Inspection on 31/01/09 for Flowerdown Nursing Home

This inspection was carried out on 31st January 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Flowerdown Nursing Home 04/07/08

Flowerdown Nursing Home 05/06/07

Flowerdown Nursing Home 23/05/06

Flowerdown Nursing Home 19/01/06

Flowerdown Nursing Home 11/10/05

Flowerdown Nursing Home 11/04/05

Flowerdown Nursing Home 10/11/04

Flowerdown Nursing Home 16/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Flowerdown Nursing Home Harestock Road Winchester Hampshire SO22 6NT Lead Inspector Christine Walsh Unannounced Inspection 31st January 2009 09:30 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000011652.V373824.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000011652.V373824.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Flowerdown Nursing Home Address Harestock Road Winchester Hampshire SO22 6NT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01962 881060 01962 881935 flowerdown@fshc.co.uk Tamhealth Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Manager post vacant Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (0) of places DS0000011652.V373824.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - N to service users of the following gender: Either Whose primary needs on admission to the home are within the following category: Old age, not falling within any other category Code OP. The maximum number of service users who can be accommodated is 53. 4th July 2008 2. Date of last inspection Brief Description of the Service: Flowerdown Nursing Home is registered to provide care and accommodation for fifty three older persons who require nursing care. The home has been extended over the years and accommodation is provided in forty eight single rooms and one shared room, situated on two floors of the old house and the new extension. The service has completed an extensive programme of redecoration and refurbishment. The home has large well-maintained gardens and ample parking space. Flowerdown is owned and operated by Four Seasons Health Care, a large independent care provider in the UK. The home is situated in a semi rural area on the outskirts of Winchester, Hampshire. The service accepts residents funded by Social Services with top-up fees. The fees for self funded residents is £700. Per week Fees range from £460.40 - £850. Service users pay extra for hairdressing, chiropody and personal toiletries etc. DS0000011652.V373824.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is “1 star ” This means the people who use this service experience Adequate quality outcomes. This site visit formed part of the key inspection process and was carried out over two days by Mrs C Walsh, regulatory inspector, the newly appointed manager and peripatetic manager, assisted with the inspection visits. Due to unforeseen weather conditions the inspection visits did not take place on consecutive days, but a week apart. The Annual Quality Assurance Assessment (AQAA) document was completed by the newly appointed manager. Since the new manager has been working in the home her priority has been to address the concerns and requirements raised following the previous inspection in June 2008. This has been done jointly with peripatetic managers appointed by Four Seasons to work in the home to support the new manager. Following the last visit to Flowerdowns it was required to provide the Commission for Social Care Inspection with an improvement plan. The service is required to tell us how they intend to make improvements and drive up standards. The improvement plan was used during this visit to measure how the home is meeting requirements. The AQAA informed us that the service ensures the race, gender identity, disability, sexual orientation, age, religion and beliefs of the residents are promoted by ensuring there is a comprehensive pre-admission assessment and ongoing assessments to evaluate the care that each person requires. Ongoing assessment of personal preferences and social requirements is also evaluated. Care plans are devised to recognise these. It tells us the ethos of care is introduced at the recruitment phase and continues throughout. The AQAA tells us the home is planning to provide equality and diversity training and will ensure staff are aware of the literature available to them in this area of care and support. The information obtained to inform this report was based on viewing the records of the people who use and work for the service, of which four residents records were looked at in depth. The day-to-day management of the home was observed, and discussions with residents, relatives and staff took place. In addition “Have Your Say” comment cards were completed at the time of the visit. DS0000011652.V373824.R01.S.doc Version 5.2 Page 6 The people who use this service are referred to as residents throughout the body of this report. What the service does well: What has improved since the last inspection? There have been significant improvements in the home following the last visit in July 2008. Eight requirements were made following the last visit and an DS0000011652.V373824.R01.S.doc Version 5.2 Page 7 improvement plan was required from the home to tell us how they were going to make improvements. The requirements focussed on the need for the service to improve the delivery of care. These included developing care plans that clearly tell staff how to support residents, improve clinical procedures such as the administration of insulin. Ensure the privacy and dignity of residents is upheld at all times, improve cleaning standards to eliminate offensive odours and improve staff training. All eight requirements have been met. The service has employed a manager who has been in day-to-day management of the home since September 2008 and who appears to have developed positive and professional relationships with residents, relatives, staff her peers and other stake holders. A member of staff told us: “The manager has high standards and she is prioritising care such as pain control and the emphasis of answering call bells promptly”. Another said: “I like the manager, she is very nice, she is hands on, really cares and wants to change the home for the better”. The home has increased staffing levels and employed staff based on their values and clinical experience. There have been changes to how residents receive their care, this being more person centred and using a named nurse system. The named nurse is responsible for a small number of residents and staff team. It is the named nurses responsibility to ensure her staff team are carrying out care in the way the residents wish. There have been improvements in how residents receive their meals and a change to the breakfast routine has allowed residents to take their time in getting up. Comments received from care managers confirm that the above improvements have been made: “A lot of training has taken place in respect of dignity and privacy and the home is trying to ensure that privacy and dignity is paramount”. “The home has significantly improved during the last few months. The majority of residents/family appear happy with the care they receive”. DS0000011652.V373824.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000011652.V373824.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000011652.V373824.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures the people who wish to move into the home have their needs assessed prior to admission, this is to make sure the home can meet all their needs. The home does not provide intermediate care. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) tells us all residents and relatives are invited to look around the home to empower them to make an informed decision, and a complex pre – admission assessment is undertaken. A trial period is put in place for all residents from the date of admission. This was tested by viewing the assessment documents for four residents, speaking with the manager to establish the process for admission, speaking with residents, a visiting relative and viewing “Have Your Say” comment cards. DS0000011652.V373824.R01.S.doc Version 5.2 Page 11 Following the last visit to the home no concerns were raised in respect of the assessment and admission of residents. Since the last visit the home has implemented a new assessment document Known as CHAP (Care and Health Assessment Profile) this is a comprehensive document and covers all aspects of the resident’s physical, mental and social wellbeing. The assessment tells the reader the resident’s strengths and areas of support is required to ensure their specific needs will be met. The assessment identifies areas of potential risk which then links to further assessment and identifies what is action is required to minimise the risk. An example of this was seen in respect of a person at risk of pressure ulcers, the assessment links to weight management plan, dietary intake and ensuring the appropriate health care professionals are involved to assist in minimising the risk. The assessment also includes an area where the social, sexual, religious, ethnic origin and their wishes at the time of their death. It was noted for the residents whose assessments were viewed that these areas had not been completed. The manager confirmed that these diverse areas are sensitive and it is felt more training is required in this area in completing the assessment. The manager also said that it is important to get to know the resident and their families before such sensitive questions are asked. It was noted that residents are asked what gender of staff they would like to have to assist them with their personal care and by what name they would like to be known by. DS0000011652.V373824.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The service is making progress in demonstrating they are able to meet the needs of the people who use the service. This is demonstrated in development of clear care plans, nursing practices and the way in which the home is managed. Some areas of care require further improvement and monitoring of by management and senior nursing staff, such as improving people’s fluid intake and record of intake. The service has systems in place for the storage, recording and disposal of medication, however incorrect procedures in administering medications, potentially places the people who use the service at risk. The service is taking steps to improve the way it treats and respects the rights of the people who use the service. DS0000011652.V373824.R01.S.doc Version 5.2 Page 13 EVIDENCE: The AQAA tells us the service has comprehensive care plans in place for all residents, medicines are recorded, stored and administered as per guidelines and privacy, dignity and respect is maintained at all times. This was tested by viewing the personal plans of four residents, speaking with the residents, observing practice, speaking with relatives, staff and managers. Following the last visit to the service it was required to ensure care plans described how the residents require and wish to have their care needs met. There is evidence that the service has taken steps to review all care plans, and train nursing staff in producing care plans that tell the reader how to support the resident. Care plans appear person centred and reflect how the resident wishes to be supported from getting up to going to bed. The home has adopted a lead nurse and keyworker system. The lead nurse has a number of senior staff and carers responsible to them who are keyworkers to a number of residents each. It is the lead nurse’s responsibility to ensure the care of the resident is carried out in the way the resident wishes and in a way that is appropriate to meet their health and personal care needs. We were also informed that it is also the lead nurse’s responsibility to ensure care plans are regularly reviewed and updated as required. The manager has a system for monitoring progress in the development and review of the care plans. A weekly report is completed and forward to the organisations regional office. The manager also told us that as part of the monitoring of care she visits each resident each day and observe nursing practices. The manager was observed providing guidance and direction throughout both days of the visit. A resident told us when he was unwell a couple days previous it was the manager with the support of another nurse who got him back on his feet again. He went on to say how wonderful the new manager is and the difference she is making to the standard of care. It was however noted on the first day of the visit that not all residents had received regular fluids and records did not show that sufficient fluids had been given. Observation told us that some residents appeared dehydrated and thirsty. This was rectified at the time of the visit and staff informed of their responsibilities. The second visit, which was also unannounced, saw a marked improvement in fluid intake, records and the condition of the residents. Following the last visit to the home it was required to ensure residents who have specific health care needs, for example diabetes receive the correct DS0000011652.V373824.R01.S.doc Version 5.2 Page 14 treatment to ensure they maintain a good standard of health. The improvement plan told us that all nursing staff had received training in diabetes, completing care plans in respect of how to administer insulin and the correct procedures for administration. A senior nurse confirmed that all staff had received training and it was observed that residents who require insulin were receiving their insulin following correct procedures. A care plan seen provided detail on the specific care needs of the resident in respect of their diabetes and how this must be monitored, including their diet, skin integrity, care of feet and toe nails and eye care. The home demonstrated that they have recently taken all care precautions in liaising with a diabetic nurse specialist and general practitioner in trying to address a resident’s unstable diabetes. Records have been kept to demonstrate monitoring of blood/sugar levels and dialogue with health care professionals. It was noted during the last visit to the service that some areas of the home had an unpleasant odour. This has improved by improving continence care. The manager has adopted a system of regular checks and recording. Following discussion with a relative it was established that further improvement is required in this area to ensure all residents’ continence needs are met to maintain their independence, dignity and comfort. During the second visit to the home is was established that discussion had taken place with the concerned relative and procedures have been put in place to meet the residents personal needs. Following the last visit to the service in July 2008 there were no concerns in respect of the administration of medication, other than those identified with the administration of insulin. There is evidence that residents receive their medication as required, using safe practices as per the Royal Pharmaceutical Guidelines. There is evidence that the manager regularly audits medication, including administration, recording and storage. Prior to this inspection visit the Commission for Social Care Inspection was notified of a medication error, it informed us that a resident had received the wrong dose of medication for up to eleven days. Social services were notified of this error through the Safeguarding Adults procedures. The organisation has been required to carry out their own investigation and take necessary action to minimise a reoccurrence of such errors. We were informed by the peripatetic manager that she would be undertaking the investigation, which she would ensure would be completed promptly. Following the last visit to the service it was required to ensure the people who use the service have their dignity and privacy respected at all times. The DS0000011652.V373824.R01.S.doc Version 5.2 Page 15 improvement plan tells us the importance of this will be addressed with staff at each handover and at heads of department meetings and training will be organised for all staff. The manager demonstrated that she has an awareness of the importance of respecting the dignity and privacy of the resident at all times and in all aspects of their care. The manager informed us that this starts for the resident at the assessment stage by asking them how they wish to have their needs met. Through observation it was demonstrated that residents were being addressed respectfully, time was being made to listen and respond and act on requests. Call bells were answered promptly, the manager informed us more time spent with residents listening to them and finding out what they want, need and making them comfortable has lessened the frequency of call bells going off. It was observed that for some residents attention had been taken in respect of their appearance and dress. Some further improvement is required in this area to establish how residents wish to dress to avoid discomfort and unnecessary complaints. DS0000011652.V373824.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The social, cultural, religious and recreational interests and needs of the people who use the service meet their expectations and preferences. The service provides a welcoming and comfortable home where residents can meet and are supported to maintain contact with family and friends. Improvements are being made in respect of supporting the people who use the service to exercise choice and control over their lives. The people who use the service receive three meals a day of their choice. Further improvement is required to ensure people receive the right tools and support to eat and drink. EVIDENCE: The AQAA tells us the service has a fully inclusive activity programme in place, all residents are encouraged to individualise and personalise their rooms. There are separate communal areas where residents can meet with their visitors and there is an accessible garden. DS0000011652.V373824.R01.S.doc Version 5.2 Page 17 This was tested by viewing activity records, activities taking place at the time of the visit, observing meal times and speaking with residents and visitors to seek their views on the daily and social activity of the home. The home has a comprehensive activity programme of which residents are encouraged to participate in. The employment of an activity co-ordinator earlier in the year was gratefully received by residents and their relatives. Sadly the activities co-ordinator is leaving. This was announced to the residents at the time of the visit and was greeted with disappointment. Evidence of the good work the activities co-ordinator, with the assistance of staff was seen in photograph albums, which are displayed in the entrance of the home. Good feedback during this visit and previous visit tells us this will be a loss to the service. An activity taking place during the visit was on current affairs and was well attended by residents. The manager informed us that they have temporarily appointed a volunteer to carry on activities, the person had been working along side the activities coordinator so is familiar with the type of activities the residents enjoy. In addition the manager is in the process of developing an activity programme in line with the organisations “Social Activity Programme”. Guidance is provided for managers in the form of an activity file which tells them the type of activities to introduce, what they need in terms of equipment to carry out the activity, how to record outcomes and how carers can identify specific needs of residents to enable them to take part. Visitors who were met with at the time of the visit informed us they are greeted politely and the manager is always available to discuss their relatives wellbeing or raise concerns. A relative told us the manager is approachable and the keyworker to her relative was very good and understanding of their needs. The home has a pleasant and tastefully decorated quiet room where residents can meet with their relatives if they wish. It has a pleasant outlook into the garden, it is warm and furnished with comfortable furnishings. The manager informed us the room can be used for family gatherings to celebrate birthdays and anniversaries. Following the last visit to the service is was issued with a requirement to ensure residents are provided with opportunities to have a say and make decisions about how they wish to receive their care. Through the development of person centred plans, which involved residents and relatives. By providing staff with training in equality and diversity and promoting the importance of respecting residents choices and decisions the DS0000011652.V373824.R01.S.doc Version 5.2 Page 18 home has demonstrated that it has met the requirement and is taking steps to improve the ethos of the service. The majority of comment cards received from residents, relatives and staff tell us people are feeling happier about the standard of care they receive. They tell us they feel more informed and meetings held by the manager has allowed them to have a say of how they feel things can be improved. Following discussion with a resident and their relative it was apparent the service could take further steps to improve how it communicates with residents who have communication difficulties. We learnt that a tool devised by a speech and language therapist was not being used. This was brought to the attention of the manager who said this would be address. It was noted the communication tool was being used during the second day of the visit. The home has made further improvements in menus and how residents are supported to make choices and assisted to eat. The manager has changed the morning routine to include breakfast in bed or in resident bedrooms if they wish. The manger told us that this has made a difference to how and what time residents get up. It means resident are no longer being rushed to get up, allowing them time to wake, have medication to manage pain and loosen limbs and get up when they want to. The manager told us this appears to be working well and has added to a more relaxed approach to the care of residents. This was evident through observation on both days of the visit. Each person personal plan tells the reader the specific likes, dislikes and food allergies resident may have. If there are concerns about residents weight a Malnutrition Universal Screening assessment takes place. This requires the service to carry out regular checks on residents weights, refer to a dietician if necessary and request prescription foods such as Fortisip. There was evidence of a number of these assessment taking place and records kept of residents weights, body mass index and dietary intake. A member of staff who was spoken with told us the services morning routine is working well and they also have a system where people who are able to eat by themselves are given their meals first so those that need assistance are given the time they need to eat their meal in a relaxed and unrushed atmosphere. The service provides resident with aids to support them to eat and drink such as guards on plates to prevent food spilling over the rim of the plate and lids on cups to prevent spillage. It was observed that not all residents are provided with suitable equipment and would benefit from an assessment, such has one that would be carried out by an occupational therapist. The handles of ceramic cups were noted to be very small and difficult for a resident to hold DS0000011652.V373824.R01.S.doc Version 5.2 Page 19 and raise the cup in a steady motion to their lips. There is a potential risk of hot drinks being spilt. The manager agreed to look into alternative equipment. DS0000011652.V373824.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The service is making progress in listening to the needs and wishes of the people who use the service, which is having a positive outcome in the number of complaints the service is receiving. The service is making progress in protecting the people who use the service from potential risk of abuse, however further steps must be taken to rule out poor practice. EVIDENCE: The AQAA tells us all complaints are recorded and replied to as per the companies policies. All staff are subject to an enhanced CRB check and the service has an open policy for visitors and residents to raise concerns. This was tested by viewing the services complaints policies and procedures, complaints log book, speaking with residents, relatives and staff, viewing comment cards and staff training records. Following the last visit to the service it was required to ensure all staff receive training in abuse awareness and know what to do to protect the people who use the service. DS0000011652.V373824.R01.S.doc Version 5.2 Page 21 The AQAA tells the service has received forty-five complaints in the last twelve months of which 95 were resolved within a twenty-eight day period. Residents who were spoken with said they knew who to speak to if they are unhappy. They told us they regularly see the manager who asks them if everything is ok. One resident said this gives them an opportunity to tell the manager if they have any concerns. A resident went onto tell us: “The manager is very approachable and you know if you tell her something is bothering you she will try and sort it out for you”. Whilst talking with a visitor a number of concerns were raised about the care and wellbeing of their relative. The relative confirmed they had spoken with the manager on a number of occasions but wasn’t convinced their concerns would be addressed or taking seriously. This was discussed with the manager who provided evidence that discussion had taken place and the concerns logged. During the second visit to the service it was established that further discussion had taken place with the relative and an agreement had been made in how they could address their concerns. Staff who were spoken with told us if a resident disclosed they were unhappy they would ensure the manager was made aware of it and they would record the concerns. Following the last visit to the service a requirement was made for the service to ensure all staff receive training in abuse awareness and know what to do to protect the residents. The home can demonstrate through training records and certificates that the majority of staff have received abuse awareness training and those who have not received training are newly employed. The service currently has a caution placed on it by social services. This means social services will not place with services that have a Zero star rating. Social services continue to monitor the service and there is evidence that they meet regularly with the manager to monitor performance. Since the last visit to the service it has been brought to our attention there have been three safeguarding meetings in respect of disclosures made by residents and staff. These are being addressed through the safeguarding adults procedures. The service can demonstrate they have taken appropriate steps to report two issues of concern but not a third. The Commission for Social Care Inspection received a notification informing us that a resident had received the wrong amount of medication for over a week. This is deemed as a reportable incident under safeguarding as the resident’s health was placed at potential risk. The DS0000011652.V373824.R01.S.doc Version 5.2 Page 22 home failed to notify social services. The manager told us lessons have been learnt in what the service could do better in their procedures for reporting concerns. The third incident was still being investigated at the time of the visit. Staff who were spoken with appeared aware of the “whistle blowing” policy and could tell us what they know to be abuse, which included denying someone their rights. DS0000011652.V373824.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service live in a spacious, clean and welcoming home, which is free from unpleasant odours. EVIDENCE: The AQAA tells us the service has a welcoming and friendly atmosphere, all areas are accessible to residents and their families and the garden is well maintained and has been made accessible to all. This was tested by touring the service, speaking with residents, viewing cleaning schedules, staff training records, comment cards and speaking with residents, relatives and staff. Flowerdown Nursing Home is a large home accommodating up to fifty-three residents. The service is built over two levels and over a number of years has been extended to accommodate the current number and needs of residents. DS0000011652.V373824.R01.S.doc Version 5.2 Page 24 A tour of the building provided evidence that care has been taken to provide a homely and welcoming environment, which has been tastefully decorated and furnished to a high standard. Communal areas are bright, airy and spacious. The garden has been landscaped and includes raised flowerbeds, a water feature and patio area. There is access to the garden from some of the ground floor bedrooms. Residents who were spoken with at the time of the visit said they were happy with the home’s environment and their own rooms. Bedrooms were observed to be homely, clean, well maintained and personalised reflecting the resident’s individuality. Following the last visit to the service it was required to keep the environment free from offensive odours so the people who use the service can live in a pleasant environment. The improvement plan told us cleaning schedules have been reinforced, a new head of domestic staff has been recruited and all staff have been made aware of the importance of maintaining a clean environment. It was evident that the service is making progress in eliminating offensive odours. The manager told us this has been achieved by introducing robust continence management and dealing with spillages as soon as they occur. This was observed on the day of the visit. The manager informed us the new head cleaner has worked with her to develop and improve cleaning schedules and procedures. She went onto say the cleaning team are hard working and take pride in keeping the service clean. A further requirement was issued following the last visit in respect of ensuring the people who use the service are protected from the potential of cross infection. This was mainly in the respect of administering insulin, where it was observed the person administering the insulin had not washed their hands or used disposable gloves. Training records tell us that all staff including ancillary staff have received training in infection control and trained staff have received training in diabetes and safe practices for administering insulin. Throughout the service including the entrance antibacterial hand gels are in place and visitors are encouraged to use them. Staff were observed wearing protective clothing to co inside with the activity they were carrying out. Different colour disposable aprons and gloves are used when supporting residents with personal care and assisting them with meals. DS0000011652.V373824.R01.S.doc Version 5.2 Page 25 Discrete notices around the service advise staff of the importance of good hygiene practices and notices in clinical areas inform the staff how they must wash their hands. Following concerns raised by some staff in comment cards re knowing if a resident has a communicable disease was discussed with the manager. The manager must consider if this information would benefit staff and change practices or if practices are robust enough to ensure the risk of infection is minimised. DS0000011652.V373824.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made and continue to be made in recruiting sufficient staff to meet the needs of the people who use the service, and how those staff are deployed to carry out their responsibilities. The service ensures all staff are provided with the appropriate training and skills to meet the needs of the people who use the service. The service carries out appropriate recruitment checks on staff, which minimises the risk of harm to the people who use the service. EVIDENCE: The AQAA tells us staffing levels are maintained as per the guidelines, recruitment has been concentrated on and improved and a full and comprehensive induction programme is in place for all staff. The AQAA goes onto tell us that the service has improved its induction process, supervision of staff and training. The service tells us it recognises it could do better to encourage more staff to access a national vocational qualification (NVQ). This was tested by viewing staffs training and recruitment records, observing their practice. Viewing “Have Your” Say comment cards from staff, residents and relatives and speaking with the manager and service managers. DS0000011652.V373824.R01.S.doc Version 5.2 Page 27 Following the last visit to the service it was required to ensure that at all times there are suitably qualified, competent and experienced staff working in the home to meet the current care, health and welfare needs of the people using the service. The improvement plan told us they have recruited to all grades of staff, the off duty rota is monitored daily and where there are any gaps in the duty rota agency are called upon. The manager told us the home is still in the process of recruiting new staff, especially nursing staff but will not just take anyone to fill posts. The manager said: “We are not going employ just anyone for the purpose of increasing staffing levels. The staff member has to meet a certain criteria and have the appropriate skills and values”. Staff were observed carrying out their day-to-day duties using a calm and relaxed approach, spending time with residents in discussion and light hearted banter and answering call bells promptly. The manager told us she believes the decrease use of call bells is because staff are spending more time engaging with residents and ensuring their needs are being met before leaving them. Staff confirmed that there is a more relaxed approach to meeting residents’ day-to-day needs with the emphasis of trying to meet their needs when they wish and not when it’s convenient for the running of the home. A relative told us: “The care provided is always carried out considerately and cheerfully, staff always have time for a chat”. Another said: “They provide a good service for my mother”. Other comments received from relatives told us a different story regarding staffing levels and skills, wishing that there were more staff, especially when staff are in training. The manager told us the home has held several meetings with family and friends and is aware of their concerns in respect of staffing levels and skills. The service has demonstrated through the inspection process that they are aware of where improvements need to be made and are taking steps to rectify them. The service must work towards having 50 of its care staff trained in a NVQ. Recruitment records for three staff, which, have been appointed since the last visit to the home, and the records of a member of staff who is currently going DS0000011652.V373824.R01.S.doc Version 5.2 Page 28 through the recruitment process were viewed. The records demonstrate that the home carries out a thorough recruitment process. It requests an application to be completed, obtains appropriate checks, for example, Criminal Record Bureau (CRB) and Protection of Vulnerable People (POVA), two references and asks them to attend an interview. The manager keeps a record of questions and answer asked at interview. Comment cards received from staff told us that their employer carried out checks before they started working in the home. A member of staff told us: “I came for an interview and I didn’t start working in the home until all checks were in place”. The service has taken steps to improve its training and quality of training for all staff. The manager provided us with a training matrix and evidence of training staff have received. Areas of training identified as a need following the last visit have been addressed. The training matrix and speaking with staff told us they have received training in infection control, diabetes, abuse awareness, and dignity and privacy. Staff with whom were spoken with told us that they had received regular and varied training since the new manager has started. A member of staff told us one thing that was good about working at Flowerdowns was the amount of training the service provides to help them do their job. The service provided us with a training schedule for February – July 2009 which includes mandatory training such as fire safety, moving and handling, health and safety and training specific to the needs of the residents such as continence awareness, male catheterisation, stoma care, abuse awareness and customer care. The services care service director told us that she has been working closely with the new manager and trained staff, especially focusing on clinical governance, communicating and improving relationships. The care service director told us she feels the intense support and training they have provided in the last couple of months has improved standards in the home. The home has introduced a new induction programme which is monitored both by the manager and the new starters mentor (A named trained member of staff). The induction programme is comprehensive covering all aspects of the day-to-day running of the home, roles and responsibilities and principles of care. DS0000011652.V373824.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. To improve stability in the service and service delivered to the people who live in the home, the service must be satisfied the person they have employed to manager the home is fit to discharge their day-to-day responsibilities fully. The service is making improvements to the quality of care and support by seeking the views of the people who use the service and their representatives. The service has systems in place to minimise risks to the health, safety and welfare of the people who use and work in the service. EVIDENCE: The AQAA tells us the service does well to have an open door policy to see people as they wish, receive monthly and every three month visits from the DS0000011652.V373824.R01.S.doc Version 5.2 Page 30 regional manager, who undertakes quality monitoring visits. The AQAA also tells us that it can do better to improve stability in the management position and will ensure in the next twelve months improved customer satisfaction. This was tested by meeting with the new manager, service manager, regional care services director, staff, residents and relatives. It was also tested by observing practices, viewing quality monitoring audits and documents relating to health and safety. The service has recently employed a new manager to manager the day-to-day running of the home. Following the last visit to the service and receiving a zero star rating the new manager and service managers told us that they were aware that there was a need for intense work in the home to drive up standards. The home provided us with an improvement plan that told us how they intend and continue to improve standards. The manager told us that there have been many challenges but with the support of service managers and her peers improvements are being made. This was evidenced by the demonstration of the managers own values and leadership skills. The manager was observed to interact professionally and positively with residents and staff. Staff were given clear direction and advice. The manager was able to give us clear information about residents and their needs and was observed supporting staff to carry out hands on tasks. The manager told us she will work hands on, which enables her to have a good knowledge of residents needs and establish the skills of her staff. We received positive feedback from residents’ staff and relatives. They told us that the manager was always available to listen, provide advice and answer any queries they may have. A resident told us: “If it wasn’t for xxx I don’t know where I would be now, she has helped me so much, especially when I was unwell. She’s superb!” A staff member told us: “Her door is always open and she will take time to listen to us and she will come and help us when we need help”. Another staff member said: “Things have really got better since the new manager has started”. DS0000011652.V373824.R01.S.doc Version 5.2 Page 31 The manager has been in post since September 2008 and was advised that she must make application to register with the Commission for Social Care Inspection as it is illegal to run a care home without a registered manager. The home has a number of systems in place to monitor the quality and performance of the service. The manager told us that she reviews the improvement plan monthly and gives a record of this review to her line manager. In addition regulation 26 visits are undertaken on a monthly basis. A service manager who does not work day-to-day in the home will visit the service and assess quality and standards by talking to residents, staff and visitors. Records relating to the residents, staff and the environment are also viewed. A report is completed identifying areas where improvements have been made and areas for further improvement. A copy of this report is kept in the service. We saw evidence of these reports, which detailed actions and time scales. There was further evidence that actions are reviewed during the next visit. The manager told us that she has arranged monthly meetings with residents and their relatives and plans to continue to hold these at various times in order that as many relatives can attend as possible. Minutes of these meetings were viewed and provided evidence that the manager with the support of service managers have been open and honest with residents and relatives regarding the current concerns relating to the homes zero star rating. The minutes also provided us with evidence that residents and relatives were asked for their views and opinions. Resident’s monies, and health and safety was not looked at in depth during this visit. All records relating to fire safety were viewed and told us that regular checks are carried out on fire alarms, fire safety equipment and staff receive regular training. DS0000011652.V373824.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 DS0000011652.V373824.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP31 Regulation 8 Requirement The service must make application to the Commission Social Care Inspection to register a manager. The manager must be of good integrity and character and have the right experience and skills to manager the care home and ensure the people who use the service receive a good standard of care. Timescale for action 31/03/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000011652.V373824.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000011652.V373824.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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