Inspection on 29/09/09 for Church View Nursing Home

This inspection was carried out on 29th September 2009.

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

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

Other inspections for this house

Church View Nursing Home 15/04/09

Church View Nursing Home 01/04/09

Church View Nursing Home 15/10/08

Church View Nursing Home 15/08/07

Church View Nursing Home 14/06/06

Church View Nursing Home 30/01/06

Church View Nursing Home 01/11/05

Church View Nursing Home 09/02/05

Church View Nursing Home 06/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Church View Nursing Home Church View Nursing Home Rainer Close Stratton St Margaret Swindon Wiltshire SN3 4YA     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: Wendy Kirby     Date: 2 9 0 9 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 34 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 34 Information about the care home Name of care home: Address: Church View Nursing Home Church View Nursing Home Rainer Close Stratton St Margaret Swindon Wiltshire SN3 4YA 01793820761 01793820180 churchview@hallmarkhealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hallmark Healthcare (Swindon) Ltd Name of registered manager (if applicable) Mrs Joanna Butler Type of registration: Number of places registered: care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: No more than 3 service users with a terminal illness may be accommodated at any one time The staffing levels set out in the Notice of Decision dated 1 December 2003 must be met at all times Date of last inspection Brief description of the care home Church View is a purpose built care home providing nursing care and accommodation for up to thirty-seven people. The home is part of the Hallmark Healthcare Group. Care Homes for Older People Page 4 of 34 0 2 0 4 2 0 0 9 0 3 3 Over 65 43 0 3 Brief description of the care home The home is located within a residential development in Stratton St Margaret, situated on the outskirts of Swindon, and is within walking distance of a local shop. Accommodation comprises of thirty-five single rooms and currently there is one double room, located over two floors. All rooms have en suite facilities. People also have access to a lounge and dining area on each floor and enclosed garden and patio area. As the home provides nursing care, registered nurses are on duty at all times and are supported by care assistants. Domestic, laundry, catering, maintenance and administration staff are also available. Current fees range from £477 to £900.00 dependent on the assessment of needs. Information about the Funded Nursing Care Contribution (FNC) is provided by the company. Care Homes for Older People Page 5 of 34 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 was an unannounced Key Inspection which included a visit to the home. The visit was completed by one inspector and lasted approximately nine hours. Prior to the inspection we (The Commission) looked at various pieces of information to gather evidence in preparation for our visit, which included the following: The previous inspection report. The homes inspection record, which gives us an account of any information we have received about the home since the last inspection. The Annual Quality Assurance Assessment, known as an AQAA. The home is requested annually to complete and return this assessment to us by a specified time. We received the AQAA on time, which contained information about what the home considers it does Care Homes for Older People Page 6 of 34 well and what plans they have for further improvements in the coming year. We sent surveys Have Your Say to people who live in the home, staff and health and social care professionals. Comments received from the surveys will be referred to throughout this report. During our visit we spoke with some of the people who live in the home, visitors, the project manager, the regional manager, deputy manager and other staff members who were on duty. We also looked at how effectively staff engage with people in the home and how they were interacting and communicating with each other. We looked at four individuals care files, which included, pre admission assessments, care plans and risk assessments. We also looked at a number of records and files relating to the day to day running and management of the home. We spent time in all communal areas of the home and some of the bedrooms. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: We have detailed throughout the report about how the outcomes for people who use the service have improved during the last six months. The report tells us that Hallmark have an action plan whereby these outcomes will continue to improve and that new initiatives will be actioned in the coming months. Some of the outcomes have been judged as adequate because they are either not fully met or because we need to be satisfied that the improvements made will be sustained. We have not made requirements as a result of this inspection because Hallmark have already identified where improvements need to be addressed and have already started to put some of their plans into practice. We look forward to seeing the effectiveness of their plans during our next visit. Care Homes for Older People Page 8 of 34 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 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. Peoples needs are assessed prior to admission to determine the suitability of placement. Evidence: Although at the last inspection there was some good practice in place when assessing prospective clients, the home had failed to recognise the importance of ensuring that if the home admits people with high dependency needs then staffing levels must be increased in order to meet those needs effectively. Evidence showed us that the dependency levels of the majority of people living in the home were very high. People needed support with personal care, continence management, eating and drinking and assistance with mobility and transfers at varying levels. The dependency levels in some cases were where people already living in the home had deteriorated and not through poor pre admission assessments, Care Homes for Older People Page 11 of 34 Evidence: however the home failed to recognise that the staffing levels in place did not meet the needs of the people effectively and subsequently peoples care was compromised. At this inspection we looked at the pre admission assessments being used which were comprehensive covering activities of daily living, a full health screen and personal history background. The information gathered pre admission should provide a sound benchmark of the persons ability, state of health prior to admission and subsequent needs when they move into the home. The AQAA tells us that since the last inspection the pre admission assessments are far more in depth and this is completed in conjunction with a tool that enables the manager to assess the dependency levels and subsequent needs of people wishing to live in the home. Since the last inspection the manager has contacted us on several occasions to discuss potential new admissions who have varying complex needs. She has demonstrated a greater understanding that if she is to admit people like this into the home she has to take into account the amount of staff required to care for people, the extra provision of suitable equipment needed and sufficient training for staff in order for them to understand peoples needs and requirements. People wishing to live in the home, family and carers are involved in the pre admission assessment wherever possible and all information is used to determine the suitability of the placement. Where possible the manager also obtains comprehensive assessments and care plans from other health and social care professionals involved, for example, social workers and hospital staff. Care Homes for Older People Page 12 of 34 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. In the short term there has been some steady progress made in the outcomes for all people who use this service. These will need to be monitored by Hallmark and the manager to ensure that these improvements are susatained. There are safe systems of practice are in place in receiving, storing, administering, and disposing of drugs which will help protect the health and wellbeing of people living in the home. Although we saw some good practice, some staff would benefit from a training update in promoting peoples dignity and respect. Evidence: From the pre admission assessments the staff are able to develop a set of care plans based on identified needs. During the first months trial period the plans are reviewed weekly and developed accordingly. Care plans were completed with regards to health and social needs including, psychological, emotional, and cultural needs which demonstrates that the home takes an holistic approach to the provision of care. Care Homes for Older People Page 13 of 34 Evidence: The plans that we looked at were fairly detailed and person centered, including personal preferences and like and dislikes. Plans told us that people had specific requests and routines, this is very good practice and helps demonstrate that people are involved in deciding how they wish to receive care. We saw that there was an overall improvement in the care documentation and this was also confirmed to us by other visiting health and social care professionals who conduct reviews with people who use the service. At the last inspection people were not receiving their care in a timely manner and specific requests and routines of people living in the home were not being respected. This was mainly due to high dependency levels and reduced staffing at busy times of the day and also because the care staff lacked direction and leadership from the trained staff with regards to effective, efficient daily routines. This has improved and the AQAA tells us Personal care is delivered effectively and in a timely fashion following re organisation of shifts and hours worked. Staff teams have developed their daily organisation of routines and allocations to enable this. We spoke with staff who agreed that systems in place were more effective and that they didnt feel that they were cutting corners in order to get the work done. Staff also felt that choice was being respected for people living in the home and that delivery of care had improved. The plans showed consistency in assessing, planning and evaluating care as required. The manager conducts random monthly audits on the care files and written feedback is given to staff including any further action required. Regular care reviews take place for people living in the home, which can include family members and care staff wherever possible. This allows the opportunity to discuss and evaluate care and any issues or concerns people might have. One relative told us, I am kept well informed about my relatives care as well as being involved with her care plans. Seven out of eleven staff surveys agreed that they had up to date information about individuals needs. We spoke with staff on duty who told us that hand over sessions prior to starting their shifts had improved and that a full past medical history is also included. Health care needs are monitored and documented in peoples care files. Nutritional assessments are completed on admission and reviewed monthly, people are weighed Care Homes for Older People Page 14 of 34 Evidence: fortnightly as part of this review, new weight monitoring forms have been introduced since the last inspection and include directions for staff should weight loss or gain be identified. Care plans are written for people who are nutritionally at risk and how this is to be managed. Specialist health care support is often sought and referrals are made to community dietitians and speech and language therapists. Since the last inspection staff have been provided with good practice guidelines and training on effective recording with regards to fluid and nutritional intake charts. We saw that staff had been consistent in maintaining the charts which provided good detail about specific amounts people had received over a twenty four hour period. Charts had been totaled at the end of the day by night staff. Staff told us that they speak to the nurse in charge should they have concerns about someones inadequate intake. A local General Practitioner (GP) visits on request, all visits and the outcomes are recorded in peoples care file. Specialist referrals and visits from other professionals including, Chiropodists, Dentists and Opticians were also seen. Three completed surveys were received from community health and social care professionals, outcomes in general had improved since the last inspection. Comments included, Their wound care has improved and they have learnt from their experiences, Many pressure ulcers have healed due to their diligent care, Communications between staff is sometimes patchy and Communication needs some attention. At the last inspection medication was looked at by the commissions pharmacy inspector and various requirements and recommendations were made. The inspector said that there were generally safe arrangements in place for the management of medicines although some weaknesses were found that needed addressing in order to help reduce potential risks with medication for people living in this home. Although we have seen some evidence that systems in place have greatly improved we may request a pharmacy inspection in the future to help ensure that the improvements are sustained. The AQAA tells us about improvements made since our last visit, Churchview has developed its medication administration system using the Hallmark Policy and Practice Guidelines, as well as guidance from our local pharmacist and GP. There is a learning module on our on line system specifically for carers who do not actually administer medication but need to be aware of the process. Policies and procedures for receiving, storing, administering and disposing of Care Homes for Older People Page 15 of 34 Evidence: medications were examined and discussed. All systems in place are audited. The home operates a monitored dosage system for the administration of medication, which is supplied at regular intervals by a local pharmacist. Six monthly medication reviews for people living in the home are completed by GPs. Fridge temperatures are recorded daily, the administration charts were legible and continuity of administration was shown with a signature from the people dispensing. The home promotes privacy and dignity to all people who use the home. Staff attend training on induction, which covers aspects such as closing doors and pulling curtains when delivering personal care and knocking on doors and waiting for an invitation to enter before going in to their bedrooms. We saw staff knocking on peoples doors before entering, members of staff spoke respectfully about individuals needs and referred to them in the term of address that they preferred, this information was also recorded in the care files. We did see that some staff did not always conduct themselves appropriately regards some aspects of respect and dignity, which is detailed under the next section Daily Life and Social Activity. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples choice and lifestyle has improved because of the additional staff deployment at certain times of the day. People will be benefit from more social interaction and additional training for the coordinator will help ensure that she has the appropriate skills to meet the needs of people. People maintain family contact and staff encourage family and friends to join in with activities and any outings. The home produces a varied and wholesome diet that people living in the home are able to influence. The atmosphere at mealtimes is sometimes compromised by inadequate behaviour of staff, which impinges on on peoples dignity and respect. Evidence: There does not appear to be any unnecessary rules in the home and it was clear that the manager and staff continue to work towards empowering people and encouraging them to maintain independence, autonomy and choice. The care files give good detailed accounts of how people want to live their lives. Care Homes for Older People Page 17 of 34 Evidence: Daily routines are flexible within the home, the care files indicate that people can get up and go to bed when they like, have their meals in their bedrooms, they can go out when they wish and participate in activities they have a particular interest in. Because of improved daily routines and increased staffing deployment at certain times during the day people are more able to live the lives they choose. There is still evidence that shows us that social stimulation and activities need to be improved. Because a large majority of the peoples needs are complex, they would benefit from more one to one interaction. The ability to provide designated social interaction, on a one to one basis is limited due to the amount of people the coordinator has to accommodate. People would benefit if additional hours were deployed. Only seven surveys stated that there were always activities available that people could take part in. Comments included, It would be nice if they could take people out for short walks occasionally, Some people are completely helpless and sit there doing nothing all day and I would personally like to see more stimulation. The home told us that they had identified that improvements needed to be made following their own quality assurance and they said in their AQAA that, We could provide more variety of activities. We are planning to do this by continuing to liaise with all the service users, letting them take the lead and direction of things to be planned. We would like to recruit more volunteers to support this venture. The activities co coordinator would also benefit from additional training in providing a service to older people and to people with dementia. We were told that this is being addressed and we look forward to seeing the progress made at out next visit. The co coordinator has also joined a local community group of co coordinators from other homes, which should help increase her awareness and offer her the opportunity of gaining ideas from other people. The home has a receptionist to greet visitors on arrival to the home and assist with general enquiries and this is often the first point of contact for visitors to the home. We saw the receptionist greet people in a warm, friendly, professional manner throughout our visit. The home operates an open door policy for visitors and people are able to see visitors in the privacy of their own rooms and there are some semi-private seating areas around the home and in the gardens. Care Homes for Older People Page 18 of 34 Evidence: In some ways the dining experience for people has improved. Refurbishment and redecoration is underway and will improve the ambiance of the dining facilities. At times we saw that peoples dignity and respect was compromised. In some cases staff have been sensitive when seating people together for lunch. We saw that some staff members supported people that required assistance with eating their meals in a respectful sensitive manner and some staff sat at the same level and assisted them without rushing. However we saw some people standing over people when feeding them and they were not engaging with the person at all. In the upstairs dining room the radio was playing loudly and the music was not appropriate. One staff member was singing loudly to the music which completely spoils the relaxed atmosphere that should be encouraged at mealtimes. A trained staff member and the deputy were also assisting with this mealtime, yet neither one of them intervened. Staff would obviously benefit from additional training in dining etiquette. We saw jugs of juices, beakers and glasses and these were being handed to people whilst waiting for lunch. Later when we visited people in their rooms we saw that jugs of fluid had also been provided for individual use. At the previous inspection we met the head cook who had worked at the home for ten years, she was very happy in her work and demonstrated good awareness of individual needs and preferences of people in the home. Although there is a four week menu plan for people living in the home, everyone is asked daily about what they would like to eat and they dont have to have whats on the menu if they dont like it. People told us that they usually liked the food offered to them and that they ask for something else if they didnt like what was on the menu. All food is freshly prepared in the home on a daily basis including, cakes, pastries, bread, soup and fruit salad. The kitchen was well organised and seemed to run efficiently and effectively. The food is home cooked offering various choices of hot and cold alternatives and fresh fruit is available at all times. The menu rota displays traditional meals and menus are reviewed to reflect seasonal trends and availability of produce. Extras are ordered on request for birthdays and special occasions. Any visitors to the home are welcome to stay for lunch. The kitchen was well equipped, spacious and clean. Stores exhibited a good range of foods. Food hygiene training was up to date for staff. Documentation was provided to Care Homes for Older People Page 19 of 34 Evidence: show that the required temperature checks were being carried out on fridges and freezers and that food was also being probed after being cooked. Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good policies and procedures in place to manage complaints and people can be confident that their concerns will be listened to and acted upon. There are good arrangements in place for staff training and awareness of protecting vulnerable adults so that people living in the home are further protected from abuse. Evidence: As we stated at the previous inspection, since the appointment of the new manager we saw evidence that complaints and concerns have reduced considerably. We receive details from the home about any internal complaints investigations and safeguarding referrals, the outcomes have shown us that these have been dealt with openly and effectively. The manager is committed to encourage an open culture within the home so that people feel comfortable and able to make a complaint or a suggestion without fear of reprisals. She makes every effort to see people living in the home Monday to Friday and her office is by the main reception area which means that visitors can see and talk to her on a regular basis. Being available has meant that people can discuss any concerns or issues with the manager before they potentially escalate into complaints. Holding meetings for people living in the home, relatives and staff has meant that communication and sharing information has improved. This further promotes people Care Homes for Older People Page 21 of 34 Evidence: becoming less frustrated, thus relieving anxieties and any potential complaint referrals. Seven out of twenty people living in the home stated in our surveys that they did not know how to make a complaint. This could be because they have been in the home for a long time and forgotten the information they were given on admission. The surveys were anonymous so we are unable to trace who these people are. We have recommended that the manager includes a reminder of the complaints policies and procedures in the agenda at the meetings that are arranged for people living in the home and relatives throughout the year. There are policies and procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse. The availability of this information should increase staff awareness and the understanding of their role in protecting vulnerable adults who live at the home. We were told that the home actively promotes staff training and education in the protection of vulnerable adults on induction and on an annual basis the staff receive an update. We spoke with staff who confirmed that they had received this training in the last six months and they were able to demonstrate its effectiveness when discussing the content of the training. A number of staff have either completed or are enrolled on the National Vocational Qualification in care award, and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At present the home is clean and comfortable. The additional work continues with the homes refurbishment and redecoration plan. This should provide a safe, peaceful and well maintained environment for everyone. In general the bedrooms, communal rooms and facilities are suitable to meet the needs of people living in the home, however by revising some areas in the home will mean that peoples privacy and dignity will be further respected. Evidence: The home has a number of aids and adaptations throughout the premises to enable physically disabled people to maximise their independence. This includes wide corridors and pathways, passenger lifts, specialised bathing facilities, grab rails and assisted toilet facilities. We walked around the inside of the home and viewed most of the bedrooms and the communal areas including the dining rooms, lounges and bathrooms. Many of the communal lounges, dining rooms, hallways and corridors have either been redecorated since our last visit or are due to be completed this year. People living in the home have been involved choosing the colours used in the home. Various items of furniture throughout the home have been replaced as they were tired and shabby. Care Homes for Older People Page 23 of 34 Evidence: Bedroom sizes are quite spacious for their stated purpose and have en suite facilities provided, communal bathing areas, showers and toilet facilities are located throughout the home. People are supported to personalise their bedrooms with pictures and ornaments and they are able to bring items of furniture should they wish. Rooms are lockable so that they can maintain their privacy and keep their personal possessions secure. All rooms had profiling beds and two people living in the home had chosen to have a divan bed. Good quality matching bedroom suites, lounge chairs and a small tables are provided in each room. Bedrooms were bright and clean with matching soft furnishings. Two lounge areas allow for people to be seated together enjoying the entertainment systems on offer and any group activities or events. Although the rooms are quite small the home has tried to set the rooms up in a homely fashion particularly down stairs where there is more space to play with. The two lounge areas and dining areas are to be refurbished and redecorated this year. The following information was identified at the previous inspection and although they havent been fully resolved Hallmark are endeavouring to find alternative solutions. As part of the refurbishment programme they are looking at various ways that space within the home can be modified to accommodate the lack of space and we will look at any progress in future visits. The home was purpose built by the previous owners and although most areas are suitable for the people who use the service, the home does lack space. Storage can be a problem and wheelchairs and hoists are left in hallways and in other communal areas impinging on peoples space. Incontinence pads are also stored in wardrobes and in the en suites which effects peoples personal space. There is no facility for training which is largely done in house. At present the training takes place in vacant bedrooms. The manager told us that training does not take place in communal areas such as the lounge or dining room. At the last inspection it was noted that the hairdresser was having to cut and set peoples hair in the lounge, which means that individuals privacy and dignity was compromised for both the people having their hair done and the people using the lounges and dining rooms for their stated purpose. At present the hairdresser is using one of the vacant bedrooms, however when the rooms are not vacant there will be limited space for this service to be provided. In general the overall cleanliness of the home received positive outcomes from our Care Homes for Older People Page 24 of 34 Evidence: surveys. People living in the home felt that the home was clean and fresh. Care Homes for Older People Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home must continue to promote staffing levels and skill mix of staff in order to help ensure that people needs can be met. The recruitment policies and procedures set up in the home should help ensure that people living in the home are supported and protected. The training provided to staff should help ensure that staff have the skills and resources to meet peoples needs. Evidence: At the previous inspection we had gathered strong evidence that peoples needs were not being met due to the high dependency levels and the lack of staff deployed to be able to meet those needs. As mentioned previously in this report we can see that there has been a marked improvement due to new routines and increased staffing levels at busy times of the day. All twenty surveys told us that people living in the home felt that staff were always or usually available and that they receive the care and support they need. There were some positive comments, however some of the feedback from people tell us that staffing levels still need to be closely monitored and adapted as needed. Comments included, Staff help me with what I want to do and support me to do it on my own, Care Homes for Older People Page 26 of 34 Evidence: Some times the staff do not respond very quickly but I assume this is due to staff count, They look after me very well, I do get exasperated when I ask to have a shower and I have to wait, however I do feel that I am well looked after, and Sometimes I think they need more staff to cope with the demands placed upon them. Only two staff surveys agreed that there were always enough staff to meet the needs of people, eleven said that there were usually enough staff, one survey said, We do have enough staff at the moment but I hope they increase the levels when they start admitting to the home again. Other staff comments included, Its a much nicer place to work in and the care has improved and The new systems of working have improved and all the staff are working very hard. The home follows a good recruitment procedure. This will help ensure that the right people are employed to work at the home, and people living in the home will be further protected. Records contained completed application forms with a full employment history, two written references and Criminal Records Bureau CRB disclosures. Qualified staff nurses, are required by law to register annually with the Nursing and Midwifery Council NMC to be able to practice, these registrations are checked annually by the manager to ensure that the staff have done this. There is an induction programme, which covers all mandatory training, including Fire, Manual Handling, Health and Safety and the Protection of Vulnerable Adults. The home has a mentor system where all new staff are linked with and shadow a senior staff member during each shift to enable continuity and continued training throughout the induction process. The home has been working hard to access and provide the staff at the home with training and development opportunities tailored to individual needs. The manager and all staff are conscientious in attending training relevant to the care needs of the people they are caring for and those relevant to the roles they perform and the response to the staff surveys supported this. We look forward to seeing the progress made regards effective training during our future visits. We spent some time throughout the day talking and observing staff carrying out their duties and assisting people. At times staff were warm, good humoured and sensitive towards people within a relaxed calm environment. Comments received about the staff were very positive including, Staff are friendly and welcoming they spend a lot of time with my relative, They look after my relative competently, The staff are very caring and also sympathetic and The staff are polite and the nursing care is Care Homes for Older People Page 27 of 34 Evidence: very good. Care Homes for Older People Page 28 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We are satisfied that the outcomes for people who use this service has improved and will continue to do so. Peoples needs and best interests are central to the management approach in the home. Good accounting methods are adopted and policies and procedures are followed correctly when handling personal money so they can be sure their finances will be managed correctly. The health and safety checks within the home will help protect the people who use this service. Evidence: Since the last inspection the manager has been registered with the commission. Although the manager was not present at this inspection she has constantly kept us Care Homes for Older People Page 29 of 34 Evidence: updated about improvements in the home over the past six months. The manager told us in the AQAA that she is enjoying the Leadership and Management in the Care Sector, NVQ 4, learning new ideas, methodologies, working practices and theories for all areas of management of the service. Some of which she has been able to implement within the home. At the last inspection we identified serious breaches of regulations which had a consequent impact on the quality of care being delivered to people in the home. Hallmark have with the support of the staff team worked hard over the past six months in order to improve many of the outcomes for people who use the service. The manager and staff are developing into a stable team that supports a commitment to providing quality care for the benefit of the people living in the home. Staff made very positive comments about how things have improved. Comments included, I think we should keep going working hard and I think we are getting better everyday, I think the home is very good and I am enjoying working here now, It is a friendly and helpful place to live and work and This is a friendly home and the residents are well cared for and individual needs are catered for in all ways. The AQAA tells us, Staff morale has increased, and staff are looking happier within themselves, not so tired, the atmosphere is relaxed and friendly and welcoming. Staff attendance has improved and very little agency is now required, on average we have covered one shift per month with agency, service users appear more relaxed and confident and are improving health wise. Visiting health and social care professionals comment on the atmosphere and helpfulness of staff, and improvements in standards of care. The home completes an annual audit to assess the satisfaction of people with regards to the service that the home provides by asking them to complete surveys. The results and comments from the surveys were generally very positive. Information from the surveys is collated and documented effectively, this information is on display for people to see. The results enable the home to identify strengths and weaknesses within the service they provide and these are acted upon in their development plan for the coming year. Progress of any outcomes are discussed with the people living at the home and relatives at their meetings. The AQAA tells us, The manager holds a relatives surgery every Wednesday afternoon or evening, inviting relatives or residents to discuss any concerns, ideas or views they wish to share. The manager, deputy and administrator have an open door policy and are available throughout the day for anyone to approach for a discussion or Care Homes for Older People Page 30 of 34 Evidence: ask any questions. By being available regularly, we do speak to the majority of service users throughout the week, and have nurtured good relationships. One which is open and honest, service users do approach us, and feel confident in raising their views, as evidenced in Summer Service User Survey on how accessible is the manager and senior staff in the home. Regular audits are carried out in the home including health and safety care documentation, medication and other procedures in the home. As mentioned previously in the report the home completes an AQAA for us which provides us with information about where the home feels it has improved and their plans to improve in the next twelve months. The AQAA was fairly detailed and gave us the information we required. The policy and procedure for holding peoples personal money was examined and four individual accounts were looked at. We could see that good accounting methods are adopted and receipts for sundries were available. The home has written policies and procedures in relation to the promotion of the health and safety for all people who use the service and associated training was provided for staff in all health and safety matters. Some of the Health and Safety records in the home were examined. Documentation showed that relevant checks were maintained correctly and at the required intervals including all fire alarms, equipment and emergency lighting. The homes records showed all necessary service contracts were up to date including, gas and electrical services and the passenger lift. The manager attended a Health and Safety course in November, and the maintenance operative is attending a fire Marshalls course. Care Homes for Older People Page 31 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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