Inspection on 06/10/08 for Bartlett House

This inspection was carried out on 6th October 2008.

CSCI 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

Bartlett House 15/10/07

Bartlett House 09/01/07

Bartlett House 04/11/05

Bartlett House 13/05/05

Bartlett House 26/01/05

Bartlett House 19/05/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bartlett House Bartlett House Old Common Way Ludgershall Andover Hampshire SP11 9SA     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: Alison Duffy     Date: 1 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 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 32 Information about the care home Name of care home: Address: Bartlett House Old Common Way Bartlett House Ludgershall Andover Hampshire SP11 9SA 01264790766 01264791687 manager.bartletthouse@osjctwilts.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Rosemary Evelyn Lusty Type of registration: Number of places registered: The Orders Of St John Care Trust care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category Additional conditions: The service user aged under 65 named in the application dated 22nd August 2006 may be accommodated at the home for a period of 3 months whilst the home is able to meet their needs. Date of last inspection Brief description of the care home Bartlett House is a purpose built residential home offering accommodation and personal care to a total of 49 residents over the age of 65 who require care primarily through old age, although the home is registered to accommodate 13 residents with dementia and 3 with learning disabilities. Five of the 49 beds are also used for respite care. The home also provides day care facilities for a further 20 clients. The home is Care Homes for Older People Page 4 of 32 Over 65 13 3 33 0 0 0 Brief description of the care home one of a number of care homes managed by the Orders of St Johns Care Trust. Mrs Julie Watts is currently the acting manager. Mrs Watts is in the process of registering with us. The home is situated in a residential area close to the centre of the small town of Ludgershall. Ludgershall is situated on the A342 between Andover and Tidworth. The home provides single accommodation, which is located on both the ground and first floor. There is a passenger lift giving easier access to the first floor. Staffing levels are generally maintained at 6 care staff including a care leader during the morning and 4 or 5 staff for the afternoon and evening. There are 3 waking night staff. The home also employs cooks, housekeepers, a maintenance person, an administrator and an activities coordinator. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 key inspection took place over two days. The first day took place on the 6th October 2008 between the hours of 10am and 6.15pm. The second day was on the 10th October 2008, between 10.30am and 5.30pm. Mrs Watts, acting manager, Ms Heather Mudie, locality manager and two care leaders received feedback. The pharmacy inspector visited to look at the medication systems. The findings of this visit are detailed within this report. We met with people who use the service in their own rooms and within communal areas. We met with the staff members on duty. We looked at the management of peoples’ personal monies. We observed the serving of lunch. We looked at careCare Homes for Older People Page 6 of 32 planning information, training records, staffing rosters and recruitment documentation. As part of the inspection process, we sent surveys to the home for people to complete, if they wanted to. We also sent surveys, to be distributed by the home to health care professionals, involved in peoples’ care and staff. The feedback received, is reported upon within this report. We sent Mrs Watts an Annual Quality Assurance Assessment (AQAA) to complete. This was completed in detail. Information from the AQAA is detailed within this report. The last key inspection of this service was on the 15th October 2007. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the care home does well: What has improved since the last inspection? What they could do better: Staff should ensure that information within written documentation is consistent between formats. Staff should continue to develop care plans to enable their knowledge about peoples Care Homes for Older People Page 8 of 32 needs to be fully recorded. Any information taken from the Internet about specific health care conditions should be summarised in terms of the individuality of the person. Clear guidelines should be in place regarding the management of pain relief patches. This may involve the use of a body map similar to those used in relation to topical creams. Consideration should be given to the most appropriate way to make sure both trolleys are secure when conducting a medication round. Continue to increase the numbers of staff with an NVQ qualification. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed before being offered a service, so are assured that their needs will be met. Assessment documentation is now much more detailed enabling staff to have further information when supporting people. Evidence: At the last inspection we made a requirement to ensure that assessment documentation reflects the prospective person’s individual needs. We said key factors such as risk must be clearly addressed within the care plan. We saw that this requirement had been met. We looked at documentation demonstrating the most recent admission to the home. The format was fully completed and identified peoples care and social needs. Some of the information was in a tick style answer format yet staff had written additional information to enable greater clarity. Factors, which were important to the person, Care Homes for Older People Page 11 of 32 Evidence: such as receiving a cup of tea in the night if awake, were clearly stated. Nutritional, tissue viability and a falls assessment were in place. Within feedback, we spoke of the need to ensure information within documentation is consistent. For example, the assessment identified a history of falls yet the falls assessment concluded that there was no risk of falling. We saw that staff had contacted the persons GP to gain confirmation of the medication they were taking. One person told us that they had lived in Ludgershall all of their life so knew that they would end their life at Bartlett House. They said they had not contemplated going anywhere else. Another person told us that their family had found the home for them. We spoke to one person who told us I know I can’t cope on my own so I’m giving it a try. Within surveys, two people told us that they were admitted on an emergency basis so received limited information before their admission. Other people who had a planned admission were satisfied with the information they received. A relative, within their survey told us prior to my XX moving to Bartlett House, my wife and I first visited the facilities and then took my XX for an assessment and to get his/her views. We were all very impressed. On recommendation of his/her doctor, my XXs admission to Bartlett House was brought forward without hesitation, the staff being most helpful. Mrs Watts told us that the maintenance person had devised a brochure with clear photographs of different aspects of the home. We spoke to the maintenance person about this. They said they felt it important that people could visually see what the home was like rather than being told about it. They were planning to update the document according to the seasons and as the home was further developed. A GP told us within their survey, the carers at Bartlett take on residents who really require more of a nursing home care. On the whole they manage these residents well but they take a lot of extra care, which can be difficult for the staff to manage. In response to this view, Mrs Watts told us that dependency levels of people had been reviewed. Some people with high dependency needs were no longer at the home. Mrs Watts said this had enabled the level of peoples needs to be accurately balanced with the staffing resources available. Staff confirmed that they now have more time to spend with people, as the majority need less support with their personal care. Bartlett House does not provide intermediate care, so standard 6 is not applicable to this service. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning has been significantly improved upon, which enables staff to have detailed information when supporting people. People have good access to health care provision. People are protected by the home’s procedures for the safe administration of medicines. People’s rights to privacy and dignity are promoted and maintained. Evidence: At the last inspection we made a requirement to ensure that all care plans reflect peoples individual needs, including the management of health care conditions. We saw that the content of care plans had been significantly improved upon. Within surveys, two care managers told us that care plans appeared accurate and are reviewed at each review. We saw that the plans detailed the support the person needed in terms of their daily living routines. Short-term needs such as the administration of antibiotics and topical creams were clearly stated. Staff had used body maps to visually evidence where the cream needed to be applied. We said this was good practice and advised that this Care Homes for Older People Page 13 of 32 Evidence: could be also be used for the management of pain relief patches. Within one plan we noted that the person had diabetes yet there was little detail of the management of this. The plan stated ensure XX is offered a choice of reduced sugar and fat meals daily. We advised that this statement be expanded upon. There was no information about the person’s blood sugar levels to ensure wellbeing. Within feedback, Mrs Watts and the care leaders confirmed that the person is reviewed yearly due to their diabetes being long standing and well controlled. They said the person is very aware of what they are able to eat so regular monitoring is not required. We advised that this information should be recorded on the persons care plan. We looked at another care plan of a person with diabetes. Staff had gained very detailed information from the Internet regarding the condition. We advised that the care plan should also include details, which were specifically relevant to the person. The care leaders said this would be completed without delay. At the last inspection we made a requirement that any potential risks such as choking and dehydration are addressed within the risk assessment process. We saw that risk assessments had been developed and had been regularly reviewed. Aspects such as, using topical creams inappropriately and the potential of injury from freestanding wardrobes had been addressed. We saw that a nutritional assessment identified a high risk of malnutrition. The care plan showed control measures to ensure a healthy food intake. However, staff were able to tell us more than what was recorded within the care plan. This included aspects such as ensuring the person had full fat milk in all drinks and puddings. They also spoke of high calorie foods. As a means to ensure the accurate recording of fluid monitoring, staff told us that the capacity of all cups and mugs had been measured. Photographs of the drinking vessels had been taken to ensure clarity. Staff told us that they are now assigned a specific part of the building to work on during their shift. This ensures continuity for people and enables staff to keep a better track of people’s food and fluid intake. People we spoke to were very happy with the support they received. They said the staff are absolutely lovely. They are friendly and just pop in to see if I need anything. Another person said they can’t do enough for you. They don’t ever make you feel guilty for needing something. They seem to want to make life better for you. We met with one person however, who said they would benefit from more staff support with aspects such as washing and dressing. Their care plan confirmed that they needed the support of one staff member. However, daily records often showed entries of no help needed. There was little evidence of the persons recent surgery. Staff told us that the person was often ready when they arrived to give support. Within feedback, Mrs Watts told us that the persons care and their wishes would be reviewed with them. Care Homes for Older People Page 14 of 32 Evidence: People told us that staff would call the doctor on their behalf if need be. Mrs Watts told us that positive links with the local surgeries were being developed. One surgery now holds weekly surgeries in the home. She said the GPs could also be contacted as needed at other times of the week. Within surveys, people told us that they were satisfied with the care and medical support they received. Comments included I always receive the care and support I need and all the family are very happy with the care received. One person told us I am very happy at Bartlett House and my family are also happy with the way I am cared for. Family and friends are also made so welcome here and the staff are always ready to help and chat. The staff really do all they can to make us all feel like its home from home. Often they are under pressure due to workload but they always have a smile and treat us with respect and friendliness. Within their surveys, relatives told us our visits to my XX are unannounced. S/he always appears well looked after and happy and my wife and I have been very impressed with Bartlett House and it’s staff. My XX seems to be happy, content and well looked after. I would like to add that it is also very good value for money. Our Pharmacist Inspector looked at the arrangements for medication handling in the home. Medication was stored securely and appropriate records kept. Many improvements have been made by the new staff member with responsibility for medication, including separate charts for the use of creams and lotions. These are backed up by the use of body maps to show where the applications are used. Medication administration records were completed accurately and clearly. When we watched the medicines being given staff were seen to take time with people and to offer their medicines in the way they particularly liked. The medication round was made more difficult by the use of two trolleys and one set of keys. Care plans were available to support the staff in their use of medicines prescribed as required and medicines for particular conditions. People living in the home are able to manage their own medicines if they wish and they are supported by staff to do this. All staff who administer medication have had appropriate training and a comprehensive policy and procedure is available to them. We were informed of a medication error prior to the inspection. Staff had not managed the error well and disciplinary action followed. Mrs Watts gave assurances that staff had learned from the incident and although unacceptable, positive outcomes had been found. We saw that staff spoke to people in a friendly, respectful manner. We heard some Care Homes for Older People Page 15 of 32 Evidence: people thank staff for their support. We heard some staff reply with no problem or its a pleasure. We saw staff knock on peoples bedroom doors and wait to be invited in. Some staff called out their name to enable the person to know who was entering. Staff told us about people who would not want to be disturbed until later in the day. Within a survey, one care manager told us, walking along corridors - most doors are left open and residents are often lying on their beds - not always in dignified positions. We did not see any evidence of this on our visit. The care leaders told us that they believed staff were very good at promoting people’s dignity. They said people generally chose whether they had their bedroom door opened or closed. They said staff would encourage doors to be closed if they saw a person’s privacy was compromised. Within another survey, a care manager said I found a mix of day care and permanent residents milling around together in the foyer. Residential staff did not know the day care customers and I felt that on occasions they were not treated with appropriate dignity e.g. lady asking where the toilet was - residential staff member asking if this person could use the toilet unattended before responding to the question (this was done in the front of the lady. We spoke about this view in feedback. Mrs Watts told us that she would ensure that both day centre and residential staff were involved in handover at the start of the day. This would ensure staffs awareness of peoples needs. Mrs Watts asked the care leaders to start this process at the beginning of the following week. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are offered social activity provision both inside the home and within the wider community. People are able to follow their preferred routines and receive visitors as they wish. Meal provision is of a good standard and enables variety to people. Evidence: Staff told us that there has been a significant improvement in the number and variety of social activities available to people. They said the whole team are now supportive of social activities and become involved if they can. We spoke with the activities coordinator who is now responsible for the day care service, as well as providing activities for people who live at the home. She told us that she now works on a full time basis, which gives greater flexibility. She said her new role had significantly improved provision with an actual base, where people knew where she would be. She said she enables a framework of what people have asked for, yet other staff also facilitate activity sessions to ensure variety. People we saw in the privacy of their own rooms told us that they could join in with activities if they wanted to. However, the majority said they were happy following their own solitary interests such as reading and watching television. Specific comments Care Homes for Older People Page 17 of 32 Evidence: included they do lots of things but I’m not really interested and its there if I want to join in but I’ve got enough to do, to keep me busy. One person brought their dog with them on their admission. We saw that staff regularly took the dog for a walk outside. The person was very appreciative of this. People told us that they could have visitors at any time. They said they were able to follow their own routines. One person said they leave you to get on with what you want to do. Another person said its like home. If I want to do something I do it. If not, it can wait until tomorrow. Staff told us that they respected peoples wishes of wanting to spend time on their own yet tried to keep individuals informed of the activities taking place. Within surveys, people told us that there were usually activities they could join in with. Within their survey, a care manager told us a lot of staff in office and not interacting with residents. Very large wall calendar in the foyer but it always has the wrong date on it. We did not see evidence of these aspects during our visit. We saw various activities taking place. Some people were being supported to make Christmas cards for a planned fund raising coffee morning. Others were within a reminiscence group. Some people were colouring and others were having their fingernails painted. Staff told us about the reminiscence boxes being used. They provided a theme to create memories. One box contained a swimming costume of an earlier age. One of the care staff modeled the costume to the amusement of people. We saw that staff interacted well with people and through this, promoted discussion. We saw photographs of events, which had taken place, displayed around the home. Staff told us that the photographs were often used to prompt people’s memories of activities they had engaged with. We saw that a Halloween party was being organised. Posters displaying the event and Halloween decorations were being put up around the home. There had been a Hawaiian day. Staff told us about a regular fruit tasting session whereby more exotic fruits were tried. We saw that there were minutes of the most recent residents meeting on the notice boards around the home. Staff told us that the meetings were well attended and people gave their views. People told us that they were happy with the food provided although one person said the worst thing is that we often have to wait around before they start serving. Another person said its ok. Its not highly exciting or very creative but traditional. We saw the lunch looked appetizing and was served according to individual appetites. There were individual menus on the tables. Any changes to the stated menu were highlighted on the menu board on the wall. People were offered wine or juices with their meal. We saw that people could have a range of alternatives to their main meal. These included snacks such as an omelete, beans on toast, a salad, sandwiches or a Care Homes for Older People Page 18 of 32 Evidence: boiled, poached or scrambled eggs. Within surveys, people expressed satisfaction with the food. A relative told us from my experience, the food and the dining facilities appear to be excellent. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A positive approach to complaints is in place and people are aware of how to make a complaint. Adult protection systems are in place to safeguard people from abuse. Evidence: At the last inspection, we made a recommendation to ensure that the complaints procedure is readily accessible to peoples relatives and is also developed within a user-friendly format. We saw a copy of the formal complaints procedure within the entrance area of the home. A more user-friendly procedure, which requested ideas, was displayed around the home. People told us they would tell the manager, a member of staff or their family, if they were dissatisfied. Within surveys, people told us that they knew who to speak to if they were unhappy. All except one person knew how to make a complaint. Within their survey, relatives told us if I have had any concerns the staff have always been attentive and responsive and my XX speaks to me and I have to speak to whoever is available. A care manager, within their survey told us, I asked for a different window covering and Bartlett House responded appropriately. Care Homes for Older People Page 20 of 32 Evidence: Within discussion we saw that Mrs Watts has a very open approach to complaints. She encourages people to raise any concerns and aims to resolve matters effectively to the satisfaction of the complainant. We saw that Mrs Watts has a clear focus to improve the service people receive. She appears very responsive to constructive criticism. A record of formal complaints is maintained. The records are clear and identify any investigations, outcomes and responses to the complainant. Mrs Watts told us that she likes to meet with the person raising a concern, as she believes this values the comments people have. Mrs Watts told us that all staff are given a copy of the local adult protection reporting procedures, No Secrets in Wiltshire and Swindon. She said that abuse is initially discussed at interview. It is then addressed in induction and at various intervals during staff supervision. Mrs Watts told us that adult protection training forms part of the mandatory training programme for all staff. Staff confirmed that they had had training on abuse awareness. They were aware of the local reporting procedures and their responsibility of addressing any suspicion or allegation of abuse. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from an environment that is clean, well maintained and furnished to a good standard. Evidence: People have a single bedroom on the ground or first floor. There is a passenger lift or various staircases giving access to the first floor. Those rooms visited were personalized to a high degree. People had brought items of furniture with them, on admission. All had a number of important possessions including pictures and photographs. Some people had their own telephone and a key to their room. Staff told us that there had recently been improvements to the environment. This has included the redecoration of some bedrooms and the refurbishment of a bathroom. They showed us the bathroom and newly refurbished sluice room. Both rooms were much improved. Staff told us that further refurbishment was planned. This included more bathrooms, toilets and the replacement of the dining room carpet. Mrs Watts told us that a quantity of bedroom furniture had been replaced. The main staircase had also been decorated. People told us that they were happy with their bedroom. One person said its just how Care Homes for Older People Page 22 of 32 Evidence: I want it, its cosy and warm and there’s not much work involved in keeping it tidy. Another person said I enjoy looking at my bits and pieces. It gives me comfort. Within surveys, people told us that the home was usually fresh and clean. One relative said clean yes, fresh no. We saw that there was an odour in one room. Within surveys, care managers commented about odours. One care manager said there is a distinct odour around the home. Floors looked in need of a hoover. Another said I visited on the 3rd September and found the home smelling of urine. I noticed, as most room doors were open, that there seemed to be a commode in every room. One person I reviewed had a very strong smell of urine in his/her room. I asked if s/he was incontinent (seeing pads under the chair) and was told s/he was not incontinent of urine and had a commode anyway. I did not investigate but wondered if the commode needed to be emptied. We discussed this within feedback. Mrs Watts told us that at times there are odours within the home. She said staff work hard to address the cause and resolve the odour as quickly as possible. Some carpets have been replaced as a means to address this issue. Care leaders told us that people often choose to have a commode. They said this wish is respected even if the person is not incontinent. Mrs Watts and the staff said that commodes are regularly checked and emptied, as quickly as possible. Within the AQAA, it is stated the home has a dedicated and experienced housekeeping team who take pride in their work. All rooms are hoovered and dusted daily and are cleaned to meet the expectations of the resident and their family. We did not look at the laundry on this occasion. People did not raise any negativity about the laundry service they received. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from positive, established relationships with staff. People are protected by a robust recruitment procedure. Staff are offered a range of training opportunities in order to enhance their practice. Evidence: We saw that staffing levels are maintained at generally at six carers including a care leader on duty in the morning. There are five carers and a care leader in the evening. Mrs Watts told us that there are approximately 60 vacant care hours each week. Agency staff are being used to maintain the required staffing levels. Mrs Watts told us that people have been recruited into these positions. Before commencing employment, checks are being undertaken to ensure they are suitable to work with vulnerable people. Mrs Watts told us that short-term sickness absence has improved recently, which has assisted with giving people continuity with their care. Mrs Watts also told us that a new Head of Care post has been developed. This was seen as invaluable and would assist with the further development of the service. People were complimentary about the staff. Specific comments included they are all very good, they work really hard and will do anything for you and Im always pleased to see them as they are so kind. Within surveys, people told us that staff Care Homes for Older People Page 24 of 32 Evidence: listened to what they had to say. One person said staff listened but did not always act. They said have asked now for a chiropodist for 3 weeks because of sore toe but not any joy yet. We asked about this in feedback but the care leaders were not aware of the situation. They said they would check with other staff and try to resolve the problem. We received positive comments about staff within surveys from relatives. These included the staff appear to be kind, attentive, patient and good humoured, the staff are caring and all the staff are very supportive and caring, couldnt ask for more. Within surveys people told us that staff were generally available when they needed them. Within their survey a care manager told us residents often enjoy being taken out locally. This can only happen if a carer volunteers to do this in their time off. We spoke about this within feedback. The care leaders told us they were able to take people out in work time but also, many staff chose to do things in their own time because they wanted to. They said that staff enjoy external events and are quite happy to stay on after their shift to take part. Mrs Watts told us that external activity provision had recently increased. She said staff are not expected to take people out in their own time. We looked at the recruitment documentation of the three most recently employed members of staff. The files contained the required information. There was a photograph, an application form and two written references. Each staff member had been checked against the Protection of Vulnerable Adults register before commencing employment. Criminal Record Bureau (CRB) certificates were in place. Within the AQAA, it is stated training starts with the required Induction training also the E-Learning programme, and over the course of the year most staff will exceed the minimum 3 days of training stipulated. As a qualified trainer I provide in house training on a regular basis. It is possible to hold small training sessions, up to 6 or 7 staff, within our dedicated training and resource room. All care staff are undertaking the Alzheimers Society Accredited Quality Dementia Care Course to assist in caring for residents unable to easily express their wishes, preferences and beliefs. All ancillary staff undertake a half day workshop in dementia care. Staff told us that they have access to a range of training opportunities. Staff told us they had recently undertaken infection control, medication and dementia care. We saw one newly appointed member of staff undertaking their induction. We looked at the training records and saw each member of staff had a record of the training they had Care Homes for Older People Page 25 of 32 Evidence: completed. Mrs Watts told us that recently a training programme for night staff had been devised. This was facilitated at night-time so that staff could attend without worrying about family arrangements. Mrs Watts told us that the level of staff with a National Vocational Qualification (NVQ) had dropped due to staff changes. However, there are currently six staff doing NVQ level two and five staff doing level three. Mrs Watts told us that all new staff would be expected to undertake an NVQ. Within their survey, a care manager told us all working towards NVQs. They said staff appear to have a good relationship with the residents I have reviewed. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are benefiting from clear leadership and a clear focus regarding the development of the service. The safe keeping of peoples personal monies is well managed. Peoples wellbeing is promoted through clear health and safety systems. Evidence: The previous registered manager left the home in April 2008. Mrs Watts gained the role of acting manager at this time. Mrs Watts managed another care home within the organisation and is already registered with us. Mrs Watts told us that the acting managers position was originally temporary although she has now decided to continue employment at the home. Mrs Watts said she was in the process of finalising her application to register as manager of the home. She said this would be undertaken without delay. Mrs Watts told us that she has NVQ level 4 in care and the Registered Managers Care Homes for Older People Page 27 of 32 Evidence: Award. She also has NVQ level 4 in Training and Development (Learning.) Mrs Watts has many years experience of working with older people in various care settings. Within the AQAA, it is stated having been in post for three months my priority has been to improve the quality of the care provided for the residents and to provide guidance and direction for the staff. We saw that Mrs Watts was committed to the service and valued the staff team. She was clear about the direction in which she wanted the service to develop. Staff told us that the change in manager had given uncertainty. They said it had been difficult and there was a period of change. Some practices had been adapted and they needed to get used to differences in management styles. All staff said that things were now settling down and they were looking forward to the future within the home. One member of staff told us I just love coming to work now. We are all learning so much and are taking on more responsibility. Another staff member said Julie [Mrs Watts] is very resident focused and is striving to make things better for them. Any ideas we come up with are tried. She is very supportive and you know where you stand. Another staff member told us she gets things done and sorted. There are so many improvements, it makes everyones life better. The home has a quality assurance system that is used within all of the homes within the organisation. The system consists of various audits and questionnaires. Mrs Watts told us that the yearly audit had recently been undertaken. She has not as yet received the report but was positive about the overall outcome of the process. Staff told us that regular residents meetings now take place. Senior managers visit the home on a monthly basis, as part of regulation 26. Records were in place to demonstrate the areas of discussion, which had taken place. Nearly all people using the service have placed small amounts of their personal monies, for the home to hold safely. We looked at the systems for managing this. The cash amounts we checked, corresponded with the balance sheets. Receipts were in place to demonstrate expenditures. The administrator told us that access to the monies had recently been restricted. Mrs Watts told us that this was done to minimise the risk of error. We saw that the system was regularly audited. The organisation has a range of health and safety policies in place. Ms Mudie told us that health and safety audits form part of the regular regulation 26 management visits. During the day of the inspection, Ms Mudie was reviewing risk assessments. We therefore did not look at these during our visit. We saw that Mrs Watts had reviewed all documentation in terms of the cleaning materials used in the home. The documentation was clear and well written. Care Homes for Older People Page 28 of 32 Evidence: We saw that the accident book contained clear recording of any incident. There were a relatively high number of falls. Mrs Watts had monitored these. No contributory factors had been found. The falls did not show a pattern. In response, Mrs Watts told us that she had contacted the falls clinic and she was awaiting consultation about matters such as medication. She said it was expected for people to have bone density tests and further investigatory measures, if they gave their consent. We noted that there had also been a number of accidents in the kitchen with staff involving hot water or hot surfaces. Mrs Watts told us she would discuss this with the staff team. The fire alarm system was tested during our visit. People appeared familiar with the noise and the procedure. One person said the noise always makes me jump and then we have to open the doors unless staff get up here first. The fire log book demonstrated satisfactory testing of the fire alarm systems. We advised greater clarity with the recording of fire instruction given to staff. During our visit, Mrs Watts addressed this. We also advised that when any faults with the system are rectified, this should be identified within the fire log book. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 7 Clear guidelines should be in place regarding the management of pain relief patches. This may involve the use of a body map similar to those used in relation to topical creams. Any information taken from the Internet about specific health care conditions should be summarised in terms of the individuality of the person. Staff should continue to develop care plans to enable their knowledge about peoples needs to be fully recorded. Staff should ensure that information within written documentation is consistent between formats. Consideration should be given to the most appropriate way to make sure both trolleys are secure when conducting a medication round. Continue to increase the numbers of staff with an NVQ qualification. 2 7 3 4 5 7 7 9 6 28 Care Homes for Older People Page 31 of 32 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). 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