Inspection on 17/09/09 for College House Residential Home

This inspection was carried out on 17th September 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

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

College House Residential Home 03/03/09

College House Residential Home 09/09/08

College House Residential Home 12/02/07

College House Residential Home 15/02/06

College House Residential Home 06/09/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

Key inspection report CARE HOMES FOR OLDER PEOPLE College House Residential Home Berrington Road Tenbury Wells Worcestershire WR15 8EJ Lead Inspector Christina Lavelle Key Unannounced Inspection 17th September 2009 9:00amDS0000064821.V377784.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.2 Page 2 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 College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service College House Residential Home Address Berrington Road Tenbury Wells Worcestershire WR15 8EJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager Type of registration No. of places registered (if applicable) 01584 810270 01584 811822 Oaktree Care Ltd Care Home 13 Category(ies) of Dementia - over 65 years of age (13), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (13), Old age, not falling within any other category (13), Physical disability over 65 years of age (13), Sensory Impairment over 65 years of age (13) College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 13; Physical disability over the age of 65 years (PD(E)) 13; Mental disorder over the age of 65 years (MD(E)) 13; Dementia over the age of 65 years (DE(E))13; Sensory impairment over 65 years old (SI)(E)) 13. Date of last key inspection Brief Description of the Service: College House Residential Home provides accommodation with personal care for up to thirteen older people. People using the service must require care due to age related frailty and they may also have care needs due to dementia, physical disabilities, a mental health disorder and/or sensory impairment. The home provides a small amount of day care, and occasional short stays when they have vacancies, as well as warden type support to some people who live in adjacent bungalows. Day care and the bungalows are not regulated by the commission because they are not covered by the Care Standards Act 2000. College House is situated amongst mainly traditional houses and cottages in the town of Tenbury Wells. The original house dates back to 1698 and has been updated and extended over the years without losing the feel of an old country town house. The house has a nice garden and is within walking distance of the shops and amenities of Tenbury town. The home is part of the community and as it is small in comparison with many care homes it still looks and feels like someone’s house, which helps to give it a homely atmosphere. Information about the service is provided in a statement of purpose and a service users’ guide. The guide is also produced in large print and is available from the home as well as a copy of the home’s latest inspection report. The weekly fee charged by College House and any additional charges should be requested from the home and be specified in individual residents’ contracts. 3rd March 2009 College House Residential Home DS0000064821.V377784.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 1 star. This means that the people who use the service experience adequate quality outcomes. This is a key inspection of the service provided by College House Residential Home. This means all the standards that can be most important to people who use care services are assessed. People who use the service at this home are called residents and it was agreed that we, the commission, would refer to them as residents in our report. As part of this inspection we spent seven and a half hours at the home. A commission pharmacist inspector also visited on the same day to inspect how the home is dealing with residents’ medicines. Our visits were made without telling staff at the home or residents beforehand. The service was rated as 0 star following the last key inspection. We therefore went back to the home in July to carry out a random inspection to check that action had been taken to meet requirements. Many improvements had been made, although three requirements had not been complied in respect of how medicines are dealt with in the home and a Statutory Requirement Notice was served. One aim of this inspection was to follow up the service’s compliance with this notice. We found that requirements have been met, which is referred to in this report as well as some other findings from our random inspection. We use a range of evidence to make judgements about the quality of the service, focusing on how well outcomes are being met for residents. The way the home is being run was discussed with the manager Laura Greenwood. Ms Greenwood was appointed since the last key inspection and intends to submit an application to register with us soon. We spoke with two other staff who were on duty during our visit and met with two residents in private to discuss their experience of and lifestyle at College house. We observed the daily life of the home and how staff interacted with and assisted residents. Surveys asking peoples’ views of the home had been completed by two residents and three of their relatives. All the feedback we received is referred to in our report. We also looked around the house, had lunch with residents and checked some of the records that care homes must keep. They include residents’ care records and others about staff, the premises and health and safety. An annual quality assurance assessment (AQAA) had been completed by Ms Greenwood before our visit. The AQAA asks managers to say what their service does well, could do better and about their plans for improvements. It also gives us numerical information about residents, staffing and other aspects of the home. All other information we have received about the service since the last key inspection is considered. This includes events that had affected the health, safety and welfare of residents (we call these notifications), complaints and allegations. College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.2 Page 6 What the service does well: The home ensures it could meet potential residents’ needs before they move in. The manager meets people to fully assess their care needs and invites them and/or their family to visit the home to check out that it would suit them. College House has a friendly and welcoming atmosphere. One resident’s relative comments that “you always have a warm greeting and a chat”. Each resident has a plan showing the care they need, their preferences, wishes and possible risks to their safety and welfare. These plans help staff to know about and give people the support they need and reduce any risks. Residents are given opportunities to socialise, take part in group activities in the home and go out in the community. They have healthy meals they enjoy. Staff ensure that the personal and health care needs of residents are met and that their medicines are managed safely in the home on their behalf. College House has a good location so people can get to shops and amenities in Tenbury easily. The house fits in well with the local community and has a nice garden. One relative comments “the house is homely, comfortable and clean”. What has improved since the last inspection? The home ensures that residents have all their personal care needs (including washing and mouth care) attended to in the mornings and at night. Residents have a moving and handling assessment carried out by a suitably qualified and competent person. This means that any aids or equipment they need are provided and staff know how to support them with their mobility. Residents’ nutritional needs are assessed so that special dietary needs can be met. The home has weighing scales so staff can monitor peoples’ weight. Action has been taken to ensure that residents’ medicines are managed safely by staff in the home, if they are not able to manage their own medicines. Residents are encouraged to join in with more group activities and there are more social events in the home. They are also enabled to go out more. Residents with bedrooms on the first floor are risk assessed if they need to use the lift. This is to reduce risks and ensure they have staff support if necessary. College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.2 Page 7 Suitable locks have been put on the home’s front door and the door of the annexe. This better ensures the safety and security of residents who have bedrooms in the annexe and makes access easier for staff to support them. Care staff have received more training and many are working to achieve a social care qualification. This should help them to have the knowledge and skills to support residents better and keep the home safe for people. Progress has been made to monitor the quality of the service and to obtain feedback from residents and their representatives to plan improvements. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. College House Residential Home DS0000064821.V377784.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 College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 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 the home. Prospective residents of College House can be confident that the home could support them. This is because a full assessment is made of their needs, which they and/or people close to them are involved in. This tells staff about them and the support they need. The home does not provide intermediate care. EVIDENCE: We confirmed during our last key inspection that the home has introduced paperwork so that staff can record the needs, wishes and preferences of any prospective residents. This covers relevant areas and should help staff know about the care people need and what they would like so that they can ensure the home will be able to provide appropriate support and meet their needs. College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 Page 10 The processes for assessing the needs and admission of prospective residents were discussed with Ms Greenwood, which was followed up in respect of a new resident. We also looked at this resident’s care records and talked with them about their experience of moving into College House. On receiving the referral for a placement at the home Ms Greenwood and the home’s deputy manager had visited the person in hospital to meet them and to complete a needs assessment. They gave them a copy of the home’s service users’ guide and met their family to obtain more information. The person’s assessment includes information about their medical condition, current health, and other relevant aspects such as their social interests, communication and mobility. An initial care plan was set up based on this assessment showing the support the person needs from staff, their preferred daily routines, goals, food likes, dislikes and with relevant risk areas assessed and how to manage them. Ms Greenwood told us they always encourage prospective residents to make introductory visits to the home whenever this is feasible. They also consider their level of needs and the impact this could have on current residents. The new person however was in hospital at the time and was happy for their family to visit and look around College House for them. Daily reports completed by staff show that this person has settled well. The resident told us they are very happy at the home and are asked about their preferred routines and food likes etc. commenting “staff are kind and helpful and let me be independent”. Three residents also indicate in their surveys that they had received enough information to help them decide if College House was the right place for them before they moved in and also that they have been given a contract. The evidence we obtained confirms the statement in the home’s AQAA that “prospective service users’ are fully assessed to ensure that we could meet their needs with other agencies, service users and their families etc. involved”. College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 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 the home. Residents’ personal and physical health care needs are being met and their medicines are now managed safely in the home on their behalf. Aspects of peoples’ social and mental health needs should be assessed, set out in their plans and managed better and their right to privacy maintained at all times. EVIDENCE: We looked at a sample of residents’ care records during this and our random inspection visits. Each person’s care plan shows their needs, preferences and wishes and is based on a full assessment of their needs. Ms Greenwood clearly recognises that residents should be involved in setting up and reviewing their own care and plans. We also saw the home continues to obtain more detailed information about residents from them and significant other people and to make their approach to care more ‘person centred ’. This means that there is College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 Page 12 a greater focus on identifying individual’s wishes, likes, dislikes and their preferred routines so that support can be provided accordingly. Residents and/or their families are also being asked to agree and sign up to their plans. Plans appropriately cover individuals’ needs, objectives and goals. They include an assessment of the support each person needs from staff in respect of their personal care with relevant instructions to show the assistance staff should offer and how to encourage self care. Personal care checklists are signed daily by staff to show the support each person has actually received. Detailed daily reports are also made by staff on each resident with helpful information about such as their health, mood, activities, family visits, meals and other events. The home now deploys a staff member in the mornings to make residents’ beds and clean their bedrooms. We found in our random inspection that this means that care staff have more time to attend to residents’ personal care in the mornings and that beds are made better and changed more often, which promotes residents’ comfort. We saw that residents were well presented and looked as if good attention is being paid to their hair and personal hygiene. Regarding residents’ health their plans cover relevant areas such as mobility, nutrition and pressure care. Their condition and any health issues are also outlined with records kept of all health care input. Ms Greenwood told us GPs now visit the home almost daily and she ensures people have the health care input they need. This included consulting an occupational therapist for advice about use of bedrails. Records confirm that people’s health is being monitored and promoted. For example one resident has had a poor appetite and so their GP is involved and staff are closely monitoring and encouraging them; making records of their food intake. We confirmed in our random inspection that the home now has weighing scales and we saw records of regular weight checks. Plans include risk assessments in relation to aspects such as mobility, nutrition and pressure areas. Ms Greenwood recently completed a certified moving and handling trainer’s course and carried out moving and handling assessments for all residents. We saw in two people’s care records that their mobility; support they need from staff with mobility and need of aids or equipment are covered in their assessments and plans. One person’s records report that they “can be aggressive” but how or to whom is not specified. Staff consider this is due to dementia however their condition and aggression should be fully assessed in consultation with relevant professionals and their plan should include how staff can support and manage their behaviours more consistently and effectively. The evidence obtained shows many improvements have been made since the last key inspection to monitor residents’ personal care better and to risk assess relevant areas to any reduce risks and so promote their health and well being. College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 Page 13 During our visit we spent time in the sitting and dining rooms with residents. We saw there is an open rapport between staff and residents and staff talked to them in a caring, friendly and appropriate way. Whilst this is positive some staff also discussed details of residents’ health and mood etc in front of other people. This should be considered by management and addressed as this lack of confidentiality is not respectful to peoples’ right for privacy. There is also a difficulty because there is no private space in the main house for staff to write daily reports and have shift handovers etc and so to maintain confidentiality and so we continue to recommend that solutions to this should be explored. The pharmacist inspector checked the management and control of medicines within the service. We found that the overall management and control of medication within the service was good. We saw that medication was stored securely in a locked medicine trolley, which means that medication is safe and therefore the people who live in the service are protected from harm. We looked at the medication administration records and overall found that they were well documented with a signature for administration or a reason was recorded if medication was not given. The manager informed us that regular checks are also made on the records to ensure that they are correct and up to date. This means that there are arrangements in place to ensure that medication is administered as directed by the prescriber to the person it was prescribed, labelled and supplied for. We found that other medication records were generally up to date. For example, we saw current records for the receipt and disposal of medication. The date of opening of boxes and bottles of medicines were usually recorded and balances of medication were carried forward from old records to new records. These records helped to ensure there was a clear audit trail of medication. We found that counts and checks made on medication were accurate, which showed that people who live in the service were being given medication as prescribed by a medical practitioner. We found detailed information relating to medication available in the care plans for individual people living in the service. This information included any changes made by a medical practitioner. The written information was clear, up to date and ensured that staff could access the information at any time. College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 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 the home. The home aims to enable residents to take part in a variety of activities and go out in their local community. Whilst people can make some choices about their daily lives and routines, their activities could meet their personal interests and social needs better. Staff support residents to maintain links with their families, friends and representatives and make people welcome. The home provides a nutritious diet for residents, who enjoy their meals and mealtimes. EVIDENCE: The AQAA states College House has a warm, friendly atmosphere and there is a programme of activities including arts and crafts, social events, bingo and religious services displayed in the home. We spent time in the communal rooms watching daily life activities and talking with residents. There is a good rapport between residents and staff and visitors are welcomed. Residents were chatting and laughing and some people read or did puzzles. One person told us they spend their time reading, doing puzzles or join in with group activities and comment that “staff are always happy to help and don’t dominate you”. College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 Page 15 Ms Greenwood told us that efforts are being made to improve activities and support residents to go out more. Staff arrange daily group activities, games, shopping trips and there have been outings. Musical groups and the vicar visit regularly and there is a weekly flower arranging session. Staff record daily what each person has taken part in and if they have been out etc. More able residents told us they follow their preferred routines e.g. choose when they get up; go to bed and to join in with group activities. This is positive but whilst peoples’ plans include some personal interests the home should aim and show how they provide opportunities for leisure and recreational activities that suit peoples’ needs, preferences and capacities; particularly how consideration is given to people with dementia and other disabilities the service provides for. Staff and residents’ told us that involvement of their families and friends is encouraged and visitors are made welcome in the home. Relatives’ surveys confirm that they are kept in touch and up to date about important matters and one comments that “you always have a warm greeting and a chat”. Regarding food provided by the home there is a new cook who is a qualified chef and has completed food hygiene training. She works on weekdays and the home employs agency staff at weekends. Cooks produce lunch and often prepare dishes for tea. We spent time in the kitchen and saw that food records kept show a good variety of wholesome meals. Whilst main meal options are not being offered currently the cook told us they will be again soon. Residents were given questionnaires to suggest meals and there is a list of their likes and dislikes. Staff know peoples’ food preferences and we saw one plan specifying they like small portions and may need help cutting up their meat. No one currently needs a soft diet but the cook knows to present meals properly if so and about special dietary needs and the importance of nutritious meals. Residents told us the home’s food is good and they like their meals. They can choose to have cooked breakfast every day if they wish such as eggs on toast. We were invited to have lunch with residents, which they were asked about and happily agreed. The meal was a very pleasant, sociable occasion. Staff asked people what they wanted, served the meal nicely and offered assistance and encouragement. The meal was home made and comprised of a steak pie, mashed potato, parsnips, cabbage and gravy followed by chocolate pudding and custard. This was all well presented, hot and very tasty. We saw that eccles cakes and a fresh fruit salad had been made for the evening meal and cook told us cakes are baked most days. We checked food stocks and they included plenty of fresh vegetables, fruit, cereals and other healthier products. We saw that the kitchen was clean and tidy. Foodstuffs kept in containers in the fridge had appropriately been dated when opened and fridge temperatures are checked regularly and maintained satisfactorily. An Environmental Health inspection report from July confirmed that food hygiene standards are good. College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 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 the home. If people have concerns about the service they know how to complain. Staff are aware how to recognise abuse, although aspects of their training and the home’s procedures need improvement to better ensure residents’ protection. EVIDENCE: The service provides a complaints procedure, which is displayed in the home. Residents told us, and their surveys and those of their relatives confirm, they know about these procedures and who to speak to if they are not happy about anything and/or how to make a formal complaint about the home. The AQAA shows the home has not received any complaints since the last inspection but that says any received would be recorded, investigated and responded to. Ms Greenwood told us they have an open door policy and so encourage people to raise concerns. There are also policies provided on whistle blowing and for managing residents’ finances and information available about advocacy. We saw there is an open atmosphere in the home and the feedback we received indicates that people are happy with the home and have confidence in staff. College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 Page 17 Policies and procedures are also provided on abuse and for the protection of vulnerable adults. Staff have received some training on these topics as well as been given an insight into the Mental Capacity Act. It is good that one of the home’s plans is to give staff more training on complaints and whistle blowing. Staff we spoke to are clear about their responsibility for residents’ protection. They told us they would report any suspicion or incidence of abuse to the provider or manager however they were not sure about who to refer to externally. The home has a copy of the local multi-agency adult safeguarding procedures, which all staff should know about and follow if necessary. The home should ensure all staff are familiar with these safeguarding procedures and preferably should receive training from Worcestershire Council, and this be reaffirmed regularly through individual supervision and in house instruction. College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 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 the home. College House offers residents a pleasant, comfortable and safe home. The environment is kept clean and steps taken to promote good infection control. EVIDENCE: College House is located near the town centre of Tenbury Wells and so is walking distance from shops and other local facilities. The property comprises of a large detached house dating back to 1698 that has been extended over the years without losing the feel of an old country town house. The home is in a residential area set amongst mostly traditional houses and cottages. Part of the accommodation is in a separate annexe to the main house and has two College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 Page 19 bedrooms and the offices of the home and domiciliary care agency. There is a nice, good sized and enclosed garden at the front of the house. We looked around the communal areas of the home and visited several of the residents’ bedrooms. The overall impression is that the home is reasonably decorated and furnished and is pleasant, homely and comfortable. Some areas have been re-floored since the last key inspection and the AQAA says that they plan to complete more redecoration in the coming year. The home employs a handyman who does redecoration, day-to-day repairs and the garden. Residents have personalised their bedrooms and there is screening in shared rooms by beds and washbasins for privacy. Five bedrooms are on the ground floor and there is a passenger lift to access bedrooms on the first floor. The lift is small and so can only comfortably accommodate one or two people without their walking frame or wheelchair. The manager knows that this must be taken into account when considering the needs of prospective residents and that a risk assessment should be carried out for anyone who may need to use the lift. Since the last key inspection we confirmed in our random inspection that coded locks have been fitted to the main door of the home and the separate annexe, as required. This has improved security and access between these buildings. The house was found to be warm, bright, fresh and clean and we reaffirmed that the home now deploys a separate staff member as domestic. Residents told us and their surveys confirm that the home is always fresh and clean. The AQAA states that protective clothing is provided for staff; there are hand washing facilities and waste disposal arrangements. Furthermore staff have received training on health and safety topics and infection control. We saw that staff used protective aprons and gloves appropriately and paper towels and liquid soap are provided in every bathroom and toilet as well as antibacterial gel dispensers in corridors throughout the home. College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 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 the home. Residents feel confident in the support they get from staff, although the home would better ensure all their needs are met by sufficient staff when staffing is more stable. People could also be protected better if aspects of recruitment procedures used by the home to confirm staff are suitable to work there are more thorough. Whilst staff continue to receive training this should also give them understanding, knowledge and skills to meet residents’ special needs. EVIDENCE: Rotas show there are three staff on duty in the mornings; two in the evenings and at night and the manager’s hours are extra to those for direct care. We had previously recommended these staffing levels should be reviewed because whilst the home is relatively small having only two staff on duty could prove difficult at times. Ms Greenwood and other staff feel there will be enough staff when new staff recently interviewed start work. In the meantime staff are working 8am to 8pm shifts to cover the home. Whilst this is not a desirable long term solution residents are positive about the support they get from staff and one relative comments in their survey “ staff at College House, although working long hours, never give you the impression that anything is too much trouble. They go out of their way to do all they can to make X comfortable”. College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 Page 21 There has also been a fairly high staff turnover in the last 12 months but staff told us that the staffing situation is stabilising. They report there is now better management support and the team are working together more. We feel staff are well motivated and are clear about their responsibility for providing a good service and their role as keyworkers to personalise care. It is positive that one the home’s main plans in their AQAA is to stabilise staffing. Regarding staff recruitment the AQAA says all staff have had CRBs and two references; are given contracts and receive induction and mandatory training. Two new staff told us they had been checked out before they started work at the home and we also looked at two staff records. Both appropriately include relevant information, proof of their identity, a criminal records bureau check (CRB) and two references. However it should always be ensured that their references are from authorised people (such as previous employers) and that their authenticity has been checked out. The application form also only asks prospective employees for their last 10 years employment and not their full employment history (with any gaps explored at interview), as now required. We also reiterated following our random inspection that suitable supervision arrangements should be put in place when new staff start working at the home before a satisfactory CRB check is obtained and with just a POVA First check. Currently only three care staff have achieved National Vocational Qualification (NVQ) in social care. However the rest of the team have enrolled on NVQ and there were NVQ assessors at the home during our recent visits. Ms Greenwood is also liasing with Worcestershire Couthy Council, Ludlow college and another training organisation to arrange further training. Some staff recently completed training on infection control and moving & handling and we were told training is planned on adult protection, pressure area care and managing challenging behaviours of people with dementia. In view that the home offers a service for people who can have dementia, a mental health disorder, physical disabilities, and/or sensory impairments it is important that staff complete relevant training to give them the knowledge and skills they need. College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 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 the home. People should be able to have more confidence that the home is being run well when the management arrangements are more stable and improvements are implemented to the service that incorporate the views of residents and/or their representatives. The environment is kept safe for people because appropriate health and safety practices are carried out. EVIDENCE: There have been four management changes at the home in the last two years or so and our last key inspection found that this had adversely affected the service and staff morale. Ms Greenwood has now been in post for six months College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 Page 23 and progress has clearly been made to develop the service and comply with requirements made from our last key inspection. This is positive, although the provider Mr Hukkeri needs to continue to actively support the home and Ms Greenwood, especially as she has limited previous management experience. An application should also be submitted for Ms Greenwood to register as the manager, as a matter of priority and it also be ensured that she has the time and support to achieve the NVQ level 4 she is currently working towards. Ms Greenwood is clear about improvements that are still needed at College House and is committed to developing the service. We particularly commend her for efforts she made to comply with the requirements in respect of the management of medicines in the home. It is recognised in the AQAA the areas that still need to be developed but the AQAA should also provide more evidence of how what the home does results in good outcomes for residents. In respect of quality assurance some progress has also been made. An annual business plan is being produced and questionnaires were given out to residents and their families asking their views of the home. Feedback obtained should now be analysed and incorporated in an action plan for the service to develop, as residents and other stakeholders wish and/or for their benefit. Mr Hukkeri’s reports from the required monthly visits to check on the conduct of the home considered as part of the quality review and assurance processes. The AQAA confirms that records of all financial transactions are kept, including for residents who have personal spending money looked after by the home. Regarding health and safety and how this is promoted the AQAA states the home has a policy and all procedures and necessary risk assessments are in place. There are servicing contracts for equipment, heating and installations and accidents and incidents are all recorded, monitored and acted upon. Our inspection confirms that staff receive mandatory training in all relevant areas including fire safety, first aid, moving & handling and infection control. The fire log shows that the handyman carries out required fire checks including alarms, doors and equipment. We noted that a fire safety certificate dated April 2009 indicates some work needed to be completed and it is presumed that this has all been carried out. There were no safety hazards observed during our visit. College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 Page 24 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 3 College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 Page 25 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 persons meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider 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 to consider carrying out. No. 1 Refer to Standard Good Practice Recommendations You should ensure that resident’s care plans also include risk assessments and individual management strategies in respect of their behaviours, with input from relevant professionals when necessary. This is so that staff know about strategies they should deploy to respond more effectively and consistently to aggression and so could manage it better. Consideration should be given to how personal matters are discussed by staff without compromising the privacy of residents. This includes exploring solutions for space for staff to hold shift handovers and meetings etc. more confidentially. You should ensure that residents are enabled to follow their personal interests and take part in activities that meet their individual needs, preferences and capacities. The home should ensure through training, instruction and/or individual supervision that staff are clear about the procedures for safeguarding adults, particularly for when incidents need external input and who to refer incidents to. DS0000064821.V377784.R01.S.doc Version 5.3 Page 26 2 3 4 College House Residential Home 5 Staffing arrangements should be kept under review until the staff team is more stable and to make sure that levels are appropriate to meet the needs of residents without the manager and care staff having to work excessive hours. You need to put systems in place to ensure that recruitment procedures followed by the home are sufficiently robust. Specifically that a full employment history is obtained for all possible new staff; that their references are from authorised people and you can show that you have satisfied yourself in respect of their authenticity. In addition that appropriate supervision arrangements are put in place when new staff start work with a POVA First check. You need to continue with plans to arrange further training for staff, including dementia to build on the introductory course provided in 2008. This is so that staff have more knowledge, understanding and skills to meet residents’ special needs. You should take urgent steps to arrange for the person recruited as manager to submit an application to be registered with the Care Quality Commission. Progress should continue to implement a thorough system for reviewing the quality of the service; to include analysing and incorporating views of the home obtained from consultation with residents and their representatives. This is so that the service improves as residents want and/or for their benefit. 6 7 8 9 College House Residential Home DS0000064821.V377784.R01.S.doc Version 5.3 Page 27 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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