Inspection on 08/01/09 for Bannow Retirement Home

This inspection was carried out on 8th January 2009.

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

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

Other inspections for this house

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bannow Retirement Home Quarry Hill St Leonard on Sea East Sussex TN38 0HG     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: Michele Etherton     Date: 0 8 0 1 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 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Bannow Retirement Home Quarry Hill St Leonard on Sea East Sussex TN38 0HG 01424433021 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bannow Retirement Home Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 26 Number of places (if applicable): Under 65 Over 65 0 26 dementia old age, not falling within any other category Additional conditions: 26 0 The maximum number of service users to be accommodated is 26. The registered person may provide the following category/ies of service only: Care home only - (PC) 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) Dementia (DE). Date of last inspection Brief description of the care home Care Homes for Older People Page 4 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: A key unannounced inspection of this newly registered but pre-existing service has taken place. This has taken account of information received about the home and from the home since the change in ownership and re-registration. An AQAA has been completed to a reasonably good standard by the manager that tells us most of the information we need to know although this would have benefited from more detail in some areas. Our inspection has included an unannounced site visit to the home on 8th January 2009 between 9:30 am -18:45 pm. During this visit we undertook a tour of the home and consulted with the manager and those staff on duty, spending time with residents Care Homes for Older People Page 5 of 37 in private and in groups, owing to the communication problems of some residents with dementia making it difficult to consult them meaningfully about their experiences within the home we have spent time observing some of their routines and the support they receive from staff. Survey responses have been sought from residents and staff and we have received back a good number of responses and these have been helpful in planning and informing the inspection and this report. As a new registration but not a new service all key standards have been assessed in addition to those whose outcomes became evident during our visit to the home. During our visit we examined a range of documentation including support plans, risk assessment information, menu records medication records and storage, staff supervision training, and recruitment information, complaints, accidents and health and safety information. In arriving at our judgment we have tried to be proportionate in considering compliance with regulation and outcomes for the residents alongside the overall risks and impacts of identified shortfalls. There were issues identified at the inspection but the provider has assured us that these have now been met or are being met. Although we have agreed this is a two star good service we will be bringing the next inspection forward to ensure these improvements have been carried out. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 37 Care Homes for Older People Page 8 of 37 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. prospective and existing residents and their representatives are provided with information about the service and what is offered, this will benefit from being developed further into a range of formats to ensure this is accessible. Prospective residents can be confident their needs will be assessed prior to admission, but this process and the homes understanding of their support needs could be enhanced by improved detail about how the dementia impacts on their day to day life. Intermediate care is not provided although occasional respite can be offered. Evidence: The service provides information to prospective residents and their families and is looking at ways in which information about the home can be made more portable and easily carried around, it is not intended that these versions would be for residents. The manager advised us that the Statement of Purpose and user guide have been updated to reflect the change in category of client and change of ownership, we did not Care Homes for Older People Page 10 of 37 Evidence: examine these at the visit but noted in an empty room awaiting a resident admission that a welcome pack had been left in the room and this contained a user guide, analysis of user survey was also provided but this was out of date. We are advised that the home is not intending to offer care to residents who are registered Blind and need to make this clear within the Statement of Purpose. The AQAA tells us that six residents have hearing impairment and two have visual impairment, therefore consideration should be given to ensuring Statement of Purpose and user guide information continues to be accessible to all residents in a range of formats. From discussion with the manager and our examination of records belonging to newer residents we are confident that all prospective residents receive an initial and basic assessment of need prior to admission, the manager confirmed this is supported by reports requested from health and social care professionals but we found the quality of these varied in the level of detail provided and how individual residents were affected by their dementia. We found the homes assessment somewhat lacking in information about how prospectives residents were effected by their dementia through observations made by the resident themself any relatives or representatives present at assessment and those of the assessor we consider this would enhance the understanding of the residents needs and is a recommendation. Staff survey feedback indicated that whilst they usually or always got enough information to inform them about new residents they found that when residents were transferring from other homes information about the level of dementia was lacking and they were often then inappropriate for the home. Some residents without dementia although in place for many years were able to talk about their experience of coming into the home and how they had been involved in the selection of the placement in the majority of cases. Residents surveyed told us that : I had attended as a day patient and for respite and also my relative is a health care professional so had some insight into the home Contractual agreements were noted in those files examined and all but one resident who returned surveys stated they had a contract in place, some residents were concerned that their contracts are with the previous owners and one reported they did not have one, we are advised that assurances have already been given by the new owners to residents that their existing contractual arrangements will be honoured, but clearly concerns remain for some residents and the manager should reassure residents about this. Residents without dementia told us that they were unhappy with the way in which the change of registration to dementia had occurred they felt let down and powerless by Care Homes for Older People Page 11 of 37 Evidence: the change, they felt this had had an impact on their daily routines and they now tended to isolate themselves within their rooms, they expressed concern at the wanderings of some residents at night and also during the day into their rooms. Whilst generally staff reported feelings of being well trained the transition to dementia is a source of concern, with staff indicating they need more training to feel confident they are supporting residents with dementia effectively and we would support this view, we have addressed issues regarding staff training elsewhere in the report. Care Homes for Older People Page 12 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The emotional physical and mental being being of residents is generally well supported and would benefit from suggested improvements. Evidence: Care plan formats are good and content reflects individual preferences but can vary in quality dependent on who is completing the plan, we have discussed with the manager the need to ensure that content is standardized so that staff are provided with detailed information about every resident to aid their support. Where residents are not in control of aspects of their daily routines and are restricted from some There is also a need to ensure that reference is made to the mental capacity act and Deprivation of Liberty Act to ensure staff practice is compliant. Residents told us that although they have key workers and are consulted about their care needs they do not get sight of their care plans routinely and this should be accessible to them more readily. Residents told us they are quite happy with the support they receive with their care needs Care Homes for Older People Page 13 of 37 Evidence: Staff reported that the clients are always supported in their needs and given dignity and respect when dealing with personal care The home is still to implement pressure area assessments and we would suggest also that nutritional screening assessments should be routinely implemented with supporting risk information where needed. Weights are recorded regularly. Residents are provided with opportunities for exercise within their activity programme and for some by weekly trips out Examination of records and discussion with residents and staff confirms that generally residents routine health needs are supported, residents told us that if they need to attend appointments they are accompanied by a staff member. One user survey completed with the help of a relative highlighted a concern that health needs are not always pursued in a timely manner, and in one instance this has resulted in the relative having to take action them self, this did not appear to be an experience common to others and did not feature in the surveys we received overall however there are some concerns that communication and feedback are sometimes lacking and this has been addressed elsewhere in the report. We noted risk information in place with evidence of updating, some potential risks in respect of access to baths in private en suites by dementia clients, have been raised with the manager who has agreed to develop those where risks are deemed higher, we have also highlighted the risks of unguarded radiators and have addressed this elsewhere in the report. We observed some lunchtime medication administration and this was undertaken satisfactorily with the staff member demonstrating patience and firmness in ensuring medication is taken in an appropriate manner. We have looked at the medication storage room which we found to be clean and tidy, this contains controlled drugs storage facilities, at present controlled drugs are not administered but the manager ensures when they are that two staff are responsible for signing the MAR sheet for each administration as good practice. Only trained staff are able to administer but we notice from the training matrix with concern how long ago some staff trained and how their knowledge may not have kept pace with current practice, nor did we note any competency assessments to ensure knowledge and skills in this area are routinely tested and would recommend this is implemented. We noted the medication room key is kept secure and handed between shifts to those Care Homes for Older People Page 14 of 37 Evidence: staff administering, however, the trolley which is stored in the medication room routinely has its key left in it, whilst it is unlikely that access to the medication room can be attained from outside it is good practice for the trolley key to be secured, this is currently bent from being knocked whilst in the lock and could affect access to the trolley if it becomes broken, this has been discussed with the manager. Stock control is managed by staff indicating within the communication book where medications are running low, this is checked by the manager or deputy on a regular basis who ensure any such shortfalls are addressed. Generally we found MAR sheets to be completed satisfactorily without omissions however we noted two examples of handwritten changes to medication administration instructions that are unsigned and undated, and the use of symbols on the MAR sheet whose meaning is not made clear in the codes section of the chart, liquid medications, creams and boxed tablets are not routinely dated upon opening and this would help with medication audits and is a recommendation, some residents do still self medicate but capacity assessments need to be established for those who do not to support judgments around this. Care Homes for Older People Page 15 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with opportunities for activities and exercise, visitors are made welcome and residents are supported to access the community for outings, some thought should be given to supporting more able residents to maintain their links in the community, and to attend activities in keeping with their abilities and preference. Residents are encouraged and supported to maintain independence and make choices, residents enjoy a good diet in pleasant surroundings. Evidence: The home ensures that a programme of activities is in place during the week and this is displayed, we are advised that this can vary dependent on the residents themselves and what they want to do on the day. The deputy manager takes responsibility for organizing activities and uses a specially purchased activity programme for use with residents with dementia in particular, there is a need to consider that some residents will not participate well in a group session and more one to one time will need to be spent with them, the present staffing levels do not allow for this to happen easily, although residents we spoke with and those that returned surveys did not complain of not having enough to do and said they enjoyed the outings. Care Homes for Older People Page 16 of 37 Evidence: Discussion with some of the small number of residents who do not have dementia but who have remained at the home following the change in registration admitted that they are tending to isolate themselves more from the downstairs communal areas but are able to occupy themselves with reading, writing letters, seeing visitors and also attend the regular outings and occasional entertainments brought into the home,they have also formed a scrabble session each week where they can meet up, they feel generally content with the compromises they have had to make in order to remain in the home. We consider that some further thought should be given to supporting those more able residents who wish to continue with activities they previously enjoyed in the community or identify activities that may be more appropriate particularly where transport and costs may inhibit them from undertaking this themselves. We spoke with one relative whilst visiting the home they told us they visit regularly and always find their relative well cared for. Another resident we spoke with informed us they were going out to lunch with their family who are visiting the area and had been fortunate to see quite a lot of them during their stay. Residents are encouraged to maintain their independence where able and to do things they enjoy, some have keys to their bedrooms and others do not one resident told us they would like a key but had been told that they could not have one because they would be unable to manage it owing to their condition, the home manager must ensure that where such restrictions are in place these decisions are not arbitrary decisions made in isolation but are supported by individual capacity assessments which are reviewed regularly with the resident significant people in their lives including health or social care professionals, where this is not possible then an external advocate should be sought. In order to ensure that residents can continue to exert some control and choice in their daily routines in spite of the effects of their dementia the home manager is already considering ways in which menu information can be made more accessible, we consider this should apply to all information available to residents about the home and for which they may be asked to make choices, particularly those with hearing and visual impairments and those whose dementia impacts on their ability to read and absorb written information. All the residents we spoke with and who returned surveys commented positively on the quality of the food and how it is served. Residents are involved in selecting their meals for the day by use of a menu card system, food likes and dislikes are known and the chef we spoke with reported that at the present time no special diets have to be catered for although these have featured in the past. The home employs two chefs and kitchen assistants, they have access to a wider training programme and are to be included more in mandatory staff training. Many residents enjoy breakfast in their bedroom although this is also served in the dining room, residents are offered aperitifs Care Homes for Older People Page 17 of 37 Evidence: in the lounge before lunch which is served in pleasant surroundings with well laid tables and staff on hand to serve each table. Lunchtime meals are three courses, and residents are consulted about e,g the mount of vegetables and gravy they want with it, portions are of a good size. One resident reported that she sometimes found staff were over keen to remove plates but we saw no sign of this during our visit and noted residents were left to finish their course before offered the next. We found that those residents who need help with their meals are provided with support discretely by staff cutting their food up before it arrives at the table thereby maintaining their dignity. Facilities are available for residents to eat separately with their guests in a smaller dining room for privacy. The chef told us that he receives feedback about meals via resident meetings, and also takes note of comments made by residents through the serving staff or from what is returned. Care Homes for Older People Page 18 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and some relatives have an awareness of the complaints procedure and feel confident about approaching staff, both residents and staff they feel listened to but do not always receive feedback about issues raised. Systems are in place to safeguard residents but shortfalls in the environment and recruitments procedures may compromise this Evidence: CSCI has received one complaint about the home since the change of registration and we consider this has been appropriately dealt with. The home tells us in their AQAA information that they have received one complaint since the change of registration and this has been resolved satisfactorily, at our visit we examined the complaints record and noted evidence of the complaint and the resulting response, as this related to a specific resident we undertook to visit their room and found it much cooler than other rooms in the home whilst acknowledging that the room lies on the side of the home that receives less sun we noted that one of the radiators was overly hot and unguarded and another was not on at all, as this had been highlighted as a concern by the complainant, the manager advised us that the radiator in question was now on and the other one had been turned off by the resident, as this would seem to be something that the resident may be prone to doing we expect the home to monitor this or take measures to prevent this happening, if the home is to instill trust in the complaints Care Homes for Older People Page 19 of 37 Evidence: system it must ensure that actions it has reported it will take are maintained if it is to avoid repeat complaints for the same problem. Most Residents spoken with during our visit and those who returned surveys indicated that they understood about making complaints one indicated they did not, information about making complaints is provided to residents in welcome room packs, all felt confident about approaching members of staff with their concerns. Stall also felt able to express their views and found management staff approachable, however staff and resident comments also highlighted that whilst they felt listened to they did not always receive feedback about their concerns or issues and found action was not always taken in a timely manner and this clearly needs to be addressed within the management team. As some residents may as a result of their dementia lose the ability to express their views or concerns the home manager and staff need to give some thought as to how the complaints procedure can continue to be accessed by people who may not verbally be able to express their distress or concerns any longer. We have not been made aware of any safeguarding issues since the change of registration, and noted that the majority of staff received safeguarding adults training in 2006 including the manager, this is now overdue for update and we would recommend this is undertaken a minimum of two yearly, we consider it is important that the manager is routinely updated to ensure they keep pace with changes in legislation, guidance and local protocols in order to provide accurate advice and guidance to staff where necessary and ensure safeguarding issues are handled appropriately. Staff we spoke with demonstrated an awareness of safeguarding issues and their responsibility to report them but were unclear what might constitute abuse between residents,we would recommend this is an area that is updated for all staff within the next three months particularly where such incidents may occur more frequently within the more vulnerable dementia client group. In our discussion with staff they indicated that currently they use distraction techniques to diffuse situations with residents when they occur but this may be handled differently by individual staff dependent on their experience and confidence, in order to ensure consistency in the delivery of support provided to residents we would recommend the development and implementation of behaviour guidelines for those residents who may be subject to outbursts and these should be subject to review. The manager is reminded that any restrictive practices that are implemented will need to be compliant with deprivation of liberty and mental capacity legislation, and should not be a decision taken in isolation by the manager or home staff, and should be subject to review. Care Homes for Older People Page 20 of 37 Evidence: The manager has advised us that the home no longer manages the personal allowances of residents and relatives or representatives are invoice routinely for any incidentals expenditure e.g hairdresser, chiropody, toiletries, papers. Residents have spoken positively about the home both through survey and interview feedback, they feel happy and safe in the home although more able residents recognize some environmental improvements are needed. Whilst we acknowledge that there are signs and impressions that some of the shortfalls within the environment are being addressed by the present provider and manager, we consider that delays in addressing some of the environment shortfalls and a failure to ensure that the recruitment procedure is robustly applied adequately safeguards residents. Care Homes for Older People Page 21 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy living in the comfortable and pleasant period surroundings, which are generally well maintained. Some identified shortfalls that could compromise their safety need to be addressed in a timely manner to ensure their overall health and safety is protected, and the home can evidence that plans are in place for achieving identified minor shortfalls over a period of time Evidence: Bannow provides residents with very pleasant accommodation with all of the period features maintained, communal rooms are well decorated and furnishings are in keeping with the house style being comfortable and stylish. Residents benefit from a well stocked library and have access to books from the visiting library service. Residents are able to bring their own furniture where this can be fitted into their room, one resident we spoke with said apart from a few small tables everything in her room was her own she told us it makes me feel so much more at home, bedrooms have en suite facilities, there are a mix of larger and smaller rooms but most are spacious and above the minimum size. There is a shaft lift to all floors, there are a range of bathrooms and toilet facilities in addition to the en suites in personal bedrooms, the home has two parker baths, and the manager reported there are plans to turn some en suites into shower rooms. We have highlighted the need with the current resident group for the manager to ensure appropriate risk assessments are undertaken for Care Homes for Older People Page 22 of 37 Evidence: those residents with their own baths who may be at risk. The majority of residents are mobile with the help of sticks zimmers and other walking equipment, hoists are available on the odd occasions when specific residents are feeling in need of additional support, these are routinely serviced as are the parker baths. We received some comments through survey and personal interviews from residents and staff about the laundry facilities, owing to the breakdown of some equipment the laundry is currently inadequately equipped for the number of residents, the laundry room itself has broken and uneven flooring, the whole area is in need of upgrading and does not comply with infection control guidance. Discussion with staff confirmed procedures are in place and adhered to for the management of soiled laundry and we observed this being collected separate to normal laundry, staff are provided with protective clothing, and a sluice wash facility exists on the remaining washing machine, although overall capacity is inadequate. The service is required to ensure the laundry is fit for purpose in that it meets infection control standards, water regulations, and is adequately equipped with enough washing and drying equipment to meet the needs of the residents. A dedicated laundress is employed for 4 hours each day, and in the current situation backlogs are occurring and a review of allocated laundry hours should be undertaken. Residents who are able to express a view commented that they generally find the laundry service in respect of their own needs satisfactory but are aware of present problems and some delays in turnaround of clothes at times. We noted stocks of clean towels on shelves within bathing and toilet areas, these are unprotected from splashes and cross infection and we discussed this with the manager who has agreed to look at placing towels within a cabinet within bathrooms where this does not impact on residents ability to manouver within the space provided. Heating has been an issue previously but both residents and staff commented on the improvement of the heating being on for longer and how much warmer the home is since the change of ownership, one resident we spoke with commented that they thought the heating should be put on low during the night also as the property is large and takes a long time to warm up in the morning although we did not notice this particularly on our visit,and most residents were in light clothing and clearly not feeling cold, however, the manager should continue to monitor resident feedback in this area. The home has a large pleasant rear garden, bearing in mind the vulnerable client group for whom the home is now registered the garden remains insecure and fails to provide a fully safe environment. The service is required to make the garden area safe for residents who may wish to use the garden more in good weather. Carpeting is of Care Homes for Older People Page 23 of 37 Evidence: good quality but is showing signs of wear in three noticeable areas, at present these do not pose a risk to residents but these must be kept under review and measures taken should any splits or holes appear, some plans are in hand for the replacement of carpeting but this will need considerable investment, also some thought should be given to the best colour schemes suited to dementia residents, gas pipe eroded and identified by gas contractor as posing a risk and in need of replacement this also needs to be prioritized for replacement. Radiators throughout the home are unguarded the manager indicates some awareness of plans to upgrade the boiler and possibly the boilers, low surface temperature radiators should be considered if this is the case but if not the service is required to establish a programme of guarding radiators deemed as posing a risk to this vulnerable group of residents either in their own or communal rooms these are required actions. The home has a good compliment of ancillary staff and a dedicated maintenance person undertakes health and safety checks and ensures water temperatures are recorded and monitored weekly in the home. Water outlets are also monitored and serviced to minimize risks of Legionella. Fire training, and the testing and servicing of fire alarm and fire fighting equipment is also regularly undertaken by the maintenance person, as are minor repairs and re decorative upgrading of internal areas. The service is required to the highlighted address shortfalls in the environment and the level of risk these pose to residents has influenced our assessment of this outcome area, whilst we appreciate that to address the outstanding shortfalls will require a level of financial investment that may need to priorities the order in which these are addressed and risk assessments should be developed to support decision making in this area, we would suggest that the development of a service development plan makes clear plans in addition to other planned improvements for works of a lesser priority that provides us with timescales for achieving these also. Care Homes for Older People Page 24 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are complimentary about staff, find them friendly and hardworking and feel well supported by them, we consider they would be better safeguarded and supported by improvements in staff recruitment training and numbers. Evidence: The new provider has recently reviewed staffing levels by increasing waking night staff to two, and introducing a twilight carer. A further review is pending a planned increase in bedrooms by two to increase single occupancy to the registered number of 26 residents. Currently only two carers are on the floor during the morning shift with support in an emergency from the manager and deputy although this is not routinely provided, whilst residents have not in their feedback highlighted staffing as a concern they have commented on having to wait a bit in the mornings sometimes, we commented on the fact that some residents remained in their nightwear until quite late in the morning, and have received a similar query from a relative of a resident who has reported this would not be in keeping with their relatives previous pattern of behaviour or preference. We are supportive of those residents with capacity to make decisions about their time of getting up and going to bed in keeping with their own preference but, where residents lack capacity to make this decision we would expect the home to Care Homes for Older People Page 25 of 37 Evidence: follow a more normal pattern of rising and sleeping as this can only add to the residents disorientation if this does not occur. The manager has advised that most mornings all residents would be up and dressed by 11.00 am taking into account personal preferences, but this appears to depend on the organizational skills of some staff over others. We have already highlighted a need for additional staffing to aid more individualized activities and to ensure residents are adequately supervised at those times when two staff are needed to attend an individual resident, and would therefore recommend the staffing level is reviewed again with these needs in mind. Residents who were able to express their views reported in survey feedback that there are always or usually enough staff, but most are able to occupy themselves are relatively self caring and are less demanding of staff time compared to those residents with dementia who should be receiving more interaction with staff. Residents have been complimentary about staff both in the annual service review of the service last year and during our visit to the home for this inspection. They tell us that: They respond quickly if you are in trouble If there is a virus about they can be ill just like the rest of us Im quite happy with the support I receive with my care needs The staff are excellent! Staff feedback would suggest that whilst they generally feel staffing has improved for the better they would like an extra carer on duty in the mornings and we would concur with this view. There has been and continues to be an NVQ training programme in place and the home has exceeded the 50 level of trained staff, and this is demonstrated in the general standard of care and support delivered by staff however, with the change to dementia staff knowledge and skills in this area need further training if they are to continue to deliver an appropriate level of support and care in line with current best practice in this specialized area. We examined four staff records of staff recruited within the last four months, we found that whilst the recruitment procedure has the potential to be robust systems for the recording of interviews and the type of documentation retained in staff files is not Care Homes for Older People Page 26 of 37 Evidence: consistent, important vetting and checks are poorly managed with only one file we viewed having two references one being unsatisfactory as it posed a conflict of interest, one file had one reference and two files had no references, the manager is unable to evidence that gaps in employment histories are explored with applicants or that verification is sought for reasons applicants have left previous care roles, and the content of files is not always consistent or in keeping with schedule 2 of the Care homes regulations 2001, where unclear CRBs are received the home cannot evidence the discussions and additional information used to inform judgments in regard to employment of affected staff. In view of these shortfalls we do not consider the home to be meeting the minimum standard in this area and we have issued a requirement for these shortfalls to be addressed. The home has made clear that the home would not be able to function as well without these staff in place and must take responsibility for ensuring appropriate risk assessments are in place and the staff in question are kept under supervision pending the return of the outstanding documentation. The home manager is aware of the common induction standards to be used with new staff and advises these are being used routinely, a training matrix is in place and this indicates a lull in training during 2008 during the sale of the home, this under investment has meant that the majority of staff are now in need of updates in at least two areas of key training, whilst there are signs that under the new owners investment in training is occurring and courses are being offered this is available to only a few staff at a time and shortfalls in staff knowledge around changes in protocols and thinking around adult safeguarding, medication administration fire safety could impact on the overall safety and well being of residents. Following the change of registration to Dementia staff have been provided with a basic understanding but this is inadequate to ensure staff have a good understanding and knowledge base to feel confident in working with this group, we would recommend that the provider consider ways in which staff training in key areas can be progressed in a more timely manner. Care Homes for Older People Page 27 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well managed and residents feel cared for and supported by staff, however significant omissions in the vetting and checks made on new staff and some inherited environmental shortfalls could impact adversely on the more vulnerable resdient group compromising their health and safety. Evidence: We found the home to be generally well managed with evidence that the present manager is seeking to update practice and personal development and has attained the necessary qualifications, she demonstrates some awareness and understanding of current changes in legislation and guidance and how this might impact on the service. We are disappointed that she has not implemented a more robust recruitment procedure which we consider could place residents at risk, the manager provides inhouse training to staff in a number of areas including safeguarding but training information viewed indicates her own training in this area in particular is now out of date, it is essential that the manager ensures that her own knowledge and practice is Care Homes for Older People Page 28 of 37 Evidence: updated so that she can monitor staff performance in these areas and that incidents are handled appropropriately. Whilst residents expressed disappointment that they had been uniformed about the home sale until it had been completed they welcomed the improvements in the heating arrangements within the home already implemented by the new ownership. The impression gained through discussion with the manager and staff is one of optimism about the future of the home, and that the new owners are keen to maintain the unique culture and appearance of the home and are willing to invest in much needed and in some cases essential improvement. The manager confirmed that under the new ownership she feels more involved in budgetary decisions and has control over some budgets. We found the AQAA to be completed to a reasonable standard telling us most of the things we needed to know, this could be improved upon by additional content in some of the outcome areas. Staff, residents and some relative responses indicate that they find the manager approachable, accessible and that she listens to what they have to say, however, they also report that they do not always receive feedback about issues raised, and where actions have been agreed these are not always addressed within a reasonable timescale if at all. Clearly communication is a key feature of successful management and our expectations are that in future the manager makes clear her intentions and where actions are agreed these should be started if not achieved within reasonable timescales. Opportunities exist for residents and staff to express their views through resident and staff meetings respectively, residents are also surveyed annually, and made clear in discussion that they always feel confident in approaching the manager or other staff if they have anything they are concerned about, however, with the growth in number of residents with dementia the manager will need to consider how best to proceed with resident engagement in future and already recognizes the need to look at how information will be made more accessible to this resident group. The AQAA tels us that the senior management team is working better together but need time for future planning. Analysis of resident feedback is made available to all residents. Although there are plans underway for improvements to the home these are not made clear within any formal development plan and evidence that resident feedback influences service development in other ways other than e.g menu development and activities is limited. We feel it is important that with so many competing demands the home develops and implements a development plan which Care Homes for Older People Page 29 of 37 Evidence: makes clear the timescales by which they would hope to address each one, the plan should take account of those improvements suggested through resident feedback. In view of the shortfalls we have identified at this inspection it is also important that the provider implements a quality assurance system that incorporates stand alone audits already in place but undertakes to ensure a programme of internal audit and review of systems and documentation and this is a recommendation. Regulation 26 visits by the providers representative are taking place on a regular basis and are recorded an examination of these suggests these would benefit from some improved detail and should make clear those spoken with to ensure that all residents and staff are spoken with over a period of time. The service does not look after the personal allowances of residents since the change of ownership and where residents monies are managed by Representatives these are now invoiced for incidental expenditures. An examination of staff records indicated that the expected number of annual formal staff supervisions has drifted for most staff, although there are signs that the manager is establishing an increased frequency in these, the home is recommended to ensure all care staff receive a minimum of six annually, staff commented that they feel well supported and have opportunities to express their views and raise issues at regular staff meetings. The AQAA tells us that Health and safety checks and servicing are being maintained and we sampled some of these, we found that the gas servicing had highlighted the problem of an eroding pipe in September 2008 that posed a risk and whilst there is evidence that the home is seeking quotes to replace this we consider that this constitutes a threat to health and safety and that action should be initiated promptly along with other identified shortfalls in the environment, a requirements has been issued for this elsewhere in the report. The Environmental Health officer visited in 2007 and no requirements resulted from that visit. The home has a full time maintenance staff member, and they maintain good systems for the routine checking of fire alarm and fire fighting equipment, testing of water temperatures around the home and the cleansing of water outlets to minimize risk of legionella, in addition to maintaining the internal decor and undertaking minor repairs. We consider that the shortfalls we have identified in the environment and the vetting and checks made of staff could compromise the health and safety and well being of the more vulenrable resident group catered for, we acknowledge that there are positive signs that the new providers are taking action on some shortfalls already in respect of some improved staffing, improved heating arrangements but as a new provider we Care Homes for Older People Page 30 of 37 Evidence: have no evidence as yet to indicate this will be sustained or a history of compliance in this service under the new owners, whilst we are optimistic that the identified shortfalls will be progressed and dealt with within the suggested timescales and will seek confirmation of this we do not at this time consider residents health and safety is sufficiently protected or promoted. We found the home is maintaining accident records satisfactorily and responding in an appropriate manner to accidents when they occur. Care Homes for Older People Page 31 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 The provider is required to address the following shortfalls within the timescales given: The replacement of an eroded gas pipe into the home already highlighted by contractors within one month of this report. To implement a programme of guarding radiators prioritizing those most at risk first to commence within one month of receipt of this report this report if low surface temperature radiators are not to be fitted. To evidence that action is being taken to securely fence and provide gates to the outside of the home to evidence action taken within one month of receipt of this report and completed within 20/02/2009 Care Homes for Older People Page 33 of 37 3 months of receipt of this report. CSCI to be notified upon completion. to ensure that the health and safety of residents is promoted and protected by these improvements 2 26 13 The provider is required to 20/02/2009 ensure the laundry is fit for purpose in that adequate washing machines and drying equipment is provided with appropriate sluicing facilities within one month of receipt of this report and that a programme of upgrading of the laundry is developed and put into place within 3 months of receipt of this report. CSCI to be notified upon completion. to ensure that arrangements are in place to prevent infection and the spread of infection in the home and safeguarding the health and well being of residents in compliance with infection control guidance 3 29 19 The provider must ensure 20/02/2009 that staff working in the home do so only following the receipt of a CRB and two written references and must evidence that staff are recruited through a robust Care Homes for Older People Page 34 of 37 process of vetting and checks. CSCI to be notified when the identified omissions have been addressed within the affected staff files. So that the provider can demonstrate that staff fitness to undertake their role has been thoroughly assessed and better safeguards residents Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The current home assessment process would benefit from the recording of improved detail in respect of individual residents mental and emotional state both observed and stated and reference to how tis impacts on their day to day life and routines the service should ensure that : handwritten entries on MAR sheets are signed and dated by the person entering the information Prescribed medication outside of the MDS system should be signed and dated upon opening this includes boxed tablets, liquid medications, creams and drops Trained staff should receive update training and competency assessments should be routinely implemented The key to the trolley should be placed in a secure setting and not left in the lock. 2 10 3 18 All staff including the manager should regularly receive updates in adult safeguarding training, with staff updates being no more than two yearly. The manager should develop behaviour guidelines for those residents whose behaviour needs some intervention by Page 35 of 37 4 18 Care Homes for Older People staff, these guidelines should be developed developed with the knowledge and agreement of the resident and significant others external to the home and reviewed regularly. Any restrictive practices must be compliant with current legislation relating to the deprivation of liberty and the mental capacity act. 5 27 A review of staffing levels is needed that takes account of the level of dependency of Dementia residents, the environment, and the need for enough staff to be available on the floor at all times to oversee and supervise residents and protect them from harm. The home should look at ways of progressing the outstanding and overdue training of staff in key areas highlighted. A programme of quality assurance should be implemented that allows for the internal audit and review of systems. An annual development plan should be established that takes into account feedback on how the service can improve from residents. 8 36 Care staff should receive a minimum of six supervisions annually 6 30 7 33 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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