Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Consort House Nursing Home Consort Village Care Centre Tor Lane Hartley Plymouth Devon PL3 5TX The quality rating for this care home is:
one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Clare Medlock
Date: 0 3 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 33 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home
Name of care home: Address: Consort House Nursing Home Tor Lane Consort Village Care Centre Hartley Plymouth Devon PL3 5TX 01752789861 01752785884 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) : XCEL Care Homes Ltd care home 52 Number of places (if applicable): Under 65 Over 65 3 0 old age, not falling within any other category physical disability Additional conditions: 0 52 The maximum number of service users who can be accommodated is 52. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following catgories: Old Age, not falling within any other category (Code OP) - maximum of 3 places Physical disability (Code PD) Date of last inspection Brief description of the care home Consort House Nursing Home is a care home which provides nursing and personal care for up to 52 people of either gender. The home is one of three homes owned by the registered Providers, XL care Homes Ltd. The accommodation is arranged on 3 floors. Only the first two floors are being used for accommodation at present. There is a passenger lift providing access to all floors. All bedrooms have an en suite WC and wash hand basin and built in wardrobe space. Communal facilities comprise of a dining room and lounge on the ground floor, and a further lounge, quiet room and Care Homes for Older People Page 4 of 33 1 4 1 0 2 0 0 8 Brief description of the care home conservatory on the 1st floor. The home is situated in its own, pleasant, level grounds and includes a pond and seating areas. There are a number of parking spaces for visitors at the front entrance of the home that is securely protected by keypad entry. The homes fees range from four hundred and fifty pounds upwards and depend on the level of care that is needed. The statement of contract lists what is included and not included within these fees. The statement of purpose and service user guide can be found in the main entrance hall. Care Homes for Older People Page 5 of 33 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Prior to this inspection we performed a random inspection in January 2009 to check compliance with requirements and recommendations set at the inspection done in October 2008. This random inspection showed that the majority of requirements made at the last key inspection had been met or systems introduced to ensure requirements will be met as new people move into the home. This key unannounced inspection consisted of a visit to the home on Tuesday 3rd February 2009. Care Homes for Older People
Page 6 of 33 Two inspectors and an expert by experience performed this inspection. The Commission for Social Care Inspection consider an expert by experience as a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. During this time we spoke to the new manager who is the person with day to day responsibility for the service, the administrator, 10 people who live in the home, 2 visitors, and 5 staff members. We had also received information from another relative shortly before this inspection. We case tracked six people who use the service. Case tracking means we looked in detail at the care six people receive. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us. We looked at three staff recruitment records, induction and training records and policies and procedures. We did this because we wanted to understand how well the systems work and what this means for people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Consort Care Home. What the care home does well: What has improved since the last inspection? Many aspects at the home have improved and are continuing to improve since the last inspection in October 2009. People at the home are aware there had been a change of manager a few months ago and the majority said it had been a change for the better. A visitor to the home said I visit quite a few people here. In previous months they had been most unhappy and full of grumbles but in recent months they tell me they are happier or their grumbles have stopped. Relatives are also aware of the changes at the home. One relative wrote The relatives meetings which the manager holds are a great idea, as she not only explains to us Care Homes for Older People Page 8 of 33 about past problems but also because we get to know all about the plans which she has for further improving things at Consort. Safety of people at the home has been the priority of the provider and manager at the home. Since the last inspection new beds have been purchased which removed the risk of unsuitable beds and poorly fitting bed rails. Risk assessments have been performed and staff training in health and safety issues has been provided. Access to cleaning products and maintenance equipment has improved because of improvements in security. Fire training and first aid training has also been provided. The management of medication has improved with new medicine trolleys, pharmacy inspections, and new medication administration system. Staff are aware of how to correctly store, administer and dispose of medications and sharps at the home. These improvements mean the risk of medication errors continues to decrease at the home. The way staff move and transfer people at the home has improved. Staff have received moving and handling training and aware of how to safely transfer a person. People told us they feel safe at the home. Staff are aware of how to keep people safe and what to do if an allegation of abuse is made. This means staff have the information to correctly report allegations. Training provided has been performed by the Plymouth City Council safeguarding adults team so have enabled information to be relevant to Plymouth staff. Staff training in infection control has also improved meaning people are protected from unnecessary cross infection. New ways of working and use of protective equipment has been introduced. The home is cleaner because of longer domestic shift times and the home is well maintained. Care practices have begun to improve at the home. People are aware they have more choice now. Staff are becoming more aware of the need to stop work practices being task orientated. The manager and deputy are providing more supervision for staff showing how people should receive care depending on their individual needs and preferences. Additional staff have been employed at the home in recent weeks. A member of staff has been employed to assist and encourage people eat and drink. An administrator has been employed to answer the telephone, monitor visitors and organise office filing systems. This means the manager and deputy have been more able to spend more time with people and the staff caring for them. Communication is improving at the home with meetings being arranged for people who use the service, their families and staff. Information passed on between staff is beginning to improve with the emphasis on making sure care is not task orientated and for the benefit of staff and their routines. Staff training has been provided on working as a team for the benefit of people living at the home. The food has improved at the home. People appreciate the improved breakfasts offered at the home. People are also appreciating the improving range of activities at the home and are pleased that they can chose to join in or opt out as they please. Care Homes for Older People Page 9 of 33 Staff recruitment is more robust since the last inspection and induction of staff has also improved. Mandatory training has been introduced since the last inspection meaning that all staff have been provided with information needed to perform their roles in a safe way. Morale has improved at the home with staff knowing that improvements are for the benefit of people in the home and help raise the standards at the home. Generally record keeping and organisation of records has improved greatly at the home. Accident reporting is more robust, office records are improving since the arrival of an administrator. There is now a programme of quality assurance at the home which has identified many areas that need to be improved or changed. The new manager has asked people and their relatives about life in the home.The Provider and new manager have been aware of the many changes that have been needed to improve life at the home and are still aware of further changes that are needed. The Provider has continued to improve communication links with the commission for social care inspection and has been keen to improve relationships with other health care professionals and agencies. What they could do better: The quality of information gathered by staff in the home prior to a person being admitted needs to improve. The reliance of memory to pass this information to staff in the home can affect the quality and accuracy of the information provided. Looking at ways to improve this information gathering process would improve staff understanding of the needs for each person and would also reflect what is written in the statement of purpose. Care plans must continue to improve to show what individual needs each person has and show how these needs can be met in a person centred way. Communication between staff should also improve to ensure staff are provided with sufficient time to exchange information. This will mean that staff have accurate information on changes and needs of each person. Changes to work practices and cultures must continue to ensure that people are cared for in a flexible way. Staff must ensure their work practices fit around each person rather than the other way around. Staff must also remember that people less able to express their views are consulted about choices about, for example, the time they were woken up or had their breakfast. Staff must also make sure they do not assume that some people consistently want the same things or routines each day. By ensuring staff cultures change at the home will mean that people will feel able to take more control over their daily lives. The safety of people must continue to be a priority of people in the home. Staff must remember that people need access to a call bell when they are in communal areas with no staff presence. Prescribed products should be appropriately stored at the home. These products should include incontinence products. Care Homes for Older People Page 10 of 33 Storage of other equipment in the home should also be reviewed to ensure equipment is available although not blocking corridors. The planned improvements of the bathrooms should also be implemented to make them more homely and less clinical. Minor repairs should also be made to the male toilets to improve privacy and repairs to the TV should be redone to ensure people are able to watch TV without the programme and sound freezing. Sheets should be replaced to ensure they are of suitable quality and are large enough to fit the mattresses. The information gathered regarding staff prior to their employment must improve by ensuring a photograph of each member of staff is obtained. This would make sure the recruitment process is robust and means that staff had had all the checks needed to show they are suitable to work with vulnerable adults. Staff from overseas should also demonstrated they have a good understanding and communication of the English language. This would mean that communication between staff and people at the home is improved. 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 11 of 33 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 33 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The improving admission process means that staff have more information to decide whether they can meet a persons needs Evidence: The Statement of Purpose and Service Users Guide have been updated since the last inspection and contain sufficient information to allow people to decide whether this is the right home for them. The Statement of Purpose can be found in the entrance hall to the home. There are also copies of previous reports. The manager told us that she plans to up date information available in the entrance hall. This will include photographs of the staff working in the home with their job title. It is intended this will assist new people moving into the home and other visitors to the home. There were no contracts available for inspection; however the administrator told us that organising contracts had been identified as an outstanding matter. For those
Care Homes for Older People Page 13 of 33 Evidence: people who are funded by the local authority, we saw evidence of contracts issued by the social services department. Assessment documents have been improved. The manager and the new clinical lead nurse are the only staff performing assessments at present. The deputy manager told us at the random inspection that all potential admissions are also discussed with her. An example of a new assessment was seen. Although the document was improved, discussion was held about how this could be improved to trigger less able staff to ask all questions which would then reflect what is stated in the statement of purpose. We looked at the care files of six people living at Consort Care Home at the time of our visit. The records on each file were variable in quality and provision of information. There was some evidence of written and verbal information collected from social and health care professionals involved in the persons care before the placement was agreed. All the care plans we looked at had copies of the new assessment forms however these were either not completed at all, or only partially completed. Dates and signatures were missing. There was little evidence to show that pre-assessment information had been collected and what we saw was insufficient to show that the care needs of the individuals could by be met at the home. Care Homes for Older People Page 14 of 33 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care people receive is good and the way in which it is delivered is improving Evidence: People we saw appeared well cared for. Hair was neatly styled and finger nails were clean. Appropriate foot wear was in place and other aids such as glasses were present. People told us they felt well cared for and were able to see the doctor or attend the hospital when necessary. One person we spoke with was not aware that replacement hearing aid batteries were available on site. The manager gave assurances that this would be addressed. One relative contacted us shortly before this inspection and told us that when their relative entered the home in November, she was terribly depressed, partly because of her physical condition, and partly because of having to accept the need to move into care. I didnt expect her to survive beyond Christmas, she was so bad. Since her admission, the change has been remarkable. Shes now laughing and joking, visiting fellow residents, and planning to re-involve herself in the social life she previously led.
Care Homes for Older People Page 15 of 33 Evidence: I am eternally grateful to the manager and her team for providing an environment in which mum has not only maintained her health, but has flourished beyond anything for which I could reasonably have hoped. Other visitors to the home commented on improvements at the home. One person said It seems calmer here now. One visitor sees more than one person in the home and said they do not grumble anymore, there is more laughter. There has been a key worker system and a night worker rota been devised where staff have been allocated as being responsible for updating care plans, providing 1:1 time, liaising with relatives and ensuring the person is recognised as an individual so that person centred care can be delivered, including what the person wanted at night and in the early morning. The manager explained that this was a way of getting staff to work as a team rather than just focusing on their tasks. The manager explained that this is a new concept for staff but signs so far are very encouraging. The manager told us that she and the deputy are also working alongside staff to monitor care practices and ensure care is being provided in a person centred way. They plan to start working on the night time shifts as some night staff have been resistive to accept and implement the changes. The staff we spoke to told us that they can see that offering people choices such as what time they wake up, is important but they find it difficult at times. Our observations and listening to the staff, we found that in some situations they were still task focused meaning that the people using this service had to fit around their work routines and timescales. For those people less able to express their views we were concerned that some staff were not offering them a choice about, for example, the time they were woken up or had their breakfast. There was also an assumption that some people consistently wanted to be woken early each day even if the person was able to say no. One person we spoke to told us that The senior carers are brilliant. Some of the carers tend to drag their heels a bit. My only complaint is the slowness to respond to the call bell and I only use it if I need help to go to the toilet. People told the expert by experience that generally the call bells were answered within 5 minutes and sometimes even quicker at night. The manager explained that some two hourly checks implemented following the previous inspection are still being used. We found that the people in the upstairs lounge had no access to call bells. The manager rectified this immediately she was told of the problem. She gave us assurances that this would be addressed with staff. The manager said she was getting the call bell system rejigged to ensure the system can alert all staff to emergency
Care Homes for Older People Page 16 of 33 Evidence: calls and that the engineer was due on the day of this visit. We saw examples of the new care plans. Completion of these was inconsistent. Some care plans were detailed and showed what needs each person had, whilst others contained gaps. Two had assessments completed by health and social care professionals only. Care Plans we saw had not been reviewed but this was due to the short time of the people being in the home rather than staff not completing them sufficiently. Staff told us working on old style care plans had not been consistent due to the many other changes taking place in the home. Four of the six care plans we looked at had had daily records completed. The care plans we looked at had comprehensive risk assessments for the use of bed rails. The mental capacity of the person was considered and if the person was able to choose and understand about the use of bed rails. There were maintenance checks monthly and any problems arising between these checks were reported to the manager and documented on the care plan. We spoke to a trained nurse about the completion of these care plans. She told us that An assessment needs to be done thoroughly and over a period of time to get a better understanding of the person. New nutritional assessments have been introduced and the need for supplementary drinks for some people has been discussed with the GP. The manager explained that monthly weights have now been introduced. It is planned that once the key worker system is fully operational, these charts will be kept with other charts (e.g. turning charts and night time checks) in each persons room. This is to ensure they are filled in at the time by the key worker and other staff entering the room. Medication management had improved at the home. New drugs trolleys have been supplied and the manager explained that a local pharmacy audit was performed where some shortfalls were identified. Since the last inspection a new drugs fridge has been ordered, and a drug audit has been performed where many out of date products have been discarded. A new medicines and sharps policy has been written and a new system of medication management has been introduced recently. Staff told us this system was working well. Prescribed products (Ensure drinks) are now stored appropriately either within store cupboards if each bottle is prescribed or within the persons room if the box has the only prescription label. During our tour of the premises we found prescribed food supplements in the lounge from the previous day. Issues were also raised regarding the storage of continence pads which are prescribed products. We also found one of the treatment rooms open at the start of our inspection. This was despite an Immediate Requirement being issued at the last Key
Care Homes for Older People Page 17 of 33 Evidence: Inspection that these rooms should be kept locked at all times they are not in use. The manager was advised about each of these matters and agreed to address them accordingly. Care Homes for Older People Page 18 of 33 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements mean that people are beginning to have more choice and control over their lives Evidence: People in the home told us that the food had improved of late and in particular they mentioned the wide choice available for breakfast including various cooked items, which were much appreciated. Breakfast is often taken in bed, an option that people seemed to like. It was noted that some lunches were still being served (with apologies for the lateness) at 1.15pm. One diner commented, Lunch seems to be a moveable event, any time from 12.30 onwards. Another person said, I have reservations about being made to have lunch in the dining room but later in the conversation said they enjoyed the company of a certain fellow diner. Kitchen staff told us they were aware of what people did not like or could not eat, but none of the people our expert spoke with could recall being asked for details of their favourite meal. People told us that late night snacks were available depending on which night staff were on duty. On the day of inspection there was minced beef, chilli con carne or sausage and mash. Pudding was sponge and custard or fruit and ice cream. A sample of the pureed soft
Care Homes for Older People Page 19 of 33 Evidence: diet was taken. Presentation was in separate portions. All samples were full of flavour, colour and texture. Staff seen assisting people with meals were done in a sensitive unhurried way. Pureed food was given in separate portions. Everyone we spoke with said they chose when to rise and retire. People told us that bathing and showering seemed to be on a weekly basis. No one had requested more frequent baths some saying, the staff would be too busy to do that and no point in asking, they wouldnt have time. One person said, not much happens between 7.30 and 8 oclock in the evening when the night staff come on duty. The activities organiser was on leave at the time of the visit but some people said that they join frequent events in the day room such as entertainers, concerts, bingo, musical activities and games. One person told us that they had particularly enjoyed the recent singer who sang a mixture of old and newer songs. This person said the room was packed and was enjoyed by all. Other people said that they chose not to partake of events preferring to remain in their own room and read, receive visitors, complete crosswords, watch television or listen to the radio. One person said I like to visit the older people in their rooms and chat with them. One relative told us he was particularly pleased about the new activities co-ordinator and said It looks as though mums picked the right place to stay. People also appreciated their visit the in-house hairdresser and spoke well of the stylist. The manager told us that the mini bus was due back following significant repairs. The plan is to re introduce trips out for people in the home. An Anglican clergyman visits fortnightly and offers Holy Communion. One person was not aware that a Roman Catholic priest also visits the home. Another person told us they had periodic visits from the vicar of the church she still attends. The majority of comments about life in the home were positive. One person said I have been here since September, the foods good, theyre all lovely, feel safe, you cant ask for more can you? Only one comment was negative. Discussion was held regarding this specific negative comment. Whilst the comment was typical of this person at this time of day the response by care staff was more dismissive. The manager gave assurances that she would look at the specific care of this person. Care Homes for Older People Page 20 of 33 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People should be confident that any complaints will be well managed at the home. The safeguarding adults training and procedures help protect people from risk of abuse and restraint Evidence: The Commission for Social Care Inspection has received one complaint since the inspection in October 2008. This is a substantial decrease in numbers of complaints. By the time this complaint had been passed to the Commission, the manager had been made aware, informed the Commission and addressed the issue in an appropriate way. The shortfalls in the complaint have been addressed with employment of a new member of staff. The home now has a complaints log where correspondence and notes are stored securely. A visitor to the home told us I visit quite a few people here. In previous months they had been most unhappy and full of grumbles but in recent months they tell me they are happier or their grumbles have stopped Everyone spoken with said that they felt very safe at the home, one adding, and happy. The manager told us that all staff had attended training provided by the Plymouth
Care Homes for Older People Page 21 of 33 Evidence: Safeguarding Team. Staff told us they knew how to correctly report allegations of abuse. A full safety audit of beds and bed rails has now been completed. This has resulted in eighteen fully adjustable beds being purchased by the provider. Bed rails that were in use appeared safe and one person told the expert that she had requested the use of a bedrail on one side of her bed saying, a bedrail makes me feel safer at night and I have the trolley table on the other side for my clock and to help me if I have to get up in the night. Care Homes for Older People Page 22 of 33 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The improvements mean that people live in a safer and cleaner environment Evidence: The home appeared tidier and cleaner since the last inspection. Slings and other moving and handling equipment were not draped around handrails as found on previous inspections. The home was totally free from any unpleasant odours. Cleaning staff told us they had changed their hours and were working later in the day now. Bedrooms also looked clean, homely and comfortable. They were well furnished with some people having brought their own furniture. One person said they liked having their own nic nacs to personalise their own space. Apart from the male staff toilet, which lacked a door lock, had a broken soap dispenser and a leaking tap, the home appeared to be in a very good state of repair. Staff said the new maintenance man was very good with jobs being done quickly. There was still a fault on the TV in the upstairs lounge which made watching television difficult. One person said it was extremely irritating when you were watching something interesting. Bathrooms have been painted but still need further attention to make them more homely. During the inspection a couch was removed which was unsightly and served no purpose. The manager said there were plans to introduce mirrors and pictures
Care Homes for Older People Page 23 of 33 Evidence: within the bathrooms. One shower room was still being used for storage of large equipment. Staff told us this shower room was not used for its intended purpose because of layout and preference of people wanting baths rather than showers. Some sheets were threadbare and not large enough for the mattress. The manager said she would address this as a matter of urgency and sent a request for an order at the time of inspection. The kitchen was well managed. Staff use the government Safer Food Better Business kitchen record to record checks performed in the kitchen. These checks include fridge, freezer and cooked food temperatures and cleaning schedules. Staff told us the kitchen cleanliness was not up to its usual standard as they were one member of staff down. Colour-coded aprons have been introduced for staff use and each has a purpose: blue for helping people eat, white for personal care and red in the event of infection. Red aprons are to be stored in the persons room. Fabric aprons are now being used to protect clothes of people whilst eating. The manager explained that informal on the floor training was being given to encourage staff to adopt good infection control practice. The manager also explained that a training DVD has been purchased and a link with the PCT infection control link nurse had been made. We saw appropriate use of protective clothing through our inspection. There were supplies of gloves, aprons and hand washing equipment throughout the home. Antiseptic hand gel was available by the visitors book at the entrance and throughout corridors in the home. Care Homes for Older People Page 24 of 33 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The stabilising staff group are beginning to improve the practices in the home. Evidence: Rotas showed that staffing levels were getting more stable but that agency usage has increased due to the training and recent departure of some staff. Agency staff told us they come to the home regularly to help with continuity. Most people spoken with commented on what they regarded as a high turnover of staff. One person told our expert I just get to know their names and they are gone. Much mention was made of foreign workers, some of whom were said, to have a limited knowledge of the English language and they have a limited vocabulary to start with. Staffing levels of care staff are eight in the morning, six in the afternoon and evening and three at night. There are also additional ancillary staff on duty. There is always a registered nurse on each floor. Since the re opening of the top floor the manager told us she was re considering the ratios of staff and nurses to ensure there would be sufficient staff for staff to be able to care for people without putting anyone at risk. The manager told us that one consideration she had was to introduce two registered nurses at night time. There is a rotation of staff between floors every month. This
Care Homes for Older People Page 25 of 33 Evidence: means that all the staff know all the people and gain experience in working in different teams across the whole home. The manager explained that by changing monthly people still have a continuity of care. We observed the handover between the night and morning shifts. We found that the carers hand over to carers and the nurses hand over to nurses. There was some discontent expressed by the carers that they have to do this in their own time, unpaid. We later discussed this with the manager, pointing out that after a long shift if carers were tired and wanting to go home, this could affect the quality of information being passed over. She advised us that the current system had only been in place a couple of weeks and it was clear that it was not working. She was still trying to find a satisfactory method for staff to pass on information between shifts. The manager told us that an administrator has been employed to answer the phone and organise filing systems to allow the manager and deputy to be more hands on. The manager explained that a plan for a 10am-6pm carer had just been implemented and was working well. This member of staff was responsible for helping with coffee, helping get people ready for lunch and helping people have afternoon tea and their supper. Most residents were complimentary about the staff saying, I cant fault the care and attention, the girls are good and the cleaners always talk to me and I enjoy their visits. Staff were also described as so kind, no complaints, the staff are wonderful to me, they look after me very well, no quarrels with anyone, in fact we have some good laughs, and I enjoy banter with the girls. New staff employed at the home have had most pre employment checks done before they are able to work. Each staff file contained an application form which asked for health declaration and criminal declaration. Files also contained interview questions, two forms of identification, two written references, criminal records bureau (police check) and POVA (Protection of vulnerable adults) pre employment checks. However, none of the files contained a recent photograph of staff members. The manager is introducing an induction programme based on the Skills For Care course. At the time of this visit the TOPPS Induction was still in use. One nurse we spoke to told us that they had completed an assessment of care needs for a new resident as part of their induction. This was to show that they understood the process and be able to undertake this task as the named nurse for any new resident. All staff are encouraged to sign up for NVQ (national vocational qualification) training. Staff said they had received all mandatory training. An NVQ assessor at the home said he was impressed with the standard of care delivered by one of his students.
Care Homes for Older People Page 26 of 33 Care Homes for Older People Page 27 of 33 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The leadership at the home provides people with a clear sense of direction and means the management of the home is becoming more effective. Evidence: People were aware that there had been a change of manager a few months ago and the majority said it had been a change for the better. Two people bemoaned the departure of the previous manager who they seemed to regard as an old and familiar friend. Records of supervision were seen at our random inspection. We were shown a new format that will be used by staff. The manager explained this process has commenced but supervision has recently been more informal and part of the new management process. The manager showed us a tool that was being used for quality assurance. We were
Care Homes for Older People Page 28 of 33 Evidence: told that staff, relatives and residents meetings have taken place and will continue. We were also shown questionnaires at the random inspection, which had been used to highlight further poor practice, which was being addressed. One relative told us The relatives meetings which the manager holds are a great idea, as she not only explains to us about past problems but also because we get to know all about the plans which she has for further improving things at Consort. Communication to the Commission for Social Care Inspection continues to be good. The provider and manager inform us of progress as it occurs. Regulation 37 notices are now being sent and accident reporting is more robust. The manager told us that an external training company called Essential 6 had given moving and handling training to all staff in December. We did not see any unsafe moving and handling on this visit. An external NVQ assessor told us they had witnessed good moving and handling techniques of staff they were assessing. Staff told us that all staff received fire training in November 2008 and that dignity training and First Aid training were performed in January. New staff told us they were being booked on mandatory training. Access to cleaning materials, paints and tools is no longer possible by having the top floor inaccessible because of a keypad lock. Maintenance records were available for inspection and showed regular contracts are in place for equipment and services in the home. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 8 13 Systems must be introduced 14/08/2009 to ensure that people in communal areas have access to call bells or ways of asking for help. So people are safe at all times 2 12 12 Work ethics and training should continue to ensure that staff work in a person centred way rather than focusing upon tasks and jobs So people can have more choice and control over their lives 14/08/2009 3 29 19 Staff must not work at the care home unless full and satisfactory information is provided, including recent photograph so it can be shown that staff have had all pre employment checks 14/08/2009 Care Homes for Older People Page 31 of 33 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 2 2 3 The registered person should ensure evidence is provided to show that each person has received a contract The assessment process should be more robust to ensure that sufficient information is obtained so that staff are aware whether they can meet the persons needs Care Plans should continue to be improved to show specific needs of each person in the home Systems are recommended to improve communication between staff at the beginning and end of each shift. Ordering, use and storage of continence products should be in accordance with continence specialist advice The fault on the TV must be fixed to prevent irritation to people in the home Suitable sheets should be provided which fit the mattress. Further measures should be made to make the bathrooms appear more homely Suitable storage areas should be provided Staff from overseas should have a good command of the English language and be able to communicate with people in the home. 3 4 5 6 7 8 9 10 7 7 9 19 21 21 22 29 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
