Inspection on 23/04/09 for Gildawood Court

This inspection was carried out on 23rd April 2009.

CQC found this care home to be providing an Adequate 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gildawood Court 20/10/09

Gildawood Court 13/07/09

Gildawood Court 29/04/08

Gildawood Court 30/04/07

Gildawood Court 17/10/06

Gildawood Court 09/11/05

Gildawood Court 05/07/05

Gildawood Court 13/01/05

Gildawood Court 05/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Gildawood Court School Walk Attleborough Nuneaton Warwickshire CV11 4PJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sandra Wade     Date: 2 3 0 4 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 35 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 35 Information about the care home Name of care home: Address: Gildawood Court School Walk Attleborough Nuneaton Warwickshire CV11 4PJ 02476341222 02476344300 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) : Gildawood Court Residential Homes Ltd care home 60 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 60 The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 60 Date of last inspection Brief description of the care home Gildawood Court is a purpose-built, 60-bed care home for older people and is registered to provide personal care for those people diagnosed with dementia. Any nursing needs are carried out by the district nurse. It provides permanent care, short stay accommodation, and day care facilities. The home is situated close to the centre of Attleborough and within a mile of Nuneaton town centre. Local amenities are within reach by foot or wheelchair, and there is parking at the front of the building. The home is divided into five units, which accommodate eleven, twelve or thirteen residents in each. Each unit has a lounge and dining area which is fitted with a kitchenette. All bedrooms are single and have en-suite toilets with washbasins. There Care Homes for Older People Page 4 of 35 Brief description of the care home are sufficient numbers of toilets and bathrooms situated around the home. There are 6 bathrooms and two of these have assisted facilities to help people in and out of the bath. There are also 5 walk-in shower rooms. There is a large activity room which is used for people who visit the home for day care and which can be accessed by permanent residents if they wish. The home has a hairdressing room and enclosed gardens. There is level access into the home and from doors into the garden areas for people with mobility difficulties or wheelchair users. The accommodation is spacious and allows for easy access by wheelchairs. Accommodation is over two floors and can be accessed via a shaft lift. At the time of inspection the fees for this home ranged from £407 - £557.85. These are subject to change. Extra charges are made for hairdressing, chiropody, Dentist consultation fees, Aromatherapist, newspapers, taxis, dry cleaning and visitor meals which need to be pre-booked. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The last key inspection took place on 29 April 2008. This inspection took place between 8.10am and 8.45pm. Two people who were staying at the home were case tracked but specific care issues relating to other residents were also reviewed. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the Care Homes for Older People Page 6 of 35 experiences of people who use the service. A completed Annual Quality Assurance Assessment was received from the service prior to the inspection detailing information about the care and services provided. Questionnaires were also sent out to residents within the home to ascertain their views of the service. Information contained within the AQAA and outcomes of surveys have been included within this report as appropriate. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, financial records, complaint records, quality monitoring records and medication records. Residents were observed in the lounge/dining areas to ascertain what daily life in the home is like. A tour of the home was undertaken to view specific areas and establish the layout and decor of the home. What the care home does well: What has improved since the last inspection? The Activities Coordinator now has more experience in her role. She has provided activity schedules on each unit so that residents and staff have a guideline as to the days activities that should take place. New artwork has been placed around the building to create a homely environment for everyone. There are also areas of interest including themed areas for residents to engage in and access when they wish. This includes a reminiscence area, baby nursery and music area which the residents regularly access. New care plans have been developed and are in the process of being implemented so that information is clearer in detailing the needs of residents and how they are to be met by staff. The timing of the main meal of the day has been changed so that the time gap between meals is more acceptable to the residents. Each Thursday between 4 and 6pm there are activities provided in the Day Room which all residents can attend if they wish. There is now another Assistant Manager in place to assist in the effective management of the home. Care Homes for Older People Page 8 of 35 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 35 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 35 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. Sufficient information is available to prospective residents about the care the home provides and preassessments are carried out to identify specific needs to ensure these can be met by the home. Evidence: A copy of the homes Service User Guide was requested that would be given to prospective residents. This contained information about the care and services provided including the fees charged. The document produced was mostly in large print to allow for easy reading. The manager has previously told us that the organisation could arrange for records to be provided in picture format, Braille or on tape to support those residents who may need records provided in this format. Since the last inspection arrangements have been made to also include a Statement of Purpose within the Service User Guide. This was noted to contain a Statement of Terms and Conditions for the home as well as a summary of our inspection report as required. Care Homes for Older People Page 11 of 35 Evidence: This helps to ensure that prospective residents or their representatives have all the information they need to help them make a decision about the home. Assessments of residents are carried out prior to admission to ensure the home can meet their needs. Copies of these are kept on the care files for each resident. Records seen contained sufficient information about the care needs of residents to enable staff to develop suitable plans of care to meet these needs. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in the process of being updated to ensure these are clear and accurate to ensure staff deliver the care required. Some attention is needed to medication management to ensure this is given as prescribed to maintain the health of residents. Evidence: Residents are cared for across five units in the home. It was evident through observations and discussions with staff that the home is caring for residents with varying levels of dependency. Care staff were observed to be friendly and supportive towards residents and were always busy going about their duties. However there were incidents that occurred during the day which indicated staffing arrangements continue not to be effective in managing care effectively consistently. This is largely due to the layout of the building and the unpredictability of some of the behaviours of the residents. Incidents are described in more detail below and the staffing section of this report. Surveys completed for residents with the help of their family showed that three out of Care Homes for Older People Page 13 of 35 Evidence: five always felt they receive the care and support they need and two felt they usually did with one person commenting there were some minor communication problems. Two people who use the service were case tracked across two units and others were observed across all five units. Care plans had been devised for each resident. They are organised into sections so that information about residents can be easily located and acted upon by carers. It had been acknowledged due to the volume of information, that care plans were not always easy to follow. The manager advised that as a result of this new care plan documentation is being introduced. A sample care plan was seen during the inspection and the manager said it was hoped that all care plans could be transferred onto this new documentation. Records contained detailed information about the care needs of the residents and the staff actions required to meet them. One person who was considered by staff to be of high dependency had a painful and swollen leg. Staff had ensured the GP had been contacted for advice and risks that could impact on this residents health had been considered and risk assessments completed. These included a pressure sore risk assessment, falls risk assessment and malnutrition risk assessment. A body chart had been completed to indicate the person had some wounds although it was not fully clear what these were. It was however clear that the district nurse was regularly visiting to treat and dress these wounds. Regular weights had been taken to show that staff were monitoring this but when the resident had lost a significant amount of weight there was no acknowledgement of this on the weight chart or indications that actions were required to address this. It was clear however that staff were monitoring the residents food intake. Some of the records indicated that the person was having a Fortisips food supplement drink but on others the words Juice was being used and it was not clear if this was ordinary juice or the supplement drink needed to ensure the residents calorie intake was sufficient to maintain their health. The medication records viewed confirmed this person had been prescribed Fortisips twice a day and were signed to confirm that they were receiving them. However it was evident the home had run out of them and the person had not had their prescribed amount for the last two days. Care Homes for Older People Page 14 of 35 Evidence: It was evident that staff were completing daily records to give a picture of this persons health, mood, whether they had eaten and whether they were in pain. Records showed that the resident had become more sleepy lately and staff said that the persons health had deteriorated. Staff were seen to support this person in the lounge and were caring and supportive towards them. They were observed to encourage the resident to eat but due to their sleepiness were unable to achieve this. Staff said that the person did suffer with pain despite being on strong pain relief medication. It was evident that on occasions the pain relief patch that staff were sticking to the skin had fallen off. They had however on each occasion taken medical advice and applied another one to ensure the resident continued to receive pain relief. Care plan reviews had been regularly carried out and identified this person was poorly and their dietary intake poor. A second resident care plan also contained risk assessments in regards to risk associated with this persons health. This included risk assessments in regard to their diabetes and intolerance to certain foods. Detailed care plans showing their care needs and staff actions to address them were also in place. The symptoms associated with diabetes had been listed so that staff knew what to look for if the person became ill and actions had been identified on what to do. It was not clear from records in place that the blood sugar monitoring had been carried out in accordance with the instructions given by the GP. The blood sugar monitoring chart also did not indicate the acceptable range for the person which varied significantly at the 8am reading. If the acceptable range is not clear, staff would not know at what reading they should seek medical intervention. This was discussed with staff who agreed this would be helpful to know. They also confirmed that the district nurse had been taking the blood sugar readings for a period of time and they recently had sought advice from the GP over the blood sugar monitoring to ensure this was being done as required. It was evident from the GP visit sheet that a gel had been prescribed for when the persons blood sugar was too low. This information had not been transferred into the care plan or risk assessment in regards to the diabetes management although there were other instructions on what sweet products could be used. Staff had also acknowledged that this person was displaying challenging behaviour on occasions and a recent Risk Assessment gave instructions for staff to record this on specific forms. A care plan in regards to the management of this was not located. Care Homes for Older People Page 15 of 35 Evidence: A care plan had been developed in regards to treatment of a sore area on the skin with instructions to staff to apply a specific cream. A body chart that had been completed showed that this person had a second sore area to this skin which was not indicated in the care plan. The manager agreed that it would be beneficial to have a care plan specifically for sore areas or wounds to any area of the skin as opposed to a care plan for one area. This is to help prevent any oversight in care and ensure staff treat all affected sore areas as required. Issues in regards to the provision of clear care plans in regards to specialist care needs have been raised during previous inspections to the home and requirements made for these to be addressed. An improvement plan received from the home on 21 August 2008 states that suitable care plans are in place in regards to specialist care needs. This inspection has confirmed there remains further actions required to address this requirement. The medication records viewed for this resident showed that one of the creams prescribed was to be applied twice a day, it was not evident this was happening twice a day. On some occasions this was because the resident was asleep which suggests the time allocated to apply this was too late in accordance with the persons sleeping pattern. If creams are not applied regularly to sore areas this can contribute to further breakdown and damage to the skin. The review of medications showed that some medications were being managed well and others were not. Controlled drugs were noted to be stored appropriately and records had been accurately completed in regards to how these had been received and given. Some of the medication records contained codes on them that were not defined so it was not clear if the medication had been given or not. For one resident there was one more Lansoprazole and Miratazapine tablet than there should have been suggesting that on one day these were signed for when they were not given. Records showed that Senna prescribed to be given two spoonfuls at night was being given regularly until it had ran out. Records showed that for five days the resident had not received this. On checking the amount received it was evident that if this had been given as prescribed it should have ran out another four days earlier than indicated on the records. This suggests that either the full dosage has not been given or records have been signed to say it has been given when it has not. It was clear from records in Care Homes for Older People Page 16 of 35 Evidence: place that the medication prescribed was not sufficient to last the full four week period of the medication cycle. It was not clear that staff had identified this and taken sufficient action to order this is good time so that it did not run out. As stated above, records showed that Fortijuice had ran out for one person who had been prescribed this twice a day. Medication records showed that the home had received forty of these at the beginning of the medication period and that at least 44 had been signed for as given. This suggests that staff had been signing records to say this had been given when they did not have any to give. Glucogel had been prescribed to be given as required. Staff should sign the medication record only when this is to be given On the medication record two entries had been made to state not required suggesting that staff did not have an understanding of what the gel was to be used for. An inhaler prescribed to be given four times a day was not always being given four times a day due to the resident being asleep at 6am. It was not evident that the timings had been reviewed to ensure this resident received this as prescribed and to ensure this did not impact on their health. Since the last inspection there has also been medication that has gone missing despite there being limited staff with access to the medications cabinet. Investigations have not resulted in locating this medication. The manager advised that there has been a further change in practice to ensure only one person in each unit removes the medication and puts it back to help reduce the risk of this happening again. In regards to the privacy and dignity of the residents, it was found that this is not being managed well. In some cases this was be due to staff being busy doing other things. One resident during the morning was seen in their nightclothes on several occasions. They were seen walking around the home and sitting in another residents bedroom with no attempt seen by staff to encourage them to get dressed. Staff said that the person became distressed if they tried to dress them before they were ready but this resident was seen for much of the morning in their night clothes. Staff were asked why one resident had no shoes or socks on and they advised that the persons slippers rubbed their feet and they were waiting for a pair of socks to dry in the laundry. The member of staff later obtained some socks for the resident. During a walk around the home a resident was noticed in their bedroom attempting to stand up whilst at the same time was eating their breakfast with a spoon. The milk was spilling onto the floor. Two carers were assisting another resident in the bathroom Care Homes for Older People Page 17 of 35 Evidence: and were not free to assist the resident. One carer left the bathroom to fetch an apron but on seeing the resident stopped and encouraged them to go with them to the lounge. This proved to be a very timely process leaving the member of staff in the bathroom with the resident awaiting support. The member of staff in the bathroom had the door half open and was clearly waiting for the other member of staff to help but there was no other member of staff on hand to help. The additional floater member of staff it was established was upstairs in the Annex. In another area of the home a resident stopped outside of a door removed their underwear and urinated on the floor. Staff were busy in other areas of the home although when this was brought to their attention they did assist the resident into a bathroom. In another area of the home a resident had taken their top off and was walking around in their underwear. Again when this was brought to the attention of a member of staff it was addressed. Care Homes for Older People Page 18 of 35 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. Social activities are provided to satisfy the social care needs and interests of people who use the service. Residents enjoy the food provided and are given some choices in how their care is delivered to help support their independence and feelings of wellbeing. Evidence: An Activities Coordinator is employed and days this person is available vary each week in accordance with duty rotas seen. Staff were seen to initiate and carry out social activities with residents during the inspection. This included giant dominoes, planting seeds in grow bags, picking flowers out of the garden, listening to music, looking at magazines and watching television. Social activity schedules viewed showed a range of social activities are organised during the morning afternoon and evening. These included pampering hands and nails, painting, colouring, dusting, arts and crafts, reminiscing, singing and dancing. During the day some residents sat in the lounge areas listening to music or watching television. Some participated in the social activities being provided. Some were asleep Care Homes for Older People Page 19 of 35 Evidence: and some wandered around the different units in the home. Residents clearly enjoyed the old time music in one unit with one resident tapping their hand along to it. Another got up from their seat and had a little dance with the carer. One resident who was participating in planting seeds said I didnt know you could buy it like that, what a good idea. Visitors were seen to come and go throughout the day demonstrating open visiting. The past hobbies and interests of residents had been documented within their care plans with indications on whether they would like to be involved in any activities provided by the home. Gildawood continues to benefit from having an experienced and dedicated Catering Manager who has worked at the home for many years. The manager is committed to producing nicely presented home cooked food for the people who use the service. At lunch time meals were delivered to each of the units in hot trolleys. The meal on the day of inspection was beef stew and dumplings with cabbage. For pudding was coconut and jam sponge with custard. The meal look appetising and residents were seen to enjoy this. It was not evident that a second choice had been provided and staff said a lot of the time there is only one choice of main meal. The manager said they were in the process of reviewing the menus and advised that two choices should be given each day. Care Homes for Older People Page 20 of 35 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 adequate 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 to ensure complaints and any possible allegations of abuse are managed in a way that protects the residents but there continues to be incidents amongst residents that present a risk to their safety. Evidence: The complaints procedure for the home is detailed in the Service User Guide and each resident is given a copy this on admission. It is also displayed in the entrance foyer of the home. Contact information is clearly detailed with telephone numbers and addresses. There had been one complaint received by the home since the last inspection this included a concern in relation to missing items. The complaint had been fully investigated and an appropriate response made. We have not received any complaints since the last inspection. On viewing the accident and incident records in the home, it was evident that there continues to be incidents of challenging behaviour that staff have to manage. In one incident a visitor observed a resident punching another resident. It was not clear that staff were present initially when this occurred. There were also a number of incidents of residents being found on the floor with injuries from falling. There were incidents Care Homes for Older People Page 21 of 35 Evidence: where medical intervention had been sought that had not been reported to us as required. A policy on the Protection of Vulnerable Adults was available in the home and staff spoken to had done training on the prevention of abuse. It was evident from speaking to a member of staff who had completed training on abuse that they knew the processes for reporting abuse to their manager and to safeguard the resident but they were not clear on the reporting process to other people involved in this process. This is important so that staff know how any allegations are managed. Care Homes for Older People Page 22 of 35 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. The home is generally clean and well maintained with both quite areas and activity areas to benefit residents to ensure they are content and live in a homely and pleasant environment. Evidence: The main building continues to be suitably decorated and well maintained with a pleasant reception area which has been further improved since the last inspection with a reminiscence area and some new pet budgies. There continues to be areas of carpet that would benefit from replacement but the manager is aware of these and has reported them to the organisation. This includes a corridor from one side of the building to the other and staff rooms which open out into the main corridors. No unpleasant odours were noted during this inspection visit. People who use the service have spacious bedrooms and the different units can be accessed via wide corridors which are suitable for wheelchair users. The home is divided into five units. Units 1, 2 and 4 accommodate twelve people, unit 3 accommodates eleven people and unit 5 accommodates 13 people. Residents can freely access units 1,2 and 3 but units 4 and 5 require the use of a door code to enter Care Homes for Older People Page 23 of 35 Evidence: them. The units are not clearly identifiable colour coded so that residents and visitors to the home are clear which unit they are in. Each unit has a lounge and dining area, which is fitted with a kitchenette. There is a shaft lift to the first floor enabling residents to have access to all areas of the home. Gardens are enclosed to enable residents to use these safely. Residents can access the garden from patio doors in all ground floor living areas and from various corridors in the home. The gardens were in need of attention and a member of staff said they employed a person specifically do this and this would soon be addressed. All bedrooms are single and have an ensuite toilet and washbasin. Communal toilets are also available on each unit. Bedrooms seen had been personalised with items of furniture, pictures and personal belongings to make them more homely. Bedroom doors had a selection of photographs or pictures selected by the residents to assist them in recognising their own room. There are suitable bathrooms in the home with specialised Parker baths which are designed to allow residents to easily access them. There are two laundry rooms in the home which have three washing machines between them to support the needs of the home. There is also a sluice room. Disposable gloves, aprons and hand washing facilities were available to staff although it was noted that aprons had been kept in a locked cupboard and staff were having to ask for keys or go and fetch aprons when they needed them as opposed to them being close to hand. Separate baskets for dirty and clean washing were pointed out but they were not all clearly labelled to ensure it was clear to staff how they were to be used. During the tour of the home the availability of underwear for residents was checked. In random rooms checked it was found that there were minimal supplies of socks or tights for the residents to wear. During the last inspection the manager said that it was the carers responsibility to regularly check rooms and make sure residents had the right clothing and sufficient clothing. However carers were noted to be busy throughout the inspection and it is therefore not clear they always have time to do this effectively. The manager said that they had recently increased the laundry hours to address any problems with this service. Care Homes for Older People Page 24 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whist staff are caring, friendly and supportive and attend regular training, staffing arrangements continue not to be effective in meeting the needs of the residents consistently. Evidence: The manager confirmed there have been no changes to care staff numbers although there had been some changes to staffing arrangements particularly around the lunch time period. The home aim to have ten to twelve carers on duty during the day and five or six at night. Duty rotas show that these numbers are being achieved with the help of bank staff. However duty rotas also show that some staff are working long shifts from 7.15am to 10.15pm. With staff working these long hours there is a risk they could become less effective. The manager states in the Annual Quality Assurance Assessment that working with people who have dementia can be emotionally and physically demanding. This should therefore be taken into account when organising staffing for the home. When there are ten staff on duty this allows two carers per unit. When a member of staff on each unit is doing the medications this leaves one member of staff to then support all residents on that unit. If two carers are needed to assist a resident these leaves no carer to observe other residents in the unit. If the home work Care Homes for Older People Page 25 of 35 Evidence: with eleven staff this one extra person cannot support all units. It was observed that staff were busy throughout the inspection completing their duties and some residents were demanding on their time. This resulted in lounge areas being unattended for periods of the day and clearly not all residents could be observed all of the time. Staff within the home are allocated to each unit on a daily basis and a notice board in the home shows which staff are supporting which unit. It was difficult to assess that the home are staffing each unit in accordance with the dependency needs of the residents as well as the number of people who need to be cared for as this information was not recorded on duty rotas or any other written record provided to us. Despite staff best efforts, incidents occurred in the home during the day which were not observed by staff due to them being busy with other residents. At lunch time staff were assisting residents who needed support to eat as well as answer the door and encourage some residents not to leave the dining area. In the morning there were two staff needed to support a resident in the bathroom but one left and ended up having to support another to the lounge and dining area. This left the member of staff on their own to cope with the resident in the bathroom. Other incidents are detailed in the Daily Life and Social Activities section of this report. Staff have raised concerns during previous inspections that there are not enough staff to support the needs of the residents effectively. They continue to share this view. One member of staff was asked if they felt there were enough staff on duty they said not always no, especially when there are two on a unit and one to do medication and one left to do everything else, no I dont think there is enough. Another member of staff said there are still times when we could do with more , like weekends as there are lots of visitors and activities and we need staff to take residents to other parts of the home. This member of staff felt that three staff on each unit in the mornings would work better. Staff surveys which the Assistant Manager confirmed had been recently completed by three staff showed they shared the view that there is insufficient staff. One states biggest weakness is shortage of staff so carers have to work on their own, putting residents at risk, another states not enough staff. Another states that a weakness of the home is working on your own, short of staff. Previous surveys completed by staff dating back to 2007 also show that staff feel there are insufficient staff. Although there have been changes to staffing arrangements including more recently changes in how staff breaks are managed over the lunchtime period, it is clear this has not been enough in ensuring staff can feel they can complete their work safely and effectively consistently. Care Homes for Older People Page 26 of 35 Evidence: We received surveys from five residents some of which had received the assistance of a family member to complete. One of the questions asked Are staff available when you you need them, one person stated always four people responded usually. All responses were positive in regards to the staff with one person stating very good staff, three first class, another wrote staff are really caring which is a very hard job looking after the elderly and their pay is not right for what they do. Since the last inspection senior staff have been provided with Walkie Talkies to help improve communication in the home. Carers who may work on the units alone on occasions do not have these so would still need to summon help by using telephones in the office. Call bells do not differentiate between an emergency or normal call for assistance. In addition to the carers there are dedicated staff who provide a laundry, cleaning and catering service to the home. There are two cooks who between them cover seven days a week and they are supported by 2 kitchen assistants. Since the last inspection there has been an increase in housekeeping support and there are now cleaning and laundry staff available in the home seven days a week. Two staff records were viewed to confirm recruitment practices carried out. These were found to contain all of the required information including two staff references and checks to ensure they were not on the Protection of Vulnerable Adults Register. Criminal Records checks had been carried out but the main section had been removed so it was not possible to confirm these were enhanced checks or the date they had been received. The provider has subsequently confirmed that the rest of the criminal record checks are kept in the home. These however were not made available to us on the day of inspection. Staff records confirmed that new staff undertake induction training based on the Skills for Care induction standards. This requires them to undertake specific training modules over a number of weeks so they can build up their competencies to care for residents safely. Records for one member of staff could not be located, the Assistant Manager said this was probably due to the member of staff having their records themselves. Both staff had completed some training although one had done most of their training at their previous employment. A training schedule is in place but it was not fully clear from viewing this that all staff were up-to-date with their training. The provider has however subsequently confirmed that all staff training is up-to-date.. The Assistant Manager advised that they have their own trainer and therefore there is an active training programme whereby all staff Care Homes for Older People Page 27 of 35 Evidence: attend regular training. The Annual Quality Assurance Assessment completed by the manager states that staff are caring and committed and staff training is good. She states that staff are encouraged to keep their knowledge up-to-date and in line with legislative requirements. The manager confirmed that there are 47 care staff employed including bank staff and of these 25 have attained either an National Vocational Qualification (NVQ) II or III in Care. She also confirmed there are an additional eleven staff in the process of completing this training and four that are due to enrol. This demonstrates a commitment by the home to train staff so they can provide more effective care to the residents. Care Homes for Older People Page 28 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home, which is run by a person of good character but whose autonomy in some areas is restricted which can impact on the quality of care and services. Evidence: The manager of the home has been in post since May 2005 but was working in the home before this in a senior position. She has attained the Registered Managers Award, a Diploma in Health Education Dementia Studies, the D32/33 Assessor Award and is a trained Registered General Nurse (although not practising). She has more recently completed a three year training programme in health and safety known as IOSH. Discussions with staff confirmed that the manager continues to share a good working relationships with staff. Quality surveys carried out by the home show that staff feel they are well supported by the manager of the home although some identify that staff Care Homes for Older People Page 29 of 35 Evidence: morale is ot good. One person has stated always short staffed, never feel as job is done properly as not enough staff to complete any task. They also comment that if the wages were better staff would stay once they have been trained. The manager has identified in her Annual Quality Assurance Assessment that staff have left once trained which has put a strain on resources. Staff have indicated on the surveys that staff training is good and those spoken to had completed training relevant to their role. Quality surveys received by us from residents and their representatives show that all feel staff listen and act upon what they say and all know how to raise a concern or complaint should they have one. Quality surveys had been sent out to residents by the home and many of the responses were positive although it was not clear that where comments had been made, these had been addressed. It was evident that audits are carried out within the service to help identify any problems to ensure these do not impact on residents. Audits seen included, environment, clinical room, bathrooms, kitchen/food preparation and laundry. The organisation had completed an overall audit of the home which did not identify any concerns in regards to staffing. Regulation 26 visits had been carried out by a representative of the organisation. These visits can include interviews with residents or visitors and an inspection of the home. A report is then given to the manager with any action points. Relative meetings are held three monthly and residents can also attend. These meetings give the manager an opportunity to report on issues relating to the management of the home as well as discuss any concerns relatives may have. Notes of these meetings are kept to show issues discussed and any actions taken. Formal staff supervision sessions do take place with staff to ensure they become familiar with all aspects of the service and any training needs are identified and acted upon. A supervision schedule was seen confirming that all staff have had two supervision sessions this year. The Assistant Manager confirmed these were regularly taking place and if any gaps in the schedule are identified these are addressed to ensure everyone has six sessions per year as required. The administrator manages resident monies or personal allowances. Detailed records are maintained and receipts are kept for transactions undertaken although some receipts only contained a signature and no clear name, address or details of the person Care Homes for Older People Page 30 of 35 Evidence: providing the service. This made it difficult to identify who actually provided the service and to determine if they were official receipts. The administrator agreed to follow this matter up with the manager. The money available for residents was found to be accurate in regards to the records in place and appropriate systems were in place for the storage of money. Incidents and accidents records were viewed and it was evident that some of the accidents that were recorded where medical intervention had been sought had not been reported to us as required. The assistant manager acknowledged this and stated this was due to a misunderstanding in regards to the guidance in relation to this. A commitment was given to ensure all accidents and incidents which impact on the wellbeing and safety of residents would be reported. Systems are in place to ensure health and safety is managed effectively. The Annual Quality Assurance Assessment (AQAA) forwarded to us showed that health and safety checks were being carried out regularly to ensure the safety of residents. This included checks on electrial portable appliances, the lift, hoists and heating system. The hoists were last serviced in October 2008 so these will now be due. A random selection of records were viewed to confirm checks carried out and no concerns were identified. Records seen showed that gas had been checked on 3 March 2009, fire alarms in April 2009 and wheelchair checks in April 2009. Care Homes for Older People Page 31 of 35 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 9 13(2) All prescribed medication 31/05/2008 must be available for administration at all times. New supplies must be sought in a timely manner to ensure service users receive their prescribed medication. 2 27 18 (1) Sufficient numbers of staff 30/06/2008 must be available to meet the needs of the residents at all times. Outstanding from the October 2006 and new timescale of 31/07/07 not met. Care Homes for Older People Page 32 of 35 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 need to be in place for each specialist need including challenging behaviour and be subject to review. This is to ensure all care needs of the resident are met consistently and safely. Target Date of 30/06/08 not met. Remains outstanding. 31/05/2009 2 18 37 All accidents and incidents which impact on the safety and wellbeing of the residents must be reported to us. This includes those where medical intervention is sought. This is to demonstrate these are being identified by the home and are being acted upon appropriately to safeguard residents. 31/05/2009 3 31 12 Suitable arrangements need to be in place to ensure the home is managed in a way 31/05/2009 Care Homes for Older People Page 33 of 35 that promotes the privacy and dignity of the people who use the service. This is to ensure the management of the home is effective and the needs of residents are met consistently. 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 14 Choices of meals on menus should be provided consistently to ensure residents have varied menu and can enjoy different choices each day if they wish. It is recommended that disposable aprons are more readily accessible to staff to ensure infection control is effectively managed and there are no delays to staff in obtaining these when supporting residents. It is recommended that laundry baskets are clearly labelled to ensure dirty and clean items of clothing are managed appropriately to maintain good hygiene practices. Effective laundry systems need to be in place consistently to ensure all appropriate items of clothing are available to residents to maintain their dignity and wellbeing. Proposed actions following quality satisfactions surveys need to be clearly documented so that it is clear comments made are acted upon. In regards to services received by residents such as chiropody, newspapers, hairdressing etc, it is advised that detailed official receipts are obtained from the service provider to ensure financial systems are suitably robust. 2 26 3 26 4 26 5 33 6 35 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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