Inspection on 23/03/09 for Bindon & Elmcroft Residential Homes

This inspection was carried out on 23rd March 2009.

CSCI found this care home to be providing an Adequate 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

Bindon & Elmcroft Residential... 27/03/08

Bindon & Elmcroft Residential... 05/10/06

Bindon & Elmcroft Residential... 12/01/06

Bindon & Elmcroft Residential... 26/01/05

Bindon & Elmcroft Residential... 07/07/04

Bindon & Elmcroft Residential... 22/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Bindon & Elmcroft Residential Homes Bindon 32-42 Winslade Road Sidmouth Devon EX10 9EX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vivien Stephens     Date: 2 3 0 3 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Bindon & Elmcroft Residential Homes Bindon 32-42 Winslade Road Sidmouth Devon EX10 9EX 01395514500 01395513586 rm.bindoncare@btconnect.com www.bindoncare.com Bindon Care Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 46 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Date of last inspection Brief description of the care home Bindon and Elmcroft (together registered as Bindon Care) are situated approximately one mile from Sidmouth sea front and town centre. The home is registered to provide care to older people who may have dementia, a mental disorder or a physical disability. Elmcroft, the smaller of the two buildings, provides personal care for up to Care Homes for Older People Page 4 of 32 Over 65 0 46 46 0 Brief description of the care home eighteen older people who have dementia. Bindon, the larger of the two buildings, provides personal care for up to twenty eight older people who may have a physical disability or dementia. The home may also admit up to five service users with dementia between the ages of fifty five and sixty four years of age. The buildings each have level access to their front entrance and to all communal areas. Bedroom accommodation is situated on the ground and first floors, with a stair lift between. Some rooms have steps leading to them. The gardens are secure and well tended. Bindon Care domiciliary care agency is run from the premises. The Home and Agency share the same registered manager and administration. A copy of the most recent inspection report is held in the Managers office and can be seen on request. At the time of this inspection weekly fees ranged from £382 to £650. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Several weeks before this inspection took place we sent an Annual Quality Assurance Assessment form (AQAA) to the home. They returned it by the required date and the completed form gave us useful information about the home and the services they provide. We also send survey forms to the home and asked them to distribute them to a random sample of people living in the home, to the staff team, and to health and social care professionals who visit the home. We received 5 surveys from people living in the home (some people received help from their friends or family to complete the form), 5 from staff, 1 from a care manager and 5 from health professionals. Their responses have helped us to form the judgements we reached in this report. During the morning we were accompanied by an expert by experience. An expert by experience is a person who, because of their shared experience of using services, and (or)ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Our expert looked around the Care Homes for Older People Page 6 of 32 home and talked to some of the people who live there. She also observed the lunchtime meal and saw how the care staff helped people with their meal. Her findings have been incorporated into this report. This inspection began at 9.30am and finished at approximately 6.15 pm. On the day there were 40 people living in the home. During this inspection we looked at the care plan files for four people chosen at random. We looked at other records held in the home relating to these people and we also talked to two of them (the other two were either asleep or unable to communicate with us). We talked to the manager, deputy manager, the provider, the Operations Manager, three staff, and a group of people who live in the home who were sat in one of the lounges during the afternoon of our visit. We carried out a tour of the home during which we looked at a random sample of bedrooms, the toilets and bathrooms, the kitchen, laundry and the communal areas. We looked at other records the home is required to keep including medications, menus, and staff employment and training records. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? The care plans files are now in good order, neatly filed, and sections have been divided to make information easier to find. Stocks of medicines held in the home are now recorded and carried forward each month to ensure there is a good auditing system in place. Creams and lotions have been dates to show when they should be discarded. The home now monitors each persons nutritional needs. They have copies of national good practice guidance on display around the home, and the chef now has a recording system in place that is followed to ensure all individual dietary needs are met. The home has taken action to make sure each persons religious needs are being met. They have recorded each persons religion and they have contacted local churches to increase the level of visits and involvement with the home. The manager has enrolled on a training course on equality and diversity. Copies of the homes complaints procedures have been given to every person living in the home, and the procedures have been displayed prominently in the home. Care Homes for Older People Page 8 of 32 There has been a marked improvement in the standard of decoration and maintenance around the home. While a few minor problems were noted, the overall standard within the home was comfortable, bright and homely. The level of training provided to staff has increased. The number of staff who actually hold a recognised qualification is still well below the recommended level of 50 , but almost all staff have been signed up for training and they are now working towards exceeding the recommended level. More training has been, or soon will be, provided on all required health and safety topics, and on other relevant health related topics. The homes quality assurance systems have improved. They were able to provide evidence of the ways they have consulted with people and listened to their comments and suggestions. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident they will be given enough information and opportunity to visit and get to know the home before they make a decision to move in permanently. The home follows good assessment procedures that ensure they can be certain they will be able to meet the persons care needs. Evidence: The home told us in their AQAA We work closely with residents, families, local care managers, and CPNs to ensure firstly we are the right environment and secondly we can provide the service they require. We offer potential residents a trial period from an afternoon visit up to a month trial. The home has a brochure they give to any person who enquires about accommodation. This gives useful information about the home. They also have an internet website, although this gives only limited information. Care Homes for Older People Page 11 of 32 Evidence: We looked at the files of two people who had recently moved into the home. We found that the home had gathered a range of information covering their health and personal care needs and important information about family and friends and health professionals involved in their care and well-being. The home had also gathered information and assessments from social services and(or) health professionals about their health and personal care needs. People we contacted during this inspection told us they were happy with the help and information they had received before they moved in. Comments included Yes, I am very happy here and know I have made the right choice. We were told that people are encouraged to visit the home and get to know it before they decide to move in permanently. Some people receive day care at the home, and some have chosen to have short stays before moving in. If a person cannot visit the home themselves due to health problems or the distance they live from the home, relatives or friends are encouraged to visit the home on their behalf. The home does not provide intermediate care. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recent improvements to the care planning systems and training for care staff means that care staff now have better information about each persons individual needs, although more work is needed to improve the level of detail about all daily routines. People can be confident that medicines are stored and administered safely. Evidence: At the last inspection we found that the information in the care plans had not been kept up to date and did not give clear and easy to follow instructions for the care workers about the care each person needed. Since then the care plans have been changed. They have been neatly filed in ring binders and each section was separated with dividers so that it was easy to find relevant information quickly. There were signatures either by the person the plan related to, or by their next of kin or representative, to show that they had been consulted and they agreed the content of their care plan. We looked at the care plan files for the four people who lived in the home. Risk Care Homes for Older People Page 13 of 32 Evidence: assessments had been carried out on moving and handling, nutrition and potential skin problems. The plans had been written in clear and easy to follow language. One persons care plan showed that one person may at times be Unstable/unpredictable/unco-operative and also Harmful/violent/aggressive. There were also statements by the home that the person could be Stubborn at times and Can be agitated if tired. We talked to the manager and deputy manager about understanding why the person may react in this way, and how to find stategies to support this person to avoid them becoming upset and agitated. The care plan file contained an appointment letter with a clinical psychologist. A report in the care plan following this meeting suggested that the home did not take full opportunity to seek guidance from this professional. Another person spent much of the day walking around the home and we heard that at times they wandered into other peoples bedrooms. The care plans did not contain any guidance to staff on how they should monitor this person to ensure they were safe. The manager told us they had taken action to prevent the person going out of the home unaccompanied. We suggested the home sought professional assessment and advice on ways of supporting and reassuring the person, and how to involve them in other activities. The care plans should be developed to give much more guidance to staff on how to support this person throughout the day. One care plan file showed that the person had said they liked a bath before they went to bed, but it was unclear if they wanted a bath daily or weekly. The home had a bath rota that suggested the person was normally offered a bath once a week. One entry in the daily records showed that they had been given a bath in the morning. We talked to the manager about how the daily reports should give evidence to show that the care plans have been followed, and if not, why not. One care plan indicated that the person was able to get themselves up and dressed in the mornings, but the daily reports said All personal care given suggesting the care workers had given assistance with all aspects of getting up, washing, and dressing. It was unclear exactly what tasks the person could do for themselves, or what they needed help with. It suggested that possibly the care plan needed to be updated. We talked to the manager about improving the level of detail in the care plans to explain each separate task (for example, helping a person to clean their teeth) and to explain how much of each task the person can do for themselves, and to explain exactly how the staff should assist the person with those parts of the task the person cannot do for themselves. Care Homes for Older People Page 14 of 32 Evidence: We saw evidence in some care plan files to show the usual time some people liked to get up. However, the Expert by Experience who accompanied us saw a number of people still in their night clothes at 12 noon. She told us I was struck by the number of residents who by 12 noon were up in their rooms but still in night clothes, and some who were still in bed but not apparently ill. When asked the manager assured us that this was a choice made by the resident and that staff would continually go back to offer help with dressing etc. We talked to the manager about ways of improving the level of detail in the care plan about the preferred daily routines of each person. Greater detail is needed to explain to staff what time the person normally wants to get up, and what the staff should do if the person wants to get up later. The daily care notes should reflect what actually happened, and these should be one of many tools used by the management team to monitor staffing levels and ensure peoples needs are met in a timely way. We looked at the way the care home helps people who have skin conditions, or who are at risk of developing pressure sores. Where people had been prescribed creams or lotions these were listed on the medicines administration charts, but there were no clear instructions either in the care plans or on the medicines administration chart to explain how, why, where or when the creams should be administered. Following this inspection we were given evidence to show that the home has introduced a body map to show where creams should be applied. We also advised the manager about the need to monitor all skin conditions and to give staff clear instructions about what they should do if the condition worsens or improves. We saw records relating to insulin administration. We were satisfied that the staff who administered the insulin had been adequately trained by the District Nurse and their competence checked. Some information had been provided by the District Nurse and we recommended they clarify some aspects of the guidance to ensure the staff know when to seek further professional guidance or intervention. The people who completed a survey before this inspection told us they always or usually receive the medical support they needed. During our visit a GP also visited the home to see one of his patients. The expert by experience who accompanied us during our visit told us about her observations Most residents I spoke with confirmed that the staff were good in providing personal care, always polite etc. A few said some of the younger ones were not so attentive. Interaction that I observed between staff and residents was always patient and offered residents choice. Care Homes for Older People Page 15 of 32 Evidence: We saw national guidance documents displayed around the home giving the care staff guidance on how to monitor peoples nutritional intake in order to prevent weight loss or malnutrition. The care plan files contained records of each persons weight, checked on a monthly basis. Our Expert by Experience watched people during their midday meal in one of the dining areas. She told us One resident left most of their meal and another refused the offer of an apron and help from a member of staff but did not make any attempt to eat her food. The only member of staff serving food in the dining room came back a few times and offered some food on a fork but was still refused. When this was raised with the manager we were assured that there is a system in place to monitor when a resident eats little or none of their meal. During the afternoon we heard that the staff had returned again a little later to offer a meal and the people had accepeted the offer and eaten their meals. We were also told that if a person refuses a meal this is noted in the daily records and the staff monitor the person closely and if they are concerned they have good systems in place to make sure this is followed up and medical advice sought if necessary. We also looked at the way the care staff recognise signs of pain and when the offer pain relief. Some people were prescribed pain relieving medicines by their GP to be used when required. However, there was no explanation either in the care plan or on the medicines administration records of how to recognise signs of pain, or when to offer pain relief. The manager agreed to implement these instructions. The home uses a monitored dosage system supplied by a local pharmacy. The medicines were securely stored. Good records have been maintained of each medicine administered and the amounts of all medicines held in the home each month have been carried forward to provide a system for auditing the records. The local pharmacist visited the home recently to check on the administration methods and to offer guidance and support. At the time of this inspection no controlled drugs were being administered. Safe methods for storage and recording of controlled drugs were in place ready for the next time any controlled drugs are prescribed to any person living in the home. Staff have received training on the safe administration of medicines and checks have been carried out to make sure they are competent. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The level of activities has improved in the last year but further improvements are needed to provide a wider range of activities to meet all individual and group needs. People are offered a good range and quality of meals to suit all preferences and dietary needs. Evidence: At the last inspection we found that the level of activities provided by the home was low. During this inspection we saw that the home had begun to address this by allocating some additional staff hours specifically for activities. A large print timetable was on display in the home to show what was provided each week. However, many of the people who completed a survey before this inspection told us that activities were provided sometimes. We looked at the timetable of activities and saw that the activities person provides one to one activities three mornings a week. This person is also one of the cleaning staff, and at the time of our inspection they cleaning team was short staffed and therefore the activities had often been dropped in order to complete the cleaning routines. We also found it was difficult to see evidence of exactly what activities had been provided on a one-to-one basis and we suggested that clearer plans should be drawn up to show exactly how they will meet each Care Homes for Older People Page 17 of 32 Evidence: persons preferences and interests. One care plan we looked at showed the person had been interested in many things including sport, reading, knitting and word puzzles before they moved in. We could not see any evidence to show how the care staff had encouraged the person to continue these interests, or to provide any group activities the person might be interested in. The timetable also showed that second activities person had been recruited to provide gentle exercises once a week. The activities timetable showed that arts and crafts were provided once a fortnight and classic films were also shown once a fortnight. Where group activities were provided they were only provided in either Bindon or Elmcroft. This means that if, for example, an activity was provided in Bindon, people who lived in Elmcroft had to walk over to Bindon if they wanted to join in. During colder weather some people may be deterred from joining in if they had to go outside in the cold to reach the other building. We would therefore recommend that the activities are developed to provide regular activities in each building. The expert by experience who accompanied us during this inspection told us about their observations The programme on offer includes one to one activities every morning and musical exercise, reminiscence groups, arts and crafts, puzzles etc in the afternoons. A number of residents told me about the exercise sessions and some said they preferred not to join group activities. The manager assured us that every resident would have some time offered by the activities organiser at least once a week either in a group or individually. There is a system in place that could identify if a resident was not involved in some activity at some time. During the afternoon of our inspection one person was taken out for a car trip in the afternoon. We also heard about plans to provide minibus outings. We saw evidence to show that the home has found out each persons religion. Since the last inspection they have contacted local churches to invite the vicar or a representative from the church to visit the home on a regular basis. We talked to the activities person, and to the manager, about ways of developing the range of activities both on an individual or group basis. We were assured that new games or activities equipment could be purchased if required. Care Homes for Older People Page 18 of 32 Evidence: We looked at the way the home meets individual nutritional needs. Printed menus were on display in Bindon and the chef told us they were developing new six-weekly menus to offer even greater choice of meals. There were at least two main dishes on offer at each meal. The home told us in their AQAA that all staff monitor peoples food and nutritional intake. They have a diary in the kitchen to record peoples feedback after each meal. The chef has spent time with each new person when they moved in to get to know their likes and dislikes and special dietary needs. He has drawn up a card index of each persons dietary needs and preferences. We saw large signs in the kitchen warning staff about those people who have food allergies. Our expert by experience watched as people in one of the dining rooms were given their lunchtime meal. They told us There is a choice of main meal at lunchtime and the menu is displayed on tables in Bindon but not in Elmcroft. Residents choose the day before what they would like, and, as staff are serving the meals, reinforce this with residents with dementia by saying here is the meal you chose yesterday, beef casserole etc. However I am not clear how some make the choice but had clearly forgotten the next day, as they said they did not want what they were served. Staff did offer the alternative but did not show the resident what the alternative was and left the resident with what they were first served. She also told us All residents that I spoke with confirmed that they enjoyed the food and it did look appetising. The manager checked during the afternoon to find out if the people had eaten later in the afternoon and the staff had confirmed that they had been offered, and had eaten a meal during the afternoon. This showed that the staff were taking care to make sure people were well nourished. We talked to the manager about the way people are helped to choose their meals, and how the staff assist those people who may need help with their meals (see also Personal Care section). We were reassured that staff had an understanding of each persons likes and dislikes and that staff showed patience and understanding with those people who may need extra support at mealtimes. All of the people we spoke to during our visit, and those who completed a survey form, said they always enjoy the meals. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the home has taken good measures to ensure people are protected from the risk of harm or abuse. Evidence: In the last year two complaints have been received by the Commission. These were passed to the provider to investigate and they told us about their investigations and the actions they took to address any areas where they found the complaints were upheld. We were satisfied they took the complaints seriously and acted promptly to carry out their investigations. During this inspection we were able to check on the issues raised and to find out if any of the problems raised were still evident in the home. We were satisfied that most areas had been addressed, and where they had not been completed we were satisfied that plans were in hand to complete them soon. The home has a complaints procedure in place and it has been displayed in the home. Four people who completed a survey form before this inspection told us they knew how to make a complaint and one person told us they did not know how to make a complaint. We talked to the manager about how they can improve peoples awareness of their complaints procedure and how they can ensure people feel able to raise concerns or complaints directly with the management team so that they can address problems promptly. The home told us that all staff have received training on the protection of vulnerable Care Homes for Older People Page 20 of 32 Evidence: adults and this has been regularly updated. The homes policy on protection of vulnerable adults has been updated and staff have been made aware of this policy. 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 live in a safe and comfortable home that has been well maintained. Laundry facilities are inadequate and this may compromise infection control procedures in the home. Evidence: The home was originally several separate terraced houses. These have been knocked together to form one large building. Where the houses have been linked there are some steps where the floor levels differ. There is a stairlift between the ground and first floors. While some people who use wheelchairs have been successfully accommodated in some parts of the home, the layout of the home may cause difficulties for people with mobility problems. This has been explained in the homes brochure. We talked to the manager about what happens if people develop mobility problems after they have moved in and we were assured that the home will offer a more suitable room if necessary (according to availability). One of the complaints received by the Commission in the last year (see Complaints and Protection section) suggested there may have been problems with the maintenance, decoration and cleanliness of the home. During our visit we carried out a tour of the communal areas home including bathrooms and toilets, and we also looked in approximately half of the bedrooms, chosen at random. Our overall Care Homes for Older People Page 22 of 32 Evidence: impression of the home was that it was bright, comfortable, and well maintained. A number of areas have been redecorated in the last year and most areas were in good decorative order. One bedroom was showing signs of wallpaper beginning to peel and we talked to the manager about how they identify when rooms need to be redecorated. We heard that occasionally an individual may have chosen not to have their room redecorated as they may feel they did not want any disruption. She also said they had already made plans to redecorate rooms that were showing signs of needing attention. The manager showed us forms she plans to use to do a full audit of each room to identify where action is needed to address any problems with the decoration, furnishings, maintenance or safety of the room. The gardens have been carefully tended and colourful spring flowering shrubs could be seen from many bedroom windows. There were paths and sitting areas for people to enjoy the garden during warmer weather. Each person had their own single occupancy bedroom. The manager told us that some rooms could be occupied by two people but they had a firm policy of only accommodating more than one person in a room if they both had specifically chosen to share a room (for example, married couples, or close friends). This demonstrated good practice. People have been encouraged to bring items of furniture, pictures and belongings to make their rooms feel homely, and we saw many rooms that were highly personalised. A few people had chosen not to bring furniture or pictures, and although these rooms did not appear personalised they were comfortable and homely. Most bedrooms have ensuite toilet facilities, and some bedrooms also have level access showers. We heard that the home normally has three cleaning staff on duty each day. However, one member of the cleaning staff had left recently and they were in the process of recruiting a new person. On the morning of our visit another member of the cleaning staff had gone off sick, leaving them short staffed. The deputy manager was carrying out cleaning tasks when we arrived. In our tour of the home we found that some carpets in bedrooms were in need of vacuuming. During the afternoon one of the staff employed by the domiciliary care agency (also owned by Bindon Care) was brought in to carry out cleaning and we saw him vacuuming carpets. Care Homes for Older People Page 23 of 32 Evidence: We found a few of the toilet bowls in peoples bedrooms were badly stained. The manager told us she had instigated a thorough cleaning of these toilets recently but they were unable to overcome the problem with heavy staining. The provider told us they would provide new toilets where necessary. We also asked the manager to look at the cleaning routines to find out why the toilets has become so badly stained. She told us that the regular audits she plans to carry out of each room should address this. In our tour of the home we found a few bedrooms had a mild odour problem although we could see that the home had taken action to address the problem as far as possible, including cleaning and de-odourising the affected areas. Windows had been left open where possible to air the rooms. Our expert by experience also looked around the home and her report reflected similar findings to our own. Some parts of the Home have undergone refurbishment, with some bedrooms having pleasant outlooks on to the back garden. Most that I saw have been personalised with residents own possessions, although some were quite sparsely furnished and decorated. The manager did tell me that one room was in need of decoration but the resident was reluctant to move out to allow for re-decoration. The communal areas were all clean and tidy and odour free, but some bedrooms were clearly in need of hoovering and a few had some odours of urine. The manager told us she has looked at the need to improve the signs around the home to help people find their way around the home. This was a recommendation at the last inspection. We recommended that she looks a current good practice guidance on decoration and signage for home that accommodate people with dementia. At our last inspection we found that the laundry facilities were poor. At this inspection we found that the facilities remained poor. There are three separate laundry rooms, and each one is small and cramped. One of the washing machines was broken and awaiting repair (one machine was also broken at our last inspection). The sinks were stained and one sink was very difficult to reach easily. One laundry was also used to store clean bedding. We were concerned about the risk of cross contamination and the difficulties the home may face if they experience an out break of diahorrea and vomiting. We recommended that the home seeks specialist advice from an expert in infection control on measures they need to take to ensure the laundry rooms are as safe as possible. One member of staff told us the home could improve by Making sure the laundry is working and the dishwasher in Elmcroft is not working. Only one washing machine is working in Bindon Care Homes for Older People Page 24 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 are cared for by sufficient numbers of staff to meet their needs. People are safeguarded from harm by the homes careful recruitment procedures that ensure only staff who are suitable for the job are employed. The level of training and qualifications for all staff is improving. Evidence: At the time of this inspection there were 40 people living in Bindon and Elmcroft. Information provided by the home before this inspection showed that there were 24 permanent care staff employed. They also employ cooks, cleaning staff, a maintenance person and administration staff. On the day of this inspection there was 1 manager and 1 deputy manager, 7 care workers, 1 maintenance person, 2 domestic staff. In addition 1 member of staff whose main employment was working for the domiciliary care agency also worked for 2 hours in the care home. Most of the people who completed a survey form before this inspection, and the people we talked to on the day of this inspection said that there were usually sufficient staff on duty to meet peoples needs. One member of staff told us They could do with a few more staff. The manager and deputy manager told us they felt there were usually sufficient staff on duty, although they were short on cleaning staff and were in Care Homes for Older People Page 25 of 32 Evidence: the process of recruiting a new person to this post. They agreed this affected the care staff team as the care staff have had to cover for this vacancy. We looked at the recruitment records for three staff recruited since the last inspection. The files were in good order, neatly filed, and showed that all required references and checks had been taken up before each person had begun work. This demonstrated that the home had taken good care to ensure all new staff were entirely suitable for the job. We also saw evidence of the induction training given to each member of staff. It was signed by the trainer and the person to confirm that both were satisfied that the person had received all the relevant information. At the last inspection we found that the level of training provided to staff had been poor. The last manager planned to implement a programme of training and this had begun before he resigned. We saw a record of the training each member of staff had received and we were given details of future training including training on dementia. Information provided by the home before this inspection showed that only 7 members of staff have so far achieved a relevant qualification known as NVQ level 2 or above (or equivalent). The manager told us that all but 4 staff have either begun this training or were about to begin this training. This demonstrated that, although the level of qualified staff was below our minimum recommended level of at least 50 , the home is working towards exceeding this level. One person told us they had concerns about those care workers who had a poor command of English. We talked to the manager about the communication skills of those staff from overseas. She showed us information about a new English language course she intends to help the overseas staff enrol on. She also said she felt their command of the English language had been showing improvements. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home has improved since the new manager has been in post and there are now good systems in place to ensure people are safe and well cared for. Evidence: Since the last inspection the previous manager has resigned and a new manager appointed. In the last 2 years there have been 4 different managers. The number of changes of manager, and the subsequent period in between when the home has been left without a manager has caused considerable disruption to the home. The current manager had been in post for 17 weeks before this inspection. She told us an application for registration was being process. She has previously been registered as manager in other care homes. She holds a relevant management qualification and has had a number of years of relevant experience. The manager of another home owned by Bindon Care has been appointed Operations Manager and she has been given responsibility of overseeing the management of Bindon and Elmcroft. She has provided advice and support to the new manager. In addition a new Deputy Manager has been appointed. We found that the management team were working closely Care Homes for Older People Page 27 of 32 Evidence: together and demonstrated a firm committment to providing good sandards throughout the home and making improvement where necessary. One member of staff told us Jackie is always available and will help anyone. Together with Deputy Nicky they make a great team. I think over the next 12 months things will continue improving with Jackie and Nickys leadership. We were shown copies of the homes most recent quality assurance survey. The questionnaires gave some useful responses. The results had been collated and we saw that the information had been used to help plan any improvements needed. We talked to the manager about gathering information from the staff team and from other professionals involved in the home. The home does not hold cash on behalf of people. If people need items to be paid for on their behalf such as hairdressing or toiletries the home will pay for the items and invoice them or their representative on a monthly basis. The home has recently purchased the services of a specialist employment law and health and safety company to advise them on relevant policies and procedures and current law. The fire alarm went off during the morning of our visit. This was not a planned fire test. We observed staff gathering quickly at the designated fire point and action was taken swiftly and calmly to locate the fault and take appropriate action. This action also highlighted that recent action taken by the care home to install a key safe by the main front door was not safe as the front door remained locked when the alarm went off and the action to open the key safe took up valuable time. We recommended that the home seeks advice from the fire authority on the most suitable method of locking the exit doors to prevent people who may be at risk from leaving the home without staff realising or accompanying them. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 Care plans should be improved to give greater detail about daily routines - times of rising/going to bed, what personal care tasks the person can do for themselves and a detailed explanation of how the staff should help the person with those tasks they could no longer do for themselves. This should include such tasks as dressing, washing, cleaning teeth, and eating. This will ensure staff are working in a consistent manner. The home should seek professional guidance and support where people are displaying behaviours that may place themselves or other people at risk of harm. Where creams or lotions have been prescribed the home should provide clear guidance to care workers on how, where when and why the creams should be applied. There should be guidance given on how to monitor the skin condition and what to do if the condition improves or worsens. A record should be completed each time a cream or lotion has been applied. Care plans should explain how staff should monitor those people who may be at risk when they walk around the home, especially if they might walk into other peoples Page 30 of 32 2 8 3 8 4 8 Care Homes for Older People 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 rooms, or if they may be at risk if they go outside the home on their own. The plans should clearly explain how staff should guide and support in order to avoid situations where the person may become angry, and also explain what staff should do if the person becomes angry or aggressive. 5 8 The care plans and daily reports should be used as a tool for the management team to monitor the care given by the care staff team and to check that the care plans have been followed, or if the care plans need to be updated. The home should develop the weekly timetable of activities to provide a greater range of individual and group activities. The activities should be planned using information in the care plans about each persons interests. The hours allocated to regular activities should be safeguarded so that the activities person is not expected to carry out other duties during the allocated activities times. More activities should be provided in each building. Where toilet bowls are badly stained action should be taken to address the problem. The manager should carry out her plans to implement a regular audit of all areas of the home to ensure all areas are kept clean, in good decorative order, safe, and well maintained. The home should consider any special needs people who suffer with dementia may have in finding their way around the home, and should seek specialist advice on any equipment, signs or decorations that may help. The home should seek specialist advice on the laundry facilities to ensure all laundry areas are clean, safe, and provide effective systems of infection control. Laundry and dishwashing equipment should be in good working order. The home should continue to work towards at least 50 of care workers holding a relevant qualification known as NVQ level 2 or above (or equivalent). The home should seek advice from the Fire Authority on safe systems of loking the exit doors to ensure people can get out of the home quickly in an emergency, and also ensuring that people who may be at risk of harm if they leave the home unescorted are safeguarded. 6 12 7 8 19 19 9 22 10 26 11 30 12 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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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