Inspection on 17/09/08 for Colonia Court

This inspection was carried out on 17th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Colonia Court 15/12/09

Colonia Court 25/09/07

Colonia Court 11/10/06

Colonia Court 14/03/06

Colonia Court 10/03/06

Colonia Court 10/01/06

Colonia Court 19/12/05

Colonia Court 03/11/05

Colonia Court 15/03/05

Colonia Court 01/02/05

Colonia Court 13/01/05

Colonia Court 09/12/04

Colonia Court 09/11/04

Colonia Court 13/07/04

Colonia Court 07/07/04

Colonia Court 22/06/04

Colonia Court 15/06/04

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Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Colonia Court St Andrews Avenue Colchester Essex CO4 3AN     The quality rating for this care home is:   three star excellent 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: 1 8 0 9 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 34 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 34 Information about the care home Name of care home: Address: Colonia Court St Andrews Avenue Colchester Essex CO4 3AN 01206791952 01206794230 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: BUPA Care Homes (CFHCare) Ltd care home 123 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: Amber Lodge - persons of either sex, who require nursing care by reason of Huntington`s Disease (not to exceed 28 persons) Blomfield House - persons of either sex, who require nursing care by reason of physical disability (not to exceed 30 persons) Mumford House - persons of either sex, who require care by reason of dementia (not to exceed 30 persons) Paxman House - persons of either sex, who require nursing care by reason of physical disability (not to exceed 35 persons) The maximum number of service users who can be accommodated is 123 The registered person may provide the following categories of service: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories Dementia - Code Care Homes for Older People Page 4 of 34 Over 65 0 0 123 0 123 123 0 123 DE Mental Disorder, excluding learning disability or dementia - Code MD Physical Disability - Code PD Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Colonia Court is registered to provide nursing and care for up to 110 residents. The site is separated into four houses. Residents are accommodated in single rooms, all with en-suite toilet and basin. Each house has a good range of communal rooms and the accommodation is all on one level. The houses are staffed on an individual basis and the central services include administration, laundry and kitchen. The home has car parking facilities and gardens attached to each house. Colonia Court is set in a residential area and is approximately one mile from Colchester town centre and two miles from the railway station. Buses run along St Andrews Avenue outside the home. The range of fees at Colonia Court in October 2006 were: personal care £590 - £630, nursing care £600 - £630, care for Huntingtons Disease £2000 - £2700. The fees were dependent on assessments. The higher range of fees on Amber Lodge for Huntingtons Disease was for 1:1 or 1:2 care. Items such as toiletries, newspapers, hairdressing and private chiropody were charged for separately. The home had a range of information for potential residents and their representatives. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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 and lasted two days. This was a key inspection, which focused on the core standards relating to older people and to follow up concerns raised with the Commission for Social Care Inspection (CSCI) about practice issues, which resulted in a safeguarding referral being made to the local authority safeguarding team. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from fourteen residents, seven relatives, two healthcare professionals, two staff Have Your Say surveys 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). Care Homes for Older People Page 6 of 34 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 safety. Time was spent talking with people who live in the home, a nurse from the Primary Care trust (PCT), two relatives and nine staff. The service manager was available during the inspection and fully contributed to the inspection process. An Expert by Experience, Jan Howard, joined us on the first day of the inspection. Experts by Experience is used to describe people whose knowledge about social care services comes directly from using them. What the care home does well: What has improved since the last inspection? What they could do better: Information about the service should be updated to reflect the revised contact details of the Commission for Social Care Inspection (CSCI), which is via the Regional Contact Team (RCT). People living in the home funded by the Local Authority should be provided with a statement of the terms and conditions of residence between themselves and BUPA, which sets out the roles and responsibility of the provide and the rights and obligations of the individual, whilst living in the home. To ensure medication is administered properly and safely, the revised monitoring and auditing of medication practices need to be closely supervised by the registered manager. They must also ensure that accurate records are maintained in relation to medications received into, and managed by, the home. There must be sufficient staff available at all times to meet the health and welfare needs of the people living in the home. This particularly relates to Amber Lodge. People using the service and their relatives told us they would like to have more regular staff Care Homes for Older People Page 8 of 34 and not so many agency staff, who have limited knowledge of Huntingdons disease. They also commented in the main we are very satisfied with the care provided, but staff ratio to residents may need to be looked at. Excluding registered nurses, the manager needs to ensure that staff are encouraged to complete a National Vocational Qualification (NVQ) to meet the recommended National Minimum Standard (NMS) of 50 of staff to be trained at NVQ level 2 or above. 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 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into this home will be provided with information and the opportunity to visit, before making a decision if Colonia Court is suitable for them. Evidence: The homes statement of purpose clearly sets out the objectives and philosophy of care, specialist services, qualifications and experience of the staff and how to make a complaint. A choosing a home leaflet is also included. Each person moving into the home is also given a welcome pack, which sets out the services provide, including catering arrangements and access to health care services. The information on how to contact the Commission for Social Care Inspection (CSCI) needs to be amended to reflect the Regional Contact Team (RCT) details. People living in the home and their relatives, who completed our (The Commissions) Have your Say surveys, said that they had received enough information about the Care Homes for Older People Page 11 of 34 Evidence: home to help them decide if Colonia Court was the right place for them to live. Surveys also confirmed information provided in the AQAA that prospective residents and their families are encouraged to visit the home prior to admission, to the meet the staff and other people already living in the home. The expert by experience said A relative explained how they had looked at several homes, but knew when they came to Colonia Court that my relative wouldnt be going anywhere else. They spoke very highly of the home, and the way the staff had helped their relative settle in. They were genuinely surprised how quickly their relative had adjusted , and now feels they would not want to live at home again. Four people living in the home (one from each unit) were tracked as part of the inspection process. Records held about these people showed that pre-admission assessments had been completed in detail and had sufficient information recorded about the person so that the manager could determine whether staff at the home could meet their individual needs. They also showed that once the individual had moved into the home, the initial assessment was reviewed and amended to reflect if there had been any changes. Each person has a contract of residence, however two of these contracts were between the authority funding the individual and Colonia Court. People living in the home should be provided with a statement of terms and conditions of residence, which sets out the roles and responsibility of the provider and the rights and obligations of the individual, whilst living in the home. People told us about their different experiences about moving into residential care and why they had chosen Colonia Court. Comments included, my relative was not in a position to make a decision at the time, therefore we, the family, identified the home and introduced our relative to it and my relative mostly has positive comments and since being at the home, the staff have provided more care to my relative as they get older and frailer. People also told us my relative seems very happy at the home, they like the staff and attention they give to them and my relative has settled in well and frequently says they would not wish to go to another home. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good 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 receive health and personal care based on their individual needs and can be assured that where errors are identified, prompt action is taken to ensure that their medication will be administered properly and safely. 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 background, health, personal and social care needs. There was evidence that wherever possible the resident of their family had been involved in planning their care. Observation and discussion with 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. The AQAA states risks to the health and welfare of residents are assessed. Care plans seen contained supporting assessments to confirm this information. Risk assessments relating to mental and physical health as well as nutrition, risk of falls, skin integrity, Care Homes for Older People Page 13 of 34 Evidence: waterlow and pressure area care and moving and handling are in place, supported by personal health, nursing and dietary charts. 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. Daily records are well written providing a good overview of how each person has spent their day. This included what has worked for the individual, where there has been progress, achievement or any concerns about their health and welfare. During our visit we looked at Medication Administration Records (MAR) charts in both Mumford House and Amber Lodge. Examination of the MAR charts in Mumford House, which provides care to people with dementia, highlighted eleven separate occasions where staff had not signed to reflect they had administered peoples medication, with no reason or explanation recorded on the reverse of the MAR chart. Examination of MAR charts and medication held in Amber Lodge, which provides care to people diagnosed with Huntingdons disease, identified the following concerns, regarding a service users medication. Citrolopram should have been dispensed for the morning dose, on the 17th September 2008, however no signature had been entered on the MAR chart to reflect this. A count of the individuals Lorazapam against the MAR chart reflected one tablet was missing/unaccounted for. Additionally, a count of Olazapine against their MAR chart reflected one tablet was missing/unaccounted for. A check of the MAR chart against another service users balance/stock of Metrochopamide identified on the 17th September, they should have had a balance of fifty-nine tablets. The actual balance was sixty, which would reflect, that on one occasion their tablets had not been administered, but had been signed as given. The service manager was left an immediate requirement on the first day of the inspection to deal with these issues, to ensure people using this service receive the correct levels of medication. Issues about medication would normally affect the rating in this outcome group, however, to be fair and proportionate, it is recognised that the service manager had taken immediate action implementing an action plan of how to address the concern about medication by the following morning. They had completed a full audit of medication in Amber Lodge and arranged with BUPA quality and compliance team to undertake a full audit of all houses. The service manager has notified us (The Commission) following the inspection, in writing, of what they have done to address these issues and reduce the risk to people using the service. As well as arranging for a full audit of medication, new systems have been established, which are being monitored using a new auditing tool, focusing on staff competency. Additionally, all nursing staff responsible for administering medication have attended further medication training. Care Homes for Older People Page 14 of 34 Evidence: Observation and discussion with staff confirmed that they were 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. People living in the home are supported to access health care services. Dates and details of appointments are clearly recorded in their care plans. Health care needs of the people using the service are managed by visits from local General Practitioners (GP) and district nurses. Time was spent talking with a Primary Care Trust (PCT) nurse who was undertaking health care needs assessments for a number of people residing at the home to determine continued health care funding. As part of their assessment process the nurse looks at care plans. They confirmed these are good, easy to read and clearly reflect the individuals up to date needs. They described the care being provided in the home as generally good and that they had not come across any issues and that staff are open to suggestions and are aware of peoples health needs. Information provided in health professionals Have your say surveys confirmed staff are proactive in requesting advice and support, particularly where there are concerns regarding development of pressure area damage or minor injuries. Comments taken from the surveys include we are building a good relationship with mutual trust and respect with the staff at Colonia Court and the care team are able to discuss and negotiate appropriate care management for residents with mental health difficulties and the care team have a positive attitude to building their knowledge base and development of the skills and understanding they need with this specific client group. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines of daily living and activities available are flexible and varied, however people told us they would like to see more staff available to support individualised activities. Evidence: The expert by experience was asked to look at all of the outcome areas listed above. In total, they spent over four hours at Colonia Court, firstly in Mumford House, where they spent most of the time and had lunch with the people living there. This is the house specifically for people with dementia. Conversations with residents, one relative and the staff, reflected that Mumford House appears to be a well-run, happy and relaxed home. The expert by experience said all residents appeared clean, well-dressed, with appropriate clothing for the weather of the day. This was with the exception of one person, whose clothing did not really seem to match, but in conversation with staff later, they stated that they try not to interfere with residents who have tried to dress themselves, even if the combination of clothing might seem slightly bizarre. The staff understood the importance of giving residents as much independence and choice as Care Homes for Older People Page 16 of 34 Evidence: they were able to manage. A member of staff mentioned that it had been a residents birthday the day before, and because they were tired, (and wanted it to still be their birthday) they had chosen to stay in bed most of the morning, and have lunch in their bedroom. This was clearly not a problem to the staff, and it seemed to me that this showed residents could make a choice about how, and where they spent their time. A number of the residents are quite physically fit and mobile, and spend most of the time wandering about the home. It was nice to see that they were not asked to sit down, but were regularly interacted with in a very kind manner, whilst respecting their desire to be on the move. It also appeared that those who chose to sit and relax, could do so whenever they wanted rather than having particular places chosen for them to sit. One relative spoke very movingly about how hard it is to deal with someone suffering with dementia, and what a painful decision it had been to find residential care for them. They commented that they are very happy with the care their relative receives. For lunch there was a choice between fish or beef hotpot, both of which smelled very appetising, and looked very appealing. There was a good selection of fresh vegetables served alongside. Most residents sat at the tables in a very pleasant dining area, but a few who were less mobile, were assisted to eat their meal in their chairs. Some people had their food chopped/pured to make it easier for them to feed themselves, each food item was kept individually, so they could still enjoy the variety of flavours. People living in the home were complimentary about the food, comments included food is very good and there is a good choice of food. During lunch there were a couple of altercations between residents, which were dealt with very calmly and efficiently. One resident threw a place of food with some force, but the situation was very quickly diffused, and the remains cleared up. The staff appear to be extremely patient, and have a full understanding of those in their care. When serving up the food, and when clearing away, the staff engaged the residents in very easy, friendly banter, and it was obvious that there was real concern and care for each person. When asked about any particular resident, the staff were well informed about their history, family life and details of where they had lived, which showed that they saw residents as individuals. This information was also used in conversations as stimulation to memory. Time was spent talking with the manager of Mumford House, who had been in post for only a few months. They were absolutely delightful, a real carer who did not claim to be perfect, stating there is always something new to learn which I found to be a very Care Homes for Older People Page 17 of 34 Evidence: refreshing attitude. They were very complimentary about the staff, most of who have been there for a number of years. I too was very impressed by the staff, who appeared very caring and understanding. They clearly work well together as a team, but their conversations were very person-centred rater than talking amongst themselves. It was lovely to see the staff having friendly banter with some of the residents, laughing over an event, or an outing they had been on together. Bloomfield House has a very different feel to it, people living in this house do not have dementia. Again, this had a lovely caring atmosphere, but these residents had more of a rapport with each other and it was very nice to join in their conversations. They all seemed very happy with the care they receive, although many of them stated how difficult it was to leave their own homes. One person said if I have to be in a home, then I am grateful it is this one. Some people like to go to the local supermarket occasionally for a coffee. Staff said some people like baking. The information provided by the expert by experience (above) was supported by information provided by the inspector (below). Discussion with residents, activities co-ordinators and the service manager, confirmed there are a range of activities provided including foot-spas, hand massages and manicures. The home has recently employed a therapist who is qualified to undertake reflexology and aromatherapy. Other activities include bingo, cross stitching and knitting groups, clothes parties, cooking old fashioned biscuits, flower arranging and gardening. Entertainment is regularly arranged, bringing musical entertainment into the home, and celebrations on important dates such as Victory in Europe (VIE day. Cheese and wine evening have been held, as well as a pink day raising awareness for cancer. Activities co-ordinators have access to community transport monthly to escort people out shopping or to other places on interest. A relative confirmed a member of staff is always made available to accompany them, when taking their relative out for a walk or shopping. Comments taken from the Resident Customer Satisfaction survey 2007, reflected that 92 of respondents were happy with the activities provided, which was an increase of 4 from the 2006 survey. However, comments reflected staffing levels impacted on the level of activities being provided. Comments included, more staff would make me happy and improve my stay here, then I will have more time to communicate with them and personal disability makes it difficult to access activities, but games have come to a stop and we would like to go out shopping with staff if possible. Feedback in residents and relatives Have Your Say surveys also provided mixed comments about the level of activities and staffing provided in the home. Comments included the more capable residents are allowed to live fairly independent lives, however less Care Homes for Older People Page 18 of 34 Evidence: capable are sometimes left unstimulated and most of the care staff appear to have a healthy attitude to wards the residents under their care, as with many care environments there are never enough staff employed to cater for all peoples needs all of the time and the staff in Bloomfield House manage the needs of their residents effectively and efficiently, though do not have enough time to give one to one care a much as they would like. Following lunch, an arts and crafts session took place in Mumford House. The session showed staff have mixed ability supporting people with dementia, this was discussed with the manager as a training need. One member of staff was clearly engaged with a resident who was taking part in the activity. Other staff were completing the task for the residents, although they were including residents in conversations. Staff were also observed having one to one conversations with individuals not taking part in arts and crafts. Time was spent talking with four residents residing in Blomfield House who told us we are happy with service, we can do as we wish, we get up and go to bed when we like. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service can be confident that their concerns will be listened to and acted on, and are protected from abuse. Evidence: Information provided in the AQAA and verified at the inspection, confirmed that Colonia Court has a clearly defined complaints policy. There are several contact points within the home, and throughout the company, to ensure complainants have a choice of who they make a complaint to. The complaints log showed that there have been fifteen complaints made about the service since August 2007. Records showed that complaints have been investigated and responded to within the agreed timescales and a record of the outcomes, as to whether the complaints had been upheld or not, were recorded. People using the service, and their relatives told us if they have any concerns about the service they are able to raise them with the registered manager, and are confident that their concerns are dealt with. The expert by experience said; one relative told me they had experienced some problems recently, but knew who to go to and was confident that these issues were being addressed, and that the matter would be resolved. Care Homes for Older People Page 20 of 34 Evidence: In addition to a complaints log, the home has a record of compliments. The file shows the service has received forty-seven cards and letters of thanks to the manager and staff for the tact, care and kindness provided to their relatives. These included we are confident that we have found the right place for our relative and thank you for the wonderful care you gave our relative and thank you for treating our relative with dignity and respect and for providing a high standard of medical care. BUPA have a robust policy and procedure for dealing with allegations of abuse of neglect. In accordance with this policy the registered manager has kept us informed of incidents, which have required safeguarding referrals. However, both incidents appeared in the first instance to have been investigated by the registered manager, rather than making the appropriate referrals. Further conversation with the registered manager and responsible individual employed by BUPA, confirmed appropriate referrals had been made to Essex County Council, Adult Health and Community Wellbeing team. BUPA are currently in the process of reviewing their safeguarding policy and procedure to ensure it complies with Local Authority reporting procedures. This was discussed with the registered manager who needs to ensure all staff are made aware of the revised safeguarding adults policy and made aware of the reporting procedures. The BUPA whistle blowing policy is promoted and included in monthly audits. There is also an ongoing programme for staff training, which includes training in respect of dealing with complaints, safeguarding people living in the home and whistle blowing. Staff spoken with were able to demonstrate that they were aware of the action to take if they suspect of witness any ill treatment of people living in the home, but were less clear of the reporting procedures (to the Local Authority) outside the line management structure of the home. The expert by experience said a number of the residents in Mumford House were seen to be especially challenging, ranging from quite aggressive behaviour, periods of distress, or a complete inability to communication verbally. All of these were observed to be dealt with in a very calm, kind and efficient manner. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Colonia Court provides the people who live there with a safe, well maintained and comfortable environment. Evidence: Colonia Court is made up of four houses, Amber, Paxman, Blomfield and Mumford. The main building consists of central services, which include reception and administration, the laundry and kitchen facilities. Communal rooms include an Internet cafe, a large lounge with a wide screen television, smoking room and a therapy room. The home has car parking facilities and gardens attached to each house. Accommodation is all on one level making all areas of the home accessible for people who use a wheelchair. A tour of the premises confirmed information in the AQAA that a refurbishment programme of all houses is near completion, which has included additional bedrooms being added to Amber and Paxman Houses. Each of the houses has been decorated and new furniture, flooring, pictures and curtains have been provided creating a warm, homely and comfortable environment. All bedrooms are single, with en-suite toilet and basins, good lighting and safe radiators. Peoples rooms are nicely decorated, reflecting individual personalities and interests. Care Homes for Older People Page 22 of 34 Evidence: The expert by experience said one of the residents offered to show me their room, and clearly enjoyed giving me the tour. Their room was very pleasant, which they had personalised with pictures of their family, and items brought from their home. They were clearly very proud of their personal space, and chatted for some time, looking out over the lovely gardens. They told me I consider myself to be very fortunate, to be living in such a lovely home, what more could I ask for. Memory boards were seen outside each residents bedroom, which contained photographs, memorabilia, and keepsakes relevant to them. This helped residents recognise and remember their own rooms. These are also a constant reminder that these elderly people have lived full and active lives. The memory boards also made the corridors far less boring and bland, as there was always something to stop and look at when walking. Appropriate aids and equipment to transfer immobile people safely and comfortably, and to encourage independence are available throughout the home. These include grab rails, adjustable beds with integral bed rails fitted, assisted baths and toilets and a variety of hoists. The home is equipped with lifting equipment that suits the needs of people who live there. Records were available to demonstrate that checks were carried out on all equipment so as to ensure that it was maintained in good working order. People assessed as at risk of developing pressure areas, had been provided with pressure relieving equipment. Care plans contained support plans for peoples personal hygiene, bathing and showering. These included risk assessments around water temperatures to ensure people were not at risk of scolding. Random checks of water temperatures in bathrooms and showers and examination of maintenance records confirmed temperatures are within the safe recommended guidelines of 41 degrees Centigrade for showers and 44 for baths. The AQAA states we have a committed and enthusiastic house keeping team who ensure cleanliness is maintained to high standards and the premises are odour free. A tour of the home and information received in residents and relatives Have Your Say surveys, confirmed this. Inspection of the laundry facilities confirmed the home has good procedures in place to prevent and control the spread of infection. The laundry was clean and tidy, with appropriate equipment to launder soiled linen, clothing and bedding. Appropriate hand-washing facilities of liquid soap, paper towels, gloves and aprons are situated in peoples rooms, bathrooms and toilets, where staff may be required to provide assistance with personal care. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are supported by staff who have the skills and knowledge to do their jobs, however, there are not always sufficient staff available to meet the specialist needs of the people who reside in Amber Lodge. Evidence: Each of the four houses are staffed on an individual basis with an allocated manager post. These posts are not registered separately with us. The four unit managers report directly to the Registered Manager for the service. The rotas seen for each house, confirmed the following staffing levels. Amber Lodge, which provides care for 28 people with Huntingdons disease, have 9 staff on the morning shift, 9 in the afternoon and 6 at night. Mumford House provides care for 30 people with dementia, with 6 staff on the morning shift, 5 in the afternoon and 3 at night. Blomfield House provides care for 30 older people with 5 staff in the morning, 4 in the afternoon and 2 at night. Paxman House provides nursing care for 35 people with 8 staff in the morning, 7 in the afternoon and 4 at night. These were the figures provided at the inspection. However, an examination of the working rotas for the two weeks commencing 12th September showed that these levels are not always maintained. This is of particular concern in Amber Lodge, which was confirmed in discussion with relatives, and from feedback in relatives Have Your Say surveys. Care Homes for Older People Page 24 of 34 Evidence: Concerns were raised about the management arrangements, staffing levels and the use of agency staff who have limited knowledge about Huntingdons disease. Another relative spoken with confirmed staffing levels were at time short, but stated, I am totally satisfied with the service my relative receives. Other comments included, it sometimes appears that there are too few staff, for example my relative was taken to the toilet and forgotten for 20 minutes and there appears to be a rapid turnover of junior staff. Similarly, the staff Have Your Say surveys reflected concerns relating to Amber Lodge. In general issues raised were about lack of management arrangements after the long-standing manager left, and there was a shortage of qualified staff with an understanding of Huntingdons disease. Staff commented we have had lots of problems, with staffing, communication barriers, no on call system during the night, with no support from management and we are always short of staff which causes stress as we cannot meet peoples basic needs and we are often working understaffed, we are able to ring agency, however, the necessity for permanent staff to consistently guide and instruct agency impacts on the workload of the permanent staff. The registered manager confirmed the long-standing manager of Amber Lodge, was dismissed earlier this year. Another unit manager had been appointed, however they too have recently been dismissed. A senior has been appointed in an acting up role for Amber Lodge in the interim. Time was spent in Amber Lodge with the acting manager who appeared confident and competent in this role. They confirmed they had had appropriate training, provided by the Huntingdons disease association to support people with Huntingdons disease. They are a registered nurse and have completed a mentorship, training and supervisory course in October 2007. They are responsible for supervising staff and provided information of a recent staff meeting where issues about Amber Lodge and the care being provided had been discussed. They confirmed there had been a shortage of staff recently, but were allowed to use agency staff to make up the shortfall, although they identified that the combined agency and permanent staff are not able to carry out the same workload effectively. The registered manager provided evidence that they are in the process of recruiting new staff. They confirmed staffing levels have been a concern, as a lot of staff from Amber Lodge and Paxman House had recently left, and maintaining staffing levels over the summer months whilst covering annual leave, sickness and maternity leave had caused problems, but stated they had rarely dropped below seven staff on shift in each of the units. They are currently working in conjunction with an employment agency to find permanent staff on an eight weeks trial basis, who will then, if suitable convert to full time employees. The manager also stated they will be advertising to recruit a Care Homes for Older People Page 25 of 34 Evidence: senior manager for Amber Lodge and a head of clinical care for the whole service. Observations and discussions with staff in the other units reflected there were adequate staff to meet the needs of people in their care. The expert by experience said there appeared to be ample staff on duty at all times, and residents had plenty of interaction with them. Whenever a problem arose, or somebody needed help it was quickly dealt with, efficiently and more importantly with care. Information provided in the AQAA and verified at the inspection, confirmed the manager of the home operates a robust recruitment process. Examination of four staff files confirmed that people had been recruited according to the homes policy and that all of the checks as required by regulation, to safeguard people living in the home had been obtained. Health professionals Have Your Say surveys, complimented the staff team, commenting I have always found the care team pleasant and approachable. I believe they have a strong leadership base that appears to care equally for staff team and residents well being and staff are good at acknowledging gaps in their knowledge and skill base and will ask for support and guidance, accepting strategies to meet residents individual needs and working together as a team to provide a high standard of care. One health professional commented, further improvements that could be made to the service, would be to appoint more staff to balance the staff and resident ratio to a manageable level. As part of a large organisation, the registered manager is able to access a wide range of training. There is an on-going programme of mandatory training, such as moving and handling, medication, fire safety, infection control, health and safety, safeguarding adults, food hygiene and Control of Substances Hazardous to Health (COSHH). More specific training to meet the needs of people living in the home and to protect their health and welfare has consisted of continence product education sessions, understanding MRSA, Mental Capacity Act, understanding dementia, managing challenging behaviour in the workplace, seminar on the funeral profession and a wound care study day. Additional training is being provided to staff to enable them to provide palliative care at the end of stages of peoples lives. Staff liaise closely with the Huntingdons society, who provide training to ensure staff are able to provide appropriate support to people living in the home who have the disease. BUPA operate a personal best programme, which encourages staff to do their personal best and is linked to a reward scheme. BUPA also provide on-going Quest Training for champions, who cascade the key operating guidelines developed across Care Homes for Older People Page 26 of 34 Evidence: the company, to ensure staff work to the required standard and have the practical skills to support the people using the service. Link nurses are also identified for key areas such as pressure area care. BUPA has its own National Vocational Qualifications (NVQ) programme. However, it was noted that the home employs 150 staff, and currently only 22 hold an NVQ at level 2 or above. These figures reflect that the service has not yet met the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. The home has a training co-ordinator who has been recruited to oversee the staff development and training programme and to ensure refresher training is kept up to date. Additionally, they are responsible for ensuring all new staff complete and induction programme. There was evidence in the staff files seen that induction training which met the required standard, had been completed. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service can be assured that they live in a home which is run in their best interest, which is tested by an effective quality monitoring system. Evidence: The home is well managed. Residents, relatives and staff told us they are regularly consulted about how the home is managed. BUPA operates a 360 degree, Surveying Our People (SOP) feedback for managers, which monitors and audits how the home is managed. This includes regular checks to assess staff training, medication, care planning and hospitality. This information is collated and used to produce an action plan to address issues where the manager needs to make further improvement. The registered manager completed the AQAA, which provided us with clear and relevant information. The manager told us about changes that have been made to improve the service and demonstrated a clear understanding of where improvements need to be made and how these are to be implemented. Managers from each unit and Care Homes for Older People Page 28 of 34 Evidence: staff confirmed they had regular supervision. People confirmed the registered manager is approachable, helpful and supportive, and will discuss issues and provide advice, as requested. The manager demonstrated they are quick to manage situations and identify where action needs to be taken. On the first day of the inspection the manager was left an immediate requirement regarding medication errors. When we returned the second day they had taken immediate action, implementing an action plan to address medication concerns. A full audit of medication in Amber Lodge had been completed, they had also arranged for BUPA quality and compliance team to visit the home the following week to undertake a full audit of medication in each of the four houses. They had held a meeting with all nursing staff and had arranged for further medication training to take place. A new audit tool was introduced immediately on the 18th September to monitor the effectiveness of medication management in the home. The registered manager agreed to provide a copy of the completed audit to us on completion, with the outcome and what they intended to do to address future errors. Information provided in the AQAA and verified at the inspection, confirmed the home has an effective quality assurance and monitoring system in place. Customer satisfaction surveys are independently collated to ensure residents and relatives feel comfortable providing direct feedback. The results are built into overall performance reviews for the individual services. A copy of the homes satisfaction survey for 2007 was provided at the inspection. This showed that residents and relatives satisfaction with the service had improved for the fifth consecutive year. Comments included I think everything is fine and the home is beautifully run and no complaints, everything is nice and cant think of anything to improve, everybody is kind and everything is fine. Whilst the majority of comments were positive, other comments included, more staff would make me happy and improve my stay here, then I will have more time to communicate with them and I would like more staff and better food. Where people are unable to manage their own finances the manager, local authority, relatives of other representative act as appointee for people living in the home. Residents also have the opportunity to have their money banked in an interest bearing bank account. Those who choose to do this do not have individual cash accounts, however the rate of interest applied to their account is calculated in proportion to their balance. Deposits are made into the cash account to allow personal spending for sundries, hairdressers, chiropodist and newspapers. Records of all transactions and balances are computerised, these were checked and were found to be accurate. The home takes steps to safeguard the health, safety and welfare of people living and Care Homes for Older People Page 29 of 34 Evidence: working in the home. The most recent Gas and Electrical Safety Certificates, including Portable Appliances Testing (PAT) were seen and records showed that equipment is being regularly checked and serviced. The building complies with environmental health standards and the local Fire Service requirements. The fire alarm system is serviced on a regular basis. The fire logbook confirmed that regular training and drills are taking place. The homes fire risk assessment is dated 2004, this needs to be updated to comply with the Fire Safety Order as per the Governments Fire Safety Risk Assessment for residential care premises 2006. The manager advised this was currently in process of being updated and re written and agreed to forward a copy of the completed assessment to us. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must 17/11/2008 promote and make proper provision for the health and welfare of service users by ensuring that prescribed medicines for service users in safe control and custody of the home are given in accordance with the doctors instruction as specified by the pharmacy issuing the medication. This will ensure that medication is administered properly and safely. 2 9 13 The registered person must 17/11/2008 put in place suitable arrangements at the home to ensure accurate records are maintained in relation to medications received into, and managed by, the home. This will ensure that medication is administered properly and safely. 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 27 4 The registered person must ensure there are persons working in the care home at all times, in such numbers 30/12/2008 Care Homes for Older People Page 32 of 34 as are appropriate to meet the health and welfare needs of the people who live there. This will ensure their are sufficient staff available to meet peoples needs. 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 Information about the service should be updated to reflect the revised contact details of the Commission for Social Care Inspection (CSCI), which is via the Regional Contact Team (RCT) . Where people living in the home are funded by the Local Authority, they should be provided with a statement of the terms and conditions of residence, between themselves and BUPA, which sets out the roles and responsibility of the provider and the rights and obligations of the individual, whilst living in the home. The registered manager should ensure all staff are made aware of the revised safeguarding adults policy and ensure they are aware of the reporting procedures Excluding registered nurses, the manager needs to ensure staff are encouraged to complete a National Vocational Qualification (NVQ) to meet the recommended National Minimum Standard (NMS) of 50 of staff to be trained at NVQ level 2 or above. 2 2 3 18 4 28 Care Homes for Older People Page 33 of 34 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. 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