Inspection on 14/01/09 for Fourseasons

This inspection was carried out on 14th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fourseasons 16/08/06

Fourseasons 19/10/05

Fourseasons 09/06/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fourseasons 33 Church Walk South Rodbourne Cheney Swindon Wiltshire SN2 2JE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sally Walker     Date: 1 4 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Fourseasons 33 Church Walk South Rodbourne Cheney Swindon Wiltshire SN2 2JE 01793527103 01793525953 coatewatercare@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Coate Water Care Company Limited care home 15 Number of places (if applicable): Under 65 Over 65 13 1 1 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 0 Four Seasons is a family owned, privately run care home. One of the homeowners assumes day-to-day management of the home. The home provides a good overall standard of accommodation on two floors. Each floor is linked by a vertical passenger lift. The home is ideally located in a quiet cul de sac with easy access to Swindon town centre. The home seeks to specialise in the care of older people who experience dementia but who do not need nursing care. From 7.00am to 4.00pm there are 3 care staff on duty. During the evening there is a minimum of two staff on duty. One of the care managers works off rota during four afternoons for administrative duties. In addition there is a full time cook and a cleaner during the mornings. An activities coordinator is also on duty during the afternoons from 2.00pm until 4.00pm. At night Care Homes for Older People Page 4 of 32 Brief description of the care home time there is one person who works an awake duty and one staff member who undertakes a sleep-in duty. This person can be called upon to assist in an emergency or meet night time needs. The range of fees for the service have not been made available. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place on 14th January 2009 between 9.45am and 6.10pm. The registered manager was on holiday. Mrs Deirdre Cook and Mrs Jan Grey, care managers, assisted us with access to information and documents. Mr Jamie Smith, trainee manager, assisted with access to records and was present, together with Mrs Grey, for our feedback. The last key inspection was on 16th January 2007. As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments can be found in the relevant section of this report. Care Homes for Older People Page 6 of 32 We spoke with people who use the service, two relatives, the care managers and Mr J Smith, the trainee manager. We made a tour of the building and looked at care records, staff recruitment and training records, risk assessments, medication and menus. We asked the providers to send us their AQAA (Annual Quality Assurance Assessment). This was returned on time. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? What they could do better: Care plans must be reviewed and revised as peoples needs change. People who have diabetes must have guidance in their care plans stating how their diabetes is to be managed and monitored. This must include parameters in blood glucose levels for continued good health. The care plan must also give guidance on what to do if the persons levels are outside those safe parameters. Consideration should be given to the specific needs of people who are visually impaired. Consideration should be given to employing male staff so that males who use the service can choose who provides their intimate personal care. Any controlled medication must be entered into the controlled drug register when it is received into the home, not when it is opened. Where a medication has specific or unusual prescribing instructions, the care plan must record how the medication is to be Care Homes for Older People Page 8 of 32 taken. This must also include medication prescribed to be taken as required. The activities co-ordinator may benefit from some training in providing activities specifically for those people with dementia. They may also need some extra time for planning and developing the activities programme. The record of meals should record variations and extra dishes that are prepared as evidence of the variety of meals provided. The bath panel to the upstairs bathroom must be replaced. The remainder of the radiators must now be covered to reduce the risk of scalding. The heating system must be reviewed so that those radiators in some peoples bedrooms are heated to a comfortable level and stop the need for additional free-standing radiators. The fire doors fitted with automatic self-closing devices must be able to close to reduce the risk of smoke and fire spreading. Consideration should be given to including staff in the quality audit questionnaires. Consideration must be given to providing safe storage space for staff to store valuables and belongings whilst they are working. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that people who use the service have all their care and support needs assessed prior to admission. Evidence: Either one of the care managers carry out pre-admission assessments with people who are considering using the service. They also carry out reviews with people who use the service who may have a period of time in hospital. This is to ensure that the home can continue to meet their needs. People have a formal review after a months stay to establish whether the home is suitable for their needs. One of the visiting relatives told us that they had been impressed on their initial visit by the friendliness of the staff and the homely smell of laundry and food cooking. Care Homes for Older People Page 11 of 32 Evidence: In the AQAA the home told us they intend to provide coffee mornings and open days to publicise the home. They also said they had created a website for people and their relatives to gain information about the home. The newsletters would be included on the website. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally peoples care and support needs are captured in their care plans. Care plans will benefit from review and revision of peoples medical care needs. People have good access to healthcare professionals and staff are prompt in referring any concerns. Medication is generally well managed but recording needs attention. Staff uphold peoples right to privacy. Evidence: All of the people who use the service had a care plan. Information was varied about their current care and medical needs. Initially people have a generic seven day care plan, which is also used for assessment during this time. Personal care preferences were well documented in peoples care plans. We could not establish from the records of one person, who was admitted in an emergency, what their current care needs were. In one part of the record it was documented that they were not eating and that a food chart was in place, provided by the hospital. In another part it stated that they were able to eat and drink independently. Another part stated that they needed encouragement. In another care plan there was good information about the application Care Homes for Older People Page 13 of 32 Evidence: of topical creams and nutritional needs. It was clear from the records that staff were following up with peoples GPs if any tests had been carried out, for example, a fasting blood test. One persons care plan stated that they had diabetes and their blood glucose levels should only be tested if there were concerns. There was no record of what a concern might be or who to refer to, when concerns were noted. There was no information about the parameters for healthy blood glucose levels. Another person had no care plan with any guidance about managing or monitoring their diabetes. We were told that the night staff monitored blood glucose levels. Night staff are trained nurses but not able to work in that capacity, as the home is not registered to provide nursing care. The night staff had been trained by the district nurse to test blood glucose levels. We saw that people who had been assessed as having poor nutrition had food and fluid charts in place. Some people were also given food supplements. Risk assessments were carried out on different aspects of peoples care and support needs. These assessments were regularly reviewed. Mr J Smith told us that regular reviews of peoples dementia care needs were carried out with them and their social worker. He went on to say that peoples capacity regarding decision making was also being assessed. The district nurses visit regularly to give treatments and advice to staff. Two people were currently having minor wounds dressed. The home made space available for the nurses to keep stocks of dressings and preparations in the home. None of the people who use the service had pressure sores. Pressure relieving equipment was in place where needed. All of the staff are female, so males who use the service do not have a choice in the gender of staff who carry out their intimate personal care. We were told that this does have an impact, as some males had reluctantly accepted female carers. We advised that the home should consider employing male carers. Staff had clearly taken care to ensure that people were well groomed. We saw that some of the ladies did not have stockings on. One of the care managers told us that this was because they did not like wearing them. Staff ensured that any personal care was carried out in private. This included making sure that any enquiries about using the toilet were sensitively discussed in public areas so that no one else was aware of the conversation. It was clear that good relationships had been built up between staff and people who use the service. The latest newsletter tells people about some of the changes in decision making under the Mental Capacity Act 2005. Assessments as to peoples capacity have been carried out and are reviewed monthly. Care Homes for Older People Page 14 of 32 Evidence: One of the visiting relatives told us that staff contacted them immediately if there were concerns about their relative. One of the care managers showed us the arrangements for people to receive their medication. The medication administration record was being satisfactorily completed when medication was given. A record is kept of most of the medication as it is received into the home. We advised that all handwritten entries on the medication administration record should be witnessed, signed and dated. We saw that the medication administration record had many entries for medication that was no longer prescribed. We advised discussion with the prescriber and supplying pharmacist to remove these medications from the computerised sheet to reduce the risk of error. We noted that controlled medication was not being recorded in the register when it was received into the home, only when it was opened. Consequently one bottle in stock was not accounted for. We advised that receipt of all controlled medication must be recorded in the controlled drug register at the time of delivery. We noted that there was a separate sheet for the recording of administration of controlled medication. This means that staff are having to triplicate recording, in the controlled drug register, the medication administration record and the separate sheet. We noted that the medication administration record stated that this medication was to be given later if the person was asleep at the administration time. There was no record of this in the persons care plan. We said that any recommendations or requirements made by our pharmacist at the companys other home should be considered at this home as a matter of good practice. We noted that specific administration instructions for one medication to be taken once a week were in the medication administration record, but not in the persons care plan. This only recorded Have at 6.30am. We advised that the care plan must state how the medication is to be taken as prescribed and action to be taken if the person does not take it for any reason. Another person was having this medication at night. We asked why this was, as the Pharmaceutical Society guidance counsels that the person should remain upright for at least thirty minutes after taking. Staff told us that this was how the GP had prescribed the medication. We found no guidance for taking this medication in the persons care plan. As a matter of good practice there was a copy of the British Pharmaceutical Societys Formulary, for staff to consult on different medication. There was also another book on medication for staff use. Staff made sure that people had a drink when they took their medication. The medication trolley was always locked when left unattended. The person giving the medication wore a tabard Care Homes for Older People Page 15 of 32 Evidence: stating that they were not to be disturbed when giving medication. One persons care plan identified that they were taking a short course of antibiotics. Some action has been taken to address the good practice recommendation we made that the recording of as required medication is reviewed. We saw evidence in care plans of what prompted an administration of paracetamol for one person. However another person was to be given their as required medication if it was needed. We said that their care plan must state what prompts an administration. Action has been taken to address the good practice recommendation we made that eye drops should be dated when they are opened. However we saw that some dates were put on the prescribing labels instead of the container. We advised that prescribing labels must not be written on. One of the people we spoke with told us they had a visual impairment. We asked them about how staff supported them and let them know what was happening. They told us that staff did not always tell them about the meals they were given. They also told us they dont tell me about whats happening. I have to ask about the weather. They told us that their dentures had been lost. One of the care managers confirmed that they were being repaired. We saw a certificate on the dining room for Sensory Deprivation Awareness dated 10.12.08. We advised that the persons visual impairment needs should be more detailed in their care plan. One person who we met with in their bedroom told us they were staying in bed because they were sick. They told us they enjoyed living at the home. They said nobody interferes with me, they come and see if Im OK. At the end of our conversation the person went to lunch with a member of staff. We saw from the persons notes that they liked to spend as much time as possible in bed. In a survey form one of the relatives told us this is such a comfortable place it is like family. My relatives better cared for than anywhere else. Better than I could give myself now. Always keep me up to date and I am always made welcome. Another relative told us always very conscientious when informing about any problems (medical) and ready to call doctor for a visit. Generally satisfied with overall care given. Give the impression that they really do care about residents. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People now have at least two hours activities each week day. The activities coordinator is very enthusiastic and endeavours to provide activities in the short time allocated. Visitors are many and all said they were welcomed when visiting. People enjoyed the variety of meals provided. Evidence: Action has been taken to address the good practice recommendation we made that consideration should be made to employing an activities co-ordinator. The person provides activities for two hours every afternoon, Monday to Friday. They are also the cook. There was no programme of published activities. The trainee manager told us that a programme used to be put on the notice boards. There was a diary with a record of which activities people had been involved in. The record included nail care, discussions, crayoning, music and singing. The activities person told us that people enjoyed colouring-in the pre-printed canvases, playing various board games and the ladies enjoyed having their nails painted. She told us that people had made Christmas cards. One person with artistic skills had been given a sketchpad. We saw that some people were colouring in pre-printed pictures with staff during the morning and again during the afternoon. The activities co-ordinator told us that in the better weather they Care Homes for Older People Page 17 of 32 Evidence: took small groups of people out for walks or to the local coffee bar for coffee and cake. They had plans for going to the local theatre and to a local water park. Local taxis were used to access the locality. The co-ordinator told us that they raised money from raffles to pay for taxis. It was clear from talking to the activities co-ordinator that they had great enthusiasm and were keen to provide a range of activities for people. We advised that some extra time be allocated for planning and developing the activities programme. We also advised that the co-ordinator may benefit from one of the many training courses provided for activities provision in care homes, particularly in the area of dementia care. The care manager told us that some of the people who use the service had spent time with families over Christmas either staying over night or for the day. The trainee manager publishes a regular newsletter. The latest newsletter tells people that the activities person and one of the care managers are going to visit a local occupational therapy unit to gather new ideas. New craft materials will be purchased. The activities co-ordinator had commenced memory diaries with people about their life histories. Some of the relatives had provided photographs to include in the dairies. The activities co-ordinator asked the trainee manager for more of the diaries so that each person could have one. The person with a visual impairment told us that they were not told about the different activities each day. They told us that they had nothing to do during the day. They said they liked to go out with their family. They told us about the telephone in the corridor that they regularly used to keep in contact with family. Another person told us they liked to read, knit or sew. They also told us I dont go out. Cant complain about the food. One of the visiting relatives told us Dad is happy here. He seems OK when I visit. Another relative told us that they were always made welcome when they visited and offered a cup of tea. They said they could visit at anytime. Action has been taken to address the good practice recommendation we made that all meals served in the home are recorded. We saw a white board in the kitchen with the weeks menu recorded. The cook showed us a book with the weeks menu recorded. The day and the month were only recorded. We also saw that as well as the published main dish, the cook had provided a quiche, which was not recorded. We advised the cook to record all of the alternative and extra dishes as evidence that the meals are in fact, more varied than the records show. Care Homes for Older People Page 18 of 32 Evidence: We saw a delivery of fresh meat from a local butcher. Mrs Grey told us that fruit and vegetables were delivered every day. We saw that there were plenty of ingredients in the store cupboards. We saw lunch being served at twelve noon. People either had ham or quiche with baked beans and chips. The dishes were well presented and people enjoyed the meal. There was rice pudding to follow. People were encouraged or supported to eat their meal. People were offered blackcurrant or orange squash with lunch. Those people who had been assessed as needing nutritional support had been prescribed supplement drinks. We saw in one persons care plan that they were prescribed a fortified yoghurt. The cook told us that there were no special diets. The people with diabetes ate the same meals as everyone else. The evening meal was assorted sandwiches and cakes. The cook told us that either sandwiches or biscuits with hot drinks were provided for supper time. One of the people we spoke with told us that they enjoyed the food and were well fed. Another person said they could have their meals in the dining room or in the sitting room. We saw that the cook had to do the washing up before they then went on to provide activities. There was no dish washing machine or allocated kitchen domestic support. In a survey form one of the relatives told us activities good. Seems to like the food, always eats it all. Another relative told us usually only colouring books available. More stimulation is required. Residents only appear to sit round for majority of day. Perhaps outside visits e.g. garden centre could be undertaken occasionally. A further relative told us meals freshly cooked and an appropriate serving size. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place for people and their representatives to complain about the service. Staff are confident in knowing how to report any allegations of abuse. Evidence: One of the people we spoke with about making complaints told us they would see someone in charge. I would make complaint if I needed to. One of the visiting relatives told us about things that they had complained about. They said the issues had been dealt with to their satisfaction within two weeks. There was no record of this in the homes complaints log with the last entry in 2007. A copy of the local safeguarding booklet entitled No Secrets in Swindon and Wiltshire was on display in the entrance. We established from discussions that staff are confident in using the procedure for reporting any allegations of abuse. In the AQAA the home told us that they intend to access training for customer service and vulnerable adults. Since the last inspection there has been a safeguarding adults investigation. This is now concluded with no further action. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from well decorated and personalised bedrooms. New furniture has been provided. There is a programme of redecoration and replacement of fittings underway. Toilet surrounds need to be added to the cleaning schedule. Generally the home was cleaned to a good standard and there were no unpleasant smells. Evidence: Peoples bedrooms are to the ground and first floors, accessed by stairs and a passenger lift. We were told that none of the current people who use the service could use the lift unaided. There are three shared bedrooms. Peoples bedrooms were furnished with personal items to reflect their personality. We saw that people had good quality bed linen and towels. The homes latest newsletter informs people about the new chairs, carpets and curtains being fitted to the lounge and dining room. A new spa bath is to be installed. A new large digital television has been installed in the sitting room. Mr J Smith told us that ten new chairs had been provided in the sitting room. This room had also been redecorated and re-carpeted. In the AQAA the home told us that the toilets and bathrooms would be improved by re-decoration. They also told us they plan to make more use of the garden and install Care Homes for Older People Page 21 of 32 Evidence: a specialist bath. There is an ongoing programme of redecoration and upgrade of the building. The company has two full time maintenance staff who are shared with the two other homes. The home was generally cleaned to a good standard. However we saw a build up of lime scale on some of the undersides of commodes, in the commode buckets and under the toilet surrounds. We also saw brown deposits on some of the commode seats. We were told that commode cleaning was part of the weekly keyworker role. Clearly these need more regular attention. Some of the commodes were badly rusted and would be difficult to keep clean to infection control standards. Some of the commodes were new. One of the toilet surrounds looked like it had not been cleaned for some time underneath, as there was a build up of black material. We said that all these items must be cleaned to infection control standards and added to the cleaning schedules. We said that the rusted commodes must be replaced. Mr J Smith told us that the commodes would be replaced within three months. Following the inspection we were told that the commodes had been replaced and the toilet surrounds had been added to the cleaning schedules. In the AQAA the home told us that the continence adviser had delivered training and given advice on managing continence. The latest newsletter tells people about what the home is doing about a smell of urine, following comments in their quality surveys. This includes regularly offering people the use of the toilet and cleaning routines. A cleaner during the mornings Monday to Friday for two hours a day. There is also a cleaner working for two hours each Saturday and Sunday. The cleaner told us that they regularly shampooed the carpets to reduce any smells. Mr J Smith told us that the company had a deodorising machine which was shared between the three homes. We did not notice any unpleasant smells at any time during the inspection. Mrs Grey showed us the checklists she was introducing for the weekly keyworker tasks, including bath rota and changes of bed linen. Some action has been taken to address the good practice recommendation we made that consideration is given to fitting covers to all radiators. We saw that new covers had been fitted to all the radiators in peoples bedrooms, but not all of the corridors. We now require that these radiators are covered as people are at risk of scalding if they should fall against them. Care Homes for Older People Page 22 of 32 Evidence: We noted that radiators in two peoples bedrooms were not working. Two freestanding, oil filled radiators had been placed in these rooms. We were told that investigations had been made and a contractor advised that the radiators were not getting hot, because they are at the end of the circulation of water and furthest away from the central heating boiler. Mr J Smith told us that under floor heating had been considered. We advised that these peoples bedrooms must have suitable heating. We advised that the home should consult with the local Fire and Rescue Service regarding the safety of the free-standing heating appliances. We said that as they are free standing, they may be at risk of falling over. Since the inspection we have discussed the use of the radiators with the Environmental Health department at Swindon Borough Council and Swindon Fire and Rescue Service. The advice is that these heaters should be kept well clear of combustible materials and not cause obstruction. Heaters should be fixed to a wall and have heat guards to prevent touch burns and anything coming into contact with the heater. Staff must be trained in correct operating procedures. One of these bedrooms had an automatic self closing device fitted to the door. This would mean that the door could be left open for easy access, but close if the fire alarm was sounded. We found that the device was stopping the door from closing against the door frame. This means that any smoke or fire would spread to the rest of the building. We saw a small room which we were told used to be a bathroom. We were told that the hairdresser used the sink to wash peoples hair. The room was also used to store the carpet shampooer and to dry laundry. One of the people we spoke with told us they are meticulous about cleaning my room. The laundry room houses two domestic washing machines and a dryer. Staff carry out the laundry duties as well as care. Systems are in place for dealing with soiled laundry. Clean laundry is placed in named baskets before being returned to people. Mr J Smith told us that the company was considering implementing a central laundry system to cater for all three of their homes. In a survey form one of the relatives told us occasional smell of urine etc. Toilets would be better not sited near the front door. Have to be passed to get to lounges and dining room. Would help if rooms were ensuite. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing hours have increased during the weekday mornings. Staff have good access to training. The home could not evidence safe recruitment practices, as most of the records were kept at one of the companys other homes. We have now agreed that recruitment records can be kept centrally at the company offices. Staff have established good relationships with people who use the service. Evidence: The staffing rota showed that there were a minimum of three care staff including a care manager on duty during the mornings and two care staff during the afternoons and evenings, Monday to Friday. At night there is one waking night staff and a member of staff sleeping in. On the day that we visited there was the cook who was also involved in activities for part of the day and the two care managers, one of whom was covering staff absence. One of the care managers does the cooking at weekends. We asked them whether they would also be called upon in their other role as care manager when they were cooking. They said that this happened frequently. Staff carry out some cleaning, laundry and activities as well as caring. The care managers told us that people, and indeed staff, had benefited from the introduction of a 7.00am to 1.00pm shift from Monday to Friday. They said that this person would help with breakfast, supporting people to get up, using the toilet and Care Homes for Older People Page 24 of 32 Evidence: provide activities during the morning. They said staff could now spend more time with people. The care managers told us that they shared the day-to-day management duties of administration and staff management. They said they were allocated 4 hours each a week exclusive of the care rota for paperwork. We saw that the staffing rota did not show times that the manager or trainee manager are at the home. The care manager told us that Mr and Mrs Smith, or Mr J Smith were available during the day from 9.00am to 5.00pm if needed and at other times in an emergency. The trainee manager told us that he spends different amounts of time at the home each week. He said he monitored the maintenance of the building, provided staff training in moving and handling and fire safety and chaired the staff meetings. The latest newsletter tells people about training that staff have recently completed. This included: induction, infection control and MRSA, medication, nutrition, safeguarding vulnerable people, dignity and respect, first aid, moving and handling, dementia and end of life care. All of the staff apart from one has NVQ Level 2 or above. One of the care managers has completed the Registered Managers Award. Mr J Smith has completed the Registered Managers Award. We saw from staff files that training had also been undertaken in fire prevention, food hygiene and person centred planning. One of the care managers told us of the benefits to staff from the training in dementia carried out recently by the Clinical Psychiatrist. Mr J Smith, as training coordinator, had produced a matrix to show which courses had been undertaken and what was still needed. Staff had been provided with workbooks as part of a new training programme, which Mr J Smith was delivering. Action has been taken to address the requirement we made that any gaps in applicants employment history must be explored. Only two staff had been employed since the last inspection. Some action had been taken to address the requirement we made that records relating to safe recruitment practices are available for inspection. Complete records were not available for all of the staff named on the rota. One person had no file at all. We were not able to determine whether they had been inducted into their role. Mr J Smith told us that this staff had been recruited to one of the companys other homes. Other staffs induction records were on file. The home keeps a record of Criminal Records Bureau certificate numbers but not when they were returned. There was no record of when Protection of Vulnerable Adults list checks were carried out. We could therefore not establish whether these checks are done before new staff commence duty. Mr J Smith told us that staff recruitment files were now kept centrally at one of the other homes. We advised that this could take Care Homes for Older People Page 25 of 32 Evidence: place. However, the home must formally request central storage of these records. Since the inspection a formal request was made. We have agreed that all recruitment files may be kept centrally at one of the other homes. We will make arrangements to inspect these files when we carry out our next Key inspection. Action has been taken to address the good practice recommendation we made that consideration should be given to sending quality satisfaction surveys to relevant stakeholders and staff. Staff had not been included in the audit. We saw that staff did not have safe storage facilities for personal items and valuables whilst they were working. Staff handbags were stored in an area where they were accessible to anyone. We advised that lockers or other suitable storage should be provided. Mr J Smith told us that he would attend to this. One of the people we spoke with said the care is superb, but the staff dont come quick enough. In a survey form one of the relatives told us staff hard working but find time for all. Another relative told us working at this home are an extremely caring group of staff. In a survey form one of the staff told us lots of support for residents also staff. Lots of training offered. Clients needs are the most important issues and everything is done to meet their needs. Do better: more staffing. More detail needed towards the homes environment. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mr C Smith is now spending more time at the home, having completed projects at the other two homes owned by the company. The home is run in the best interests of the people using the service. Systems are in place for assessing any risks in the environment. Evidence: The providers own two other larger care homes in the area. Two care managers have been appointed to manage the day to day care in the home. Mr J Smith told us that he regularly visits the home during the week. His name was on the rota but there was no indication as to how much time he spent in the home. Both Mr J Smith and one of the care managers has the Registered Managers Award. Staff told us that they regularly had supervision and records were on file but not examined in detail. Care Homes for Older People Page 27 of 32 Evidence: Systems are in place for safe holding of small amounts of cash for people in the homes safe. Records and receipts are kept of all transactions. Some toiletries and other items were purchased in bulk. We advised that the receipts should be numbered and relate to the entry on the record, for auditing purposes. The home had sent questionnaires to various stakeholders as part of their quality assessment audit. There was no report on the findings of the consultation. There was no plan giving details of what is considered necessary to improve the quality and delivery of the service provided. We advised that although details of the outcome of the quality audit were included in the newsletter, the amendment to the regulation now requires a formal report. We said that staff should also be included in the surveys. Mr J Smith is a trained trainer and regularly updates staff in moving and handling and fire safety. He is also a trained trainer in risk assessment. Risk assessments had been carried out on the environment and tasks that staff were involved in. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 19(1) The registered person must ensure records relating to safe recruitment practices are available for inspection. 01/02/2007 Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must give details of peoples current care and support needs. This must include eating and drinking, managing diabetes and specific administering instructions for some medication. To ensure continuity of care. 15/05/2009 2 9 13 A record must be made of all 15/05/2009 medication as it is received into the home. As evidence of stock control. 3 19 23 All of the fire doors must be able to close against the door surrounds if the fire alarm sounds. To reduce the risk of smoke and fire escaping to the rest of the home. 15/05/2009 4 25 23 The two bedrooms indentified must have sufficient heating from the homes central heating system. Free-standing 30/04/2009 Care Homes for Older People Page 30 of 32 radiators are not a long term solution. So that all people using the service can enjoy comfortable heating in their bedrooms. 5 25 13 All radiators must be fitted with guaranteed low surface temperature guards. To reduce the risk of scalding. 15/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 A request should be made to the GP and supplying pharmacist so that mediciaton that is currently not prescribed is removed from the medication administration record. Prescription labels should not be written on. Dates of opening limited life eye drops could be written elsewhere on the container. Consideration should be given to providing suitable training in activities provision for the co-ordinator. Consideration should be given to allowing time for the activities co-ordinator to plan activities suitable for individuals as well as group sessions. A record should be kept of all the additional choices of meals provided. The trainee managers hours in the home should be recorded on the rota. Consideration should be given to employing male care staff so that people who use the service who are male have more choice about who provides their intimate personal care. Receipts should be numbered and relate to cash entries for each individuals sheet for auditing purposes. 2 9 3 4 12 12 5 6 7 15 27 27 8 35 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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