Inspection on 23/04/09 for Aspreys Nursing Home

This inspection was carried out on 23rd April 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Aspreys Nursing Home 04/06/08

Aspreys Nursing Home 06/12/07

Aspreys Nursing Home 25/04/07

Aspreys Nursing Home 13/09/06

Aspreys Nursing Home 08/12/05

Aspreys Nursing Home 06/04/05

Aspreys Nursing Home 12/10/04

Aspreys Nursing Home 29/06/04

Aspreys Nursing Home 04/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Aspreys Nursing Home 1 Kents Road Torquay Devon TQ1 2NL     The quality rating for this care home is:   two star good 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 Proctor     Date: 2 4 0 4 2 0 0 9 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. 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. 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 35 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Aspreys Nursing Home 1 Kents Road Torquay Devon TQ1 2NL 01803201500 01803201700 matron@aspreys.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Friendly Care Homes Ltd care home 33 Number of places (if applicable): Under 65 Over 65 10 25 old age, not falling within any other category physical disability Additional conditions: 0 0 A minimum staffing level that follows the previously agreed Health Authority staffing notice must be available to meet the needs/dependancy of Service Users who require nursing One named Service User, named elsewhere, under 60 yrs of age (PD Category) Service Users from age 60 years and above may reside at the home. The number of Service Users who require nursing is limited to 31 Two lower ground floor rooms must not be used for Service Users who require nursing Date of last inspection Brief description of the care home Aspreys Nursing Home is located in Wellswood, approximately one mile from Torquay town centre. It has level access to the local shops, pubic house and restaurants all being within 100 yards from the home and the St Matthias Church is within 200 yards of the home. The home operates its services on all of the four floors with the dining room and rear garden area being on the lower ground level, the lounges, matrons Care Homes for Older People Page 4 of 35 Brief description of the care home office and some rooms on the ground floor and the remaining rooms being on each of the two upper floors. All floors can be reached by a shaft lift. The home offers both Nursing and personal care mainly to people over the age of retirement (60 years). It is registered for up to 31 people who require nursing and for 2 people who require personal care only. The staff group is made up of registered nurses and social care staff (Health Care Assistants). There is a good level of specialist equipment like a Parker bath, hoists and stand aides available to meet the needs of disabled people. The inspection report is available on request at the home. A service users guide is provided in each person?s room and the homes statement of purpose is provided in the reception area of the home. The fee levels were stated at the time of this inspection as a range from #350- #570. The current fee levels can be obtained by contacting the home. The fees are dependant on the care needs of the peoples and the room occupied. Those people who require nursing care have higher fees. Additional charges include chiropody, hairdressing and any personal purchases. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key unannounced inspection, which took place on over two days, 23rd and 24th April 2009. A visit to the home was undertaken as part of the inspection. An expert by experience joined the inspection on the morning of the first day. A short observation tool was used during the inspection to access the experiences and quality of interaction people living at Aspreys had. One person observed during this period had their care followed. Three people had their care followed; one of these had been admitted for respite short-term stay at the home. During this visit a tour of the home was completed. People living at the home and staff were spoken to and some records were inspected. The owner was present for the duration of the inspection. Information received from the home since the last inspection was also reviewed. We received anonymous survey forms five form people living at Aspreys, one Health professional Care Homes for Older People Page 6 of 35 and four from staff working at the home. Some of the comments made during in the inspection have been incorporated into this inspection report. What the care home does well: What has improved since the last inspection? What they could do better: The intermediate care facility that now operates within the home does not take into account the guidelines contained within the National Minimum Standards. This includes providing dedicated accommodation, together with specialized facilities, equipment and staff to deliver the short-term intensive rehabilitation, which enables people to return home. Medication records had not been completed fully to show the reasons why medication was not given. The way medication was recorded and managed did not fully ensure Care Homes for Older People Page 8 of 35 people received the medication as their GP intended. The owner has responded swiftly and ensured practices have changed to reduce the risk of errors happening again; prior to the publication of the draft report. Although the activities programme had improved people who had chosen to stay in their own rooms were not always having their needs for social activities and interaction met. Not all the people spoken with were aware of the meals on offer each day and what choice was available for them. The last meal of the day was between 5:30 pm and 6:00 pm and breakfast was any time between 9:00 am and 11:00 am. This means that some people would be with out food for more than 12 hours each day. People who have chosen to stay in their own rooms were not always given the opportunity to have hot drinks mid morning and early evening. Although robust risk assessments for hot surface radiator people living in the home have access to was in place; not all radiators had been covered. This could mean some people may still be at risk from hot surface burns. The planed program of maintenance, redecoration and renewal of worn carpets should continue. This should ensure that all the people living at Aspreys have the same high standard of accommodation. Staffing levels or the way staff are deployed at the home may not be sufficient to ensure people who have chosen to stay in their own rooms are provided with hot drinks during the day and early evening. Although there was a robust recruitment policy in place not all pre-employment checks had been completed prior to a member of staff starting work. This may put people who use the service at risk from unsuitable staff. Although there was a clear commitment to providing training for staff including NVQ training. There has been a high turn over of staff since our last inspection. And this has affected the homes ability to provide 50 of its care staff trained to NVQ level 2 or above. Aspreys nursing home does not have a registered manager. The owner has acknowledge this in the pre-inspection information provided stating We are still advertising and looking for a registered manager. Once this has been achieved, I am sure we will then be able to concentrate better on providing the staff with the leadership and direction that would better enable them in their duties. The Commission has not received Regulation 37 notification of events that affect people living in the home in a timely manner. This means the Commission has not been kept fully informed of incidents and events that have affected people in the home. If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 9 of 35 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 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. The homes Statement of Purpose and Service Users guide are easily available for people who live at the home and visitors. This ensures that people have sufficient information about the home and the service it provides to make an informed choice about whether the home can meet their needs. The assessment and care planning process for people provides clear information about the person health, social and personal care needs. This should ensure that staff have sufficient information about the care needs for individuals to provide continuity of care. Evidence: The statement of purpose was available in the reception area of the home. This can also be printed off from the homes computer records. The owner had made some changes to the statement of purpose since our last inspection to reflect changes. People spoken with during the inspection were able to confirm they were given Care Homes for Older People Page 12 of 35 Evidence: information about the home. Four of the five people who returned survey forms said they were given information about the home prior to their admission. One person admitted through the crisis team was spoken with during the inspection. They said that staff had spoken to them about their care needs and staff at the home had told them about the home and its services. Their care planning information and assessments also contained copies of their community assessments and care plan. These detailed the aims of the emergency placement. One relative spoken with said they had spent time with staff when their relative was admitted talking to them about their care needs and what was important to them. The home does not offer intermediate care in the fullest sense . However it does offer short respite and a crisis admission service. Separate facilities for people accessing respite and crisis admissions at the home are not currently provided. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment processes for new people admitted to the home ensure that staff are aware of the needs of the person. The way the peoples health and personal care are managed by the caring staff team should ensure that their needs are met. Medication practices did not have sufficient safeguards to ensure people received the medication at the times their GP intended. This means people did not always receive the medication they needed, which could put them at risk of exacerbation of their illness. Evidence: At the time of this inspection nineteen people were living at Aspreys nursing home, two of these people had been admitted for crisis intervention. Three people had their care followed as part of this inspection, one of these had been admitted for short stay crisis intervention. People who had their care followed were spoken with where possible in private. Their plans of care and other paperwork relating to their care were seen. The individual rooms these people occupied were also visited Care Homes for Older People Page 14 of 35 Evidence: The home provides nursing care for people who live there. Registered nurses who cover a 24-hour period seven days a week oversee their care. People have access to health care professionals who provide advise support and treatment for the people living there. Each of the three people whose care was followed had a plan of care in place, which had been developed from an assessment of need. One of these people had been admitted to the home as a crisis by the intermediate care team. This person had a copy of the community assessment and care plan, which included a record of the medication that person required. The nurse in charge advised that medication was checked with the GP surgery on admission where possible. And the person or their representatives are also asked about medication. A record for checking all relevant information was available for the people admitted for emergency placement was being used. The documentation for respite, short stay crisis intervention had been up dated and improved since the last inspection. One of the three people whose care was followed was also observed in the lounge during the morning of the inspection. The observation was part of the short observational assessment process, which looked at how people were being supported. Their care plan included their health, personal and emotional care needs. Risk assessed had been completed for manual handling, risk of falls, nutritional risk and environmental risk. Where risk had been identified a care plan had been put in place to guide staff how they should care for the person to reduce risk. They had been assessed by an NHS nurse in the last 12 months and the banding for their care needs agreed. Their care plan had been reviewed monthly or sooner if their care needs had changed. One person whose care was followed had been at the home for more than two years. They were being cared for in their own room. They did not have a call bell with in easy reach. The care plan stated that they were unable to use a call bell and guided staff to check this person regularly to ensure they had what they needed. Bed guards were being used on the bed. A risk assessment had been completed for the use of bed guards. The persons care plan indicated that they had a poor appetite; a nutritional risk assessment had been completed. The care plan information showed they had been referred to the dietitian. The nurse in charge confirmed that they were being given nutritional supplements. The person appeared to be comfortable in their bed; they had clean nightclothes and had a drink with in reach. The television or radio were not on. The person indicated that they could not see the television and did not want the radio on. Their care plan had risk assessments completed for manual handling and risk of falls. They were identified, as at high risk of falls and high risk for manual handling Care Homes for Older People Page 15 of 35 Evidence: needed two carers and a hoist for all transfers. A wound care plan had been completed which stated the type of dressing used and the state of the wound. The dressings being used were the same as those prescribed on the medication record. The nurse in charge advised that their wound was healing; however no measurements of the wound had been recorded. Their care plan had been reviewed monthly or sooner if their care needs had changed. The medication records for the three people whose care was followed and one person who was no longer at the home were viewed. One complaint has been received by the Commission, which related to medication not being given as the GP intended for one person, this was substantiated. There were gaps in the recording of medication given where the reason for not giving the medication had not been recorded. The owner has responded swiftly and ensured practices have changed to reduce the risk of errors happening again; prior to the publication of the draft report. Eye drops were being stored in a locked fridge. However one persons eye drops appeared to still be being used more than 28 days after they were opened. These were disposed of as soon as it was pointed out. Records of medication disposed of were being kept. The controlled drug book was checked against the stock held for one person as correct. The expert by experience found that of the people they spoke with, in the main they were very complimentary about the staff and the support that they received from them. One person said, The girls are all lovely to us . Two of the people spoken with seemed to be quite poorly one was having oxygen and the other needed inhalers for asthma; they both said that the staff were very good at helping to support them with their care needs. Observation made during the inspection using the short observational tool showed staff to be respectful friendly and very supportive of the people they were caring for. Staff always explained what they were doing and made every effort to involve the person. The response people gave to the staff supporting them showed that this was a regular occurrence and they were used to staff speaking to them and involving them. Staff were seen knocking on bedroom doors before entering a room. They explained what was happening as a person was hoisted from their wheel chair to a seat in the lounge. The expert by experience noted that Where they did see staff talking to people, they seemed to be polite respectful and friendly and helpful. The expert by experience made the following observation. The two people from the physiotherapy service said that they visited the home regularly to see their patients, from our general conversation they seemed quite satisfied with things. Care Homes for Older People Page 16 of 35 Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff at Aspreys try to ensure that people living at the home have access to the activities they prefer and enjoy. Although the activity program provided may not be meeting every one needs. Although a choice of food at meal times was provided not every one spoken with knew this. Although menus were provided with the statement of purpose, the menu for the day did not appear to be easily available for people to enable them to see what was for being provided for them each day. This may mean that people do not have the opportunity to choose. Although we were told people had hot drinks mid morning at early evening those people spoken with told us they did not always get hot drinks at these times. This may mean that not all the people living at Aspreys nursing home are asked if they would like a hot drink mid morning or early evening Evidence: Two bright communal lounge areas are available for those who wish to sit and socialize. Those who wish to remain private are able to do so. On the day of the inspection people were able to receive communion from a visiting church member if they wished. This person also advised that they provided communion for people in Care Homes for Older People Page 18 of 35 Evidence: their own rooms if they were unable to participate with others. The owner advised that an activities program was in the process of being put together to allow people to see the activities arranged for the month. The first draft of this was provided during the inspection. This showed that a variety of activities had been arranged for April and included music and movement and model making. The information provided prior to the inspection indicated that, The activities program had been extended and they hope as the good weather approaches, to encourage some gentle gardening in the built up flower beds suitable for wheelchair users. The garden area was set out mainly as a patio area with small boarders. The garden had level access from the lower ground floor, which was accessible via a lift. Visitors were coming and going through out the inspection, they were seeing people in their own rooms or one of the communal areas of the home. The home appeared to have an open visiting policy for people. The home has its own hairdressing salon. Four people spoken with during the inspection were pleased to be able to use this facility. Five people living in the home returned surveys when asked Are there activity arranged by the home that you can take part in One person indicated always, two people indicated Sometimes and two indicated Usually The expert by experience met with the group of six people who were in the sitting room, there was quiet classical type music playing in the background and a member of staff was chatting and interacting with them. There was a good supply of fruit squash and water on the tables for people to have a drink and they were all offered a glass of sherry prior to lunch. They told me that in the afternoon they had someone coming in to do a Music and Movement session and they were looking forward to that. Of the five people the expert by experience met with in their own rooms, two had commented on the time spent on their own, saying, you can spend hours on your own and I spend long periods on my own. Both people were only at the home for a short stay. The nurse in charge advised that staff do try to spend time with people who choose to stay in their own rooms but this isnt always possible. One person who was staying at the home for a short period said they preferred to stay in their room but had enjoyed going to the dining room at lunchtime. The expert by experience commented that in the morning, there was crockery and the remains of breakfast still in the rooms of some people; this was at 10 am, which meant that for those people, they had had breakfast before 11 am. The space between evening meal and breakfast was more then 12 hours and not every one appeared to have been given the opportunity to have a hot drink or snack early evening. One Care Homes for Older People Page 19 of 35 Evidence: person said, the breakfast was enormous with porridge and toast served for them. When the expert by experience later spoke with people about the lunch, most people only seemed to know it was chicken for lunch, however, people did say that the Cook would always offer an alternative to suit what they wanted and that the food was good. A written menu for the day was not seen and no one confirmed that there was a written menu provided each day. However staff were observed speaking to individual people in the morning telling them what was on offer for lunch and asking them what they would like. The five surveys returned by people living in the home when asked, Do you like the meals? three people indicated always, three people indicated usually and one person indicated some times. The owner advised that people have a hot drink when night staff come on duty soon after 8 pm. However speaking to people not all said they were given the opportunity to have a hot drink at night. One commenting they some times did not get another hot drink offered after the evening meal hot drink at 6 pm. The expert by experience found when they talked with people in the Sitting Room about the meals. People said that supper was at 5 pm and was usually soup, sandwiches and cake, when asked if they had a warm drink and a snack later in the evening, the three people the expert by experience was with said that they did not have another warm drink until breakfast next day. The owner said he would look at the tasks night staff do first and making providing hot drinks for people in the evening a priority. This should ensure that people are given the opportunity to have a hot drink early evening if they wish. During the inspection two people in their own rooms who were visited by the expert by experience did not appear to have had a mid-morning warm drink and in one room the care worker came in at about 11-45 am to ask if the person wanted a cup of tea or coffee, but they did not see it arrive. Some people had cold drinks available, but one lady visited, who was very frail appeared to have the same cold drink in front of her from when we had met with her almost two hours earlier they felt the person would have needed help to have had a drink. Since our last inspection one complaint had been received about the quality and quantity of food provided for people. The cook said that small meals are provided for people but there was always the opportunity to have larger portions if the person wanted this. One person had commented that after they had asked for larger meals this had been provided. During the lunch time meal staff were heard to ask people if they would like more. Staff who were assisting people to eat their meals were taking to them as they helped telling them what was for lunch and taking about general topics. Food had been prepared to enable people who needed a soft or pureed diet to experience the different tastes of the food. The lunch time meal observed was unhurried with people eating their meals at their own pace. Care Homes for Older People Page 20 of 35 Evidence: The owner provided the following information prior to our inspection, We offer a wide variety of home cooked meals using fresh produce. There is always a choice of main meals and puddings or the cook is happy to cook a specific dish if required. Meals are presented well with a lot of attention to detail. Our cakes are all homemade. Fresh produce was seen in the kitchen during the inspection and a cake had been made for afternoon tea. The cook advised that she made fresh cakes every day for people living in the home. Care Homes for Older People Page 21 of 35 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 staff team at Aspreys value the people who live there and take any concerns they raise seriously. Evidence shows that management use concerns raised to improve peoples experience of care, by reviewing practice and making changes. People were aware how to raise concerns and say they have confidence that their concerns would be listened to. Staff are provided with training that enables them to understand how to protect people. This should ensure that people are protected. Evidence: The complaints procedure was easily available for people living in the home and their representatives. This had been up dated to show the Commissions new contact number and address details. People living at the home spoken with during the inspection confirmed they knew how to raise concerns. All five people living at the home who responded to anonymous surveys stated that staff listen to them and act on what they say. Four of the five said they knew how to make a complaint. The owner advised that he has continued to speak to people living at the home about their satisfaction with the services provided. The Commission has received six complaints since our last inspection, five of which related to people admitted for short respite stays by the intermediate care team and Care Homes for Older People Page 22 of 35 Evidence: one relating to the quality and quantity of food. The complaint relating to the food provided was not substantiated. The owner has responded in a clear and timely way to any concerns raised. He has continued to change practice where this has been indicated to ensure the people living at Aspreys receive good care and their concerns are taken seriously. The information and care planning for people admitted for short stay has improved since our last inspection. Two people who were staying at the home for short stay were complimentary about the care and services they were receiving. This shows that concerns people had raised had been acted on and systems improved to prevent further concerns about short stay placements. One safeguarding referral relating to medication management has been received just prior to this planed Key inspection, this referral were still ongoing at the time of this inspection. An immediate requirement relating to medication practice was made at this inspection. The owner has responded swiftly and ensured practices have changed to reduce the risk of errors happening again; prior to the publication of the draft report. The registered owner has told us that refresher training for medication had been organised for staff. And the medication policy for staff has been up dated to reflect changes. The registered nurse in charge has also advised that the home will be using a blistered pack monitored dose system for all the people living at the home in future. A policy and procedure was available for staff in the office relating to protection of vulnerable adults. Staff training included protection of vulnerable adults. Staff spoken with were aware of the adult protection processes to follow should any concerns be raised. Care Homes for Older People Page 23 of 35 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 live in an adequately clean and comfortable home. Adaptations and equipment provided that meet the needs of the less able people living in the home. Assessment of environmental risks for the people who live at the home are completed for each person and the room they occupy. This means that the staff team are mindful of the safety of the environment people live in Evidence: Aspreys Nursing Home is a spacious building with a range of different size bedrooms available, some of which have en-suit facilities. The accommodation is arranged on four floors with passenger lift access. Hairdressing salon is available on the lower ground floor for people to use if they wish. During the inspection to people commented on how nice it was to have hairdressers in the home. A tour of the home was completed as part of this inspection. All communal areas and disabled access bathrooms and toilets were seen and some individual peoples rooms were entered. Rooms had been personalized with items of the persons choice. Two people visited in their own rooms by the expert by experience did not have a call bell within easy reach. Both care plans indicated that they were unable to use the call bell and staff were guided to check the people at regular intervals to ensure they had Care Homes for Older People Page 24 of 35 Evidence: everything they needed. The call bell system is cancelled at the point of call. Two of the individual peoples rooms entered during the inspection had carpets that were uneven. This could cause a trip has had for the person or staff providing their care. The owner advised that he was in the process of replacing carpets in individual rooms. Other rooms entered during the inspection had been fitted with new carpets. The owner had advised at our last inspection in June 2008 that all the radiators would be covered by the end of the year. However some individual rooms entered still had radiators that were not covered. The individual care plans seen for people showed that risk assessments are completed for radiators and individual rooms for people. The owner confirmed that radiators were continuing to be covered on an as needed priority basis. Completing risk assessments on an individual basis for radiators used in individual rooms should ensure that people are protected. The training coordinator who is also the head of care for the health care assistants advised that they were continuing ensured staff receive the mandatory training. Records of training for fire protection and manual handling were available. Fire extinguishers were available on each floor where people were living. These have been serviced as expected. The information provided prior to the inspection indicated that hoists have been serviced regularly. There appeared to be sufficient hoists staff to use for people who needed them. The preinspection information indicated that all staff had received infection control training since our last inspection. Practices observed during the inspection showed that staff were mindful of prevention of infection and were using gloves and aprons when providing personal care for people. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Aspreys nursing home are cared for by a friendly and supportive staff team that have their best interests at heart. However people did not always receive hot drinks when they expect them. This may mean that staff deployment does not always take into account the resources needed to ensure people have hot drinks when they want them The homes management team are committed to ensuring staff receive the training they need to do their jobs. Staff training and developed needs to continue the improvements made, to ensure people continue to be cared for by a staff team who understand their care needs. The home has still to achieve 50 of its staff trained to NVQ level 2 in care. This may be because of the turn over of staff in the last twelve months. The home has a robust recruitment policy and procedure in place. However people may be put at risk from unsuitable staff if all pre-employment checks are not carried out prior to a new staff member starting work Evidence: A duty rota was provided, which showed the number of staff on duty during the day and night. This showed that a registered nurse is on duty over a 24-hour period seven Care Homes for Older People Page 26 of 35 Evidence: days a week to monitor and manage peoples health care. The staff spoken with during the inspection felt they usually had enough time to care for peoples needs. However the fluctuating additional short stay respite placements increased the number of people they cared for living at the home. The four staff who returned anonymous surveys indicated they always or usually had sufficient staff on duty to do their work. The owner advised that he has continued to limit the number of respite people admitted to the home. The pre inspection information indicated that 21 staff have left Aspreys employment since our last inspection. This may mean that although there was a good commitment to providing training for staff; new staff employed may not have had the advantage of joining an established staff team. One staff member commented in an anonymous survey. My manager is very helpful and supportive. I am very happy to work for Aspreys During the inspection the expert by experience noticed the following when visiting people in their own rooms. Not all appeared to have had a mid-morning warm drink and in one room the care worker came in at about 11-45 am to ask if the person wanted a cup of tea or coffee, but this did not arrive by the time the expert by experience left their room. Some people had cold drinks available, but one person visited in their own room, who was very frail, appeared to have the same cold drink in front of them from when they had met with them almost two hours earlier. It appeared they would have needed help to have a drink. When people were asked by the expert by experience if they had a warm drink and a snack later in the evening, the three people spoken with said that they did not have another warm drink until breakfast next day. When the owner was asked about this he said people are usually offered a hot drink when night staff come on duty at 8 pm. He advised that he would speak to the night staff to ensure people are offered a hot drink at the start of their shift. People living in the home who returned anonymous surveys indicated that staff are available when they need them, two responded always and three responded usually. One health care professional who responded to anonymous surveys indicated the homes staff; Always respond to our request to take clients to their own room when carrying out treatment or interviews. One staff member who responded to an anonymous survey indicated that. Carers worked really hard and do their jobs well, service users needs are met and staff really do try hard to make sure residents are happy and comfortable The preinspection information indicated that of the 11 care staff employed two staff had achieved an NVQ level 2 or above and a further three were working towards this Care Homes for Older People Page 27 of 35 Evidence: qualification. This does not provide 50 of the care staff team trained to NVQ level 2 or above. The home also employs six registered nurses who cover shifts over a 24 hour period seven days a week. One member of staff told the expert by experience that she had worked at the home for a few months and was pleased to have been registered to start an NVQ. Another member of the care staff the expert by experience spoke with said that the work was heavy, but she expected that, they had equipment to help them with the work. Staff who were asked to respond about their induction said; Induction carried out by acting matron, All training has been supported by management. They also responded Yes and always very satisfied with the induction program provided. Five new staff employment records seen during the inspection did not have two written references on file. And one did not have a reference form their previous employer on record. This may put people who use the service at risk from unsuitable staff. The owner advised that this would be followed up with the staff. The staff records seen had evidence that police checks had been completed and other pre-employment checks had been completed prior to the staff member starting work. Registered nurses employed had a record of their current registration with the Nursing and Midwifery Council (NMC). The nurse in charge advised that these are checked on the NMC web site as well as asking the registered nurse for a copy of their PIN number card. The training coordinator who is also head of care advised that they are continuing to oversee the training for care staff and ensure all mandatory training was completed. Staff records had copies of training staff had completed, this included fire prevention, manual handling and health and safety training. The owner advised that he ensures staff had access to training that helped them do their jobs well. The five staff who returned surveys also supported this. Care Homes for Older People Page 28 of 35 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. Aspreys nursing home does not have a registered manager. A suitably qualified manager to lead the staff and oversee the quality of care would ensure that the people who live at Aspreys nursing home continue to have their health, safety and welfare promoted. The continued improvements made since the last inspection and the commitment of the staff and owner should enable the people who live at Aspreys to have confidence that the home is being run in their best interests. Evidence: Aspreys nursing home does not have a registered manager. The owner has acknowledge this in the pre-inspection information stating We are still advertising and looking for a registered manager. Once this has been achieved, I am sure we will then be able to concentrate better on providing the staff with the leadership and direction that would better enable them in their duties. Each registered nurse takes Care Homes for Older People Page 29 of 35 Evidence: responsibility for the management of the health and personal care for people living in the home during their shift. They are supported on a daily basis by the owner who takes responsibility for overseeing the quality of the service provided at Aspreys. The Commission has been kept informed regarding arrangements for the management of the home until a suitable manager can be found. The owner confirmed that he spends more time at the home since the manager has left and was completing some of the management tasks the manager had responsibility for. The head of care has continued to be responsible for the health care assistance training, support and supervision. The following statement was provided with the pre-inspection information. The owner is hands-on almost every day. We remain unsuccessful in attracting a suitable Manager despite offering an extremely substantial salary. However the owners continue to provide the main parts of that roll together with our full time RGNs. There is a friendly atmosphere between Management, Trained staff and carers. The owners are constantly monitoring the operation of the Home. This was found to be the case during our inspection. The owner advised that quality audits are carried out on a regular basis. Questionnaires for the quality audit survey were being prepared during the inspection. These were being sent to people who accessed the service, their relative and supporters as well as health care professionals who visit the home. The statement of purpose and service users guide were easily available for people who visit or live at Aspreys nursing home. The nurse in charge of the shift advised that policies and procedures were in the process of being up dated and reviewed. The pre inspection information indicated that some policies had been reviewed in February 2009 and other had been reviewed in February 2007. The owner has kept the Commission informed of actions taken to address the Requirements made at our last inspection. All had been completed apart form one which had almost been completed. This related to covering radiators to reduce the risk to people living at the home. The owner has ensured that a robust risk assessment process was in place for each individual who had access to a radiator that did not have a cover. The planed program the Commission was informed of to cover all radiators has continued. Currently the home assists several people with the administration of their personal allowances. This was recorded with the use of a computer system. Money was available for people on request. Receipts are retained by the home of any purchases made on behalf of a person and when money was received on behalf of a person the home keeps a record page on the computer as a receipt. These records were seen to be in order and one persons money was checked and it was noted that the records balanced with the amount actually held. The Commission had not received information from the home regarding a possible medication error through the Regulation 37 Care Homes for Older People Page 30 of 35 Evidence: process. The Torbay Care Trust had been working with the home staff to look at issues raised for one individual. The owner confirmed that this would be sent and staff provided with reminders of the guidance for the things that should be reported to the Commission through the Regulation 37 process. Since our last inspection an electrical safety certificate has been issued. The owner had confirmed this had been completed prior to this inspection. The checklist risk assessment introduced has continued to be completed for individuals for the room they are occupying. These were contained in individuals plans of care as part of the risk assessment process. The nurse in charge confirmed that all the people living in the home had had a risk assessment of the environment they were using (bedroom). The record showed that radiator temperature and hot water in washbasins had been risks assessed to ensure individuals using the room were not being put at risk by the unprotected radiators (hot surface) or hot water. The owner confirmed that all radiators in areas people who live at the home have access to would be covered using the risk assessment to ensure those posing most risk were covered first. Warning signs had been placed over each washbasin where water was hot. Care Homes for Older People Page 31 of 35 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 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Medication records had not been completed fully to show the reasons why medication was not given. The way medication is recorded and managed must be reviewed and if necessary changes made to ensure people receive the medication they need. 21/05/2009 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 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 6 The Registered person should consider ways of managing the busy intermediate care facility that now operates within the home taking into account the guidelines contained within the National Minimum Standards. This includes providing dedicated accommodation, together with Page 33 of 35 Care Homes for Older People specialized facilities, equipment and staff to deliver the short-term intensive rehabilitation, which enables people to return home. 2 12 The registered person should consider how people who chose to stay in their own rooms have their needs for social activities and interaction met. People who have chosen to stay in their own rooms should be given the opportunity to have hot drinks mid morning and early evening. The registered person should ensure that people are aware of the meals on offer each day and what choice is available for them. The timing of meals through the day should ensure that people have no more than 12 hours between meals. The planed program of maintenance, redecoration and renewal of worn carpets should continue. This should ensure that all the people living at Aspreys have the same high standard of accommodation. OP 29 (000055383) Not ensuring all the required preemployment checks are completed prior to a member of staff starting work may put people who use the service at risk from unsuitable staff. OP 28 (000055383) The Registered person should continue to ensure staff have access to NVQ training. This should enable the home to achieve 50 of its care staff trained to NVQ level 2 or above. OP27 (000055383) The registered provider should consider how the way staff are deployed can ensure people who have chosen to stay in their own rooms are provided with hot drinks during the day and early evening. The Registered person should continue to complete risk assessments for hot surface radiator people living in the home have access to. And continue the program of covering all radiators as planed. The Registered person should appoint a manager to lead the staff team as soon as possible. The Registered person should ensure that the Commission receives Regulation 37 notification of events, that affect people living in the home in a timely manner. 3 15 4 15 5 19 6 20 7 20 8 20 9 25 10 11 31 37 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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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