Inspection on 16/02/09 for Coniston

This inspection was carried out on 16th February 2009.

CSCI found this care home to be providing an Good 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

Coniston 19/02/07

Coniston 06/03/06

Coniston 12/10/05

Coniston 21/03/05

Coniston 28/09/04

Coniston 25/02/04

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Coniston Garfield Road Felixstowe Suffolk IP11 7PU     The quality rating for this care home is:   two star good 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: Julie Small     Date: 1 6 0 2 2 0 0 9 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 36 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 36 Information about the care home Name of care home: Address: Coniston Garfield Road Felixstowe Suffolk IP11 7PU 01394278484 01394274441 leanne.seager@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Colin Robert Bentley care home 21 Number of places (if applicable): Under 65 Over 65 0 21 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 1 0 Care Staff on Duty There will be a minimum of 3 (three) care staff on duty at all times between 08.00 and 22.00, and 2 (two) carers on duty at all times between 22.00 and 08.00. Designated Double Room All bedrooms to be single accommodation except Room 7 which is designated as a double room if required. Number of Service Users The number of service users is not to exceed 21 (OP 21, MD 1) Date of last inspection Brief description of the care home Coniston is situated in a residential area of Felixstowe, a busy seaside town with a good selection of shops and sea front facilities. The building is believed to be approximately 100 years old and is built into the cliff side. A new extension was completed in 2004, which adds a first floor level to the building. The bedrooms in the home have en-suite facilities including a shower, and all doorways are wide enough to allow the easy passage of wheelchairs. Care Homes for Older People Page 4 of 36 Brief description of the care home The entrance to the home is on this first floor, leading off the driveway across a footbridge, and provides level access to the home. The lounge and Dining Room have very pleasant views with the new bedrooms upstairs to the front of the building have views out over the sea. The Home has a pleasant, well-tended garden with shrubs and pots, which are looked after by the more able service users. A large area of wooden decking has been built to the rear of the house, and there is a summerhouse at the end of the garden that service users are able to use. The manager stated that the current scale of charges was £354 to £575, with additional charges for chiropody services, hairdressing, public transport and requested newspapers. Care Homes for Older People Page 5 of 36 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: two star good 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 unannounced inspection took place Monday 16th February 2009 from 09:10 to 17:10. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small, who was accompanied by regulation manager, Karen Howman, as part of the CSCI (Commission for Social Care Inspection) quality assurance processes. The registered manager and the provider were present during the inspection. The requested information was provided promptly and in an open manner. Three staff members and four people that lived at the home were spoken with. We tracked the care records of three people that lived at the home and the records of a further two people were viewed. Further records that were viewed are identified in the Care Homes for Older People Page 6 of 36 main body of this report, which included three staff recruitment records and five staff training records. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home and was returned to CSCI (Commission for Social Care Inspection) within the required timescale. Staff, relative and service user surveys were sent to the home. Two staff, six relative and nine service user surveys were returned to us. What the care home does well: What has improved since the last inspection? What they could do better: The administration of insulin was being undertaken at the home. The manager and a staff member that were spoken with stated that they had been provided with training to administer the insulin and they clearly explained the procedures. However, there was no documentary evidence to show that this training had been provided, the manager told us that they would ensure that the training would be recorded. There also needed to be written guidance in place to ensure that the insulin is administered safely. To ensure that peoples needs can be met by the home the assessment process needed to be improved. There needed to be the provision of clear processes and procedures to appropriately cleanse commodes to ensure that cross contamination is minimised. The service was overall a good service, which provided good outcomes for people who lived there. The manager assured us that the shortfalls that had been identified would be addressed. Care Homes for Older People Page 8 of 36 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 36 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 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be provided with a written statement of terms and conditions of the home and to have their needs assessed prior to moving into the home. However, they cannot be assured that the assessment process is sufficient to ensure that their needs are met when they move into the home. The home does not provide an intermediate care service. Evidence: The AQAA stated at Coniston we do not provide short intermediate care, this is mainly due to the waiting list that we have at Coniston as rooms are filled as soon as they become vacant. The records of five people that lived at the home were viewed and each held a contract and a statement of terms and conditions of living at the home, which had been signed by the person and the homes manager. The terms and conditions included details of Care Homes for Older People Page 11 of 36 Evidence: the support that was provided at the home, details about trial visits and CSCI (Commission for Social Care Inspection) contact details. It was noted that they had been updated to show the current CSCI contact details. The document did not identify the actual fees that people paid to live at the home. The provider was spoken with and stated that people were informed of the fees verbally when they moved into the home and changes to the fees were communicated to them by letter. The fees needed to be included in the terms and conditions. Seven service user surveys stated that they had received a contract, one said that they had not and one stated have forgotten receiving my contract but have been shown my contract. Peoples records held needs assessments which had been undertaken by the homes manager prior to them moving into the home. The records of one person who was a local authority customer also held a local authority needs assessment. The AQAA stated as part of the pre-admission process it is essential that a full needs assessment is undertaken, as the manager it is my responsibility to carry out this assessment. I usually visit the potential resident in their own home. Also family are invited to attend the assessment and are encouraged to have an input into the process. The AQAA said that they had made improvements to the assessment process and stated with the improved pre-admission needs assessment form I have been able to determine whether Coniston would be able to cater for their social and health care needs, not only present but in the long term as well. The form also enables me to look at the long term and decide whether the resident would need more specialised care at a later date, resulting in them having to move from Coniston, we try to avoid this at all times as it causes unnecessary stress to the resident and their family. Coniston was registered to provide care to older people. However, a person had been admitted into the home for which they were not registered. The persons diagnosis had been referred to in the initial assessment and it was noted that here had been no further investigation into the diagnosis of the person and their specific needs following the initial assessment. The manager was spoken with and accepted that they had admitted a person to the home for which they were not registered for and that they were unable to meet the persons needs. Since it had been identified that the persons needs could not be met at Coniston the manager had worked with the persons relatives and had made contact with their social worker to ensure that a more appropriate placement could be found. They accepted that a more robust assessment process and further investigations into the persons needs may have assisted the manager to identify that they could not meet their needs before they moved into the home. We discussed the issues of the assessment process and the registration of the home with the manager and the provider. Care Homes for Older People Page 12 of 36 Evidence: Peoples records that were viewed included care plans which identified how their assessed needs were to be met. Care Homes for Older People Page 13 of 36 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 that use the service can expect to have their needs are set out in an individual plan of care, to have their health care needs met and to be treated with respect. Evidence: The care plans of five people were viewed and each included a care plan which identified how their assessed needs were met. The care plans included details of the support that people required and preferred in their daily living, the areas of their support that they could attend to independently, their preferred form of address, how their diverse needs were met, details of their wishes at the time of death and their preferred routines such as what time they usually got up in the mornings and what time they went to bed. The AQAA stated at Coniston each resident is treated as an individual, with this in mind their personal care plans are in-depth and very informative. The process starts with the pre-admission information and then the care plan is built around the information attained from the resident themselves, their families and advocates if Care Homes for Older People Page 14 of 36 Evidence: used. This helps us to generate a comprehensive and informative care plan enabling us to provide the highest possible care in all aspects of health, personal and social care needs. The care plans included risk assessments, which identified the assessed risks in peoples lives and the methods of minimising the risks. The risk assessments that were viewed included areas of risks in manual handling, Waterlow skin assessments, mobility and personal care. The risk assessments and care plans were reviewed regularly with peoples changing needs and preferences. It was noted that a person had suffered two falls recently and the risk assessments had not been updated to identify how the risks could be minimised. However, two staff members were spoken with and explained the actions that had been taken to minimise the risks to the person, which included the disposal of their slippers, which the staff members said may have been the cause of the persons recent fall. They stated that the staff had been made aware of the issues by the homes management. Daily records were viewed, which clearly identified peoples well being and the support that they had been provided with each day. Each persons records included regular weight checks. There were records of the health care support that people had been provided with, which included doctor, dental and optical appointments. Eight service user surveys said that they always received the medical support that they needed and one said that they usually did. Two people that were spoken with stated that they were provided with the medical support that they needed and one person told us about how an ambulance had been called when they had fallen and that they had requested a doctors appointment, which had been actioned by a staff member in the home. The AQAA stated staff are trained to recognise skin and tissue viability and how to reduce the risk of pressure sores occurring. We work well with the District Nurses who are always called if we feel that a resident may have a potential problem with a pressure area, however we have not had any occurrences of pressure sores developing in the home. This is due to the high standard of care that the residents receive. If a resident is bed fast or of limited mobility then they are either turned on a two hour regular basis and appropriate equipment is supplied to the home through the District Nurses or the Occupational Therapists, or if a resident has been incontinent then they are assisted if needed or encouraged if they are self managing, to wash and change as soon as the incontinence has occurred. We work very closely with the continence adviser who is a regular visitor to Coniston. Three people were visited in their bedrooms and each person had a copy of their manual handling risk assessment and a detailed care plan of how their needs and preferences were routinely met in their bedrooms. Care Homes for Older People Page 15 of 36 Evidence: Two staff members that were spoken with stated that the information that was in peoples bedrooms was in sufficient detail to enable them to support the people in the way that their preferred and needed. The staff survey asked if they were given enough information about the needs of the poeple that they supported, one answered always and one answered usually. Two staff surveys said that the ways that they passed information between staff about the poeple who lived at the home usually worked well. Three people that lived at the home were spoken with and stated that they felt that their needs were met and comments that they made were people are very kind and the staff are very good to me. The service user survey asked if they received the care and support that they needed. Eight answered always and one answered usually and comments included most definately, staff always considerate and willing to give help and support, I have no complaints whatsoever about the treatment I receive. All the staff are wonderful and a very pleasant place to live in. The relative survey asked if they felt that their relatives needs were met at the home. Four answered always and two answered usually and comments included the staff are very aware of my (the person) interests and likes, the gardener will pick (the person) flowers, always willing to discuss needs and give advice and physical needs are addressed very effectively. The survey asked if they relative was provided with the support that they expected or agreed. Five answered always and one answered usually. During the inspection it was noted that call bells were answered promptly and two people that were spoken with said that the staff were quick to answer call bells. It was observed that the call bells had been placed within easy reach of people that were in their bedrooms and the call bell had been pinned to the blanket of one persons bed to ensure that the person had access to it. The service user survey asked if the staff were avilable when they needed them. Six answered always and three answered usually and one commented never had to wait for them. It was noted that people were treated with respect and that their privacy was respected. Staff were observed to knock on peoples bedroom doors before entering and the interaction between staff and the people that lived at the home was observed to be polite, respectful and professional. Four people that lived at the home were spoken with and stated that their privacy was respected, that the staff respected their choices and that the staff treated them with respect. Nine service users surveys stated that the staff listened and acted on what they said and one commented if I ever have a problem they have looked after me and put everything right. Care Homes for Older People Page 16 of 36 Evidence: The relative survey asked if people were supported to live the lives that they chose. Five answered always and one answered usually. Two staff members that were spoken with stated that they had been told how they should treat people with respect and to respect their privacy and dignity in training and in guidance from the homes management. One staff member said that they were confident that all people were treated with respect and stated the owners expect 110 from us in the way that we treat people. The AQAA stated all staff are aware for the need for privacy and dignity, at the induction training it is discussed that at Coniston residents are treated with respect at all times. All staff knock on a residents door and wait until they are told it is OK to enter the residents room before doing so. Whilst providing personal care staff are mindful to respect that not all residents feel comfortable with being assisted with personal care and they are to try to put the resident at their ease and to go at a pace and speed that the resident feels comfortable with. Part of the lunch time medication round was observed and a staff member explained the procedures for the safe handling and administration of medication. People were offered their medication in a polite way and the staff member was observed to check the dosage of the medication to be administered in the MAR (medication administration records) charts and they signed the charts when they had observed people taking their medication. The MAR charts were viewed and it was noted that there were no unexplained gaps and all medication was accounted for. Peoples medication was stored in MDS (monitored dosage system) blister packs in secure cabinets in their bedrooms. Medication that needed to be refrigerated, such as insulin, was stored in a locked refrigerator in the office. The records of regular refrigerator temperature checks were viewed which showed that the medication was stored at the appropriate temperatures. The manager explained that medication was administered by senior staff and they had been provided with medication training to ensure that medication was handled safely. The training records of three staff were viewed which confirmed that they had been provided with medication training through Boots. The manager said that they had been provided with eye care and insulin training from a district nurse. However, there was no certificate or evidence that this had been provided. There was no protocol in place around the use of insulin, such as methods of administration, possible side effects and actions to take if there were concerns about peoples well being and this information was not detailed in the care plan of a person with diabetes that was viewed. The manager stated that insulin was administered by staff at the home and they Care Homes for Older People Page 17 of 36 Evidence: confirmed that they would make contact with the district nurse to discuss the insulin administration in the home. A staff member was spoken with stated that they had been provided with medication training and training from a district nurse for insulin adminstration and eye care. The AQAA stated at Coniston we use the MDS administration system, staff who administer medication have received the appropriate training enabling them to use the correct technique for administration and recording of medication. At the training staff are taught how to recognise any adverse effects or contra-indications with medication being given and that their responsibility is to contact the GP for advice. Care Homes for Older People Page 18 of 36 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. People who use the service can expect to be provided with the opportunity to participate in activities which are of interest to them, to be supported to maintain contact with their family and friends, to be supported to exercise choice and control in their lives and to be provided with a balanced diet. Evidence: Peoples interests and hobbies were identified in the care plans that were viewed. Since the last inspection the home had employed an activities coordinator and people that were spoken with were complimentary about them and the activities that were provided. People said that if they did not choose to participate in group activities they were provided with a one to one activity of their choice, such as chatting or going to the local shops. During the inspection people were observed to participate in activities in the morning, which was a quiz and discussions about current affairs, and in the afternoon, which was a knitting circle, provided by the homes activities coordinator. People in the knitting circle were spoken with and they stated that they were knitting squares for a hedgehog rescue service and they were making drinks coasters. The service user survey asked if there were activities arranged in the home that they Care Homes for Older People Page 19 of 36 Evidence: could participate in. Five answered always, two answered usually, one answered sometimes and comments included activities are arranged but I dont get involved due to my health but the activities (person) comes down to my room and talks to me and takes me out for walks, regularly on set days and I am not a great one for activities, knitting etc is not my thing but I thoroughly enjoyed the Christmas festivities. The AQAA stated most residents now look forward to the daily activities and are coming up with new ideas and things that they would like to do or see at Coniston themselves. (The activities coordinator) encourages the residents to participate in quizzes, games as well as gentle physical exercises, this encourages residents to use their memory recall, participate in activities that they enjoy as well as socialising and interacting with other people. Peoples care plans that were viewed showed peoples chosen religion and how they wished to worship, for example if they wished to attend local church services. Regular religious services were held at the home and the AQAA stated residents religious and cultural beliefs are taken into consideration and supported at all times. We have visiting representatives from varied denominations on a regular basis who come into the home and provide the residents with church services and the taking of Holy Communion if they want to participate. Peoples records that were viewed included the details of the contacts that they chose to maintain with their family and friends and their chosen methods of the contacts such as telephone calls or visits. Two people that lived at the home were spoken with and stated that their relatives were always made welcome at the home when they visited and that the staff always offered them drinks. The AQAA stated visitors are welcomed at any time at Coniston, they are encouraged to spend time with the residents in their own rooms or in the communal rooms, all visitors are asked they would like a drink when they arrive and are made to feel welcome. People that lived at the home that were spoken with stated that they made choices in their lives and that the staff listened to what they wanted to do. A person told us that they had chosen to bring items of their own furniture to the home when they moved in and said that it was nice to have their own things around them. Two staff members and a person that lived at the home stated that people attended regular home meetings where they could discuss issues in the home. The AQAA stated residents meetings are always lively and with plenty of input regarding food, the menus are always discussed, with the residents having a large say in the food that is Care Homes for Older People Page 20 of 36 Evidence: served. We aim to serve a wide a varied choice of home cooked food, with plenty of fresh meat, fish and local fruit and vegetables, the cooks are aware of the importance of good nutritional food as this is vital for good health and well being. The manager told us that fresh fruit had been provided in bowls around the home for people to help themselves to. However, they stated that the fruit had often gone bad as people had not eaten it. They said that currently the fresh fruit was stored in a cool place in the home and that people were regularly offered fresh fruit. Peoples records that were viewed clearly identified their specific dietary requirements. Two people that were spoken with stated that their dietary requirements were met. The menu was viewed and it was noted that people were provided with a balanced diet, which included fresh fruit and vegetables. During the inspection the lunch was soup, a choice of cold meat, new potatoes and salad and pears and ice cream. Two staff members were observed serving lunch and it was noted that they wore suitable protective clothing, such as disposable aprons. The dining room was light and attractively furnished and decorated to ensure that peoples dining experience was positive. There was sufficient seating for people and there were water jugs, table cloths and napkins on each table. Four people chose to eat their meal in their bedrooms. The cook was spoken with and confirmed that if people required a softer diet all food was liquidised together and not separately. A person was spoken with who was provided with a liquidised diet stated that they were happy with how it had been serviced to them. Three people that were spoken with said that they enjoyed the food at the home and that they were always provided with enough to eat. The service user survey asked if they liked the meals at the home. Five answered always, two answered usually, two answered sometimes and comments included the cook will make me something else if I dont like what is on the menu, not nearly as good as they were when I came a few years ago and the food is excellent. During the inspection staff were observed to offer drinks to people regularly throughout the day. A person was visited in their bedroom and it was noted that they had a jug of squash and a cup within easy reach, they said that they were provided with the drinks that they wanted. A staff member was observed preparing a jug of water with fresh oranges and sugar. They told us that a person that lived at the home was provided with the drink regularly and that it was made just as they liked it. Care Homes for Older People Page 21 of 36 Care Homes for Older People Page 22 of 36 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 that use the service can expect to have their complaints be listened to and acted upon and to be protected from abuse. Evidence: The AQAA stated that there had been no complaints made since the last inspection, this was confirmed by the manager who was spoken with at the time of the inspection. The AQAA stated Coniston has a clear, comprehensive and effective complaints procedure, there is a summary of this is included in the written terms and conditions, in addition to this the residents are given a copy of the complaints procedure when they are admitted to the home. The terms and conditions were viewed and included the complaints procedure and the contact details of CSCI should people wish to contact us if they chose to. Two people that lived at the home that were spoken with said that they knew how to make a complaint if they were unhappy with the service that they were provided with. Nine service user surveys said that they always knew who to speak to if they were not happy and comments included there is always someone in authority to speak to at any time of the day or night, I speak to everybody and if they cant sort it out they find someone who can and I could speak to anybody. Nine service user surveys said that they knew how to make a complaint and comments included although I have no reason for complaint and manager always available. Care Homes for Older People Page 23 of 36 Evidence: Six relative surveys stated that they knew how to make a complaint and that concerns were always responded to appropriately. Two staff surveys said that they knew what to do if a person wished to make a complaint about the service that they were provided with. Three staff members were spoken with and explained the procedures for dealing with a complaint. The AQAA stated we would deal with the complaint immediately and effectively, ensuring that the resident and their family were kept informed and updated of events and that they felt that the matter was being dealt with and the complaint procedure carried out to their satisfaction. Several compliments cards were viewed, which were in the entrance hall to the home. They included notes of thank you to the staff at the home for the support that they had provided and for specific times, such as birthday celebrations. There had been no safeguarding referrals made since the last inspection. Three staff members were spoken with and clearly explained the actions that they would take if they suspected that a person was being abused and they confirmed that they had been provided with safeguarded training. The training records of staff that were viewed confirmed that they had been provided with safeguarding training. The AQAA stated the home has good effective policies in place to safeguard residents from abuse from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, whistle blowing, racial harassment. Care Homes for Older People Page 24 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can expect to be provided with a homely, comfortable and well maintained environment to live in. Evidence: People were provided with a clean, well maintained and comfortable home to live in. During the inspection people were observed to enjoy the communal areas of the home, such as the lounge and dining room. The decor of the home and the furnishings were attractive and people that were spoken with said that they were happy with their home. Nine service user surveys said that the home was always fresh and clean and comments included the cleaning staff are excellent and the home is immaculate. The AQAA stated Coniston is decorated to high standard in all the rooms and communal areas, colours are warm and inviting with paintwork being white, giving the impression of a clean open feel. There are nostalgic photos on the walls along the landing of the surrounding area of Felixstowe and areas of interest giving a homely feel. The home provided an attractive decking area, where people could sit outside and Care Homes for Older People Page 25 of 36 Evidence: enjoy the view of the sea. The AQAA stated the outside decking area has just been revarnished and pots and established flower beds are constantly kept free from weeds and seasonal plants planted creating an inviting area for sitting in during the nice weather or looking out onto in the winter months. Three people were visited in their bedrooms and they stated that they were happy with their bedrooms and one stated that they had bought items of their own furniture when they had moved in the home. It was noted that peoples bedrooms reflected their choice and individuality, each held items of their personal memorabilia. It was noted that there was a stand aid, hoist, a passenger lift, which accessed the upper floors in the home, and a stair lift, which led to the ground floor, which were provided to ensure that people were supported with their mobility and that the home home was accessible to people. The laundry was viewed and it was noted that it was a small and it did not provide clean and dirty areas. The AQAA stated all laundry is dealt with in the designated area of the home, with laundry being put into bags to be carried to the laundry room to prevent cross infection. Soiled laundry is put into red disolvable sacks and then placed straight into the washing machine so that staff do not have to come into contact with potentially contaminated laundry. There were hand washing facilities in the laundry which included hand wash liquid and disposable towels. The manager was asked where commodes were cleaned. They stated that only one person used a commode regularly and that it was initially washed in their bedroom and bought to the laundry in a carrier bag and was cleaned with two disposable bleaching tablets. It was noted that there was no protocol in place to ensure that cross infection was minimised when cleaning commodes in the laundry and in other areas of the home. The manager stated that they recognised that this was not ideal and that when the home was extended there would be a more suitable laundry area provided. Toilets and bathrooms held hand wash liquid and disposable towels, which provided the staff with adequate hand washing facilities to prevent cross infection. During the inspection staff were observed to use good infection control procedures, such as wearing protective aprons when serving food. Two staff members were spoken with and explained the procedures for infection control, which included appropriate hand washing. The AQAA stated I (the manager) have attended the essential steps infection control training, this will now enable me to ensure that all staff are trained and updated in infection control as well as doing an internal audit highlighting our areas of good Care Homes for Older People Page 26 of 36 Evidence: practice and areas for improvement. The training was confirmed in the managers training records which were viewed. Care Homes for Older People Page 27 of 36 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. People that use the service can expect to be supported by staff that are trained and qualified to meet their needs. Evidence: People were provided with support from sufficient staff numbers. The manager was spoken with and stated that the home was staffed twenty four hours each day and that there were no staff vacancies at the time of the inspection. The staffing rota was viewed and observation of the staff working at the home at the time of the inspection confirmed what the manager had told us. Two domestic staff and a cook worked each day. The staffing arrangements were during the morning there were shift three carers and one senior, the afternoon shift there were two carers and one senior and there were two waking night carers during the night. The manager said that the manager and the provider were present in the home during each week day. Three staff members were spoken with and they stated that they felt that there were enough staff on each duty, that they had enough time to spend time with the people that lived at the home if they wanted it and that the staff team and the management in the home were supportive. The staff survey asked if there were enough staff to meet the needs of the people who lived at the home. One answered usually and one answered sometimes. Care Homes for Older People Page 28 of 36 Evidence: Three people that lived at the home stated that they felt that there were enough staff at the home, that their call bells were answered promptly and that the staff met their needs. The service user survey asked if the staff were available when they needed them. Six answered always, three answered usually and one commented never had to wait for them. During the inspection it was noted that call bells were answered promptly and staff were attentive to the needs of the people that lived at the home. The interaction between staff and people was observed to be friendly, respectful and professional. The AQAA stated we ensure that there is sufficient and adequate number of staff on duty throughout the day catering for the needs of the residents, there is a mix of qualified and unqualified staff at all levels at all times of the day and night and have not used the services of an agency, holidays and sickness are covered by our own staff. This also ensures that the residents are receiving continuity of care by staff that they know and who know them, this is something that the management feel very strongly about at Coniston. The relative survey asked if the care staff had the right skills and expereince to look after people properly. Five answered always and one answered usually. The staff working at the home had achieved the target of 50 of staff to have achieved a minimum of NVQ (National Vocational Qualification) level 2 by 2005 as identified in the National Minimum Standards relating to older people. The AQAA stated we have a ratio of 75 of staff that are NVQ 2 trained or above. Four staff training records that were viewed showed that they had achieved a minimum of NVQ level 2. Two staff members that were spoken with stated that they had been supported to achieve their awards in the home. Three staff recruitment records were viewed, one was of a staff member that had not yet started working at the home. Their records included an application form, two written references, details of their employment history and a POVA (protection of vulnerable people) first check. There was no identification, photograph and a CRB (Criminal Records Bureau) check. The manager stated that the person had started training and that they were waiting for the CRB check before they started working at the home and that the further required information would be in place when they started. The records of two staff members included all the required checks to ensure that people were safeguarded. However, it was noted that one staff member had started working at the home three months before their POVA first and CRB checks were received. The manager stated that the person was known to the homes Care Homes for Older People Page 29 of 36 Evidence: providers and that they were suitable to work at the home. The provider stated that at the time they thought that CRB checks were portable and that they had a satisfactory check from their previous employment. The manager confirmed that newly recruited staff would not start work at the home until the appropriate checks had been received. The AQAA stated any person applying for a position at Coniston is only appointed after we have received two satisfactory references and any vague or gaps in employment history have been explored. CRB and POVA first checks are carried out and appointment commences once these have been confirmed. Two staff members that were spoken with and two staff surveys stated that their CRB checks and references were in place before they started working at the home. Two staff members that were spoken with stated that they had attended a Skills for Care induction programme when they started work. The manager told us that staff were also provided with an in house induction programme, where they were provided with the information that they needed to enable them to meet the standards that were expected at Coniston. The AQAA stated all new staff are required to complete the Skills for Care programme if there are no formal qualifications or history of length in care with evidence to back this up. Staff were provided with the training that they needed to enable them to safeguard people and to meet their needs. One senior staff member was spoken with stated that they had been provided with medication, manual handling, safeguarding, eye drop, insulin, first aid and fire safety training. Two carers were spoken with and confirmed that they had been provided with safeguarding, first aid, manual handling, food hygiene and fire safety training and that they had been booked onto Mental Capacity Act training for the following month. The staff members that were spoken with stated that they felt that the training provision at the home was good. Two staff members told us that they had been instructed on how to ensure that peoples privacy and dignity was respected at all times. The staff training records of five staff members were viewed and they confirmed that staff were provided with the above training. Two staff surveys said that they had been provided with training which was relevant to their role, helped them to understand peoples needs and that kept them up to date with new ways of working. Care Homes for Older People Page 30 of 36 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 who use the service can expect that the home is managed by a person who is fit to be in charge, that the home is run in their best interests and that their financial interests are safeguarded. Evidence: The home was managed by a person who was fit to be in charge. They had achieved the appropriate qualifications, had been successful in the registered manager application process with CSCI and they had updated their knowledge regularly. The AQAA stated as the registered manager I have obtained a NVQ level 4 in care and management and have been the registered manager for Coniston for 27 months. Since I have been at Coniston I have attended many courses, these include risk assessment, Mental Health Capacity Act, first aid training, moving and handling, Deprivation of Liberty, essential steps infection control, palliative care update, looking after the bereaved family, food hygiene and POVA training. The training records of the manager Care Homes for Older People Page 31 of 36 Evidence: were viewed and confirmed that they had attended the above training. Three staff members that were spoken with stated that the manager was approachable and that they ensured that any issues were dealt with promptly. The manager had completed the AQAA in the required timescales and it was of good quality and included the information that we required. The manager told us that the provider did not complete Regulation 26 visits as they attended the home on a daily basis. The manager stated that they had a good working relationship with the provider. The home was run in the best interests of the people that lived there and their views about the home were listened to. There were regular house meetings where people could discuss their views about the home. People that lived at the home and their relatives were provided with the opportunity to express their views about the service that they were provided with in regular satisfaction questionnaires. The results for the recent questionnaires were available for people to view in the entrance hall to the home. There was also a suggestion box at the entrance hall where people could make anonymous comments. Peoples finances were safeguarded. The finance records were viewed, which identified the spending monies of people that were stored in the homes safe. The records clearly identified the transactions that people had made and they had been signed by two staff members to ensure that the finances were safeguarded. The manager told us that the manager and the deputy manager had audited the finance records January 2009, which was confirmed in the finance records that were viewed. The AQAA stated where residents do not have the capacity to be independent in dealing with their own finances the office has a safe where residents money is kept and only members of the senior team have access to the safe. When a transaction has taken place the residents records are updated accordingly and receipts logged. When money is credited by a relative they are asked to sign to say that the money has been credited and that they agree with the balance. People were safeguarded by the homes health and safety procedures and processes. However, a potential risk regarding the washing of commodes was identified which is discussed in the environment section of this report and there was a potential risk in the lack of guidance around the safe administration of insulin, which is discussed in the health and personal care section of this report. The fire procedure was displayed around the home to ensure that people were aware Care Homes for Older People Page 32 of 36 Evidence: of actions to take in the case of a fire. The training records of staff that were viewed showed that they had been provided with fire safety training. We looked at a fire extinguisher in the home, which showed that it had been serviced May 2008. There was a fire risk assessment in place and the records of regular fire safety checks were viewed. The records of the temperature checks of the medication refrigerator were viewed. The homes freezer was serviced February 2009. The records that were stored in the bathrooms were viewed which showed that bath temperature checks were undertaken at the time that each person took a bath to ensure that they were provided with bathing facilities which were safe. The accident book was viewed, which clearly identified accidents and actions that had been taken to safeguard people. The records of people that lived in the home included risk assessments, which identified the risks in their daily living and methods of minimising the risks. The AQAA stated all appliances used in the home are serviced on a regular basis and certificates held for this in the office. Safe environment checks are carried out by myself (the manager) and the senior staff daily and any problems that arise from these checks are dealt with immediately. Care Homes for Older People Page 33 of 36 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 34 of 36 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 3 14 The homes assessments procedures and processes must be robust and peoples specific needs should be identified and investigated before people are admitted into the home. To ensure that peoples needs can be met and that the home is registered to meet peoples specific needs. 25/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 35 of 36 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. 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