Inspection on 26/11/08 for Colne House Care Home

This inspection was carried out on 26th November 2008.

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

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

Other inspections for this house

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Colne House Care Home Station Road Earls Colne Colchester Essex CO6 2LT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Deborah Kerr     Date: 2 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Colne House Care Home Station Road Earls Colne Colchester Essex CO6 2LT 01787222227 01787224749 colnehouse@kingsleyhealthcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Althea Healthcare Properties Type of registration: Number of places registered: care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 38 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Colne House is owned and operated by Althea Health Care, who are part of Kingsley Healthcare. The home is a Grade 2 listed building set in spacious grounds. The main house provides accommodation to thirty three people. Communal rooms in the main Care Homes for Older People Page 4 of 33 Over 65 0 38 38 0 Brief description of the care home house consist of three lounges, a conservatory and a dining room. These are well furnished with domestic style furniture, carpets and curtains. From the dinning room double doors lead into large conservatory, which has good views over the gardens and pond. There is an additional annex separate to the main house providing accommodation to a further five people. The annex has its own communal areas and kitchen facilities. Colne House is close to the village of Earls Colne, which has a range of shops, a libary, post office, doctors surgery, public houses and churches. Care Homes for Older People Page 5 of 33 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: The inspection was unannounced lasting one and half days. This was a key inspection, which focused on the core standards relating to older people. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from one relatives Have Your Say survey and the Annual Quality Assurance Assessment (AQAA), issued by the CSCI. This document gives providers the opportunity to inform the CSCI about their service and how well they are performing. We (CSCI) also assessed the outcomes for the people living at the home against the key Lines of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and Care Homes for Older People Page 6 of 33 safety. Time was spent talking with people who live in the home, two relatives and six staff. The service manager and administrator were available during the inspection and fully contributed to the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: The statement of purpose requires some amendments to accurately reflect Colne House, their are some typing errors and incorrect information relating to other services owned and run by the same organisation. The manager should look at devising a way of monitoring the weight of people who are on permanent bed rest. Additionally, where people using the service require hoists to aid their mobility an Occupational Therapist (OT) needs to make an assessment of the individual to ensure they have the correct slings, in relation to their weight, height and size. More could be done to improve the daily life of the people using the service, by incorporating information in their life histories and previous social interests to ensure they are engaged in meaningful activities of their choice. Consideration should be given to splitting mealtimes into smaller sittings to promote a more relaxed and social setting. The smaller service in the annex could be further developed to encourage and support the people who live there to experience a more independent lifestyle. On any occasion where an individual is physically restrained, however minor, the circumstances, including the nature of the restraint, must be recorded. This will ensure incidents involving restraint are evaluated and action taken to prevent incidents from reoccurring in the future. Staff working in the home should be provided with adult safeguarding training and information in a format they understand to ensure people using the service are protected from abuse. Persons employed in the care home must receive training appropriate to the work they are to perform. This will ensure staff have the knowledge and skills to support people with mental health needs, which is based on current good practice. Care Homes for Older People Page 8 of 33 To ensure the safety and welfare of the people living and working in the home, the manager must consult with the fire service and take adequate precautions against the risk of fire, including arrangements for containing fires. Where there is a potential risk to service users safety, a risk assessment must be carried out and significant findings recorded showing the action taken to minimise the risks. The manager was advised they need to revisit the homes fire risk assessment to ensure it complies with the governments most recent legislation for fire safety in residential care premises. To reduce the risk of cross infection and ensure the safety of the people who live in the home, the infection control policy and procedure for dealing with soiled linen needs to be amended to comply with the Department of Health guidelines (DOH), Essential Steps. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering using this service are provided with the information they need to decide if this is the right home for them and will only be admitted to the home following a full and detailed assessment to ensure the home can meet their needs. Evidence: The homes Statement of Purpose and Service Users Guide provides detailed information about the service, setting out their aims and objectives, the accommodation and facilities and How to Complain. However, the statement of purpose requires some amendments to accurately reflect Colne House, there are some typing errors and incorrect information relating to other services owned and run by the same organisation. The files of four people tracked as part of the inspection process contained evidence that they had been provided with a contract, setting out their fees and the terms and Care Homes for Older People Page 11 of 33 Evidence: conditions of occupancy, including the role and responsibility of the provider and the rights and obligations of the individual. Information provided in the AQAA and verified at the inspection confirmed no person is admitted to the home without having a full assessment of their needs and wishes undertaken. Each of the files contained a pre addmission assessment completed by manager. The manager had also obtained copies of a completed Care Programme Approach (CPA) from each individuals Local Authority. Both sets of assessments provided comprehensive information about the individual(s) needs, which formed the basis of their care plan. People spoken with confirmed they visited the home, and were issued with information about the service, which included, an official welcome letter, SUG and welcome pack. They also confirmed they had an assessment undertaken before moving into the home, to establish that the service could meet their individual needs. Care Homes for Older People Page 12 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service receive health and personal care, which is based on their individual needs. Evidence: The care plans of four people living in the home were looked at as part of the inspection process, all four contained information, which provided a comprehensive overview of the individuals needs. These had recently been reviewed and updated on Kingsley Health Care Homes paperwork. However, none of the care plans contained a photo of the resident for identification, the manager advised these are in process of being printed. The care plans had been generated from the pre admission assessments and contained all the required information covering all aspects of the individuals physical, mental, health and social care needs. Each need had been broken down into individual support plans identifying the individuals goals, aims and objectives and the interventions required by staff to support the individual to achieve these. Care Homes for Older People Page 13 of 33 Evidence: Assessments to promote and maintain peoples mental and physical health, nutrition, risk of falls, skin integrity, pressure area care and moving and handling are in place. These are being monitored, reviewed and updated regularly to identify where there have been changes in an individuals health and to assist with planning their future care. People who are on permanent bed rest did not have health charts in place to monitor regular turning to prevent pressure areas occurring, or to monitor their food and fluid intake throughout the day. This was discussed with the manager, who immediately implemented the charts and instructed staff to complete these daily and after every task. Peoples weight is being monitored on a monthly basis, however the care plan of one individual who is on permanent bed rest, due to being in a lot of pain, has refused to be weighed. They have not been weighed since December 2007 and their last recorded weight was 10 st. On meeting the individual it would suggest they have lost weight during the year. The manager was advised they need to look at devising a way of monitoring the individuals weight and to make a prompt referral to an appropriate specialist, if weight loss has been significant. The manager stated that the individual has recently had a review of their medication to better manage their pain, which should allow staff to weigh them. The daily records seen in peoples care plans are well written and provide a good overview of how each person has spent their day, including what has worked for the individual, where there has been progress, achievements or any concerns about their health and welfare. These also identified minor incidents and injuries and where the district nurse had been requested to visit. People living in the home are supported to access health care services. Dates and details of appointments are clearly recorded in the care plans. Health care needs of the people using the service are managed by visits from local General Practitioners (GP) and district nurses who make regular visits, where required for pressure area care. Peoples care plans described the pressure relieving equipment provided and contained an information fact sheet for staff guidance about pressure area prevention. Staff confirmed that they are aware of the needs of people living in the home and were able to provide a verbal account of the needs and preferences of each individual. Observation and discussion with staff confirmed they are aware of the need to treat people with respect and dignity when delivering personal care. The interactions between residents and staff were observed to be friendly and appropriate. Staff were observed calling people by their preferred name. Care Homes for Older People Page 14 of 33 Evidence: The home has an efficient and comprehensive medication policy and procedure in place for ordering, storing and administering medication. The practice for administering medication is generally well managed. Medication Administration Records (MAR) were inspected and were found to be completed correctly, with no gaps. Staff had made good use of the reverse of the MAR chart to reflect when PRN (as required) medication had been given or if medication had been refused. Individual photographs were attached to the records to avoid mistakes with the persons identity. The controlled drugs book was examined. There are currently two people people prescribed controlled drugs. A check of the stock of their medication against the balance in the controlled drugs book was found to be accurate. Medications that need to be stored at low temperatures, such as eye drops were checked. These were being stored, and used correctly with in the use by date. The fridge temperatures for storing medications were being checked and a record of the temperature is being recorded daily. The manager undertakes a monthly audit of medication. A copy of the last audit completed on the 04/11/08 highlighted timodene cream had not been applied for one individual, as prescribed by the GP. Additionally, three missed signatures had been identified. These had been investigated and discussed with the senior member of staff responsible for the error and addressed. All staff with the responsibility for administering medication are currently completing distance learning medication training course. The manager has also completed this training. The senior was observed administering the breakfast medication. Concerns were raised with the senior and the manager about the length of time it had taken the senior to complete the breakfast medication round. They were still administering medication at 10.40am and one resident was observed expressing their anxiety that they had not received their 9am medication. It is acknowledged that the senior had stopped to spend time to talk to the inspector, they also confirmed they had recently been appointed to the post of senior and that administering medication took them longer than a more experienced senior. The manager is in the process of discussing with the GP about starting the morning medication earlier to ensure peoples medication is administered at the correct intervals. Care Homes for Older People Page 15 of 33 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. People who use this service are provided with the opportunity to take part in a variety of activities, within the home, however people tell us that they would like more involvement within the community and to go out more. Evidence: People using the service and their relatives provided mixed views about life in the home since the take over by Althea Care Homes. A resident commented that they felt restricted, and had no freedom and stated they felt shut in, and does not go out much anymore. They did however confirm they go out with their relatives who visit regularly and enjoyed walking around in the garden. Another person told us they have lived at Colne House for about four years under the ownership of the previous providers. They stated that the new company appear to be spending a lot of money on new furniture and that the food is good. They also said they do not go out much, but did receive regular visits from relatives. Relatives comments, included, my relative is treated nicely here, they are able to walk around in their night clothes, if they want to, I am more than pleased with service and there appears to be more choices of food and stated, Colne House is a Care Homes for Older People Page 16 of 33 Evidence: nice place to be, set in nice surroundings, overall I believe the service is OK. One relative commented, my relative is very aware of what goes on, I feel they are lacking in stimulation, they used to be very active. They stated their relative used to do a lot of reading and watched Coronation St and other programmes, such as murder mysteries. They have noticed that they do not watch these now. This was discussed with the manager about building these aspects of the persons interests into their care plan, by ensuring the television was switched on at the right time and on the right channel for these programs. Colne House currently has one activities co-ordinator, who works three days a week. They have attended various training courses to assist activities for older people and those with mental health needs to provide mental and physical stimulation. They have developed a four week schedule, which alternates to ensure a variety of activities are provided. These include, exercises, a range of games and craft based activities and reminiscence. People have access to newspapers, talking papers, and audio books. Other activities have included, monthly coffee mornings, residents outings in conjunction with the Alzheimers society and in house entertainment. Six residents were observed playing a board game and appeared to enjoy taking part. The December activity schedule seen, included in house entertainment from local churches, schools, a sing and dance session with Touch and Go, and a Christmas buffet. A record of activities is being kept for each person, which reflects the activities they have taken part in or where they have refused. The records of people being tracked as part of the inspection showed they had taken part in a picture quiz, ball therapy, helped to do a patchwork, helped to write a poem and spent time out with friends and relatives. The records also demonstrate that people living in the home have access to religious services, in the community, listening to communion service, and receive visits from a priest on a weekly basis. People on bed rest are also included in activities, one person had made a picture book, and spent time looking through this with staff. Care plans contained Life Story books, however not all had been completed. Those that had been were very detailed containing interesting information about peoples past life leading to the present day with photographs of significant events and family members. These provided a detailed understanding of the individuals past, focusing on significant and important events in their life, what matters to them and why. This information provides vital links to the persons past, which has formed their identity, and forms the basis of communication and understanding of the individuals current behaviours. The lunchtime meal was observed. The meal time was not rushed and people were Care Homes for Older People Page 17 of 33 Evidence: able to eat their meal at their own pace. However, some residents were quite vocal and agitated, during the meal, one resident in particular was very vocal, staff did try to placate and interact with them, however this did not promote a relaxed mealtime. Consideration should be given to splitting mealtimes into smaller sittings. Staff raised concerns that the new company had reduced the food budget and that people using the service had less choice. They provided examples, indicating people had only been given one sausage at lunchtime and where there used to be two choices of meat or fish, now the second option was a vegetarian based dish. Discussion with the cook and examination of residents nutrition records showed one resident had had four sausages, where as others with smaller appetites had one sausage. The cook confirmed people could have as much or as little food as they wanted and they had never been told to restrict the amount of food purchased. Menus and residents nutrition records showed a good range of meals, which included meat and / or fish alternatives. The cook also confirmed people can have alternatives, if they do not like what is on menu, for example, omelete or jacket potato. People who use the service told us that the food is very good, excellent and definitely better than average. A check of the food stores showed that minimal stock is held, however there was sufficient food available until the next delivery of food. Fresh and frozen meat and vegetables are delivered weekly and diary and bread produce is delivered fresh to the home daily. Colne House has an annex, separate from the main building, which provides accommodation for five people. Currently peoples meals are prepared and cooked in the main house, however the annex has its own kitchen facilities. This smaller service could be further developed to encourage and support the people who live there to experience a more independent lifestyle. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are supported to raise their concerns and have access to robust, effective complaints procedures, and are protected from abuse, however incidents which involve restraint of an individual must be fully investigated and recorded. Evidence: Information provided in the AQAA and verified at the inspection confirmed that the home has a clear complaints procedure and an appropriate adult safeguarding policy in place, which includes clear guidance of the procedures staff must take to report allegations of abuse. The AQAA also states all staff have received safeguarding adults training, and have been made aware of the comprehensive whistle blowing policies and procedures. Staff spoken with, during the inspection confirmed they had received Protection of Vulnerable Adults (POVA) training, however due to their comprehension of the English language, some staff were less clear about the approach they need to take and their duty of care if they had concerns about the welfare of a person living in the home. This was discussed with the manager who needs to make sure all staff working in the home receive training and information in a format they understand to ensure people using the service are protected from abuse. Managers have been issued with a safeguarding adults toolkit, which links into Kingsley Care Homes policy for adult protection. The toolkit is available to staff to ensure they are aware of the safeguarding adults policy and reporting procedures. Care Homes for Older People Page 19 of 33 Evidence: Information provided in the AQAA states the homes philosophy is that it should be easy for people to raise concerns and that these are taken seriously. People living in the home and their relatives told us if they have any concerns about the service, they are able to raise these with the registered manager and are confident there concerns are dealt with. The complaints log identified the service has received one complaint since being registered with us (The Commission) in May 2008. The complaint raised several issues, regarding the quality of food, un ironed clothing, no towels and not being informed about a relatives recent scan. The complaint was fully investigated by the manager, who provided the complainant with a full explanation, both in writing and in person. The manager showed the inspector a written response from the complainant reflecting their satisfaction with the outcome, who stated, despite little niggles, I find staff kind, helpful and very obliging, which is nice for me and my relative, thank you. Outcomes of complaints and feedback from the homes quality assurance are used to make further improvements to the service. The service has robust recruitment procedures in place. Staff files seen confirmed all staff are subject to Criminal Records Bureau (CRB) and Protection Of Vulnerable Adults (POVA) checks, prior to commencing employment. Care plans contained risk assessments for supporting people whose behaviours can be challenging to others or them selves as a result of self neglect, self injury or physical and verbal aggression. These identified triggers, which may lead to individual’s behaviour becoming dangerous to others and disadvantageous to them selves. The assessments provide good descriptors of how staff are to manage these behaviours. These linked into protocols for administering PRN (as required) medication. However, no record had been made of a recent incident involving one individual who grabbed another resident and had been restrained by staff. Further discussion with the manager reflected the individual had been held by the arm and guided to their room , to calm down. The incident had been reported in the daily notes of the individuals care plan but not on a separate incident form. This was discussed with the manager who needs to ensure each case is evaluated and action taken to prevent incidents from reoccurring in the future. Care Homes for Older People Page 20 of 33 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. The continuing refurbishment of the home means people who live there are provided with comfortable and pleasant surroundings, however the manager needs to ensure people have the right specialist equipment and are protected by the homes infection control procedures. Evidence: Colne House is a grade 2 listed building set in large private gardens. The main house provides accommodation to thirty three people. There is an additional annex separate to the main house providing accommodation to a further five people. The annex has its own communal areas and kitchen facilities. Communal rooms in the main house consist of three lounges, a conservatory and a dining room. These are well furnished with domestic style furniture, carpets and curtains. From the dinning room double doors lead into large conservatory, which has good views over the gardens and pond. Information provided in the AQAA and verified at the inspection confirmed there has been a rolling program of refurbishment to all communal areas of the home providing the people who live there with comfortable, homely and warm environment. The refurbishment of communal areas is near completion. Additionally, some bedrooms Care Homes for Older People Page 21 of 33 Evidence: have been redecorated and there are further plans to decorate the remaining bedrooms as they become vacant. There are further plans to upgrade the rest of the home, including making improvements to bathrooms. This will involve revamping one bathroom, currently not suitable for any of the residents, into a wet room and creating a space for the hairdresser. As part of the refurbishment, the main lounge has been split into two, creating a quiet room. New wood effect flooring has been laid in the dining room, and new tables and chairs have been purchased. Carpets and curtains are to be replaced in all communal areas and new furniture and two wide screen televisions have been purchased. All communal areas have a good range of seating, including peoples own, recliner armchairs. The refurbishment of the home has received a mixed reaction from residents and their relatives. This was confirmed in information received in a relatives Have your Say surveys and reiterated in the homes own quality assurance. Comments included, refurbishment has removed the family style homeliness offered by the previous owners. The home has been riped apart, stripping the home of all homely touches, such as pictures, ornaments and soft furnishings, and replacing warm colours with off white tones. Other people told us they liked the new decor. Another relative commented, that they felt the standard of cleanliness in particular bedrooms and bathrooms had declined. The home appeared clean, bright and tidy and free from any unpleasant odours at the time of the inspection. Bedrooms are suitable for the needs of their occupants, with appropriate furniture and fittings. Peoples rooms are nicely decorated to reflect individual personalities, hobbies and interest, with personal effects. The home has five shared rooms, three have access to their own private en suite toilet and washing facilities. The other shared rooms have been provided with screening to ensure privacy for personal care. People told us they are able to bring their own personal items into the home, one person commented I have a very nice room. The home is equipped with lifting equipment, which suits the needs of people who live there, however there is no system in place to ensure that the correct size slings are being used. The manger must consult with an Occupational Therapist (OT) to ensure people are assessed for the correct slings, in relation to their weight, height and size. Records were available to demonstrate that checks were carried out on equipment to ensure that it was maintained in good working order. People assessed as a high risk of occurring pressure areas, had been provided with pressure relieving equipment. To ensure the safety of people living in the home, all radiators are guarded with purpose built radiator covers, which minimises the risk of people falling against them and sustaining burns. Care plans confirmed that people are individually assessed prior Care Homes for Older People Page 22 of 33 Evidence: to using their bathing facilities, which includes hot water temperature and any equipment required. Maintenance records confirmed hot water temperatures are being maintained with the safe recorded temperatures of 41 degrees centigrade for showers and 44 degrees for baths, which minimises the risk of people living in the home being scolded when taking a bath or shower. Appropriate hand washing facilities of liquid soap and paper towels are provided in all en-suite and toilet facilities where staff may be required to provide assistance with personal care. Due to the mental health needs of some of the people living in the home, the paper towels are locked in cupboards in bathrooms to prevent people eating these items. The laundry facilities are sited away from the kitchen, however, the home still has a sluice room, next to the kitchen. Discussion with the laundress, confirmed linen sluiced of any soiled matter is washed separately. The washing machine does have a sluice program. The homes infection control policies and procedures states red soluble bags are to used, however, the laundress confirmed these were not being used, but does have access to personal protective equipment, of gloves and aprons. The manager was to review the the practice of dealing with soiled linen, to ensure they complied with the Department of Health Guidelines (DOH) and to reduce the risk of spreading infection. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are available in sufficient numbers, however further training is required to ensure staff have the knowledge and skills to support people with mental health needs, which is based on current good practice. Evidence: Information provided in the AQAA stated that the home is staffed by a senior and eight carers during the day and four awake night staff. The duty roster and conversation with staff did not confirm this. A head of care and senior are included within the numbers of staff, not as an additional person. Staff confirmed two carers are designated to the annex, with a senior and four carers allocated in the main house, making a total of seven staff during the waking hours. Staff spoken with confirmed there was enough staff available to meet the needs of the people currently living in the home. This was confirmed in discussion with people using the service, who told us, staff are very good, we do not have to wait, they are very, very good. Positive feedback was also provided about staff in the relatives questionnaires used to compile the homes own quality assurance. Comments included, staff are available and helpful and the staffing ratio seems good and staff are very friendly and treat my relative with kindness and affection. Care Homes for Older People Page 24 of 33 Evidence: Staff were mixed in their views about the take over of the company, some felt this had gone well, others felt the service was not so good as before. They commented that during the take over by the new company a lot of staff left and that the remaining staff are having to work extra hours to cover the short falls. However, one member of staff stated, although it did have an impact on the residents in beginning, things are moving on now, there is a lot of work being done to improve the service. Discussion with staff confirmed they had been recruited fairly and that they received good training and support to ensure they have the skills and knowledge to do their jobs and to meet the different needs of the people living in the home. Most recent training has included person centered planning, medication, food hygiene, fire safety and moving and handling. However not all staff had received up to date training to meet the needs of people with mental health problems. Additionally, some moving and handling training is out of date. The manager advised they are in the process of arranging to update their train the trainer qualification and will arrange for training for all staff in the new year. Staff files examined confirmed, all relevant documents and recruitment checks, required by regulations, to determine the fitness of the worker had been obtained prior to them commencing employment. Kingsley Healthcare have developed their own induction training program, which meets the requirements of the Skills for Care Induction Standards. Information in staff files confirmed that new employees had completed their induction training within the first six weeks of their employment. The training program consists of the induction standards, specialist training and access to regular training courses, which are used to form a port folio, and which forms part of the terms and conditions of employment as stated in employee handbook. Information provided in the AQAA and verified at the inspection confirmed that Colne House provide staff with the opportunity for completing a National Vocational Qualification (NVQ). 12 staff are currently undertaking NVQ 2 incorporating basic English, as the service employs a high number of Hungarian staff whose use of and understanding of English language and traditions of older people are limited. In total the home employs twenty four care staff, five staff have completed NVQ level 2 or above, with twelve staff currently working towards completion of the award. These figures reflect 50 of care staff hold or are working towards a recognised qualification, which meets the National Minimum Standard (NMS). Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people using the service, their opinions are central to how the home develops and reviews their practice, however the manager needs to ensure the home complies with the most recent fire safety legislation to ensure the environment is safe for people living and working in the home. Evidence: This is the first key inspection following the take over of the service by Althea Healthcare Properties in May 2008. The service has a new manager in post, who has the appropriate qualifications and experience and is competent to run the home. They are a registered nurse and has worked in the care and nursing sector since 1997. They have experience of working with older people and those with mental health needs and has also completed NVQ level 4 in Management and holds a Bachelor Degree in Commercial Management. Care Homes for Older People Page 26 of 33 Evidence: Staff gave positive feedback about the manager, they told us the new manager is very good, cant fault them, they are very approachable and they are very good, kind and supportive and there is a different atmosphere in the home. One member of staff described the take over as a positive step and that they are now getting used to following new company rules, and little by little are developing a relationship with the new company. They stated, I still enjoy working at the home. Althea Healthcare continue to have suitable processes in place for the monitoring of the service and care provided at the home, including twice yearly internal quality monitoring visits. A report is produced following these visits and is used as an action plan to develop service. This is in addition to the homes annual quality assurance system, which seeks the views of people who use the service and their relatives. A copy of the most recent annual quality report for October 2008 was provided at the inspection, which states what the service does well and highlights where they need to improve. Comments included, quality of care is excellent, staff interact very well with service users and there is a warm, welcome feeling at Colne House, however other people suggested there could be improvements made to the provision of more varied snacks, laundering of clothing and the provision of more activities, as residents frequently doing nothing. The manager does not hold individual monies for people living in the home. People that are able to manage their finances, hold small amounts of money for personal expenditure. People who are unable to manage their own finances, are supported by relatives or by the Court of Protection. All other finances are managed at head office, however the home does have petty cash on site, so that people can access money when they need it. This is then reimbursed from head office and deducted from their account. Monthly audits of the incident and accident log are conducted. The audit shows where concerns were raised about an individual regarding repeated falls they were referred to their General Practitioner (GP) who reviewed their medication, and weight loss and made a referral to a dietician. The log also showed that serious incidents, for example where an individual had been admitted to hospital following a fall, had been reported to the Health and Safety Executive (HSE), in line with Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR). Staff files had records to confirm that regular supervision takes place, this was also confirmed in discussion with staff. The documentation reflects that these sessions include discussion of general work objectives, performance and development and identify training needs. Care Homes for Older People Page 27 of 33 Evidence: The home was inspected by Environmental Health, in October 2008. The report showed a number of issues that were highlighted around the management of food safety. A second visit to the home in November confirms the home had taken action to redress these issues. Action taken has included provision of food hygiene training in the use of the safer food better business procedures, replacement of loose tiles, maintenance of fridges and freezers and safer food management. Records examined and information provided in the AQAA confirms the home takes steps to safeguard the health, safety and welfare of people living and working in the home. The most recent Gas and Electrical Safety certificates, including Portable Appliance Testing (PAT) were seen and records showed that all equipment is regularly checked and serviced. The fire logbook showed that the fire alarm, emergency lighting and fire fighting equipment is regularly serviced. Emergency lighting and the fire alarm system are tested weekly and regular fire training and drills take place. Although the home is sectioned in to fire zones, with fire doors placed at intervals in corridors, none of the bedrooms have automatic door closures fitted, these if left open, would not close in event of fire and would leave people at risk. The manager was advised they need to revisit the homes fire risk assessment and consult with the local authority fire service, to ensure the home meets the governments fire safety requirements of the most recent legislation for fire safety in residential care premises. Concerns were also raised with the manager about the top floor, which has a large window over looking stair well. There is a significant drop should an individual fall through the glass, although the window appears to have toughened glass in situ, no risk assessment has been completed. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 The manager must ensure people are consulted about their social interests and arrangements made for them to engage in activities of their choice. This will ensure people who use the service have access to and enjoy the amenities within their local community. 24/01/2009 2 18 13 On any occasion on which a service user is subject to physical restraint the circumstances , including the nature of the restraint must be recorded. This will ensure incidents involving restraint are evaluated and action taken to prevent incidents from reoccurring in the future. 09/01/2009 3 22 13 The manger must consult with an Occupational Therapist (OT) to ensure people are assessed for the correct slings, in relation to 24/01/2009 Care Homes for Older People Page 30 of 33 their weight, height and size. This will ensure the people using the service are provided with equipment that is suitable for their individual needs. 4 26 13 The infection control policy 24/01/2009 and procedure for dealing with soiled linen need to be amended to comply with the Department of Health guidelines(DOH), Essential Steps. This will reduce the risk of cross infection and ensure the safety of the people who live in the home. 5 30 18 Persons employed in the care home must receive training appropriate to the work they are to perform. This will ensure staff have the knowledge and skills to support people with mental health needs, which is based on current good practice. 6 37 13 Where there is a potential 24/01/2009 risk to service users safety, a risk assessment must be carried out and signifcant findings recorded showing the action taken to minimise the risks. This will ensure the safety and welfare of the poeople living in the home. 7 38 23 Following consultaion with the fire service, the 24/01/2009 31/01/2009 Care Homes for Older People Page 31 of 33 regsitered person must take adequate preecations against the risk of fire, including adequate arrangements for containing fires. This will ensure the safety and welfare of the people living and working in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The statement of purpose requires some amendments to accurately reflect Colne House, their are some typing errors and incorrect information relating to other services owned and run by the same organsitaion. The manager should look at devising a way of monitoring the weight of people who are on permanent bed rest. If significant weight loss is identified a prompt referral should be made to an appropriate specialist. Consideration should be given to splitting mealtimes into smaller sittings to promote a more relaxed and social setting at mealtimes. Staff working in the home should be provided with adult safeguarding training and information in a format they understand to ensure people using the service are protected from abuse. The smaller service in the annex could be further developed to encourage and support the people who live there to experience a more independent lifestyle. The manager was advised they need to revisit the homes fire risk assessment to ensure it complies with the governments most recent legislation for fire safety in residential care premises. 2 8 3 15 4 18 5 19 6 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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) Commission for Social Care Inspection (CSCI). 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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