Inspection on 20/08/09 for Bon Accord

This inspection was carried out on 20th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bon Accord 10/06/09

Bon Accord 03/03/09

Bon Accord 03/04/08

Bon Accord 18/04/07

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for older people Name: Address: Bon Accord 79-81 New Church Road Hove East Sussex BN3 4BB     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: Elizabeth Dudley     Date: 2 0 0 8 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 35 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 35 Information about the care home Name of care home: Address: Bon Accord 79-81 New Church Road Hove East Sussex BN3 4BB 01273721120 01273730983 bonaccord@schealthcare.co.uk leeminggarth@schealthcare.co.uk Southern Cross (Hamilton) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Nicola Jayne Stevenson Type of registration: Number of places registered: care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 41. The registered person may provide the following category/ies of service: Care home with Nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Bon Accord is a care home with nursing and is registered to provide nursing to 41 older people with mental health needs.It is owned by Southern Cross(Hamilton) Limited. 19 of these places are contracted to the local authority. Residents accommodation is spread over three floors and consists of thirty-five single Care Homes for Older People Page 4 of 35 Over 65 0 0 41 41 1 0 0 6 2 0 0 9 Brief description of the care home rooms and two shared double rooms. Twenty-one of the single rooms and three of the shared rooms have ensuite facilities consisting of a washbasin and wc.There are two assisted bathing facilities and three assisted shower facilities. All staircases and the front door have a secure keypad entrance system. A shaft lift serves all floors.Communal accommodation consists of three lounges and two dining rooms. There is access to a large rear garden. The home has a large garden at the front with limited parking facilities.The roads around the home are metered parking only but the home is served by public transport and there is a train station at Portslade, which is approximately twenty minutes walk from the home.The home maintains links with the local psychiatric hospitals and local General Practitioners and associated health care professionals visit the home. Current fees range between £585 and £850 per week. These do not include extra services such as hairdressing and chiropody and charges for these are available from the manager. The last key inspection took place on the 3rd March 2009 Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This unannounced key inspection took place on the 20th August 2009 from 10:00 to 18:00 and was facilitated by the appointed manager of the home and the area manager for the company. The appointed manager has been in post for four months and is not yet registered with the Care Quality Commission. For the purposes of this report she will be referred to as the manager throughout. The Annual Quality Assurance Assessment (AQAA), a document required by regulation in which the provider or manager informs us about what has happened in the home in the past twelve months, any achievements or changes and aspirations for the next twelve months, was not applied for due to this being the second key inspection in the twelve months. Prior to this inspection, surveys were sent out by the commission to residents or their relatives, staff, and health and social care professionals. Of the fifteen surveys sent out Care Homes for Older People Page 6 of 35 to residents or their relatives six were returned, none were received from either staff or health and social care professionals. Information gained from surveys is used to inform the judgements made in this report and provides a valuable insight to the daily life within the home and the ways in which the home ensures the residents well being. Thanks are extended to those who responded. Methods used to inform judgements used during the key inspection included visits to all parts of the home, including residents private accommodation and examination of documentation, which included residents admission documents, care plans, medicine records, personnel files and health and safety records. Other documents which ensure the smooth running of the home and verify compliance with regulation were also viewed. Medication rounds, staff working with residents, and the serving of meals was observed, and time was spent talking to residents, four visitors and ten staff, and observing residents in the lounges in the home. All residents were seen at some time during the day, and five residents were involved with the inspection insomuch as discussions were held with them, where possible, regarding their care, and their documentation, including their care plans were examined. Discussions were held throughout the day with the manager and the area manager. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? There have been several improvements made in the home in the past four months. The home has complied with all the requirements made at the previous inspection. Care Homes for Older People Page 8 of 35 Concerns were raised at the last inspection regarding the provision of care not corresponding to that written in the care plans. This has improved to some degree, and this has been helped by the increase in the staffing levels across all grades of staff, therefore giving staff more time to spend with the residents and for senior staff to ensure that the care required is being given. There has been changes in management across all levels of the company and staff spoken with said that they believed that big improvements are being made. Levels of housekeeping staff have increased and this is evident in the improvement of the standards of cleanliness across the home. Maintenance in the home has also improved and there has been some investment in equipment, lighting, carpets and bed linen. All bathrooms are now in working order. A survey received said Home recently redecorated and looks good and there are no odours. Monthly relatives meetings recently set up which is good and the manager is ensuring that the staff record details of food and drink. I have confidence in the new manager and that she will endeavour to carry out the improvements as required by the Care Quality Commission The adult safeguarding policy is now in line with the Multi agency guidelines which ensures that staff are following the correct procedures to ensure that residents are safeguarded. The home is now using the corporate menus fully, this has ensured that all residents are offered fruit and finger foods at regular intervals and have a well balanced menu which allows them choice and enables dietary needs and preferences to be met. Food served is well presented and has cream and butter added to it for those residents that require the extra calorific intake. Training days for staff have been set up ensuring that all staff are receiving mandatory training and where previously there had been concerns raised about moving and handling practices in the home, although they were not aware they were being observed, staff were seen using correct techniques. The company is in the process of refunding monies spent by residents and their relatives on necessary equipment. What they could do better: Whilst there have been substantial improvements throughout the home there were some areas that caused concern and requirements have been made. There are still some concerns around the amount of fluids being made available to residents and also concerns around oral hygiene. A requirement has been made, although it must be stressed that no residents appeared dehydrated and therefore this may be a recording problem. Accident records show that occasionally residents have been found with unexplained bruising, although it is recognised that this may be due to the residents poor mobility or sensory perception, this should be reported to the relevant authority and also to the commission. Care Homes for Older People Page 9 of 35 Neither management or staff have attended any training in the application of the Mental Capacity Act or Deprivation of Liberty Safeguarding, and whilst it is recognised that the home has been concentrating on effecting the improvements required, this is of importance in a home with this category of registration. The home is not always informing the commission of any incidents adversely affecting residents and this must commence. There is no written evidence to show that staff have received formal supervision within the time scales as directed in the National Minimum Standards, although staff said they had supervision, they could not recall when. A requirement has been made. There has been a substantial staff turnover in the past four months with thirteen staff having left the home, this has affected the homes rating on the number of staff with the National Vocational Qualification level 2 or 3 in Care. Whereas previously 68 of the care staff had attained this qualification, this level has dropped to 33 . The home should encourage staff to attain this qualification. As there were no staff surveys returned, there is no indication of why so many staff have left the home. Whilst discussion with staff showed that they believed that so many recent changes of management may be the cause, they also firmly believed that recent changes have led to improvements for the home in general. 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 10 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective and existing residents receive sufficient information about the home which is updated and relevant to the current running of the home. All residents receive a comprehensive assessment prior to being considered for admission to the home to ensure that the home can meet their needs. Evidence: The home provides each resident with a Service User Guide, and a Statement of Purpose is available for the use of visitors and other interested parties. Both these documents have been recently reviewed to show changes that have occurred in the home including recent management changes. Both the Service User Guide and Statement of Purpose have been produced in a manner which make it easier for the information to be read and assimilated by most residents and visitors. Care Homes for Older People Page 12 of 35 Evidence: Discussions were held with the manager and area manager regarding the production of the Service User Guide in a format which would benefit those residents who have difficulty in understanding the written word or retaining information due to their cognitive impairment. The information in both the Service User Guide and Statement of Purpose is also available in a recorded format for those residents that require this. All residents, irrespective of how they are funded, receive a contract and Terms and Conditions of Residence on their admission to the home. Examination of preadmission assessments at the last inspection showed that these were comprehensive. There have been no new admissions to the home since the last inspection; and the manager gave assurances that all prospective residents would continue to be assessed prior to admission by either herself or a registered nurse, and would continue to receive written confirmation over whether the home can meet their needs. Residents or their representatives are encouraged to visit the home prior to making the decision about whether they wish to live there. The home is registered to provide care for forty one residents, nineteen of these places are contracted out to the Local Authority. Residents are admitted for either permanent and respite care, the home does not provide transitional or intermediate care. The home is still awaiting a new certificate of registration from the Care Quality Commission to show the change of management status, and this is being addressed. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in care planning and recording are assisting staff to give a standard of care to residents that meets their needs. Residents appeared to have a greater state of well being and generally appeared content. The standard of medication administration and recording safeguards the residents. Forward planning for the residents care at the end of their lives will ensure that their needs and wishes are met. Evidence: During the course of the day five care plans were examined. These identified that staff were aware of the individuals needs and clearly showed how the care to meet these needs was to be given. Care plans had been formed in consultation with the resident or their representative wherever possible, and showed evidence of being reviewed on a monthly basis. Each resident has a six monthly review,and relatives or significant others are invited Care Homes for Older People Page 14 of 35 Evidence: to these, and relatives also said that staff make arrangements to see them monthly to discuss the residents progress. Nutrition care plans include the Malnutrition Screening Tool (MUST) and staff have updated their knowledge in the use of this. Continence care plans showed that residents have had a complete review of their needs for continence aids and those supplied meet the needs of the individual, some carpets have been renewed and housekeeping staff said that with the upgraded continence aids, improved management of residents continence needs, and frequent cleaning of the carpets, odours are minimised. There were no odours in any rooms. Records of mattress pressures required for individuals pressure relieving mattresses are monitored on a regular basis and kept in the residents rooms. Risk assessments for bed rails were in place and were robust and reviewed regularly. No residents are currently judged to be at any risk from having call bells available, and therefore all residents have call bells for their use or the use of relatives or staff requiring assistance. Call bells were being answered promptly. Daily records showed that the care being given is in accordance with the planned care. However four out of the five residents whose care was being followed in depth,were not receiving any form of oral care. It was noted that the fifth resident had refused oral care on three occasions and then there was no evidence of whether this had been attempted. There was no evidence of what, if any, actions were to be taken to address this. Staff must be made aware of the importance of oral care and its effect on the general well being and health of the individual. No care plans contained any form of mental capacity assessment or whether a resident is being deprived of liberty. The manager is aware that this must be put into place following the recent Mental Capacity Act and Deprivation of Liberty safeguarding. The manager was aware that this may be relevant for some of the residents in the home but has not yet had time to address this. Some areas of the home are protected by key pads for resident safety and this needs to be assessed in line with Deprivation of Liberty safeguarding. There was evidence that health care professionals including the Wound Care Specialist Nurse, Physiotherapists and Consultant Psychiatrists are being brought in as required. Residents appeared to be content and well groomed, there was improvement noticed Care Homes for Older People Page 15 of 35 Evidence: in the general well being of the five residents whose care was followed at both this and the previous key inspection. Residents were seen being treated with dignity and respect by the staff. The home has implemented the Dignity in care training and now has two Dignity champions who ensure that staff are aware of the latest developments in the care of the older person with mental health conditions. Although the manager now ensures that records are in place to ensure that staff visit the conservatory lounge on a regular basis, there were no staff in this lounge on two occasions when it was visited. The residents here are very vulnerable and need very regular attention. One survey received said The home could improve by having a carer in the sun lounge (conservatory) all the time whilst a visitor said I do worry about leaving her in there (conservatory) as staff are not around all the time and its what might happen when there is no one there that worries me. This was discussed with the manager. The Yesterday, today, tomorrow concept, whereby the staff and residents interact in all activities of daily living enabling the residents to participate in their personal care and to ensure that their preferences are met, is continuing in the home. More staff are now undertaking the training in this and staff said that this easier to implement now staffing levels have improved. Two surveys received from relatives of residents in the home said I am very pleased with the care given by the staff to my (resident); My (residents) physical health has improved, so take that as an indication that the home does that very well. On speaking to visitors comments were received which included The management are more sensitive to the staffing requirements of the home which has led to our relatives having much better care. The staff have a really difficult job to do in this home, more so than other nursing homes, they do a really good job, now they are better supported by extra staff, and top managers are aware of their needs, the people here are being cared for really well. Whilst food and fluid charts are being accurately recorded, the present charts do not give sufficient space for any extra fluids given to be recorded, particularly at night. Three fluid charts examined showed that these residents were receiving slightly under the recommended fluid intake daily, although did not appear to have any symptoms of Care Homes for Older People Page 16 of 35 Evidence: dehydration, therefore it may be that fluids are not always being recorded. There were also no fluid charts in any of the lounges to record the fluids taken in whilst residents were in these rooms. Fluids did not appear to be readily available to residents in the conservatory and most of these residents would require assistance with fluids. Staff must ensure that fluids are given outside the normal beverage times and some method of ensuring this must be put in place. Registered nurses said that they are now ensuring that all records are examined daily and actions taken to address any deficits that are found. A survey from a relative received by the commission stated The manager has ensured that staff records details of all food and drinks given. All other charts recording nursing interventions in residents rooms were up to date and staff were seen employing correct moving and handling techniques when dealing with residents. Medication administration systems in place safeguard the residents. Creams, ointments and other external medications kept in residents rooms were prescribed for the person who lived in the room and were signed following administration. It is good practice to ensure that the date of opening is written on bottles of liquid medication and also in the case of PRN (as required only) medications, to ensure that charts are included in the individuals medicine chart, which detail the symptoms specific to the individual which would warrant giving the medication. Not all residents had end of life care planning in place. It is good practice to commence this on admission to ensure that residents can make their decisions known whilst still well enough to do so. Two residents had end of life care plans in place, these were comprehensive and included residents wishes for advanced treatment, but did not include preferred place of death. Registered nurses are attending updating of their skills in the provision of syringe drivers (a method of giving pain relief) and the management are considering sending staff on End of Life Care training courses. management are also considering the implementation of the Liverpool Care Pathway and Gold Standards Framework (nursing tools for ensuring that residents receive a recognised standard of pain relief and care at the end of their lives). This is specifically important in homes with this category of registration as residents are often not able to make their needs known in Care Homes for Older People Page 17 of 35 Evidence: their last weeks. Care Homes for Older People Page 18 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The promotion of leisure activities within the home is having a positive effect on the well being of the residents. The activities coordinator is continually exploring ways in which the residents can be mentally and physically stimulated and is adding new activities to the programme on a regular basis to see whether the residents enjoy these. Catering systems and the menus and quality of the food offered in the home has greatly improved ensuring that residents experience a pleasant dining experience and receive a nourishing diet which is suitable for their needs and tastes. Evidence: The home employs an activities coordinator who works on a full time basis to provide leisure activities to the residents. A programme of activities is in place but this is flexible according to the wishes of the residents. Activities provided include some outings, crafts, reminiscence therapy, one to one sessions and a lunch club. Entertainers are also coming in and a fete was held in recent weeks. The home is considering employing a part time coordinator to provide activities at weekends. Staff said that they can see the benefits of having regular activities provided especially Care Homes for Older People Page 19 of 35 Evidence: the one to one sessions with those who are not so cognitively able, with residents being more alert and responsive to them. Whilst Records are being kept of the participation of individuals in the activities, the manager should ensure that social care plans are in place which include peoples past interests and current social needs and progress made through the benefits of the activities. Routines within the home have sufficient flexibility to meet the needs of the residents in the home and residents spoken with said that they had sufficient choice. Residents preferred times of rising and retiring are recorded in the care plans. Visitors are welcome at any time, there appeared to be good interaction between staff and visitors and staff were observed giving information about residents progress to the visitors. Discussions with visitors showed that they were more confident about the home and the care of the residents and that they thought highly of the staff and the work that they were doing. The activities coordinator accompanies those residents who wish to attend church services to the local church on a Sunday. The minister from this church also visits the home and provides a service in the home for residents who wish to attend this. Other ministers of religion visit the home as required. There is an improvement in the quality of the meals being offered in the home. The home is now using the corporate menu. The inspection commenced as morning coffee was being served, and it was noted that residents were being offered bowls of fruit, finger foods, chocolate and other snacks. Fruit bowls were also placed in each lounge and either residents were helping themselves or staff were bringing fruit to them during the day. Staff said that residents in their rooms are also offered fruit both at coffee time and throughout the day. Clarity of the hand written menu board could be improved by only writing what is to be served at the next meal. This would assist residents and prevent misunderstanding. The home has recently commenced pictorial menus which show photographs of each meal on the days menu. This will greatly assist residents in their choice of meals. The menu provided a choice at all meals including a daily vegetarian choice, and staff were seen speaking to the cook about what the individual vegetarian residents wished to eat that day. Care Homes for Older People Page 20 of 35 Evidence: Baked beans and spaghetti rings are still in evidence but staff say that they are not featuring on the menu so often. The cook is aware of which residents require the addition of butter and cream to meals and gave assurances that this was taking place. One survey received stated that Food needs to be age appropriate- chicken nuggets, beans and tinned spaghetti and meatballs not always suitable. This was discussed with the manager who said that these items were either not or were rarely on the corporate menu. Meals being served were well presented and of reasonable portions, pureed meals have their components served individually and staff were seen assisting residents with meals in an empathetic manner and talking to residents whilst they did this. There was no evidence of any residents now dining alone. Fresh fruit juice is now available at all meals including breakfast, and there was grapefruit and other fruit available for breakfast for those residents who wished for this. Tables were well laid out with napkins and table cloths and in the dining room condiments were on the tables, however this did not extend to the individual trays being taken to peoples rooms. The kitchen was clean and good hygiene practices were seen. The home was awarded five stars by the Environmental Health Authority in its Scores on Doors initiative. Care Homes for Older People Page 21 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is sufficient information around the home to ensure that residents and visitors are aware of how to make a complaint. Improvements in the adult safeguarding policies will ensure that staff follow the correct procedure for reporting any incidents and therefore ensure residents are fully safeguarded. Failure to report unexplained bruising or other incidents could put residents at risk Evidence: The home has a complaints policy which is included in both the Statement of Purpose and Service User Guide. Residents rooms include folders in which there is space for visitors to write any matters they wish to bring to the attention of the staff including minor concerns. During the twelve months up to the previous inspection in March 2009 there had been four complaints and seven adult safeguarding issues. There have been no complaints since that inspection and two adult safeguarding issues, both of which were taken out by the home against outside agencies. Whilst the manager agreed that there have been minor concerns reported since the last inspection there have been no records kept of these or the actions taken to commence this. It is good practice that records are kept of minor concerns in order to ensure satisfaction for the resident or representative and to provide evidence in any future issues. Care Homes for Older People Page 22 of 35 Evidence: The company now has produced a revised adult safeguarding policy which follows the Multi-agency Guidelines. This gives clear direction to both managers and staff about how adult safeguarding protocols and the ways of reporting these to ensure the investigations remain robust. However on examining the accident and incidents records there were some incidents of minor bruising to residents, which could either have been caused by the resident bruising themselves, or by poor moving and handling techniques, and may have required reporting for adult safeguarding investigation. This was discussed with the manager. Staff have received recent updating in adult safeguarding. Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a pleasant and clean home for residents. Evidence: There have been many improvements made to the general maintenance and decor of the home in the past few months. Communal areas have been furnished with new lighting, although some visitors to the home have said these are too bright and one survey said After campaigning to get new lighting we feel very disappointed at the institutional type lights which are too bright and have no dimmer switches. However staff said that Its nice to be able to see what you are doing and residents did not seem affected. This was discussed with the area manager and the home manager who said that they would look at this. The majority of the chairs and in particular the dining room chairs, have been deep cleaned, the manager stated that some furniture is due to be replaced and a new freezer is required for the kitchen. Residents rooms have been redecorated and re carpeted as required and new bedding has been purchased. Residents have chairs and other equipment appropriate to their needs which the company or the PCT provides. The company is in the process of refunding money spent by residents and relatives on required equipment, and the area manager stated that any necessary equipment required by a resident will be funded by the home, or arrangements made with the Care Homes for Older People Page 24 of 35 Evidence: relevant authorities to get this equipment provided. Hot water temperatures have been monitored and recorded on a regular basis, some of these were on the lower end of the recommended scale and it is preferable that they are maintained at the higher end of the scale to ensure residents comfort. The home now has two assisted baths and three showers, all of which are in working order and can be used by the residents. Staff said that the majority of the residents currently in the home are preferring to use the baths rather than the showers. Housekeeping staff spoken with said that provision of extra housekeeping staff and the ongoing maintenance and replacement of equipment in the home in recent months, have made a difference in helping them to maintain the cleanliness of the home. All areas of the home were very clean and free from odours. The standard of both the laundry and the ironing has improved. Staff are aware of their role in controlling any infection that may occur. There is an infection control champion (members of staff who undertake courses with the Health Protection Agency and liaise with this agency regarding latest policies and procedures to be implemented and practices within the home). Sufficient supplies of disposable gloves, aprons and the home has recently purchased supplies of alcohol hand gel for staff use. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number of staff across both care and housekeeping areas has been increased and tangible improvements have been observed across all areas of the home. Staff are encouraged to undertake further training to ensure that their knowledge of the residents needs is up to date and relevant to current research. Recruitment systems, whilst reasonably robust, could put residents at risk. Evidence: Staff spoken with and duty rotas examined showed that staffing levels have been increased and that there are generally sufficient staff on duty to meet the needs of the residents. There has been improvement both in the cleanliness of the home and the care of the residents due to the increase of staffing levels in the morning and to a lesser extent in the afternoons. Discussions were held with the manager regarding this as there are eight care staff in the mornings and two registered nurses and seven most afternoons. On this specific afternoon there were eight care staff on duty and staff spoke of the difference it made to have the extra member of staff on in the afternoon. Staff were seen to be continually occupied with care and other matters therefore this was not over staffing. The area manager and manager agreed to increase the levels to eight care staff every afternoon and were also asked to discuss staffing levels with the night staff to ensure Care Homes for Older People Page 26 of 35 Evidence: that they had sufficient staffing early evenings and early mornings, although it is doubtful extra staff would be necessary through most of the night. The levels of housekeeping staff have also been increased and new catering staff are in place. New staff undertake the homes local induction course over three days which includes mandatory training and then follow on with the recognised induction course:Skills for Care, designed to lead onto the National Vocational Qualification level 2 or 3 in care. Currently 33 of the staff have this qualification although previously 68 had attained this. Other training including mandatory moving and handling, fire and safeguarding adults training is taking place and all staff have been updated on these. Staff are also encouraged to participate in other training relevant to their role and these have included, Dementia care training, Dignity training and Infection Control training.Other training is supplied by both the company and the nursing home support training. Registered nurses are being encouraged to update their skills with the nursing home support team. The activities coordinator has undertaken an accredited course for the provision of activities for people with cognitive deprivation and now intends to do a National Vocational Qualification in this area. The manager must ensure that all staff, including registered nurses, participate in Dementia care training. Discussions were held with the manager regarding staff training in basic life support and also the application of the Mental Capacity Act and Deprivation of Liberty safeguarding. Housekeeping staff said that they are applying to participate in the National Vocational Qualification scheme relevant to their role. All catering staff and the majority of other staff have the food hygiene course. There has been a significant staff turnover in the past few months with thirteen members of staff having left the service. The home is in the process of recruiting new staff. Four personnel files were examined: although these generally contained all the checks that are required by regulation to ensure the safety of residents, one new member of staff had been commenced with only one written reference and one verbal reference. The manager was reminded that verbal references are not acceptable and referred to the relevant regulations. She gave assurances that she would ensure that all staff have the required documentation prior to commencing work at the home. Care Homes for Older People Page 27 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recent change of management has led to changes throughout the home and mostly to improvement. Residents may be at risk in some areas which are not risk assessed and lack of formal supervision for staff may lead to bad practice. Evidence: The appointed manager has been in post for four months. She is suitably qualified and has sufficient experience to ensure the smooth running of the home. Much work has been put in by the manager and the staff in the past four months with the assistance of the area manager. Staff turnover has been high, with thirteen staff having left the home since the last inspection, however the majority of the core staff and all the registered nurses have remained. This has led to substantial changes for both residents and staff and whilst some staff said that the atmosphere was not the same, all existing staff said that the changes and improvements made were for the Care Homes for Older People Page 28 of 35 Evidence: better and that they needed to take place. Visitors spoken with said The staff here are very good, am kept well informed and know about my relatives plan of care considerable improvement in the home in all levels in the past few months. The staff have always been very good but now seem to be working under more direction in a more controlled manner and the registered nurses seem to have everything under control and keeping tabs on everything. I am very pleased with the care. Neither the manager or the staff have yet attended any training on the Mental Capacity Act or Deprivation of Liberty Safeguarding, therefore no residents have received assessment under this. The area manager said this is planned for the near future. No Annual Quality Assurance Assessment ( AQAA) was requested prior to this inspection. The manager says that relatives meetings are held regularly and their opinions of the service asked. Relatives stated that these meetings were useful and enabled them to discuss things with the manager and staff, but added that they now had monthly meetings to discuss their residents progress. Staff meetings have been held monthly and minutes of these were seen. The manager was unsure about how quality monitoring takes place but intends to put out questionnaires and surveys to residents, relatives and stakeholders. There is an annual quality monitoring assessment undertaken by the head office, but the home has not received up to date information from this. The home does not act as appointee for any resident nor keep any money in the home belonging to residents. Any money received from residents is put into an interest bearing bank account apportioned to the resident. All residents have advocates or relatives to deal with their money. Whilst staff said that they had received supervision at regular intervals they were unsure about the exact time scales and there was insufficient evidence to support that all staff have received regular supervision at the two monthly intervals directed by the National Minimum Standards. The manager gave assurances that this would be addressed. Regulation 26 visits have been taking place monthly (visits by the provider or a person appointed by the provider to do these required by regulation on a monthly basis and the generation of reports following these visits) and the reports generated by these were seen in the home. Care Homes for Older People Page 29 of 35 Evidence: The registration certificate in the home is not current and does not reflect management changes which have taken place. The Commission has been kept informed about all changes which have taken place,but a new certificate has not been issued. The area manager received apologies and assurances that this would be addressed from the inspector. The commission has not been informed about minor accidents or incidents to residents. This must be commenced and a requirement has been made. Risk assessments were not in place for portable fans and risk assessments for the home have not been updated recently. These must be put in place. Evidence of servicing of utilities and equipment were seen and were up to date. Other maintenance records, including fire alarm testing, were up to date. All staff have received mandatory training in moving and handling, fire, safeguarding and health and safety. No poor moving and handling practices were seen in the home. Care Homes for Older People Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The manager should ensure that staff maintain the oral care and hygiene of the service users on a regular basis To ensure that service users oral hygiene needs are met 01/10/2009 2 8 23 Staff must ensure and be able to provide evidence that fluids are being offered regularly to service users outside of the normal meal and beverage times. To ensure that service users especially those who cannot make their needs known, receive sufficient fluids throughout the twenty four hour period. 01/10/2009 3 18 13 The manager and senior 21/09/2009 staff must ensure that any unexplained marks on service users are reported to the relevant authority. Care Homes for Older People Page 32 of 35 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 To ensure that service users are safeguarded 4 31 18 That the manager and senior 02/11/2009 staff attend training regarding the mental capacity act and deprivation of liberty safeguarding and ensure that all service users that require this are suitably assessed by a person qualified to do so. In order that all service users that require this are suitably assessed as to their mental capacity and to ensure that none are deprived of their liberty. 5 36 26 That all staff receive regular formal supervision. To ensure that staff working in the home are doing so in a manner which meets the policies of the home and ensures that service users receive the appropriate care. 6 38 13 That risk assessments are put in place for any equipment such as portable electric fans, and risk assessments are carried out throughout the building and updated regularly 30/09/2009 02/11/2009 Care Homes for Older People Page 33 of 35 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 To maintain the safety of service users 7 38 37 That the commission is 10/09/2009 informed of any accidents or injuries to the service users. To ensure that the commission is aware of events which are injurious to service users. 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 15 That individual trays for meals are set out in an attractive manner and include condiments to enhance the dining experience for all residents. That the menu board only contains the menu for one meal at a time to ensure it is legible and that it does not confuse the residents. That the manager keeps records of any minor concerns reported and how they have been addressed to ensure that these have been addressed to the individuals satisfaction and to provide future evidence should further issues be raised. That staff receive encouragement to attain the National Vocational Qualification Level 2 in Care, to ensure that the home has sufficient staff trained to give care to the residents. 2 16 3 28 Care Homes for Older People Page 34 of 35 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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