Inspection on 05/02/09 for Four Seasons Care Centre

This inspection was carried out on 5th February 2009.

CSCI found this care home to be providing an Good 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

Four Seasons Care Centre 19/11/07

Four Seasons Care Centre 15/09/06

Four Seasons Care Centre 18/11/05

Four Seasons Care Centre 27/06/05

Similar services:

Ashlea Mews Residential Home

Eastwood

West Lodge

Arran House

Avenue Community Nursing Home

Cosin Lodge

Farmborough Court

Connolly House

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

CARE HOMES FOR OLDER PEOPLE Four Seasons Care Centre Ox Close Saltburn-by-Sea TS12 1NR Lead Inspector Stephen Ellis Unannounced Inspection 10:30 5 & 6 February 2009 th th 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 Four Seasons Care Centre DS0000063463.V374121.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. Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Four Seasons Care Centre Address Ox Close Saltburn-by-Sea TS12 1NR 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) 01287 624516 01287 624008 fs@keyhealthcare.co.uk Key Healthcare (Operations) Limited Manager post vacant Care Home 53 Category(ies) of Dementia - over 65 years of age (53), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (12) Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two of the twelve MD(E) beds can be used for two existing service users between the age of 55 - 64 years until they are no longer required. They will then need to be removed from the registration certificate. The twelve beds MD(E) can be used for the twelve existing service users until they are no longer required . They will then need to be removed from the registration certificate. The existing 28 bedded unit will provide Nursing Care and the new 24 bedded unit will provide Personal Care. 11th September 2008 2. 3. Date of last inspection Brief Description of the Service: Four Seasons Care Centre has been operational as a Care Home since 1989. In April 2005, Key Healthcare Ltd became the Registered Provider. The home operates two separate units, 52 beds in total: a 28 bedded nursing unit, primarily for older people with dementia, but also including up to 12 older people with a mental disorder, and a 24 bedded residential unit for older people with dementia. All rooms are single rooms and the rooms within the residential unit also have en suite facilities. The home is situated on the outskirts of Saltburn, within close proximity of local shops, church and public transport. The sea is about one mile distant and can be seen from some parts of the home. The fee charged at Four Seasons Care Centre varies between £450 and £497 per week (exclusive of any free nursing care charge where applicable), but the actual amount payable by people using the service depends on their individual circumstances. Four Seasons Care Centre DS0000063463.V374121.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 2 stars. This means the people who use this service experience good quality outcomes. This unannounced fieldwork visit to Four Seasons Care Centre took place over 2 days (14 hours in total) on 5th and 6th February 2009 as part of the statutory inspection of the service. Information received prior to the fieldwork visit was used in preparation and during the visit. This included the home’s Annual Quality Assurance Assessment (AQAA) that it completed on 27th October 2008. The last key inspection of Four Seasons Care Centre took place on 19th November 2007 and a random inspection of the home was carried out on 11th September 2008. Both of those inspections were unannounced. The visit to the home on 5th and 6th February 2009 included a tour of the building, an examination of a sample of the documents and records that the home is required to keep, and various discussions with people who use the service, relatives and staff, plus a meal with people who use the service on the nursing unit. Comments were received during the visit and from surveys that we carried out before the visit. In total, there were comments received from 8 people who use the service, 10 relatives, one visiting health care professional and 13 staff, including the newly appointed manager, Bridget Logan, who is not yet registered in respect of Four Seasons Care Centre. What the service does well: The service achieves good outcomes for people who use the service in most key areas covered by the National Minimum Standards, with the exception of outcomes for daily life and social activities, where an excellent standard has been achieved. The home has been awarded a good four stars rating for food hygiene by the local environmental health authority (the maximum possible rating is five stars). It has also been awarded a maximum five stars rating by Redcar and Cleveland, the Local Authority responsible for contracting with the service, for 3 successive years (2006 to 2009). Typical comments received from people who use the service and/or their relatives included: “I received enough information about this home before I moved in so I could decide if it was the right place for me.” “I was very satisfied by what the home had to offer me. I heard very positive reports about the care given to residents.” Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 6 “Staff always listen and act on what I say.” “I always receive the care and support I need.” “I always receive the medical support I need.” “I am broadly satisfied with the standard of care; my wife’s physical condition has improved since she came here nearly two years ago. The staff discuss her care plan with me and I sign it afterwards” “The carers are marvellous, although there’s been too much turnover of staff; we visit four or five times per week and all we’ve ever seen is people being well looked after and kindness. Mum’s always clean and has clean clothes in her wardrobe.” “I would just like to say that everyone is very helpful and caring. They put me at ease. Thank you everyone.” “There are always activities arranged by the home that I can take part in.” “I am very happy with what has been offered; the activities keep me entertained; never had to grumble.” “Very willing to join in; always pleased with the entertainment.” “The parties, like the Halloween Party, are the best we’ve been to; children and families are always welcome. Last summer, the home put on a seaside event with paddling pools full of sand, sand castles, real donkeys, Punch and Judy show, ice creams and bags of chips!” “The activities organiser, Sharon, is brilliant. I can’t speak highly enough. She will always involve my wife. A man visits with snakes and insects to show the residents from time to time and there are weekly pat a dog visits. Sharon raises all the funds herself: raffles, car boots, pie and peas suppers, little plays involving the carers etc. At Chinese New Year (year of the Ox) Sharon made a cloth ox for every resident and there was a Chinese dancer. At Christmas and New Year there were celebrations, with party hats and every resident received a set of Christmas presents. There are trips out about twice a year when a minibus is hired and my wife has been to the Alan Shearer Centre, even though she is severely physically disabled.” “I know how to make a complaint.” “I can talk to the staff about anything I’m not happy with.” “The home is always fresh and clean.” A visiting health care professional said: “The care here is good.” What has improved since the last inspection? Improvements have been made to the nursing unit’s bath seats, toilet and bathroom locks and decoration, the lift on the nursing unit and furniture, floor covering and decoration in ground floor rooms on the nursing unit, health and safety procedures, medication audits and medication competency assessments, care planning and evaluation, staffing levels, staff recruitment procedures, staff induction and mentoring arrangements, staff training in safeguarding adults, risk assessments, complaints procedure and, latterly, management arrangements. Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 7 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. Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 8 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 Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 9 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): 1, 2, and 3. People who use the service experience good quality outcomes in this area. People, who are thinking about using the service, and their representatives, have the information needed to choose a home that will meet their needs. They have their needs assessed and a contract which tells them about the service they will receive. Intermediate care is not provided. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Comments received from people who use the service, relatives and staff confirmed that full assessments of needs were carried out prior to admission to the home. Most people felt there was enough information from which to make a choice about the home, and trial stays and introductory visits are encouraged, often with the assistance or involvement of relatives and social workers. The home supplies comprehensive statements of purpose, service user’s guides and contracts/terms and conditions of residence. These Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 10 informative documents are readily available in reception areas, along with the home’s last inspection report. The home keeps these documents under review (last reviewed and amended January 2009). The home’s main reception area is on the residential unit, close to the manager’s office on the ground floor and a variety of useful information is available, including the service user’s guide, brochures, monthly newsletters, residents’ charter of rights, the home’s philosophy of care, complaints procedure, statement of purpose and last key inspection report. There is also a large board with staff photographs and job titles on both units to aid identification. A welcome pack is provided in each bedroom and includes useful written information about the home, plus small gifts of towel, toiletries etc. Typical comments included: “I received enough information about this home before I moved in so I could decide if it was the right place for me.” “I was very satisfied by what the home had to offer me. I heard very positive reports about the care given to residents.” The plans of care of six people who use the service were examined (three from each unit) and revealed comprehensive, detailed assessments of need being carried out prior to admission, with regular evaluations and reviews of care needs and care plans at appropriate intervals following admission. These assessments showed that the home only admitted people whose needs were known and could be appropriately met by the service. The manager or senior member of staff visits the prospective service user and completes a written assessment of needs. This assessment plus other information supplied by social workers or care managers, helps determine whether the home’s admission criteria are met and whether the service is right for the individual. Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. The health and personal care received by people who use the service, is based on their individual needs. The principles of respect, dignity and privacy are put into practice. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People who use the service and/or their relatives felt that the health and social care needs of people who use the service were well known by the staff team and were well met. An examination of six care plans confirmed that health and social care assessments and treatments/interventions were being carried out, with good input from the home’s nursing and care staff, local doctors, hospital specialists, dentists, opticians, falls team, speech and language therapist, tissue viability nurse, community liaison nurse, occupational therapist, physiotherapist, chiropodist and social workers. People who use the service and/or their relatives said that they felt supported by the staff team and the Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 12 local health and social care services that worked in partnership with Four Seasons Care Centre. For example, the community nurse or doctor would see them whenever required and they were satisfied with the quality of service they received. They felt they were treated with respect and sensitivity. Families are involved in the care planning process and relatives’ signatures were often found in plans of care, indicating consultation and agreement, as representatives of the people who use the service. Relatives are also involved in biographical life histories so that staff can get to know the whole person better. Typical comments included: “Staff always listen and act on what I say.” “I always receive the care and support I need.” “I always receive the medical support I need.” “I am broadly satisfied with the standard of care; my wife’s physical condition has improved since she came here nearly two years ago. The staff discuss her care plan with me and I sign it afterwards” “The carers are marvellous, although there’s been too much turnover of staff; we visit four or five times per week and all we’ve ever seen is people being well looked after and kindness. Mum’s always clean and has clean clothes in her wardrobe.” “I would just like to say that everyone is very helpful and caring. They put me at ease. Thank you everyone.” A visiting health care professional said: “The care here is good.” There have been occasions over the past year when relatives and other representatives of people who use the service have not always been satisfied with the standard of care provided. However, the home’s management have taken such concerns and complaints seriously and have tried hard to rectify problems and prevent their recurrence, often in collaboration with external agencies, such as Local Authority Commissioning and Safeguarding teams, plus Primary Care Trusts. The home has demonstrated a willingness to learn from the experiences of people who use the service and their representatives and to work with external agencies where appropriate to put things right and improve its performance. Care plans and risk assessments from across the home were found to be detailed and comprehensive about the health and social care needs of people who use the service, providing clear guidance to staff. They were subject to regular review and evaluation, involving people who use the service, relatives and external health and social care professionals where appropriate. There were many examples of good provision and practice. These included each person who uses the service having a named nurse and/or key worker; special, adjustable beds and pressure relieving mattresses and chairs in many instances; objects for people to touch and manipulate; attractive pictures on walls plus enlarged photographs of local scenes taken many years ago; artwork done by people who use the service; a named photograph on the bedroom door of the person who uses the service, of good size, taken at a key Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 13 moment in their lives, often in early to mid-adulthood, in attractive frames; doll therapy; memory boxes to stimulate recall and reminiscence; old fashioned ornaments, objects, games, newspapers and magazines; notice boards with up to date information, including activities and social events; clocks at the right time; aprons draped over handrails with interesting objects sewn into pockets, such as spoons and louvers; good quality furnishings, fittings and décor; personalised rooms; plus regular audits of care plans and medicine records. Staff training, such as National Vocational Qualifications (NVQ) level 2 or above, includes the important issues of privacy and dignity and over 50 percent of permanent care staff have achieved NVQ in care. The home’s induction programme also addresses these issues systematically. There are generally good arrangements for the safe administration of medicines, including comprehensive policies and procedures. All staff members responsible for the administration of medicine have completed Safe Handling of Medicines courses or equivalent. A dedicated Pharmacist supplies medication in Monitored Dosage form (in blister packs with the medication clearly identified for the individual person who uses the service). There are good storage systems, with designated senior staff checking all medication when it is received into the home. Medication is kept securely in lockable cabinets and trolleys. People who use the service may attend to their own medication, but in practice most prefer to delegate this responsibility to staff. Unused medicines are collected by a licensed waste disposal agency. The home is careful not to stockpile large quantities. The manager or senior staff members carry out regular medicine audits, sampling individual records and stocks. They take advice from the Primary Care Trust’s (PCT) Pharmacist. A photograph of the individual person who uses the service is kept next to their Medicine Administration Record, along with their name, date of birth and room number, to aid identification. Management have introduced periodic competency assessments and this is recommended as reinforcing good practice and helping to minimise the risk of errors in the administration of medicines. There have been a few occasions over the past year when medicines have not always been administered as required by the prescribing doctor, due to human error on the part of the member of staff responsible at the time, and/or delay in obtaining the medicine and/or poor communication. These important issues are being systematically addressed by the home in conjunction with the Local Authority and PCT and there is evidence of good progress being made. Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15. People who use the service experience excellent quality outcomes in this area. People who use the service are able to choose their lifestyle, social activity and keep in contact with family and friends. Social, cultural and recreational activities meet people’s expectations. People receive a healthy, varied diet according to their assessed requirement and choice. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Most relatives said that they thought that people using the service enjoyed living at Four Seasons Care Centre and described the staff as being caring and helpful. People who use the service and their families liked the atmosphere in the home, describing it as being friendly and supportive. They liked having the choice of using a number of lounges and dining areas across the home. They were free to use any of the facilities within their particular unit, including any lounge or dining area, or their own bedroom. All appeared satisfied with the Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 15 arrangements for daily life in the home. A kitchenette is available in one first floor lounge on the residential unit so that people who use the service can make drinks and small snacks with the support of staff, and visitors can also make a drink. Comments received from people who use the service and their relatives, plus staff, confirmed that people were supported to exercise choice in their daily lives as far as practicable, such as what clothes they wore and how they spent their time, including when they got up and went to bed. There were many different events and activities that they could take part in if they wished, including seasonal events such as Halloween Party, Chinese New Year celebrations and Valentine’s Day Party; nail care, board games, crafts (including the making of a collage of people’s handprints in the shape of a peacock in which they placed small pictures of things that were important to them, plus plate painting), plays (such as murder mysteries) put on by the staff in which staff members dressed up and acted out parts, visiting pat dogs, visiting ‘zoo lab’ with animals, quizzes, raffles, chair exercises plus monthly physical motivation sessions, videos and DVDs, reminiscence and memory boxes, some shopping trips, occasional outings to places of interest such as Beamish Museum and Eden Camp, clothes parties, monthly newsletters, aprons draped over handrails with objects to be manipulated sewn into pockets, doll therapy, music, television and radio. A hairdresser visits weekly and is very popular. The home has a highly skilled and enthusiastic activities coordinator who takes responsibility for devising a hugely impressive, varied programme of social and recreational activities, which she implements with the help of staff and support of people who use the service and their families. The home did very well last year to be highly commended and placed in the top 35 out of 350 care services nationally that participated in a competition concerning ‘A breath of fresh air’ about the quality and range of activities available for older people who use its services. There have also been computer courses at a local college, which six people who use the service successfully completed and were awarded certificates. The home has a computer in one lounge and the activities coordinator hopes to have it fully operational and connected to the Internet if at all possible. Recently, people who use the service were asked to create ‘spring couplets’ about things that mattered to them and these were displayed on walls. One example was: “May I always have enough money to share. May I be healthy enough to play football.” Biographical life histories are provided for each person who uses the service and daily diaries are being placed in people’s rooms to record daily events. Examples of these were seen and were very good and included the use of photographs. Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 16 Typical comments from people who use the service and relatives included: “There are always activities arranged by the home that I can take part in.” “I am very happy with what has been offered; the activities keep me entertained; never had to grumble.” “Very willing to join in; always pleased with the entertainment.” “The parties, like the Halloween Party, are the best we’ve been to; children and families are always welcome. Last summer, the home put on a seaside event with paddling pools full of sand, sand castles, real donkeys, Punch and Judy show, ice creams and bags of chips!” “The activities organiser, Sharon, is brilliant. I can’t speak highly enough. She will always involve my wife. A man visits with snakes and insects to show the residents from time to time and there are weekly pat a dog visits. Sharon raises all the funds herself: raffles, car boots, pie and peas suppers, little plays involving the carers etc. At Chinese New Year (year of the Ox) Sharon made a cloth ox for every resident and there was a Chinese dancer. At Christmas and New Year there were celebrations, with party hats and every resident received a set of Christmas presents. There are trips out about twice a year when a minibus is hired and my wife has been to the Alan Shearer Centre, even though she is severely physically disabled.” The relatives of people who use the service are invited to quarterly meetings with the manager, at which matters of interest and suggestions are discussed. The minutes of these meeting are recorded. People who use the service and their relatives are encouraged to make comments or suggestions for improvements at any time. Relatives confirmed that they attended such a meeting recently. People said that visitors were always made welcome and there were no set visiting times. Some people went out with relatives or friends for part of the day. The religious needs of people who use the service were also addressed (for example, clergy will visit to give people Holy Communion if they wish). Comments received from people who use the service or their relatives indicated that the catering was good. They felt there was a good choice and the Cook understood their preferences. Typical comments included; “I always like the meals at the home.” “I have a good appetite and it is a pleasure to eat the meals here.” Nutritional risk assessments were documented in plans of care and there was evidence of appropriate referrals being made to a Dietician for advice and guidance. The home provides a wide range of meals based on healthy eating and appetising menus for older people, including much home baking. Special diets are provided, including liquidised meals. People mainly dined together in the various dining areas. They could, however, eat their meals elsewhere (such as their bedrooms) and at different times if required. Décor and furnishing in dining areas was attractive, creating a relaxed and welcoming environment. Tables were supplied with linen tablecloths and napkins. Staff members will assist people with their meals wherever needed and this was observed being done skilfully on the nursing unit. Records are kept of meals served. A good choice of menu is provided. Birthdays are Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 17 always celebrated with a cake and a special tea, and are mentioned in the home’s monthly newsletter. The home has been awarded a good four stars rating for food hygiene by the local environmental health authority (maximum award is five stars). Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 18 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): 16 and 18. People who use the service experience good quality outcomes in this area. Residents have access to a robust, effective complaints procedure and are protected from abuse. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Many people who use the service and/or their relatives said that they were confident about approaching staff and management about any concerns or complaints they might have. They described the staff and management as being very approachable, helpful and friendly. A written complaints procedure is provided in the statement of purpose, service user’s guide and in the reception areas. The home invites comments, compliments and suggestions, plus complaints, which it records along with any necessary action taken to investigate and address issues. Typical comments included: “I know how to make a complaint.” “I can talk to the staff about anything I’m not happy with.” The home actively seeks feedback from people who use the service and their representatives about the quality of its service, including inviting written comments and suggestions, quarterly meetings of people who use the service and relatives, frequent reviews of people’s progress and face-to-face discussions with staff and management. Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 19 Staff and management are aware of the need to safeguard adults from abuse or neglect and most have undergone robust training in these issues, including the Tees, Esk and Wear Valley adult protection workbook. Staff members confirmed they are aware of the home’s ‘whistle blowing’ policy, which requires staff to speak out about any suspected abuse or neglect. All staff members undergo enhanced Criminal Records Bureau (CRB) checks and Protection of Vulnerable Adults (POVA) checks, as required by law. Also, two references are obtained in respect of each new employee, with special attention given to the last employment. This is to ensure that unsuitable people are not employed to care for vulnerable adults. Staff confirmed that new staff members go through comprehensive induction and foundation training, so that they have the right knowledge and skills to do their jobs competently. Records examined in three staff files supported these conclusions. Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 20 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): 19, 21, 22, 23, 25 and 26. People who use the service experience good quality outcomes in this area. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: All staff members have undergone training in health and safety, fire safety, moving and handling, first aid, food hygiene and infection control. All bathrooms and toilets were found to be lockable and supplied with liquid soap and paper towels in wall-mounted containers, to help prevent cross infection. All people who use the service have their own personal towels and flannels, which they keep in their rooms. A Health and Safety Committee meets monthly and there are regular audits completed to ensure that the premises Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 21 and operating procedures are safe and promote the welfare of all people who use the service. The home was clean and well presented in all the areas inspected. The kitchen has recently received a good 4 stars award for hygiene from the local environmental health authority. The Laundry was found to be well equipped and well organised, being operated by dedicated, experienced staff. The home is planning to extend the Laundry so that it becomes more spacious, with increased capacity. People who use the service and/or their relatives said they were generally pleased with the premises, finding them comfortable and homely, as well as clean and practical. However, several relatives commented about the inadequate heating systems at times in very cold weather. The nursing unit uses electric storage heaters and the residential unit uses gas central heating radiators. The home is reviewing its provision to see where improvements can be made. One of the issues is that the home is in a hard water area and some of the plumbing is affected by scaling, which the home is addressing by using de-scaling procedures. The home tries to avoid using supplementary heaters because of the hazard they present. However, in exceptional circumstances, as a temporary measure, the home may use such supplementary heaters provided a full written risk assessment has been completed and the risks of accidents have been minimised. It is recommended that the home urgently reviews and improves its heating provision. Monitoring of room temperatures would assist this process and, to this end, safe thermometers should be placed in bedrooms (alcohol thermometers are probably safer than mercury thermometers, just in case they should be broken and the contents ingested). Similarly, a minority of wash hand basins on the nursing unit appear to be affected by scaling of pipes and/or thermostatic mixer valves, so that the temperature of hot water delivered is variable and often lower than it should be. The home is aware of this intermittent problem, but needs to ensure that it always takes prompt action to rectify such matters, which can cause inconvenience to people who use the service. The hot water system on the nursing unit would benefit from review and improvement. Typical comments included: “The home is always fresh and clean.” The home is well maintained, with much evidence of repairs, checks and servicing being carried out promptly and according to schedule. New bedroom furniture has been provided on the ground floor of the nursing unit, along with new floor covering and carpets in many areas, and many parts have been redecorated. The home intends to replace its passenger lift on the nursing unit next financial year, along with doors, as part of its ongoing improvement plan. Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. Staff in the home are trained, skilled and in sufficient numbers to fulfil the aims of the home and meet the changing needs of people who use the service. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: On both days of the fieldwork visit, the home was full, with 52 people who use the service being accommodated: 24 people on the residential unit and 28 people on the nursing unit. Four consecutive weeks of staff rosters were examined, including the week beginning 09/02/09. These showed the following typical pattern of staff deployment: During the day (08:00 to 21:00) on the nursing unit there is one registered nurse and 4 care staff; on the residential unit there is one team leader, or senior carer, plus 3 care staff. At night, there is one registered nurse and 2 care staff on the nursing unit, plus one senior carer and 2 care staff on the residential unit. During the day there is also, normally, a full time activities coordinator, although on the second day of the inspection she was working as a senior carer. In addition, there is a full time manager whose hours are not included in the care hours provided, a full time maintenance officer, plus catering and domestic staff in sufficient numbers to support the smooth running of the Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 23 home. There is no administrator, but the full time administrator at the home’s sister home, Victoria House Care Centre at Middlesbrough, provides an input. Typical comments received from people who use the service and relatives included: “Staff always listen and act on what I say.” “I always receive the care and support I need.” “I always receive the medical support I need.” “I am broadly satisfied with the standard of care; my wife’s physical condition has improved since she came here nearly two years ago. The staff discuss her care plan with me and I sign it afterwards” “The carers are marvellous, although there’s been too much turnover of staff; we visit four or five times per week and all we’ve ever seen is people being well looked after and kindness. Mum’s always clean and has clean clothes in her wardrobe.” “I would just like to say that everyone is very helpful and caring. They put me at ease. Thank you everyone.” There has been a problem with staffing levels and staff leaving over the past 18 months. Staffing levels have fallen from time to time below the current pattern of deployment, sometimes due to staff being unwell and sometimes due to staff leaving at short notice. The home tries to cover such absences by deploying staff from its bank and asking staff to work extra shifts. It also has employed agency nurses. This important issue will be addressed more fully in the next section of this report, concerning the home’s management. In each bedroom there is written information detailing the personal key worker and named nurse, where appropriate, for the individual person who uses the service, plus photographs of the staff members concerned. The home is in the process of updating these notices to ensure they are always accurate. There are photographs of staff members displayed in groups in each reception area, along with their names and roles. This is regarded as good practice and helps to identify staff members for people who use the service and visitors. Full staff induction, training and development programmes are in operation, including moving and handling, first aid, safe handling of medicines, safeguarding adults, fire safety, dementia care, managing challenging behaviour, health and safety, food safety, plus National Vocational Qualifications. Staff comments and records examined confirmed extensive programmes of induction and foundation training. Over 50 of permanent care staff members have achieved National Vocational Qualifications (NVQ) at level 2 or above, and most of the remaining care staff members are working towards NVQ, which is good. The home has introduced a mentoring scheme whereby new staff members are assigned to named mentors to help induct and support them. This is also regarded as good practice. Thorough pre-employment checks are carried out on all staff, including enhanced checks with the Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) register, plus the taking up of two references, as evidenced in staff files. Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 24 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): 31, 33, 35 and 38. People who use the service experience good quality outcomes in this area. The management and administration of the home is largely based on openness and respect, with increasingly effective quality assurance systems being developed by an experienced management team. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The new manager, Bridget Logan, is suitably qualified and experienced in senior roles within health and social care settings. She has acted as the registered manager of Four Seasons Care Centre in the past. Latterly, she has been the registered manager at the home’s sister home, Victoria House Care Centre at Middlesbrough. When the previous, registered manager at Four Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 25 Seasons Care Centre left in mid December last year, Bridget Logan divided her time between the two homes, usually providing 3 days cover per week at Four Seasons. She is a registered nurse who has completed dementia care training at Teesside University and is currently working towards the Registered Manager’s Award (RMA) at National Vocational Qualification (NVQ) level 4. She is well supported by a staff team of approximately 50 people, including registered nurses, a team leader for the residential unit, senior carers, and other care staff. However, over the past 18 months over 30 members of staff have left the home, including registered nurses and care staff. This has caused problems from time to time with the continuity of care, and difficulties for the remaining members of staff who have had extra shifts to cover and added responsibilities in inducting new staff. Staff morale has suffered as a consequence and is still fragile. The early signs are that the staff team are pleased to have a full time manager again, although there are concerns about staff turnover continuing. It is very evident that the home requires a full time registered manager who can lead the service and ensure consistently safe and positive outcomes for people who use the service, by creating an enabling culture or ethos within the service that recognises and reinforces good care practice by staff members, values such staff and implements a staff retention policy to minimise staff turnover and promote continuity of care. Nothing less is likely to rectify the problems described. The issue is so serious that consideration was given to awarding only an adequate quality rating to the outcomes associated with this management section of the inspection report. However, that would have had the effect of downgrading the quality rating for the whole service in terms of outcomes, from good to only adequate. That would have been unfair and not strictly accurate, because of the good outcomes experienced by people who use the service and their representatives, in so many of the areas covered by the National Minimum Standards for Care Homes for Older People. There is a real management challenge here to be addressed. This service could potentially be excellent, but it could also fail. Good accounting procedures are followed in the main, with receipts being obtained for most financial transactions involving the personal monies of people who use the service, in which the home is involved, wherever practicable. Relatives help look after the personal monies of people who use the service in some cases, and in others’, the commissioning Local Authority may be involved. In those situations where the home looks after people’s monies, such as pocket monies, clear individual records are maintained. These are subject to regular, independent audit. Computer records are maintained, but it is strongly recommended that there should be paper records as well, with two signatures recorded against each financial transaction involving the personal monies of people who use the service, wherever possible, so that a comprehensive audit trail can be established. For example, when someone pays money for hairdressing, two people should witness that, and sign to confirm that fact in the account record of the person who uses the service. Similarly, when money is received into someone’s account, two signatures Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 26 should support that deposit, unless there is an alternative, reliable means of confirmation of amount, date and method etc. People who use the service have ready access to their money and computer account balances, even at short notice. Comments received from staff and management confirmed that there are good health and safety policies, procedures and practices that promote the health, safety and welfare of people who use the service and staff. The manager and senior staff members take lead roles in facilitating Health and Safety risk assessments and audits across the home. There is a Health and Safety committee of a cross-section of staff that meets monthly, plus a full time maintenance officer who is directly involved in monitoring systems and equipment. All relevant staff members do refresher training in Health and Safety, such as moving and handling, fire safety and food hygiene. This helps reinforce the registered provider’s written policies on Health and Safety. Health and Safety issues are also discussed at regular staff meetings and in 1 to 1 staff supervision sessions. Many people who use the service and/or relatives and staff expressed satisfaction with the way the home was currently being run and the good standards that were evident in many instances. For example, most people commented that the home was always fresh and clean and they were pleased with the improvements carried out in recent months. It is good that there are named photographs of staff members in groups, strategically placed at key points, as this helps identify staff roles and responsibilities and aids communication with people who use the service. The manager routinely invites comments and suggestions for improvements from people who use the service and visitors to the home, via regular meetings, surveys and consultations. She makes a weekly report to the registered provider who visits the home at regular intervals, including monthly visits as required under regulation 26 of the Care Homes Regulations. Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 27 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 3 3 X 2 3 STAFFING Standard No Score 27 3 28 3 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 Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 28 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 OP25 Regulation 23 (p) Requirement Timescale for action 01/06/09 2 OP31 Heating arrangements on both units need urgent review and improvements will need to be made so that warm temperatures can be achieved and maintained, even in the coldest of weathers. Monitoring of room temperatures would assist this process and, to this end, safe thermometers should be placed in bedrooms (alcohol thermometers are probably safer than mercury thermometers, just in case they should be broken and the contents ingested). 8, 12 (5), The home requires a full time 01/05/09 18, 21, 24 registered manager who can lead the service and ensure consistently safe and positive outcomes for people who use the service, by creating an enabling culture or ethos within the service that recognises and reinforces good care practice by staff members, values such staff and implements a staff retention policy to minimise staff turnover and promote continuity of care. DS0000063463.V374121.R01.S.doc Version 5.2 Four Seasons Care Centre Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Management has recently introduced periodic competency assessments for the safe handling of medicines and this is recommended as reinforcing good practice and helping to minimise the risk of errors in the administration of medicines. A new lift on the nursing unit is being considered for the next financial year and this is recognised as being highly desirable due to the age of the present one. An upgrade of bathing and toilet facilities on the nursing unit, and an enlargement of the laundry, are being considered for the next financial year, and these improvements are recommended. The hot water system on the nursing unit would also benefit from review and improvement because some wash hand basins in a minority of rooms are not always achieving the required hot water temperature. Staffing levels and skill mix are being kept under close review, but the home should remain vigilant to ensure it always has the right number of staff with the right competencies at all times Computer records of people’s personal monies are maintained, but it is strongly recommended that there should be paper records as well, with two signatures recorded against each financial transaction involving the personal monies of people who use the service, wherever possible, so that a comprehensive audit trail can be established. 2 3 OP22 OP22 4 OP25 5 OP27 6 OP35 Four Seasons Care Centre DS0000063463.V374121.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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