Inspection on 19/11/08 for Endeavour Residential Home

This inspection was carried out on 19th November 2008.

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

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Fairfields Country Rest Home

Poldhu

Queensmount

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Didsbury Court Rest Home

Stallcombe House

Belma

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Endeavour Residential Home Endeavour Chudleigh Road Alphington Exeter Devon EX2 8TS     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: Deirdre McEvoy     Date: 1 9 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Endeavour Residential Home Chudleigh Road Endeavour Alphington Exeter Devon EX2 8TS 01392250148 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Endeavour South West Ltd Name of registered manager (if applicable) Mr Santokh Singh Bhullar Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 20. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (Code MD) Dementia (Code DE) Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Care Homes for Older People Page 4 of 34 care home 20 Over 65 0 0 20 20 20 0 Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home, and an assessment of what they do well and what they plan to improve upon. Before our visit to the home we sent a number of confidential surveys to people living there, to staff and outside professionals to hear their views. We received completed surveys from 8 people living at the home, (staff had helped four people to complete surveys), and from 9 staff. Three outside professionals had also completed surveys. The comments and responses we received have helped us to form the judgements we have reached in this report. Care Homes for Older People Page 6 of 34 We (The Commission) spent just over 9 hours at the service. There were 20 people living at the home at the time of our visit. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to 3 people. Most people living at the home were seen or spoken with during the course of our visit and we spoke with 8 people in depth to hear about their experience of living at the home. Not everyone was able to express their views about the quality of the support they received so we spent a considerable amount of time observing the care delivered to people and the interactions at the home. We also spoke with 4 relatives, one visiting professional and 6 members of staff, including the registered manager. We looked around the home and checked records, such as, care files, medication records, staff recruitment and training records, quality assurance records, and some safety records. We completed an Annual Service Review of the home on 21 November 2007, which indicated that the home was still providing a good service to people. Copies of this report can be obtained from CSCI. What the care home does well: We received lots of positive comments from people living, working and visiting the home. People living at the home told us they always received the care and supported they needed. Their comments included, It is a happy home, I like it here, We have very good staff and I cant fault it at all. Relatives and other visitors told us, This is a very good home, fantastic care, We were extremely lucky to get this place and We have no regrets about placing Mum here. A visiting Rector described the home as, Always warm, comfortable and friendly when I visit. A visiting professional told us, I would have no hesitation to recommending the home to a relative. We looked at the way the home gathers information about people who are considering a move to the home. We found that the home takes care to get to know the person and understand how they want to be helped and cared for before any decision to move in is made. People are given written and verbal information and are encouraged to visit the home to help them decide if it is the right place for them. Care is well planned and generally delivered in a way meets peoples needs and preferences. Peoples health needs are well met, one GP told us that the home provides, Personal, homely care; good continuity of care. People told us that the daily routines were flexible and that they could make choices in their daily lives. Most people enjoy the social life and activities at the home, which provides some daily variation and stimulation. Relatives told us they were always welcome at the home and that they were informed of important issues concerning their relative. Several people described the atmosphere at the home as warm, friendly and welcoming. People were happy with the food served at the home, they told us, The hot meals are very good, Very nice food and Its tasty food. People feel confident that their complaints or concerns will be addressed. Most staff have a good knowledge about how to safeguard adults from abuse. There are systems in place to ensure that peoples money and valuables are protected. The home was clean and free from unpleasant smells, and private bedrooms were homely and personalise. There are enough staff on duty to make sure peoples care needs are met. People told staff were available when needed. People living at the home and visitors to the home commented on the friendly and kind approach of staff, one relative told us, Staff have been marvellous, Staff are always very helpful and Staff are very good. Staff feel well supported and have access to variety of training to ensure they can do their job well. People benefit from living in a well managed home that encourages them to share their views and opinions about the service provided. Overall, health and safety is well Care Homes for Older People Page 8 of 34 managed and people are safeguarded from harm. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Older People Page 9 of 34 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering a move to the home have good information about the service to help them make a decision about whether it will be right for them. People benefit from a good admission and assessment process, which ensures that the home can meet their needs. Evidence: Everyone returning our survey said they had received enough information about the home before moving in so they could decide if it was the right place for them. A visiting relative told us they had visited quite a few places before choosing Endeavour. They confirmed that they were given a brochure about the services provided at the home to help them make a decision. There is a copy of the latest CSCI report in the hallway for anyone to look at. The AQAA tells us that people and their relatives are given information about the services Care Homes for Older People Page 12 of 34 Evidence: provided and they are also invited to spend a day at the home as part of the initial assessment. One relative spoken with during our visit told us, The staff have been marvellous, patient and understanding whilst trying to settle her at first. Another relative told us, We are extremely lucky to have found this place. They seem to be caring for her very well. A third relative said, We looked at several homes and we liked this place a lot. When asked why, the relative said, The cleanliness and cheerfulness of the place. The home gathers information about peoples needs from other professionals and family members where possible. The assessment information for the most recent admission to the home was looked at and this gave good information about the individuals personal and health care needs. A personal history was provided, which gave staff valuable information about this persons background, cultural and religious needs and their likes and dislikes. A comprehensive assessment was also completed by Social Services. The registered manager, Mr Bhullar, will always visit people, either in their own home or in hospital, to get to know them, to provide information about the home, to answer any questions, and to carry out a full assessment of their needs. This ensures that the home can meet peoples individual needs. Pre-admission assessments now include information about peoples capacity under the Mental Capacity Act, and information about advanced decisions or lasting power of attorney, to ensure peoples rights are protected and their needs are met. People told us they had received a contract, which informs them of their rights and responsibilities. This home does not offer an intermediate care service. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangement in place for planning peoples care generally ensures that people get the care they need in a way that suits them. Peoples health needs are met and supported by the appropriate involvement of health professionals and overall medication is managed well. On the whole, people are treated with respect and their dignity is promoted. Evidence: People told us (via surveys) that they always receive the care and support they need, one person told us, We have very good staff another said, I am quite please with everything here. We spoke with four people who were able to confirm that they were happy living at the home. One told us, I have no complaints at all, another said, This place suits me. Visitors spoken with were confident that their relatives were receiving the care they needed. One relative told us, They are all so kind here we know she is getting good care. We are very pleased with everything. Another relative told us, We cant fault Care Homes for Older People Page 14 of 34 Evidence: anything. We have no regrets about placing Mum here. Outside professionals told us the home supports people to live the life they choose and that the home responds well to the different needs of individuals, for example their cultural or religious needs were taken in to consideration. One visiting professional told us, I would have no hesitation to recommending the home to a relative. We looked at three plans of care on this occasion. Care plans covered a range of identified needs, including personal care and social needs, cultural and religious needs, nutritional and skin care needs, and general health care needs. There were good details about peoples preferred routine, and their likes and dislikes; for example, what time they liked to get up or go to bed, and what their favourite foods are. One care plan usefully informed staff about triggers which may indicate changes in one persons behaviour, so staff could act to prevent those triggers. This information helps to provide a consistent approach when delivering care. Another care plan had good information and clear instructions for staff to follow relating to one persons specific cultural and religious needs. Staff spoken with were aware of these needs and had a respectful attitude. Staff have a quick reference plan of care so that they have information to hand as to how they should support someone with their personal care, mobility and activities of daily living. Staff keep detailed daily notes about the care delivered, the diet taken by individuals who may be at risk nutritionally, and the choices people have made during the day, for example how they spent their time. Where possible the home involves the individual in the development and review of their plans of care and some plans had been signed by the individual or family member to show their involvement. We could see evidence that the plans had been reviewed and updated when a persons needs had changed. All staff returning our survey and those spoken with during the inspection said they are always given up to date information about peoples needs. One told us, Our care plans are always being up dated by the manager and we are informed accordingly, another said, The care plans were really useful helping me to get to know people. Staff also described the daily handovers and staff meetings as a way of ensuring staff are aware of any changing or emerging needs. Overall there seems to be good commincation between the manager and the staff team to ensure peoples needs are met. The home has developed a profile form for each person which can be taken to hospital to share important information with other professionals. This is a good idea, particularly for people who have communication difficulties and might not be able to Care Homes for Older People Page 15 of 34 Evidence: tell other professionals about their health history or medication. People living at the home told us that they always received the medical support they needed. Health professionals told us the home always sought advice and acted on it. They told us peoples health care was always met by the service. One told us there was, good continuity of care at the home. Another said, Advice is sought when new situations occur from the appropriate external agency. There is a high motivation to achieve quality care. Records show that people see a variety of health professionals to ensure health needs are monitored and met. These services include out patient appointments, GP and District nurse visits, chiropody and optician services. Other nurse practitioners or specialists are also consulted when needed, for example the Community Psychiatric Nurses. There was good evidence to show that people at risk nutritionally are well monitored. One persons records show a considerable weight loss over a short period of time. We saw that assessments and the care plan had been reviewed, advice had been sought and action had been taken to monitor and address the weight loss. The records for another person showed they had a healthy increase to their weight since arriving at the home. No one living at the home had a pressure sore at the time of our visit. Attention to peoples personal care was good; people were well dressed and groomed. One relative told us, She is always well dressed and looks well kept, another said, She always looks lovely, nicely dressed, hair done etc. All people returning our surveys told us that staff always listen and act on what they say, this shows that staff respect peoples wishes and feeling. Overall staff were friendly and respectful when assisting people. Their approach was unhurried and helpful; they consulted with people, offered choices and responded to peoples requests. They supported people with their personal care in a discreet manner. A visiting professional told us (via survey) Evidence we have observed confirms individual culture needs, beliefs and preferences are met and individuals differences are valued. There are two shared rooms at the home. These rooms are fitted with privacy curtains, which provided some private space for people. People can meet with their visitors in the privacy of their own room if they wish. Staff organised a tray of tea for one person and their visitor to take to their room for a private visit. Care Homes for Older People Page 16 of 34 Evidence: On two occasions the language used by staff to describe people who needed assistance with eating was inappropriate and disrespectful. This was discussed with the manager, who recognised this and said he would bring this to the attention of all staff. The local pharmacist providing a service to the home told us the home was, Very good at ensuring patients have correct meds at appropriate times and minimising waste of medication. A visiting GP was also satisfied with the way the home supported people with their medication. We looked at the way the home stores and administers medicines. Although not in an idea location, medication is stored safely at the home. Currently the home does not have storage for Controlled Drugs which meets the requirements and must make arrangements to ensure that Controlled Drugs could be stored safely if necessary. Records show that people get their medication as prescribed. Medications were observed being given to people at lunchtime and the procedures followed were considered to be safe. The home ensures they receive written confirmation from GPs when changes are made to peoples medicines, and on the whole two staff sign handwritten entries on the Medication Administration Record (MAR) to verify accuracy, although there were two entries not signed by two staff. Where medication is prescribed as when needed, accurate records are kept to show the actual dose given, when and why. One medication with a limited shelf life once open had been dated to ensure it was used within the timescale suggested by the manufacturer. A second eye cream had not been dated once open. The AQAA tell us that all staff have had training to ensure the safe management of medication. Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy regular and varied activities and links with family, friends and the local community are good. People enjoy a balanced diet which takes into account the likes and dislikes, however people could be better supported at mealtimes. Evidence: Everyone returning a CSCI survey told us there were always activities arranged at the home that they could take part in. One person wrote, I enjoy crosswords and reading the paper, another told us, I do exercise in the morning. Activities in the afternoon. A third person told us they liked, Singing, jigsaws, crosswords, magazines and exercise. People also told us they werent expected to join in with activities if they didnt want to. One person told us, I like conversations with people, and my own company. Staff respect this. Since the last inspection an activities coordinator has been appointed and works five mornings a week from 09.00 to 12.00. This person showed a good understanding of peoples interests and abilities, she also had good ideas about how to develop Care Homes for Older People Page 18 of 34 Evidence: activities. During the morning she engaged several people in a group activity. A dining area provides the space and the activities coordinator has put a lot of thought into ensuring that a sociable and relaxed atmosphere is created. We observed that she encouraged and supported people by working at their pace and ensured people were included in conversation. The activities coordinator keeps a good record of the activities people have engaged with and whether they enjoyed them etc. This helps her plan suitable and enjoyable things for people to do. The home has some equipment and materials for activities, although some equipment, such as childrens puzzles does not seem to be particularly creative or appropriate for adults. The home might like to look at more suitable equipment for people with a sensory impairment, such as rummage bags or boxes. The home enables people to be involved in light household chores, such as drying crockery, laying tables, dusting and polishing. The care plan for one person highlights their interest in some domestic chores and we saw that this person enjoyed pottering in the dining room preparing for lunch. One person told us, I like setting the table at lunch. People also talked about the friendships they had made at the home, one person told us, I have got company here, which I like. Ive made friends with the other ladies. The staff are helping people to develop scarps books about their life, these are made up of photographs, information about past work and family life and details of special events. These provide an opportunity for discussion and reminiscence. Special celebrations are organised by the home, for example birthday parties and special Christmas celebrations that include a meal at a local Hotel, a visit to a local pantomime, and a visit to the Exeter Christmas lights. The home has identified peoples religious needs and supports and encourages people to be able to meet these needs. For example, the home has made arrangements for people to attend a regular service at the home and visits from the Priest or Rector and prayer circle have also been arranged. On the day of our visit many people attended the monthly service at the home. The visiting Rector told us, They value the spiritual input here. He told us about the special arrangements for Christmas at the home, including a carol service, which he described as A lovely celebration, informal, warm and friendly. People told us (via surveys) that staff always listen and act on what they say, this helps to promote choice and enables people to make decisions about their daily life. People spoken with told us staff respected their preferred routine, which is recorded in Care Homes for Older People Page 19 of 34 Evidence: care plans. One person told us, You can do what you want more or less, another said, No one tells me what to do. I get up myself when the light comes in. Two other people confirmed they could go to bed and get up when they wanted to. During the day people could join in with activities if they chose to, they could chose where to spend their time. Several people had visitors during the day and one person went out for the afternoon with family. We met with four relatives, all told us they always get a lovely welcome and were always offered refreshments. Relatives told us they could visit freely and that the home kept them informed of any changes or events affecting their relative. One said, We are always given our privacy and another said, There is a happy relaxed atmosphere here. People returning CSCI surveys told us they always liked the meals at the home. Their written comments include, Very nice food an Always eat everything. During our visit people told us, The food is very good. I like most things, The food is not bad at all. There is always something I like and Food is generally good. The daily menu is displayed on a board in the lounge; people had the choice of a traditional roast, fish or a salad. There was also a choice of puddings. Special diets, such as diabetic or pureed are also available. The dining room tables were nicely laid with condiments and napkins. The meals looked appetising and were well presented, including the pureed meal. On the day of our visit several people needed assistance with their meal, staff told us five people needed help. As a consequence lunchtime was a busy time and presented a challenge for staff. We saw staff standing over and behind people when assisting them with lunch. This did not promote a relaxed and pleasant mealtime for some. We also saw one member of staff trying to assist two or three people, moving between tables to offer a couple of folks of food before moving on again. This did not give people the individual attention they needed. One persons lunch sat in front of them untouched throughout the lunchtime. Staff were spoken to about this and told us that this person would be offered something a little later and a more substantial supper if necessary. Following the inspection the manager wrote to us to say that the lunchtime situation on the day of our visit was unusual because peoples needs had changed on a temporary basis, and that people who required assistance during our visit would not usually need such assistance. The manager would normally be present at lunchtime to assist but was busy on this occasion, partly dealing with the inspection process. Care Homes for Older People Page 20 of 34 Care Homes for Older People Page 21 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples views and complaints are listened to and acted upon. People feel safe and well cared for. Most staff are aware of the procedure to follow to protect people from abuse or harm but some would benefit from a fresher training. The AQAA shows that all staff, including recently appointed staff had attended Devon County Councils Safeguarding Adults Training course. In addition staff have in service training and read the safeguarding policies and procedures. Staff spoken with confirmed this. Staff spoken with had a general knowledge of the various forms of abuse and were aware of their responsibilities to report any concerns. However one carer described the intervention she would take, although very well intentioned, it could jeopardise a proper investigation. This person would benefit from a refresher course. Evidence: All people responding to our survey are aware of the homes complaints procedure and know who to speak with should they have any concerns. People told us they would speak to, The manager and manageress. Relatives spoken with were also aware of who to speak with about any concerns they may have. One relative told us, I am confident they would listen to any concerns we may have, another said, I have no concerns but would speak with the manager if need be. All staff returning surveys said they knew what to do should someone have a complaint or concern, one told us, Care Homes for Older People Page 22 of 34 Evidence: Depending on the concern I would report to the manager however if the concerns were about the manager I would report to the appropriate social services or if necessary to the police. There is a copy of the complaints procedure on the notice board in the entrance hall telling people who to speak with should they have a concern about the service. No complaints have been received by the home directly since the last inspection. One complaint has been received by CSCI, which was referred to the manager to deal with. The complaint related to security at the home (refer to standard 19), the cleanliness of parts of the home and infection control procedures (refer to standard 26). This complaint was thoroughly investigated by the manager and a full response was received within the agreed timescale. As part of the investigation, the manager had asked 17 relatives and other visitors to complete a survey in relation to security and infection control at the home. The surveys completed indicated that all felt the premises are well secured to provide protection from unwanted visitors. Peoples responses also show that they are very satisfied with the cleanliness of the home and the communal toilets. People spoken with told us they felt safe at the home and that staff treated them with kindness. One person told us, They are always so good, another said, Staff have always been nice to me, accepted me. They listen to me and are kind to me. All visitors spoken with were happy with the level of care and attention given to their relatives. A record of any bruising observed on anyone living at the home is kept, and where possible an explanation of why this may have occurred, e.g. following a fall. The AQAA tells us All vulnerable service users are given a check following each shift and any concerns are followed up. One person had a deep bruise on their hand and told us, I cant tell you how that happened, its always happening. Its not painful. Care Homes for Older People Page 23 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made and are being made to ensure that people continue to enjoy a good standard of accommodation that is clean, homely and well maintained. Evidence: Endeavour is a detached house with 16 single bedrooms and 2 double bedrooms, many with en suite facilities. We visited all communal areas and bedrooms. People are encouraged to personalise their private bedrooms with their own furniture, and other items such as pictures and photographs. Each room has a call bell and privacy lock. There are 2 lounges and 2 dining rooms, one of which has been extended since the last inspection and provides more space for people to enjoy activities. The home is secure and visitors have to ring the bell to get in, visitors are asked to sign in and out of the building so that the staff are aware of who is in the building should there be an emergency such as fire. The back door is also secure being connected to the fire alarm. Overall the decoration and furnishings are homely and comfortable. We noticed that some toilets and bathrooms needed redecoration as paint was chipped and beginning to peel in places. A section of tiles in the kitchen were removed recently to install a new boiler. This has left an area of wall exposed. Following the inspection the manager Care Homes for Older People Page 24 of 34 Evidence: wrote to us telling us he had taken action to retile the wall. The home has used distinctive colours on particular doors (toilets and bathrooms) and pictorial signage on peoples bedroom doors to promote the independence of people with dementia. Information sent to us by the manager verified that there is a continuous programme of refurbishment at the home, for example, bedrooms are redecorated when vacant, the home is considering changing furniture in the dining room and lounge, parts of the home were recently extended to provide more room for activities and new equipment has been bought. When replacing carpets the provider might like to consider using unobtrusive colours and fewer heavy patterns. A small accessible garden surrounds the house, with a secluded level patio area to the rear. A passenger lift gives easy access to all areas of the home. The home has equipment such as a bath hoist, mobile hoist, grab rails and moving and handling equipment to assist people with limited mobility. The laundry was extended recently to provide better facilities; it was well equipped and appeared to be well organised. Care staff are responsible for the cleaning at the home and they work hard to ensure the home is clean. On the day of our visit the home was clean and fresh throughout. People responding with surveys said the home was always clean and fresh. Relatives also told us that the home was kept clean and odour free. One relative told us, The home is always clean and her room is lovely, another said, The standard of cleanliness is very good. Never unpleasant smells. All staff spoken with during our visit had completed an infection control course to ensure good standards in this area; the AQAA shows that 11 of the 12 staff members have completed training in the prevention and control of infection. During our visit the home was using towels in communal toilets rather than paper towels, which would better reduce cross infection. This was discussed with the manager during the visit and following the inspection the manager wrote to us to tell us a paper towel dispenser had been installed in all communal toilets. Care Homes for Older People Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are generally sufficient to ensure that peoples care needs are met, and people benefit from having some experienced, competent and friendly staff who have a good understanding of their needs. People are protected by the homes recruitment practice, which is good. Evidence: Six people returning surveys said staff were always available when needed; two people said this was usually the case. All people responding to our suvey said they always received the care and supported they needed. Several people, including relatives spoke highly of the staff. Comments included, They are kind and friendly, The staff here are marvellous, They have always been nice to me, and The staff are always smiling which makes all the difference. All staff responding to our survey said there was always enough staff on duty to meet peoples needs. Comments included, Management provide enough staff to meet the individual needs at all times and There are satisfactory staff on duty to cover each shift & provide the care of the clients. On the morning of the inspection there were two care staff, the activities coordinator, the deputy manager and manager on duty. Care staff are involved in domestic tasks Care Homes for Older People Page 26 of 34 Evidence: such as cooking and cleaning. Staff were busy during the morning, cleaning and preparing lunch, and appeared to have little time to engage people socially, for example chatting etc. In spite of this there was a calm and orderly atmosphere and staff were attentive and with the exception of lunchtime, peoples care needs were met. We discussed the staffing arrangements over the lunchtime period with the manager (see standard 15) and he informed us that the home was considering employing a cook, which would relieve staff of this duty and allow them to spend more sociable time with people. The duty rota shows in the afternoon there are three care staff on duty supported by the manager until 5pm. Staff appeared to have more time to spend with people in the afternoon and staff engaged people with various activities. Relatives and health professionals were confident that staff had a good understanding of individual needs. Three health professionals told us staff always have the right skills and experience to support individual health and social care needs. One wrote, All the staff and management I have contact with display behaviours, which are dedicated to high levels of care, and respect for all individuals. Information in staff surveys, the AQAA and records looked at in the home confirmed that staff receive regular training, which is relevant to their role. Records show that staff have attended training in relation to Dementia, sensory impairment, the Mental Capacity Act and six staff attended a foot care course at the local hospital. Staff told us, The manager shows great interest in staff training, If any staff are interested in doing particular course the manager always arranges this for them and My manager arranged different training courses which helps me to do my skilled job and also helps me to keep up to date with new ways of working. All new staff have induction training to enable them to get to know the people living at the home, the philosophy of care, safety procedures, all procedures and the general layout of the home. Staff returning surveys told us their induction training covered everything they needed to know. One wrote, Very good induction before I started work, another told us, I am a new employee so my induction training is on going, it is of a very high standard. The AQAA shows that over 50 of care staff have achieved a nationally recognised qualification in care (NVQ), which helps to promote good standards of general care. A visiting NVQ assessor told us, The manager operates a quality service and takes a keen interest in the training and development of staff of mixed cultures. Care Homes for Older People Page 27 of 34 Evidence: We looked at the recruitment files for three people appointed since the last inspection. Relevant pre-employment checks, including Criminal Records Bureau checks (CRB & POVA) had been taken up prior to employment. This helps to ensure that individuals are suitable to work with vulnerable adults. Care Homes for Older People Page 28 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed, with good systems in place to ensure that peoples views are sought and acted upon. Satisfactory systems are in place to promote the safety and health of people living and working at the home. Evidence: The manager is both qualified and experienced. He is a registered nurse and has obtained the Registered Managers Award. He has 20 years experience of working with older people with mental health needs. People living at the home and their relatives described the home as a friendly place and staff spoken with said there was a good atmosphere with everyone working together. All spoken with had confidence in the managers abilities and felt that he was approachable and ready to listen. People are asked for their views on the service they receive. Regular questionnaires Care Homes for Older People Page 29 of 34 Evidence: are given to people living at the home, their family and friends, and outside professionals. The results are audited by the manager, and a report is completed and made available to people. Action is taken where issues arise. Residents and staff meetings are held, both providing an opportunity for the manager to give and receive information about the home. The home does not deal with the financial affairs of the people living there other than to hold, if required, small sums for personal items. Records are maintained of money held and safeguards are in place to ensure balances are checked. The accounts for two people were checked and found to be in good order. Health and safety at the home is generally well managed. During our tour of the building no immediate hazards were identified. Staff receive mandatory training such as manual handling, infection control, fire safety and where appropriate food hygiene. The AQAA shows that the majority of staff have undertaken food hygiene training to ensure that standards in this area remain high. The home is generally safe for people; radiators are covered to reduce the risk of burning to people. Windows on the upper floors are restricted to prevent accidents from falls, and the manager told us that water temperatures are regulated to prevent harm from scalding. The AQAA showed that maintenance of equipment and systems, such as water, gas and electrical systems, and equipment such as the passenger lift, chair lift and hoists were up-to-date. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 9 13 You must review the 28/04/2009 arrangements for storing controlled drugs (including Temazepam) To ensure that, if such medicines are received into the home any time in the future secure storage facilities comply with current legislation. 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 9 It is recommended that handwritten MAR entries be signed by two competent people to ensure accuracy. Any medication with a limited shelf life once open, such as eye drops, should be dated when open to ensure they are used within the timescales recommended by the manufacturer. Prescribed creams and lotions administered by the home must be recorded each time they are administered. In order to promote respect for people at all times, staff should be aware of the language they use when referring to people who need assistance with eating. 2 10 Care Homes for Older People Page 32 of 34 3 15 In order to ensure people enjoy a relaxed and pleasant mealtime, staff should sit next to people when they are assisting them with meals. Some staff would benefit from having refresher training relating to safeguarding adults so that they are clear about the action to take should they have concerns about peoples welfare. 4 18 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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