Inspection on 09/02/09 for Fernihurst Nursing Home

This inspection was carried out on 9th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fernihurst Nursing Home 10/08/07

Fernihurst Nursing Home 22/06/06

Fernihurst Nursing Home 28/11/05

Fernihurst Nursing Home 14/04/05

Fernihurst Nursing Home 10/11/04

Fernihurst Nursing Home 27/07/04

Similar services:

Fairfields Country Rest Home

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Fairfax House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fernihurst Nursing Home Fernihurst Nursing Home 19 Douglas Avenue Exmouth Devon EX8 2HA     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: Teresa Anderson     Date: 0 9 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 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Fernihurst Nursing Home 19 Douglas Avenue Fernihurst Nursing Home Exmouth Devon EX8 2HA 01395224112 01395224117 andy.mack@sanctuary-housing.co.uk 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) : Sanctuary Care Ltd care home 50 Number of places (if applicable): Under 65 Over 65 50 50 dementia mental disorder, excluding learning disability or dementia Additional conditions: 0 0 Registration allows for the admission of five people aged between 55 and 65 years of age The maximum number of placements, including that of the 5 people aged between 55 and 65 years, will be 50 The terms of the staffing level agreement made on 17/05/04 must be met. Date of last inspection Brief description of the care home The date of the last key inspection of this service was 10th August 2007. A random inspection was undertaken on 5th September 2008. Fernihurst is a care home registered to provide accommodation for up to 50 people over the age of 65, but that has also successfully applied to accommodate up to five people over 55 years of age within the 50 beds. The homes service is for people whose main needs relate to their mental health, and whose needs are such that they require 24-hour supervision by nurses. The great majority of the people living at the home have dementia-related care Care Homes for Older People Page 4 of 34 Brief description of the care home needs. The manager is a nurse trained in the mental health field, as are some of the other nurses, and one of them is usually on duty at the home or on call. The home does not offer intermediate care.The home was purpose built in 2000, with an 11-bed extension added in April 2004. The 50 single bedrooms are spread over three floors (although only 49 are currently in use), served by two passenger lifts. All bedrooms in use have an en suite lavatory. There is a lounge / dining area on each floor, with a ground floor conservatory and level garden at the rear of the home for anyone at the home to use. There are on-site parking facilities. Information relating to fees are available direct from the home. Fees do not include hairdressing, chiropody, toiletries, newspapers/magazines, telephone calls, relatives/visitors meals, or routine hospital transport costs. Staff escort time for hospital appointments is charged for if more than two hours (at the hourly rate of pay for staff). And fees do not include other outings of any sort; people can pay for extra staff time (at the hourly rate of pay for staff) if they wish to go out accompanied by staff, by arrangement in advance, through the manager. The latest Commission for Social Care inspection (CSCI) report on the home is kept in the reception area, with copies available from the home on request or through CSCIs website. 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: 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: This unannounced key inspection was undertaken as part of the normal programme of inspection. The visit to the home was undertaken by two inspectors, Teresa Anderson and Rachel Fleet. It started at 10.00am and finished at approximately 6.00pm. Prior to this inspection the commission had carried out a random inspection in September 2008 to check progress made on requirements made at the previous inspection. During this visit, we (the commission) wanted to speak with people living here to gain their views on the service they receive. However, as the majority of people living here have communication difficulties we could not do this by speaking directly with them. Care Homes for Older People Page 6 of 34 We spoke with those we could speak with and observed others, and also observed their interactions with staff. We looked closely at the care and accommodation offered to five people. We did this to help us understand the experiences of people using this service. This is called case tracking. We looked at peoples written assessments and plans of care, the environment in relation to their needs and at how their health and personal care needs are met. We spoke with the manager, with four members of staff, with two visitors, with the administrator and with the cook. We visited the communal and service areas in the home and saw approximately fifteen bedrooms. Other records seen including those relating to medication, peoples personal allowances and recruitment. When requested (seven months prior to this inspection) the manager provided information about the service in an Annual Quality Assurance Assessment (AQAA). We also sent surveys to 15 people living here and 12 were returned. The majority of these had been completed by or with the help of relatives as the people living here were not able to complete them alone. We sent surveys to 8 members of staff and 2 were returned, and to health and social care staff who visit the home and none were returned. Feedback and comments are included in the main body of this report. What the care home does well: What has improved since the last inspection? What they could do better: This inspection highlighted the following areas for improvement. The way that care is planned could be more detailed to help ensure that risks to peoples health and welfare are minimised and that care is person centred. This includes helping people to deal with imagined fears and anxieties, and ensuring that people only receive care from a carer of the same sex when this has been deemed as a preference or as appropriate. Some records in relation to medicines could be further improved. Care Homes for Older People Page 8 of 34 Staff would benefit from further training in communication and caring for people with dementia in a person centred way and in a way that promotes dignity. Staff would also benefit from being supervised to ensure that training given is always put into practice in line with the ethos of the home. Some people living here would benefit from alternative ways of interacting with them, and from having their social needs met in a different way. Some would also benefit from having the choices available to them broadened, and from more variety in the meals served. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who consider coming to live at here have the information they need so that an informed choice can be made. They have their needs assessed to ensure that the home can meet those needs. Evidence: In surveys four of the five people surveyed said they had enough information about the service before they came to live here. We spoke to a relative and they said they had visited the home before making a decision and that this had helped them to make their decision. They told us they visited without an appointment at the busiest time of the day and were made welcome and shown all parts of the home. We looked at the information that the manager told us is given to people. This includes information about the company which owns this home and information about this particular home. It provides details about activities, the menu, the staff structure and Care Homes for Older People Page 11 of 34 Evidence: how to make a complaint if this were necessary. The manager told us this information could be made available in different formats if this were needed. We looked in care plans and found that people are assessed prior to coming to live here by a Registered Nurse, usually the manager. This helps ensure that the home can meet each persons needs. The assessment we saw of one recently admitted person is written in enough detail to ensure this decision can be made. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the way care is planned and delivered would ensure that all people living here have their physical and mental health needs met. Some improvements in how staff protect peoples dignity would also help to enhance the care given. Medicines are well managed meaning that people receive the medicines they need safely. Evidence: We found that each person living here has a plan of care and these are easy to access and well organised. Staff told us that the format has recently been changed and they are becoming more familiar with this. We found that each person undergoes an assessment of their needs which identifies risks such as of developing pressure sores, of becoming malnourished and of becoming dehydrated. We looked closely at five care plans. One person had been identified as being at risk of developing pressure sores. A plan of care was not written at that time as to how that risk was to be managed and how the development of a pressure sore prevented. Records show that this person went on to Care Homes for Older People Page 13 of 34 Evidence: develop a pressure sore, as recorded in the daily records. However, a care plan was not written at that time to inform staff as to how this was to be managed. The specialist tissue viability nurse was contacted a month following the first record relating to a pressure sore. A plan of care detailing how this sore was to be managed was then developed. Ongoing records show that this sore improved. However, a care plan as to how further pressure damage might be prevented is not in place. We did however see that this person sits on a pressure relieving cushion and sleeps on a pressure relieving mattress as is good practice when risks have been identified. This person is also at risk of malnutrition and records show they are losing weight. The assessment which has resulted in this person being identified as being at high risk of malnutrition states that a care plan should be developed and that treatment should commence. However, a plan of care as to how this risk is to be managed has not been written, and records are not kept of how much this person eats. The care plan states this person has a normal diet and has a good appetite. It has been reviewed and states that the plan of care is appropriate. Staff told us that this person is becoming less compliant when eating and drinking and we observed staff having to work very hard to get this person to open their mouth to have a drink. This would indicate that the care plan needs amending to ensure this person gets the care they need. This person is also identified as being at risk of dehydration and we saw that this person can be resistive to having drinks. The care plan states how much this person should drink every day. However, no records are kept of how much this person actually drinks, meaning this might not happen. The care plan shows that this person has repeatedly developed sore, sticky eyes. These are treated by bathing, informing the GP and administering eye ointment. However, the care plan does not contain a plan of care as to how these sticky eyes might be prevented, as would be good practice. The care plan states that the person can be aggressive and resistive. It does not give information about what might preempt aggression or resistance and does not give any information about how this is best managed for this person. We noted in the daily notes that one nurse administered a medication to help the person to sleep because they were chatty. As there are no other records relating to this intervention, it might not the the most appropriate. Records show that this person worked as a professional and had a middle class lifestyle. Some staff were heard referring to this person as my love and love. Staff had also shortened this persons name. However, records do not indicate what this persons preferred or usual form of address is. When given a drink one member of Care Homes for Older People Page 14 of 34 Evidence: staff said good boy. These are indicators that this person is not always treated with respect and does not always have their dignity promoted. Another person we case tracked had been identified as being at risk of malnutrition and had a care plan in place as to how this is to be addressed. This person is given supplementary drinks and records show they are maintaining, and at times, gaining weight. Another persons care plan also identified that they need supplementary drinks. However, records (in the care plan or the medicines chart) do not show that this person is getting these. Whilst the above shows variable practice in relation to managing the risk of malnutrition, in general records demonstrate that people living here are maintaining their weight and our observations show that people, even when otherwise engaged or distracted, were helped to have afternoon tea and cake. Records show, and we observed, that one person is becoming increasingly distressed around issues of imagined loss. We observed staff very kindly and gently trying to deal with this. However, because staff kept telling this person they were wrong, this persons distress was not relieved. The care plan does not provide staff with instructions on how to deal with this. We spoke with staff and they told us that they deal with it the best they can, that they have not received training and are sometimes at a loss. This shows that staff really want to help this person, but without guidance cannot always do this. Care plans seen state that each persons abilities and independence should be maintained. However, records are not kept of each persons abilities and strengths and do not record what might help them to maintain these, and reviews of abilities and dependence are not carried out. This means that people might lose their abilities and skills. Another care plan showed that the person had been assessed as being depressed. An assessment specifically designed for use with people with dementia had been used, which is good practice. However, a care plan has not been drawn up to address this need. In addition, one assessment indicated that this person showed signs of pain. Other assessments said this person did not have pain. We could not find evidence that these assessments and contradictions had been followed up or if this persons pain had been addressed. Care plans show that reviews of peoples care take place. However, the majority of these state that there should be no change to the plan of care, sometimes when the evidence suggested there should be. However, one care plan contained a recent and Care Homes for Older People Page 15 of 34 Evidence: detailed review of the plan of care. This evaluated how the person had been since the last review and how effective, or otherwise, the care plan had been. This is good practice. Staff told us that they had not had training in person centred dementia care planning. However, they say they use their common sense and initiative. They also say that the home has registered mental health nurses who they can ask for advise. Records show that people see their GP and other health care professionals such as the dentist and chiropodist. In a survey one person said there is excellent liaison between the nurses and myself. In other surveys people say they always get the medical support they need. We looked at the way medicines are managed. We found that each persons capacity to manage their own medicines is considered and that frequent reviews are undertaken of the medicines that people are taking. We found that medicines are stored safely and records of medicines entering, given and leaving the home are kept. We found that medicines that need to be stored using special precautions (controlled drugs and drugs requiring refrigeration) are stored safely. We found that some medicines have a limited shelf life. However, staff are not always recording when these medicines are opened meaning that they might be used beyond this period of time. We looked more closely at the medicines managed on behalf of the people we case tracked. We found that one person has been prescribed a medicine (a sedative) to be given when it is needed. However, records do not provide guidance as to what would prompt this medicine to be used, or what other methods might be used to settle this person. We observed during this inspection that this person was restless and mostly unoccupied. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people living here would benefit from increased engagement and more flexible routines suited to their needs and abilities. People enjoy a nutritious diet, although choice and variety might be improved. Evidence: Fernihurst is arranged over three floors. Each floor has its own communal area where people can sit or walk around. During out visit to the home we found that there was a relaxed feeling throughout the home. Mellow music was being played in the lounges and some people were heard singing along with this. Visitors were heard commenting on it and using it to speak and engage with the person they were visiting. The home has an activities co-ordinator. This person organises activities such as bingo, a trolley shop (where people can buy items such as sweets, chocolates and toiletries) and visiting dogs and donkeys. She also carries out one to one visits with people and has conversations with them. She sometimes reads the newspaper to people and talks with them about local and national news items. During this visit we saw that people spent long periods of time along, unoccupied and Care Homes for Older People Page 17 of 34 Evidence: unengaged. Staff are very kindly and gentle, however we observed that their interactions with people related to the tasks they were carrying out such as giving drinks or food. Records show that very disabled people are involved in activities such as bingo, which they would be unable to be involved in, and which some had not previously shown an interest in. In surveys the majority of people say that there are usually or sometimes activities which can be joined in with. One person commented that some people miss out because the activity such as music is happening on the ground floor and not everyone who would benefit from this is taken to it from the top floor. The social care plan of one person we casetracked stated that the intention was to reduce anxiety, to promote self esteem and to encourage the person to engage with activities and conversations. This care plan has been reviewed on four occasions, but does not given an overview of the type of engagements that have happened or how successful these were in meeting the aims of the care plan. Daily records and observations show that this person remains anxious and upset. Another care plan of a recently admitted person to the home contains in depth information about their past, preferences, what might engage them and what they like to watch on television. A plan of care as to how this information will help this person to engage and interact has not yet been developed as they have only been in the home for a short time. The records relating to one person we casetracked record the type of interests they had in the past. The activities they have been involved with since being admitted here do not relate to their previous interests and activities. This person was also identified as having a type of religion and being a member of that religious community. However, the care plan does not give information relating to how this religion might for example affect what they eat or other effects on their lifestyle. This person has visitors from the local religious community who might have had information relating to this. Records do not include any reference to seeking advice from these visitors, as would be good practice. We spoke with a visitor who says they come and go as they please. They say they can visit at any time and that they are always made welcome. We saw another visitor being helped to take their relative out for coffee and being helped to settle this person back in again when they returned. We saw that some staff are very skilled in helping people to make choices in their lives and in engaging with them. For example, one person wanted to walk around the Care Homes for Older People Page 18 of 34 Evidence: lounge. A member of staff talked to this person, tidied their clothing and wished them well. Another person was looking at a book and making comments about it that could not be understood. A member of staff sat down beside them, made eye contact with them on numerous occasions and really attended to them. Other staff were not as skilled as this. For example, we heard one person asking to go to the toilet and saying how uncomfortable they were. Staff told this person they would have to wait. We overheard another person saying it was cold, and another person agreeing with this. Staff did not hear this because they were talking amongst themselves at that time. We saw one person trying to get up from their chair and walk around. They were repeatedly asked to sit down, and when this did not work they were helped to sit in their chair, before rising and attempting to walk again. We also observed that people are given drinks without being asked what they would like or being offered a choice visually. We observed that one person tried to get attention from the staff by trying to make eye contact with them and/or reaching towards them, and that attention was not offered to this person by staff. We saw some staff ensuring that people were supported to eat and drink. They did this by sitting with each person individually and making eye contact with them. Some staff explained what each type of food was before giving it and made sure that they supported each person at a pace that suited them. This shows attendance to each persons individual needs, not only their need to eat but also their need to be engaged with. In surveys the majority of people say that the meals served at the home are usually or sometimes liked. Comments included staff do their best to encourage people to eat and he seems to enjoy them. Other comments were meals are not very appetising or varied enough. They do not reflect what is shown on the menu, more variety and finger food is needed. The food is sometimes unsuitable because of lack of teeth or inability to use cutlery. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are usually listened to, they are kept safe and actions are taken to address any concerns raised. However, additional training in communication would enhance staff skills in understanding and dealing with peoples feelings of distress and vulnerability. Evidence: There has been one complaint/allegation made to the commission about this service. This was investigated by the local authority and not upheld. The service itself have received one complaint which it dealt with within the timescales set. We saw the care plan of the person this complaint related to and changes had been made in response to the issues raised, as is good practice. People living here are not able to make complaints on their own behalf. However, in surveys relatives who had responded on peoples behalf said that they know how to make a complaint. We observed staff taking notice of the behaviour cues which might indicate that someone is not happy. For example, one person refused to eat their lunch. The carer went to get something different for this person as they interpreted their behaviour as a type of complaint. The person then ate this. We spoke with a visitor and they said that they can raise issues with the staff and they are dealt with easily and efficiently. Another visitor said that the response from staff is variable and depends on the individual. One person, in a survey, said that their relative could not voice their concerns, but can only show distress which tests the staffs reactions and Care Homes for Older People Page 20 of 34 Evidence: this is varied depending upon the individual. We spoke to staff about safeguarding issues. They demonstrate a good understanding of what abuse is and what to do if they suspected or saw any form of abuse. Records show that staff receive training in safeguarding and the manager demonstrates a good understanding of the locally agreed procedures in relation to safeguarding. One person we casetracked has made an accusation against a member of staff. Appropriate actions were taken to ensure this was investigated by the appropriate agencies and shows that locally agreed procedures were followed. Whilst it was found that there was no substance to this accusation, this person continues to make allegations. Records show that these are not being addressed although this person believes that this is happening and experiences distress related to this belief. The care plan of this person states they should only receive personal care from female staff. We observed a male carer providing personal care to this person. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in an environment where the homliness and ambience has much improved, and continues to improve. Evidence: In surveys people told us that the home is usually or always clean and hygeinic. One person said that the home can smell at times, and during this inspection we noticed pockets of odour. However, another visitor to the home said they had chosen this home as it does not smell. Another person said that the bedrooms are usually clean and fresh, but that the lounge area needs more attention and another that inevitably - occassionally - there are accidents by incontinent people. We saw staff washing their hands and using protective clothing and hand washing facilities appropriately. We saw staff clearing away used cups and and glasses for washing to help keep areas clean and tidy. Records show that staff receive training in infection control. We looked at the laundry and found it to be quite tidy and clean, and that clean and soiled items are seperated to help prevent the spread of infection. Since the last inspection work has been ongoing to help to enhance the overall Care Homes for Older People Page 22 of 34 Evidence: homliness and ambience of this home. Curtains and bed spreads continue to be replaced with matching items, and these are of a good quality. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living here benefit from being cared for by caring staff, who are recruited robustly and employed in sufficient numbers to meet their needs. Further training and supervision would help to develop staffs communication skills and their skills in caring for people with dementia. Evidence: We looked at the duty rota and saw that each day and night there are two registered nurses on duty. There are usually nine carers on duty in the morning, eight in the afternoon and evening and three at night. In addition the manager is supernumerary to these numbers and there is an activities co-ordinator, a cook, a kitchen assistant, cleaners, a maintenance person, a receptionist and an administrator. On the day of this inspection there were 47 people living at the home. In surveys the majority of people say that they always receive the care and support they need but at times care assistants are thin on the ground and at times are fully stretched and sometimes (care and support is) good but this is down to individuals, so varies. During our observations we saw that some staff are skilled at caring for people with dementia who cannot communicate verbally. For example we saw a member of staff Care Homes for Older People Page 24 of 34 Evidence: making eye contact with someone who was talking, although the carer could not understand what they were saying. This carer waited until the person had finished speaking before responding to them and used the visual cues this person was giving, such as pointing to a book, to engage with them. We saw staff using some peoples preferred name to engage with them, which clearly helped staff to get the persons attention and helped the person to focus on the interaction and respond to staff. We saw other staff being less skilled. For example, we saw staff ignoring people who were trying to get their attention, either through eye contact or asking for help. One person, in a survey, said that staff are not always quick enough to respond when residents need the toilet. We saw one person trying to undress themselves who was not attended to until the member of staff had finished another task. When the staff member did go to this person they did not help them with their state of undress. We also noticed that some people were not wearing stockings or socks. We asked a visitor if their relative normally wore these and were told that some staff could be lackadaisical about this. We were told by staff that some staff are more diligent than others. Another carer asked another person who was undressing if they were hot. When the person said they were, the carer helped them to leave the lounge and go to their bedroom where the issue could be addressed in private, as is good practice. We looked at what training and supervision staff receive to help them to develop their skills. The manager reports that staff have a dementia awareness training for half a day. He also reports that the registered nurses are about to start training related to caring for people with dementia which it is planned they will then deliver to other staff. We spoke with staff about their training. Staff said they had a good induction but could not remember having training in dementia care or communication. One carer hoped this would be covered in their National Vocational Qualification (NVQ) training which they had recently commenced. The manager told us that 20 staff are about to commence training in demenita care. The manager reports that the home employs 37 carers of whom 9 (24 ) are qualified to NVQ level 2 or 3. The government recommends that 50 of care staff hold this qualification. However, the manager also reports that 12 staff are working towards achieving NVQ level 2. Successful completion of this training would mean that the 50 target would be exceeded. We looked at the training records of some staff. We saw that staff receive a lot of training in one day, and that some of these carers do not have English as their first Care Homes for Older People Page 25 of 34 Evidence: language. For example training in person centred care, moving and handling, infection control, health and safety, fire awareness, basic food hygiene and safeguarding adults was delivered in one day. The majority of this training is done through watching a DVD and staff then complete a questionnaire about their knowledge after watching this. We looked at three staff files to see if staff receive supervision to monitor their practice and knowledge. We could not find a record of this. When we asked the manager, he told us that supervision was a role undertaken by the deputy manager. This post has been vacant for approximately one year. The manager says he provides supervision for those staff where a problem has been identified. We looked at three staff recruitment files. We found that all the checks necessary to help ensure that only suitable people work with vulnerable adults are undertaken. This includes an enhanced police check, written references and proof of identity. Nurses who work here have their registration, which entitles them to practice, checked annually. One person working here is under 18 years of age. The manager reports that he has read the guidance relating to this issued by the commission, and that he is following this. For example he says this persons induction training is based on Skills for Care as is recommended for younger carers, and that it is planned for this carer to start their NVQ training in the very near future. Care Homes for Older People Page 26 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home where the management and staff strive to sustain a standard of care and bring about improvements, helping to ensure that people live in a safe home that is run in their best interests. Evidence: The Registered Manager of this home has many years experience of working in health and social care, with people with mental health needs and in management. He has successfully completed the Registered Managers award and has continually shown his commitment to maintaining and improving the standards of care given to people living in this home, and to people with dementia generally. Staff and visitors to the home say that the manager is easily approachable and has made many positive changes to the home. The manager is usually supported by a deputy manager who has designated responsibilities and tasks, one of which is to supervise staff and monitor practice. In Care Homes for Older People Page 27 of 34 Evidence: the absence of this role, the manager reports he has introduced a senior carer system, where the aim is to have a senior carer on every day shift monitoring practice and acting as a role model. However, during our visit to the home we observed that care given by staff was of variable quality. It was also evident that the quality of care improved when the manager was in the vicinity, indicating that closer supervision is needed. One visitor said that the manager and one of the nurses crack the whip if they saw something improper, but they feel more staff supervision is needed. The manager reports that he has tried to involve residents/relatives in the running of the home but that formal residents/relatives meetings have not worked. He reports that low attendance has resulted in them being discontinued. One visitor told us they would like to attend meetings. The organisation carries out satisfaction surveys which are analysed at head office and results and comments passed to the manager. It is then the managers responsibility to produce an action plan as to how issues are to be dealt with. Staff report that staff meetings take place every month and that the minutes of these meetings are made available to all staff. We looked at how monies held on peoples behalf is managed and found this to be in order. We looked at two peoples monies and records. We found that each credit or debit is checked and signed for by two people as is good practice, and that the amounts seen match the balance recorded. We saw that all monies are kept securely and were told there is limited access to these monies, helping to keep these safe. Staff say there is enough equipment, such as hoists, for them to do their job safely. They say they receive mandatory training including moving and handling, food hygiene and fire training. Records seen confirm this. Records show that appropriate safety checks are carried out. These include fire checks, recording of fridge and freezer temperatures, bed rail checks and checking of water temperatures. The kitchen isclean and tidy, with food being covered and dated. Cleaning schedules are in place. Care Homes for Older People Page 28 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 29 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 7 15 Each person should have a 30/06/2009 plan of care which identifies their needs and which shows how these are to be met. The plan of care should be reviewed in a way that shows how the intervention is working and the plan amended when needs are not being met or new needs are identified. Each plan of care should be tailored to individual needs and preferences. This will help to ensure that risks identified are addressed and health is promoted. Reviews of how the plan is meeting the need identified will help to ensure that the plan is tailored to each persons needs and meets those needs. Tailoring the plan of care to each persons needs and preferences will help to ensure that each person Care Homes for Older People Page 30 of 34 receives care that is person centred and which supported each persons capacity for self care and autonomy. 2 8 13 The health and welfare of each person living here should be promoted and maintained as far as is possible. This includes meeting needs relating to preventing and treating pressure sores, meeting nutritional and continence needs and maintaining and where possible improving peoples psychological health. This will help to ensure that people are kept as healthy as possible for as long as possible. 3 10 12 Each person living here should have their dignity protected and promoted. This will help to ensure that each person is treated with dignity and in a person centred way. 4 12 16 Each person living at the home should have their needs relating to activities, engagement and social interaction met in a person centred way. This will help each person to have their need to be social and to be interacted with met in a positive way which suits each persons ability and preference. 21/08/2009 30/06/2009 30/06/2009 Care Homes for Older People Page 31 of 34 5 14 17 Each person living here should have their ability and capacity to make choices and to exercise autonomy maximised. In this way people who are disabled will be enabled to make choices and to have flexible routines. 21/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 A record should be kept of when a medicine with a limited shelf life is opened so that the medicine is used for only as long as it is effective. Where someone is receiving a medicine to be given when needed, the actions to be taken prior to using the medicine, the reason for using the medicine on that occasion and the effect of using the medicine on the person should be recorded. People who are identified as having a religious belief should be helped to observe their religion in a way that suits them. The menu, choice and variety of food should be kept under review to ensure that people are enjoying the food offered. Where people show signs of distress these should be dealt with, with due regard to that persons feelings and ability to communicate and understand. Where someone is opposed to receiving care from a male carer this should always be adhered to. The amount and type of training given to staff in relation to delivering person centred care to people with dementia should be kept under review and enhanced where needed. The way that people are involved in the running of the home should be kept under review. This includes keeping under review the need for relatives/supporters meetings. Staff should be appropriately supervised in a way that helps them to put into practice the ethos of person centred and high quality care which has been adopted by this Page 32 of 34 2 9 3 4 5 12 15 16 6 7 18 30 8 33 9 36 Care Homes for Older People home. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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