Inspection on 10/06/08 for Care-a-lot Ltd Trading As The Old Rectory Nursing Home

This inspection was carried out on 10th June 2008.

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

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

Other inspections for this house

Care-a-lot Ltd Trading As The... 30/05/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Care-a-lot Ltd Trading As The Old Rectory Nursing Home Church Lane Barham Ipswich Suffolk IP6 0PS Lead Inspector Mrs Jan Sheppard Unannounced Inspection 10th June 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Care-a-lot Ltd Trading As The Old Rectory Nursing Home Church Lane Barham Ipswich Suffolk IP6 0PS 01473 830247 01473 832435 pdorai@ornh.co.uk Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ms Prema Antionette Dorai Mrs Noreen Theresa Warde Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The total number of service users to be accommodated at any one time shall not exceed 34 but may be up to 36 including 4 day care service users. Service users may be accommodated in the home if they come within one or other of the following categories of service users: OP old age (defined by reference to the service users` presenting conditions and chronological age) not falling within any other category set out in schedule 7 part II paragraph 7 of The National Care Standards Commission (Registration) Regulations 2001 (Categories DE dementia and TI terminally ill being amongst those other categories as explained by annex F to the Guidance entitled `NCSC - Transitional Provisions and Transfer of Registration` (circular HSC 2001/21:LAC(2001)30)) 30th May 2007 Date of last inspection Brief Description of the Service: The Old Rectory is a privately owned care home situated in Claydon, a small village on the outskirts of Ipswich. Claydon has a number of shops, public houses and a post office and there are bus links to the nearby town of Ipswich. The home has recently completed some extension work and can now accommodate thirty-two residents. All the residents’ rooms are located on the ground floor and comprise twentysix single rooms and four double. Seventeen of the rooms have en suite facilities. There are two assisted bathrooms and two shower rooms. The large lounge has an attached dining area and there is a new conservatory that over looks the enclosed sensory courtyard garden. The current fees for the home range from £480.00 to £560.00 per week. This fee does not include toiletries, newspapers, hairdressing or chiropody. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2*. This means the people who use the service experience good quality outcomes. This unannounced inspection took place over seven and a half hours during a weekday. This was a key inspection that focused on the key standards of the Care Standards Act 2000 relating to Older People. The report has been written using accumulated evidence gathered prior to and during the inspection including information given in the annual quality assurance assessment (AQAA) completed by the manager and comments made in the twelve pre inspection surveys completed by residents, relatives , staff and by other professionals. During this inspection the inspector made a tour of the building, had in depth discussions with the homes manager who was present throughout and met and had discussions with the homes owner and with the administrator. A number of staff and many of the residents were also consulted along with the large number of visitors who were in and out of the home during the day. The requirements made at the last inspection have been met. Although the inspection was completed by just one inspector the wording used in the report will refer to “we” as the report is written on behalf of the Commission. What the service does well: The home continues to provide good quality person centred personal and health care in a relaxed and homely atmosphere. Care is delivered according to each persons assessed care needs. Staff are warm and friendly and have good insight into peoples individual emotional care and nursing needs. Comments from relatives to support this view included ; “The staff show kindness and care at all times which I think makes people feel safe and secure” Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 6 “ The staff get to know the residents as individuals. The ethos seems to be to observe each resident and carefully target the staff behaviour to the idiosyncrasies as well as the needs of the resident” Staffing levels are good and on the day of this inspection staff were observed spending time with the residents talking and undertaking activities. The atmosphere was calm and unhurried. There are clear management arrangements in place and staff reported that they were well supported in their role. What has improved since the last inspection? What they could do better: No requirements have been made following this inspection. Issues which were identified were addressed by the manager on the day and have been documented in the main text of the report. The manager had good awareness of areas which could be developed further and was able to evidence steps planned or already taken to move these forward. These areas include the following; The second assisted bathroom is due to be refurbished. Alternative arrangements for the storage of equipment away from the bathrooms are to be introduced. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 7 The management are to review the present system for storage and administration of medication. Improved Infection Control measures in relation to soiled linen are due to be introduced this to provide better cross infection control. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1.2.3.4.5. Standard 6 is not applicable as the home does not provide intermediate care. People who use this service experience excellent quality outcomes in this area. People who may use this service have the information they need to make an informed choice about where they live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Old Rectory has a detailed statement of purpose, service user guide and brochure which includes photographs and gives detailed information setting out the aims and objectives of the home and the services provided. Prior to moving into the home each applicant has a pre-admission assessment completed by the homes Manager who visits them where ever they may be usually either in their own home or in hospital. This assessment which covers all aspects of care including health social and personal care needs is carried out to determine if the home could meet these needs and to form a view as to Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 10 whether the environment provided at the Old Rectory would be suitable for the applicant. Then they, and if they wish their relatives also, are invited to visit to view the accommodation meet some of the other residents and join in with a meal or with the activities of that day. People who had recently moved into the home consulted during the inspection spoke very positively about their admission experience. They felt that they had received a warm welcome one said “ the staff have been very kind and helpful introducing me to other residents and not letting me feel isolated and alone and they have helped me arrange the things that I need in my room also .” One relative spoke appreciatively about the time given by the administrator during her initial visit to the home, “ He showed me round and explained all the complicated bits about the contract and the funding arrangements that the social worker did not explain to me I felt so reassured. My relative has been here for six weeks now she is very settled and happy and has started regaining the weight that she lost in hospital. I am very pleased with the good care given to her and the kindness and regular communication given to me by the staff” During this inspection the professional reception given to relatives who arrived unannounced seeking a double room vacancy was witnessed. Despite the unplanned visit staff were seen to give them good attention answering their questions fully and allowing them time to consider what they had seen and been told. They were shown around the home encouraged to talk with staff the residents and with other visiting relatives. They commented how much better this experience had been to what they had experienced when visiting other homes. The files of two fairly recently admitted residents were seen and both contained documentation for a pre-admission assessment of need. The areas covered included communication, mobility, personal hygiene, continence care, sleep patterns and oral care. Other potential needs assessed were the resident’s lifestyle and social needs, their mental state and cognition, level of anxiety or challenging behaviour and their final wishes. Further information recorded was past medical history, any known allergies, medication and skin integrity. The Manager said that if possible at this initial assessment she tries also to commence acquiring details as to their earlier life history, their occupation where they lived and general interests, as staff found that such information even if scant was very useful in enabling them to help the new resident settle into the home. Good initial information as to any dietary preferences was also found to be essential. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. People who use this service experience good quality outcomes in this area. The health and personal care people receive is based on their individually assessed care needs. The homes medication policy and procedures are robust but some quality improvements are recommended. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The three residents files seen all contained a care plan to assist staff in supporting the resident as they chose. Each contained a thorough initial assessment, regular reviews and risk assessments which had also been kept up to date. The Manager explained that since the last inspection all the care plans had been reviewed and extra detail concerning how each individually assessed care need was to be met had been added to the documentation. It was seen that the areas of need covered included personal hygiene, night needs, pain control, continence care, nutritional and feeding and emotional needs. Some aspects of these plans had been generated in response to risk Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 12 assessments that had been completed for skin integrity, falls and moving and handling. The Waterloo score recording format was used for skin integrity and there was evidence that the home linked closely with the local Tissue viability nurse service. Whilst there were no residents with pressure wounds at the time of this inspection staff were aware of those who because of their frailty were at risk of these and knew of the extra precautions being taken to prevent this. Helpful details noted on the care plans seen included; “X needs to be kept in a quiet area of the home” “ Requires reassurance offer a cup of tea , if anxious sit with her and maybe read to her”. The outcomes of particular care interventions were also noted, for one resident who had on admission to the home been withdrawn and non communicating with other residents an improvement with this was noted at the first review and suggestions as to how this improvement might be maintained were given. Each file had details of the resident’s GP and other health professionals involved. There was a record of visits to or by health professionals and of any treatment prescribed. Staff were observed knocking on doors before entering rooms and addressing residents respectfully. Staff were heard to offer residents choices about where they wanted to eat their meals and whether they wanted to return to their room for a nap after lunch. Staff encouraged residents to be as independent as they were able with gentle prompting and guidance. One incident witnessed was of the opportunity being given for a resident to rise unaided from their chair but when this proved too difficult prompt assistance was given by the carers in a very kindly reassuring manner with ensured the residents safety and enabled them to retain their full dignity. This resident told the inspector “ Staff are so kind and helpful thanks to them I am so much better now”. Part of a medication administration round was observed. It was seen to be being given sensitively at a speed appropriate for the resident to manage. The MAR ( medication administration record ) sheets seen were found to be well maintained with no gaps in signatures and explanations given on the reverse of the sheet for any changes which were also identified by the correct code letter. ”As required “ medication which allows for a choice of dose i.e. one tablet or two, was seen to be properly recorded with what numbers were actually given and why. MAR sheets had identification photographs of the residents attached to them. A list of specimen signatures of nurses authorised to give medication was also seen. The controlled drugs (CD) register was seen and a random check on the CDs showed that they tallied with the records. Staff were reminded that the drugs trolley must be locked each time it was left for the nurse to give out the medicines. The residents medication is currently prescribed from various local pharmacists as used by their doctor. Other medication administration systems which save on time and offer better safety were discussed with the Manager. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 13 Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. People who use this service experience excellent quality outcomes in this area. People who use this service are able to make choices about their lifestyle and activities. People who use this service receive a varied good quality diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs activity co-ordinators who prepare a weekly activity programme which was seen to be displayed around the home. Activity needs and interests are generated from the assessed needs of the residents as stated on their care plans. During the inspection a number of activities, board games craft work and discussion of current affairs from the newspapers, were seen to be being conducted either with small groups of residents or individually on a one staff to one resident basis. One staff member was seen to be engaging a resident who did not wish to participate in group activity in one to one discussion about local Harvest traditions as illustrated in a book of Rural England. Residents and visiting relatives spoke positively about the recently increased activity programme mentioning the Reminiscence Therapy sessions and the Complimentary Therapy hand massage as being particularly appreciated. Staff were seen to be taking residents out into the village or for Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 15 walks in the garden. One resident who had during her working life been an assistant in a local village shop told the inspector how staff regularly took her to visit that shop so that she could retain links and friendships. Since the last inspection the home has purchased a Mini Bus with wheelchair access to provide transport for outings and a number of planned outings over the summer months were mentioned to the inspector. Visits to garden centres the coast and to the Broads for a boat trip being particularly popular. Also since the last inspection more space in a small dedicated lounge area has been given over to activities and craft work. Residents who gave information in surveys said that they were happy with the level of activities now available for them to choose from and comments from a number of relatives also confirmed this. The manager explained that the home had recently joined NAPA the National Association for Providers of Activities for Older People which had given them new activity ideas and the co-ordinators had been able to access better activity training which they will in turn cascade down to other staff. The home has an open visiting policy and a number of visitors came and went during the day. Those spoken with said that they were always made welcome in the home were offered refreshments and could if they wished have their visit in private. All said that they were happy with the care that their relative received and spoke very positively as to the calm relaxed and warm manner in which staff delivered this care. One told the inspector “ the service is always very professional staff are always on hand and assist in a kindly manner nothing is ever too much trouble the management always ring us to keep us informed I have been really surprised by the quality of the service” The care files examined all contained the spiritual persuasion of the resident ,if any, and in some cases their final wishes had also been recorded. The home is regularly visited by representatives of different religions who conduct services and or meet with individuals in the home. The kitchen was visited and found to be clean and tidy. Temperatures of refrigerators and freezers are recorded daily and showed they were functioning within safe limits. There was a wide range of dry ingredients and fresh fruit and vegetables. The menus were seen to offer good choices at each meal along with a variety of night time snacks and a continual supply of hot or cold drinks as required. Staff had a good awareness of the need for good hydration especially in hot weather and residents who wanted had fresh supplies of fruit and water in their rooms. The kitchen had been subject to an Environmental Health Inspection on 26th March 2008 and the recommendations made then for minor improvements were seen to have been already been completed. The lunchtime meal was seen served and this looked hot and appetising; residents spoke well of the Shepherds pie and confirmed that various Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 16 alternatives were always available. A very large selection of sweets was seen to be available. Staff who were observed to be assisting residents with the feeding process were seen to be doing so in an appropriate manner going at the residents speed and stopping to talk with them as they wished. The meal period was protracted to accommodate the varying eating speeds of the residents and was a very relaxed and happy occasion with lots of conversation, banter and laughter. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience good quality outcomes in this area. People who use the service can be confident that the policies and procedures in place will ensure that people are listened to and protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Neither the CSCI (Commission for Social Care Inspection) nor the home has received a complaint about the service since before the inspection before last. The complaints policy is robust and available in the entrance hall. Residents spoken with were clear whom they should approach if they had any concerns about the service they received. One said “ I would speak to the Manager first she often comes to talk with us and I am sure that she would sort things out”. The home was able to evidence that a number of Complimentary comments and letters of appreciation had been received since the last inspection. During this inspection the manager was visited by relatives wanting to thank the home personally and a similar comment was made in a telephone contact. The home has a Protection of Vulnerable Adults ( POVA ) policy that is in line with the guidance given in the Vulnerable Adult Protection Committee of Suffolk and a whistle blowing policy to protect staff who report any concerns. Staff spoken with were very clear about their duty of care. The homes training records evidenced that all staff had had POVA training and that a number had attended refresher training on this since the last inspection. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 18 Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 ,20 21,22,23,24,25 and 26. People who use this service experience good quality outcomes in this area. People who use this service can expect to live in a well maintained safe and homely environment which is well appointed to meet their individually assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the building evidenced that it was clean and tidy with no mal odours. Residents rooms were seen to be well personalised with personal items that met their needs and reflected their interests and tastes. These included family photographs, ornaments pictures and small items of furniture. Several residents spoken with said that they liked their rooms and confirmed that they had everything that they needed. One spoke of the help and assistance given to them by the Administrator in sorting and arranging their room when they were first admitted to the home “ Having my room straight and organised helped me to settle in more quickly ” she said. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 20 The home has a rolling maintenance and refurbishment programme which could be evidenced as on going during this inspection. Works to complete new flooring, plumbing refurbishment works and the fitting of blinds in the Conservatory were all on going works on the day of this inspection. Areas noted in need of redecoration, mainly corridors and door frame woodwork had been already identified by the manager who had made plans for this work to be commenced. Since the last inspection a number of improvement works had been made including the completion of the building of the Conservatory, the addition of a number of fully compliant single bedrooms and the upgrade of one double room to include en-suite facilities. All bedrooms now meet the National Minimum Standards although some which were registered prior to the current requirements do not have en-suite facilities. These refurbishment works have enabled the single to shared room ratio to raise from 63 to 76.5 . The administrator explained that new flooring and carpeting was planned for the communal areas and for some of the bedrooms and it was seen that some of these areas were already benefiting from this new provision. The Manager mentioned that since the last inspection a number (6) of new Profiling Beds had been purchased the comfort and safety of these being very much appreciated by the residents. She explained that the home planned to purchase further profiling beds hopefully one new bed each month. New lounge and dining room furniture had also been purchased since the last inspection. Works to create a secure Sensory garden have been completed since the last inspection and residents spoke of their involvement with the planning and development of this attractive new facility. The home provides adequate provision of assisted bathrooms to meet the standards and the needs of the residents. Since the last inspection one of these bathrooms has been enlarged and a new Argo bath fitted. The bath in another of the assisted bathrooms where the bath is positioned against the wall is now rarely used Plans to refurbish this bathroom have been drawn up and to ensure the safety of staff working in this area and the comfort of the residents these works should be commenced as soon as possible. Unfortunately on the day of this inspection all the bathrooms seen had an institutional appearance being very crowded with stored equipment and other items not specifically associated with individual residents taking a bath in a homely manner. Changes to the arrangements for the storage of equipment which will thereby promote the residents dignity and give a more domestic appearance to these bathrooms must be made. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 21 The laundry facilities seen were clean and tidy with appropriate equipment to launder clothing and bedding, the washing machines have a sluice hot wash programme which promotes the safe management of soiled linen. It is recommended that red bags are used to store soiled linen this to ensure effective infection control measures at all times and to prevent cross infection. There was evidence of protective clothing being available for staff with liquid soap and paper towels being provided at hand washing facilities. Residents consulted all spoke positively about the standard of their laundry and the speed with which it was returned to them and all residents were seen to be well dressed with freshly laundered clothes. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that they will be supported by appropriate numbers of skilled and trained staff who have been robustly recruited to ensure their protection and to ensure the smooth running of the home. EVIDENCE: The home benefits from a stable core group of staff many of whom have worked at the home for many years. The manager explained that the home no longer recruits nursing staff from the far east and most of the staff now live locally. The home currently has very few staff hours vacant and these could be covered by using known bank staff avoiding the use of agency staff. The duty rotas evidenced that there was a trained nurse on duty throughout the twenty four hour period assisted in the morning by six carers, in the afternoon by four carers and during the night by three carers. Housekeeping staff a cook and kitchen assistants and the administrator support the care team. The registered manager who is supernumerary was present throughout the day of this inspection and the owner who is also frequently present in the home was there for most of the day. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 23 Staffing numbers have been increased since the last inspection to meet the care needs of the extra residents now occupying the new bedrooms. Staff spoken with said that they felt there were enough staff to meet the needs of the present resident group and residents told the inspector that their requests including the ringing of their call bells were usually answered promptly. One said “ Staff are always there to help me nothing is too much trouble for them, I am very glad that I came here although it was very hard to leave my own home. The manager explained that the staff working patterns had been varied since the last inspection with extra staff being bought in for a limited period to cover extra busy periods such as lunch time. Three new staff files were inspected and they all contained two references and evidence of identity checks. POVA 1st. and criminal record bureau ( CRB ) checks had been made and a full work history recorded. Each file had a photograph of the member of staff and a copy of the terms and conditions of their employment. There was evidence that each staff member had undergone an induction training that covered areas of care including fire awareness, infection control, moving and handling, food hygiene and POVA issues. It was seen that the Staff Handbook had been updated in November 2007. Since the last inspection the number of care staff holding an NVQ qualification at level 2 continues to meet the NMS requirement of 50 and has further increased by some ten percent. The manager said that the home continues to work towards its own target of having 95 of carers holding an NVQ level2 qualification or equivalent. Four staff are currently completing NVQ at level 4 , one has just completed and another is about to commence this training at level 3. Staff spoke positively about their training opportunities although one did say that she would like more training on Dementia care. The homes training records evidenced that training in the core subjects is maintained up to date and that this is now planned on an ongoing basis for all staff. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using this service can be confident that their welfare will be protected by the professional approach of the qualified and experienced manager and by the sound management administration systems operating in the home. EVIDENCE: There have been no changes in the Management of the home since the last inspection. The home has a stable and committed management team as both the registered provider and the registered manager have been at the home for a number of years. They are both trained nurses and the registered manager who also holds the NVQ qualification of the Registered Managers Award has had more than ten years experience managing a nursing home. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 25 At the time of this unannounced inspection the home was found to be well organised with a calm and homely atmosphere. The quiet professional leadership of the manager and the skilled and dedicated approach of the care team producing a seamless service and evidenced an ethos which very clearly puts the needs of the residents first. Comments written on the surveys from relatives also evidenced this; “ The Matron and staff give consistently excellent care to our relative both in terms of her physical dependency and of her mental welfare.” “ We have huge respect and admiration for the way the manager and staff deal with the wide range of needs and the different characters of the residents.” “ The staff keep us informed promptly and when ever we have had queries they have listed sympathetically and have moved quickly to sort out the issue; this gives us confidence that the residents best interests are well cared for”. Other comments that evidence that the home is being run in the best interests of the service users included; “ The home treats the residents with respect; it treats them as individuals “ “The management establish good relationships with friends and relatives”. The high number of friends and relatives who visited the home during the time of this inspection was noticeable as was the fact that many of them stopped off initially to speak with the Manager and administration staff. Several bought gifts for the home flowers and produce from their gardens one gift of home made sweets from a local craft fair was appreciated by the residents with whom it was shared. The records evidenced that a supervision matrix is in place to ensure that all staff receive formal supervision at least six times a year. Staff spoken with confirmed that they well supervised and managed and that they could speak with the Manager at any time. The manager said that one of her objectives for the next period is to further develop the quality of the supervision offered by the various levels of staff. Regular staff meetings are held and the minutes of the last one on 21/4/08 evidenced a pre-planned agenda with good attendance and participation from a range of staff. To promote better practice a particular topic is taken at each meeting the subject at the last meeting being Infection Control measures when it was seen that the importance of sterilizing sprays being of the correct strength and the essential need for each room to be deep cleaned after a resident has left being emphasised. The home has a proven record concerning quality assurance and discussions with the Manager evidenced that she is proactive in promoting equality and diversity in the service and in meeting the service users individual needs. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 26 Regular questionnaires are sent to relatives and given to residents and an analysis of the results of these could be evidenced in the review document dated May 2008 of the Old Rectory Nursing Home Development Plan which set out the annual development objectives set for the home for the next year. The records relating to Fire testing, the monitoring of water temperatures, risk assessments for the environment and safety checks for the homes equipment were seen to be well maintained this ensuring the safety of the residents at all times. Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 3 3 Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Care-a-lot Ltd Trading As The Old Rectory Nursing Home DS0000066661.V366175.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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