providers Guild Care, carry out regular audits within the home and they had been due one around medication storage and administration when this would have been picked up however this audit had been postponed. We saw that staff could read guidelines and policies on medication administration, errors, household remedies, prescription terms, and generic abbreviations. Medication had been booked into the home and there was a record of the amount the home had received We saw in the medication records kept by staff there were twenty seven gaps where medication was prescribed to be given and there was nothing to indicate if the medication had been offered, refused or destroyed. We saw that where there is a choice of dosage to be given for example one or two Paracetamol, there was not always a record of how many tablets had been given. Where a medication was as required there was no record of why it had been given and outcome for the individual. We saw that there were examples of medication that were to be given as directed with no directions for staff to follow. There was no indication in the medication records that creams and lotions and artificial tears that had been prescribed for individuals had been administered or applied. We saw for one individual their liquid Sodium Valporate was not available and staff had given the person tablets instead. We could not see if the tablets had been the individuals or someone elses. We saw that three other individuals had not received medication that had been prescribed for one or two days as the medication had been out of stock. We saw recorded on the MAR charts for one individual that staff had been unable to find an eye ointment for four days, for another calcium tablets had not been given for three days as none found. We saw that staff sometimes used the code Care Homes for Older People Page 16 of 32 Evidence: on the MAR charts to indicate why a medication had not been given. We saw for one person that O other had been used for loose stools, not swallowing, asleep and poorly. We could not identify which medication this referred to and which date. We discussed these areas with the manager within the feedback. All surveys returned by staff indicated that they are given up to date information about the support they are to give people that live at the home. Relatives spoken with on the day were happy with the care they saw being given, they felt able to approach staff and the maanger about any conerns, they felt involved in the care of their loved one. Care Homes for Older People Page 17 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. Evidence: The AQAA for the home said that: Open visiting, and ability for relatives and friends to take an active part in any social or other activities in the home. Regular Bingo club, where outside visitors from a Guild Care Sheltered Scheme attend. Outings; 1 to 1 and as a group activity. We provide a well balanced nutritional 6 week rotating menu with resident involvement through meetings and menu surveys which is changed twice a year. Have special themed days throughout the year to enhance the meal experience e.g. Chinese new year. The home currently has activity coordinators that run events mornings and afternoons five days a week. The coordinator on the day told us that in October this will go to seven days a week. On the day we where there, there was a bowls tournament in the morning where people collect points and then there is a prize and there was music, singing and playing hand instuments in the afternoon. We saw the activity book and Care Homes for Older People Page 18 of 32 Evidence: saw the programme for August for example had included a games afternoon with a table each for dominoes, cards and scrabble. Quizzes, bingo, skittles, communion, one to one time, film shows, basketball, car racing, frog drives, a trip to the Sea Centre at Littlehampton and a play your cards right event. We saw the menu for the day of the visit and saw that there was the choice of beef stew or chicken chasseur, jacket potato with cream cheese, potatoes, green beans and carrots. For dessert there was stewed fruit and cream, or chocolate mousse. For supper there was soup of the day, cauliflower cheese, pork pie and salad, cheese sandwiches and apricots and cream. There is also a late snack offered and food throughout the day for those that are hungry or eat at different times. We saw fresh fruit in the lounges and a wide selection of condiments on the table. We were able to speak with some relatives and people using the service on the day of our visit and they felt that the amount of activities offered by the home was good and offered choice and different experiences. Some relatives also take their loved one out and feel that this is supported by the home. Relatives are also able to eat at the home and one person has moved to the sheltered flats opposite Ashmount owned by Guild Care is enabled to spend time with their partner. Care Homes for Older People Page 19 of 32 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 who use the service are protected through the open complaints process and the staffs knowledge and understanding of safeguarding and protection issues. However with new legislation now in force regarding peoples capacity and deprivation of liberty staff will need to receive training in these areas. Evidence: The AQAA for the home said: We have a clear system in place for staff to follow. Respond to complaints when they arise, take the complaint seriously. Our Talkback service enables the person to communicate directly with the CEO. All new staff attend Adult Protection training run by Guild Care. This item is on the agenda for both general and senior team meetings. In the last few months complaints have been investigated by the Operations Director and now by the new Home Manager. The approach to complaints has changed, staff are aware of the complaints, action plans have been produced to consider the lessons learnt and complainants are satisfied that their complaints have been dealt with.The complaints gave us the opportunity to look in detail at the service and complete our own internal investigation which led to the departure of the previous Manager. The home has a complaints procedure, which is outlined in the Statement of Purpose and Service User Guide and on display in on a notice board above the visitors signing in book. Care Homes for Older People Page 20 of 32 Evidence: The homes safe guarding adults policy was observed to have been regularly updated and included the West Sussex Multi Agency Adult Protection flow chart on how to report suspected abuse. We saw that some staff at the home have had training in safeguarding in July and that training is undertaken with new staff as part of their induction. It was not clear that this training included the Mental Capacity Act and Deprivation of Liberty. At the time of writing this report there are currently three safeguarding allegations being investigated by social services. We saw that the home and providers Guild Care have been working with social service to investigate and resolve the issues that have arisen. The registered manager had been to a meeting about the concerns with the Registered Provider the morning of our visit they have written an action plan which they are to present to social services. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a living environment which continues to have ongoing redecoration and refurbishment to improve it. Evidence: The AQAA for the home said: We have significantly invested in the interior of the home to make it more attractive and appealing to residents and vistors. Comprehensive call bell system, with choice of equipment to meet individual needs hard wire call button neck pendants. Range of fully assisted bathing facilities are available throughout the home. Access to Sky package, at residents own expense. Encouragement given to personalise own bedrooms and add homely touches. We have upgraded the lift. We have re-decorated and re-carpeted the ground floor and first floor of the home to make the home more attractive. We have significantly reduced the odour problems within the home. We have de cluttered the home removing unwanted items of furniture and linen which was causing storage difficulties. We have purchased new bed linen, towels, cutlery and catering accessories for the dining room. We have purchased new pictures to refresh the communal areas now the redecoration has been completed. We have installed new double glazed windows in the dining room and a new entrance door which is more attractive to visitors. We have upgraded a number of resident rooms as they become empty. We looked around some of the home and we were able to see communal areas such Care Homes for Older People Page 22 of 32 Evidence: as the dining room, lounge, bedrooms and bathrooms. People who live at the home are encouraged to furnish the room with personal belongings such as furniture and pictures. The home was seen to be very clean throughout, with no malodour. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work are covered. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home. Individuals commented to us that they were happy with their accommodation those that had them liked having ensuite facilities. They described small pieces of furniture that they had been able to bring. They liked the lounges where they could sit with others and chat, watch television, read or listen to music or just be quiet. Laundry facilities are sited away from areas where food is prepared and stored. Care Homes for Older People Page 23 of 32 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. Current recruitment practices at the home help to protect the people who use the service. Staff have received all the mandatory training that is expected each year, and training to help them meet specific individual needs. Evidence: The AQAA for the home said: Guild based staff training strongly encourage, with several areas mandatory, to meet minimum standards e.g H and S Skills for Care. Generous staffing levels fully meet needs of residents non care staff for all catering domestic and laundry duties, allowing care team to provide for Residents needs primarily. Good skill mix. At the time of the visit there were forty four people living at the home. The staffing structure at the home consists of the registered manager, deputy manager, nurses, senior care staff, care staff, administrator, kitchen staff and housekeeping. Staff spoken with on the day of inspection indicated that they were aware of the needs of the people who live at the home. On the day of our visit the registered manager and deputy manager were available. There were two nurses on duty with those that required nursing care and a senior carer was managing where individuals required personal care. They were supported by up seven care staff and housekeeping. There have been several people employed at Care Homes for Older People Page 24 of 32 Evidence: the home since our last visit. The manager explained that there have been major changes in the staffing at the home following the departure of the previous manager, mostly at the senior level. We looked at five people have been employed to work at the home recently and we saw that there were two references. There was evidence that a CRB had been received or applied for and that a POVA First check had been carried out however the policy of Guild Care is to send the top half employers copy of the CRB and there is no date on this. We were unable to confirm whether the CRB and POVA had been received before the individuals had commenced employment. Since the visit the manager has sent us the dates of commencement of employment and receipt of the POVA and CRB checks. We saw that the individuals had commenced an induction process. Supervised placements take place when the employee has begun work, and after recruitment checks have been returned. All staff information is kept at the home in locked drawer in the managers office. We spoke with the manager about the recruitment checks when we gave feedback. She said she would check the dates of the CRB and POVA checks and send them to us. The training plan was not available at the time of the visit, in an easily readable format and would have taken a lot of time to see how many staff had completed training in specific areas. The manager said it may be possible to extrapolate the information and send this to us. We could see on the files we looked at that staff had undertaken medication administration training, food hygiene, fire safety, first aid, infection control, safeguarding adults and moving and handling. Since the visit the manager has sent us confirmation of dates of the training and numbers of staff who attended. The new staff undertake induction training which includes an introduction to the home for example fire procedures. The individual works through a pack with questionnaires on areas such as the home, safeguarding and their own personal development. We saw that the individual meets with the manager as needed before being signed off as completing the induction. Four surveys returned by staff state that there are usually enough staff on to meet individual needs and four surveys indicated that there were always enough staff. Six surveys from people that use the service indicated that they receive the care they need and staff are always available when they need them, three surveys indicated that they usually receive the support they need and that staff are usually available when they need them. Care Homes for Older People Page 25 of 32 Evidence: In the surveys staff were generally happy feeling they received training and support, there weer comments about use of agency staff and staffing numbers get rid of agency staff and appoint more staff. Care Homes for Older People Page 26 of 32 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 systems and procedures monitor and maintain the quality of the service provided and promote the safety and welfare of those living and working in the home; the exceptions are care planning and medication. Evidence: The AQAA for the home said:RMA RN New manager experienced in management, has worked for Guild Care for the best part of 10 years. New Care Services manager is a long standing Registered Nurse and experienced Guild Care Manager. Head Chef experienced, Qualified chef, with CICH training certificate and Advanced Food Hygiene qualification. Personal training and development records for all SMT show continual development of own personal development including management skills. Positive feedback from several sources. Evidence within Trustee, Reg 26 reports. Other reports, such as facilities manager H&S Audits. In the past 4 months we have provided support to the home via a specialist team. As a result team meetings have been reestablished, are now regular and dates for the year published. Staff supervision is improving and all Supervisors have attended a supervision refresher course. Dates Care Homes for Older People Page 27 of 32 Evidence: have been set for supervision, new supervision lists have been produced, meetings have been held with all staff with poor sickness records, probationary periods have been reviewed and appointments confirmed, extended or terminated. Several sessions have been undertaken to provide refresher training to RNs and Senior Staff on care planning and adult protection. We saw that the home has plans for the next twelve months:Establish the new senior team especially the home manager and the Care services manager. Review the current systems and optimise their use. Introduce IT where appropriate to make work quicker and easier. Establish an inclusive culture for both residents and staff, use meetings as opportunities for consultation and feedback. Use feedback from above to increase the efficiency of the home and quality of life and outcomes for residents. The manager came to the home last November to assist in updating the home and supporting the team. Mrs Hall stayed at the home following the departure of the registered manager and became the registered manager earlier this year. She has worked for Guild Care for ten years and has attended training herself in the last six months in managing change, team supervision, performance management, communication and bullying and harassment. We saw that the certificate related to the homes registration was displayed in the hallway and displays the details of the core registration for the home. We saw that there have been staff and resident meetings. The residents commented on food and activities. The home does not look after any personal monies for individuals at the home. The manager informed the commission in the AQAA that the servicing of all utilities and equipment used in the home has taken place. We saw the policies available to staff and that new ones have been introduced as necessary for example training and medication. We looked at the records for fire safety training and monitoring of equipment we saw records that indicated that staff have received training every six months. The records for testing the fire alarms had been completed weekly. We saw that the records for the monthly checks on emergency lighting were last completed monthly. Care Homes for Older People Page 28 of 32 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 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 15 Sch 3 (1)(b) The registered person must ensure that residents have clear individual care plans describing the support that staff give to meet identified needs. To ensure that individual needs are met safely 14/11/2009 2 9 13 13 (2) The registered person must ensure that a record is kept of the amount of medication that is given where there is a variable dosage and why and when an as required medication is given and its effect. This will ensure that the individual receives the correct medication and helps to monitor their health. 14/11/2009 3 9 13 13 (2) The registered person 14/11/2009 must ensure that lotions and creams are administered at Page 30 of 32 Care Homes for Older People 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 the times and in the amount that it has been prescribed, and that a record is kept. This will ensure that the individual receives the correct medication and helps to monitor their health. 4 9 12 12 The registered person must ensure that medication that has been prescribed is available for the individual. This will ensure that the individual receives the correct medication and helps to monitor their health. 5 9 13 13(2) The registered person must ensure that the records relating to the medication being stored as a Controlled Drug are kept accurately. This will ensure that the individual receives the correct medication and helps to monitor their health safely. 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 14/11/2009 14/11/2009 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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