Inspection on 23/01/09 for Homeleigh

This inspection was carried out on 23rd January 2009.

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

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

Other inspections for this house

Homeleigh 08/09/06

Homeleigh 06/12/05

Homeleigh 15/06/05

Homeleigh 16/09/04

Homeleigh 19/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Homeleigh 24-28 Stocker Road Bognor Regis West Sussex PO21 2QF     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: Mark Hemmings     Date: 2 3 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 36 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Homeleigh 24-28 Stocker Road Bognor Regis West Sussex PO21 2QF 01243863373 01243863056 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) : Homebeech Ltd care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 40. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Up to 40 older people can make their home in Homeleigh (the Service). The people who live in the Service can receive nursing care as well as personal support. The property is a detached older house, to which extensions have been added. The accommodation is on the ground, first and second floors. There are two passenger lifts that give step free access around the place. Everyone has their own bedroom. Each bedroom has got a private wash hand basin and 32 of them also have a private toilet. There is also a call bell system. This has call points in each of the bathrooms and toilets. There are also call points in all of the bedrooms and their private bathrooms. This means that people can ring for assistance. Care Homes for Older People Page 4 of 36 Brief description of the care home The Service is in a quiet residential street. Theres a shop quite nearby and Bognor Regis town centre is about one mile away. The Service doesnt have its own car. The Registered Provider is a private company. It owns three more residential services that are near to Homeleigh. If you want to find out more about the Service and about the fees charged, you can phone the Service and speak with the Manager. Care Homes for Older People Page 5 of 36 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: The quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of nursing and care services. This inspection of the Service was Key Inspection. We arrived at the Service at about 8 oclock and were there for about seven hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with five of the people who live in the Service. We also spoke with the Manager, two Care Homes for Older People Page 6 of 36 nurses, two care workers, the chef, two housekeepers and the laundry manager. We walked around parts of the accommodation and we looked at a selection of key records and documents. Before we called to the Service, we asked ten of the people who live there and 10 members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of Homeleigh. Ten of the people who live there and seven members of staff kindly sent them back to us. Later on in our report, well tell you what people say in these questionnaires. The Registered Provider has done its own questionnaires. These have asked the people who live in the Service and their relatives to say what they think. Well tell you what they say as we go through our report. What the care home does well: What has improved since the last inspection? What they could do better: Some people might like to have the chance to do more social things. The quality assurance system doesnt fully involve all of the people who live in the Service. This is important because they are the experts on what it is like to live in Homeleigh. They need to have a direct say in how things are going. Also, they need to be told what is going to be done to respond to any improvements they may come up with. There are some shortfalls in the fire safety regime. These might reduce the level of protection available in the Service. Care Homes for Older People Page 8 of 36 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 36 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 36 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. Standards 3 and 6. People who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods will be helped to go back home. Evidence: The Manager asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving in to Homeleigh is the right thing for them. She also talks with family members and with people like care managers (social workers) and medical staff. All of this information is collected so that the Manager can build up a really good picture of how the persons nursing and other everyday needs can best be met. After shes got all of this information, she can then decide if Homeleigh can support the person in a way thats right for them. Care Homes for Older People Page 11 of 36 Evidence: We looked at the information that has been collected for one person who has recently moved into the Service. We wanted to see what sorts of things are being considered. There is lots of important information. This includes things such as the way they need to be helped to manage their continence at night. There is also information about how they like to be helped to have their meals. The Manager says that when she gets the information she shares it with nurses and with the care workers. This is done so that they know in advance about what nursing care and support they will need to provide. We asked two nurses and two care workers about how all of this works out in practice. They say that they are indeed told about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days, while they get to know them better. The Manager recognises that moving into a residential setting is a big step for anyone to take. She says that she wants to do everything possible to put the persons mind at rest. We agree that this is really important. She says that as part of the introduction process, people are invited whenever possible to visit Homeleigh. This is so that they can see what the place is like first hand. During these visits, people can ask any questions they want. There are also some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Manager is quite happy for them to take away a copy if they want to have a look at them at their leisure. In our questionnaire we ask people who live in the Service, did you receive enough information about this home before you moved in so you could decide if it was the right place for you? Everyone says that yes they did. Nearly all of the people who move into the Service do so with the intention of making it their longer term home. However, there is the chance that someone will only want to stay for a shorter period. This might be so that someone who cares for them at home can have some time to themselves. Or, someone might move in because they been in hospital and arent quite ready to go home yet. When someone moves into a residential setting theres always the risk that their stay might become longer than is necessary. The Manager is aware of this. She says that people are helped to make any arrangements that are necessary for them to leave as planned. This has recently been done for one person who moved into the Service while they waited for a place to become available in another service thats nearer to where their relative lives. The Manager was aware of the short timescale from the start. She was very active in the few days the person stayed in the Service. She contacted several medical people. This Care Homes for Older People Page 12 of 36 Evidence: was because she was concerned that the persons medication needed to be reviewed. These medical staff checked the medication and then changed it. This was done just in time for the person to be started on their new medicines before they left the Service three days after they had come. Care Homes for Older People Page 13 of 36 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. Standards 7, 8, 9 and 10. People are provided with the personal and health care they need. Medicines are handled safely. People are treated with kindness and respect. Evidence: The people who live in the Service say that the nurses and the care workers offer them all the assistance they need. There is a written individual plan of nursing care and personal support for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to nurses and care workers so that they know what to do. We looked at three of these plans. They give a clear account of who needs to do what and why. For example, there is important information about things such as health care, helping people in the bathroom and about keeping people safe. In more detail, one person needs special help when they become anxious about troubling thoughts. Another person isnt very well and needs to be cared for in bed. Someone Care Homes for Older People Page 14 of 36 Evidence: else has difficulty understanding long sentences. They find it helpful for people to say things in a straight forward way so that they can give yes and no answers. We asked two nurses and two care workers about some of these things. We wanted to know what all of this written information means in practice. In effect, we wanted to know if its used or not. They know all about it. In our questionnaire for people who live in the Service we ask, do you receive the care and support you need? Seven people say that they always do, two people say usually and one person says sometimes. The latter three people dont say anything about why they are answering in this way. One of the people who replies always says that, the support is good. Sometimes you have to wait to be taken to the toilet and to get up in the morning. There seems to be less carers to help than when I was first here. The Registered Providers questionnaire for relatives asks, what do you think about the service your relative/friend receives? Six people say that its excellent, 12 people say that its good and no one says that its fair or poor. The support plans are kept up to date so that they are accurate. This involves nurses and care workers making daily notes about how things are going. There are then monthly reviews. This is when the Manager and the nurses check out with the person concerned, with their relatives and with the care workers how things are going and what might need to be changed. In our questionnaire for people who live in the Service we ask, do staff listen and act on what you say? Nine people say that yes they do. One person answers no, but they dont say why they are answering in this way. As we have said, the support plans are detailed and comprehensive. We think that the people who live in the Service might need more help if they want to look at their plan in order to confirm whats being written about them. The Registered Provider has already made a useful first step towards doing this. It has developed a document called, This is Your Life. People will be invited to write down things about themselves so that members of staff have a better understanding of whats important to them. Naturally, people wont have to say anything if they dont want to. Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, some people are a bit unsteady on their feet. They are accompanied by a nurse or a care worker so that they dont lose their balance. There are special rails fitted to some of the beds. This has been done so that people dont have to worry about rolling out of bed. People are helped to keep healthy. Nurses and care workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, Care Homes for Older People Page 15 of 36 Evidence: people have seen their local doctors as and when necessary. There have also been contacts with specialist hospital based medical staff. We looked at some of the records about how quickly doctors are being called after the need for medical attention is first noted. Its being done straightaway. In our questionnaire for people who live in the Service we ask, do you receive the medical support you need? Eight people say that they always do and two people reply that they usually do. These latter people dont say any more about their answers. People can manage their own medication when its safe for them to do so. No one is doing it at the moment. Theres a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. There is a system to make sure things like eye drops dont go beyond their use by date. Also, there are special security arrangements for some medicines. This is because they can be misused by some people if they get out in to the community. Only the nurses give out medication. There is a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. We watched a nurse giving out some tablets. She checked that the medicine was the right one for the person concerned. After she had given it, she recorded in the right way that this had been done. We examined six more sets of these records for a period of several recent days. They are being correctly completed each time a medicine is given. We looked at four medicines in more detail. This was done to see if the remaining stock matches what should be there. Again, we found things to be in order. People say that the nurses and care workers are courteous and attentive. When we were in the Service we talked with people a lot about this. They are very positive about the nurses and care workers. One person summarises the general mood in their comments to us. They say, the staff are very kind indeed and theyre always willing to help. They make the place really and you never feel that youre being a nuisance. We also received comments from a relative. They say, I come to (the Service regularly) and Im very happy indeed with all the care (given). The staff here are absolutely wonderful. Ive worked in a nursing home and so I know how hard work it can be. But here, I always find (her) to be neat and clean in herself and her bed to be made nicely. The staff cant do enough and I know that (she) is having the very best of nursing care. The Registered Providers questionnaire for relatives asks, what are your overall impressions of the home? Five people reply excellent and 13 people say good. No one says fair or poor. One relative says, overall, staff (are) excellent, kind, considerate (and) polite. Nurses and care workers are relaxed and informal in how they are. Things are orderly Care Homes for Older People Page 16 of 36 Evidence: without being too much so. When people want to use the bathroom, they are helped to leave the lounge without drawing attention to themselves. Then they are helped in the bathroom with the door closed so that they can have privacy. People are helped to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use the phone if they want. Care Homes for Older People Page 17 of 36 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. Standards 12, 13, 14 and 15. There are some interesting things for people to do. However, some people might like to do more. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: The Manager says that the plan is that on most days there is a social thing that people can do. She says that about once a week there is someone who comes into to the Service to play music or to lead some gentle exercises in the main lounge. We looked at the records of these events and they confirm what the Manager is saying. The Director of Operations says that the Manager can arrange for individual people to have one to one time with a care worker if this would be helpful. No one was receiving special one to one time in this way when we were in the Service. Most of the social activities are organised by the care workers when theyve finished their other work and have time. Theres no real plan for this. When we asked members of staff about the sorts of activities they do, no one was quite clear about what to say. When we asked about how often things are done again people were a bit hesitant in their replies. One Care Homes for Older People Page 18 of 36 Evidence: person says, its difficult at the moment because we have had to reduce staffing to reflect the lower number (of people living in the Service). In our questionnaire for people who live in the Service we ask, are there activities arranged by the home that you can take part in? Seven people say that there always are, one person says usually and two people say never. The latter three people dont give us anything more to go on. One of the first group says, keep fit, singer with guitar and piano (has not been seen) not seen recently. Carer plays the flute. More activities would be good. When we were in the Service we asked people about this and we got different replies. One person says, I do my magazines and watch the television. Im quite happy here and I like all the company. However, another person says, it can be a long day here in the lounge all the time without much to do. I think about things in the past a lot, it might be nice to have more things to do, like the exercises and music we sometimes have, but more often perhaps. When we were in the Service we kept our eyes open to see what people were doing. They werent doing that much really. Most people spent a lot of time just sitting and not seeming to be engaged much with anything going around them. We especially noted what one person was doing on the six occasions we saw them. This took place over a period of several hours. Each time, they were sitting in the same place and looking ahead of themselves. We didnt see them talk with anyone or doing anything in particular. The Registered Providers questionnaire for relatives asks, are there aspects of the service that you feel could be improved? Nine people say yes and four people say no. No one says sometimes or never. In their comments one person says that they, would like (to see people have) some outside activities (and) daily chair activities. We looked at the records for two people to see what activities they had done during last December. The records do not show them having done any activities that were organised by the care workers. Theres a balance to be struck between people having the chance to do interesting things and not being jollied into things that theyd rather not do. We dont think that the balance in Homeleigh is quite right at the moment. The Manager says that one of the care workers has been asked to take a lead in developing the calendar of activities. The Manager wants the range of things on offer to be extended and she wants social opportunities to be more frequent. We think that this is a good idea. As a first step, shes going to consult with each person who lives in the Service to see what additional things they might like to do. The Manager hopes to have this done by 1 June 2009. People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Manager keeps in touch with family members so that they know how things are going. For example, if someone is not well or if they are Care Homes for Older People Page 19 of 36 Evidence: admitted to hospital. The Registered Providers questionnaire for relatives asks, do you think that you are kept sufficiently informed of relevant issues and events? Fifteen people say that yes they are and no one says no. Two people say sometimes and no one says never. We looked at what has been done recently to keep relatives informed. There are plenty of examples to choose from. One of them involves the Manager sending an email to a relative in India. In this she says how the person isnt very well at the moment and how they have just seen the doctor. The Manager also says that the person is being given some new medicine. The Registered Providers dont get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Its a good idea not to get involved in this way. This is because it avoids conflicts of interests. These can sometimes lead to complicated misunderstandings about who has the right to do what. Instead, most people get help from members of their family or from the local authority. The Assessment says that people are encouraged to make their bedrooms their own private space. They are asked to bring in things for their own homes so that they can have personal items around them. We saw lots of examples of this. People have their own photographs and ornaments so that their bedrooms feel more like being home. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. Some people choose to dine in the privacy of their bedrooms. One of the questions we ask in our questionnaire for people who live in the Service is, do you like the meals? Eight people say that they always do, one person says usually and one person replies sometimes. The latter two people dont say any more about this subject. One of the former people adds that the Service has an excellent chef. The summary of the Registered Providers questionnaire for people who live in the Service says that both of them, are very happy with (the) presentation and quality of (the) food. When we were in the Service we asked people about their meals. One person summarises the general mood when they say, the meals are really good and we always have enough to eat. We have plenty to eat and the food is really tasty. Better than I did for myself at home actually. There is a choice of dish at each meal time. We looked at the records of the meals provided over a two day period. We wanted to see if different people are actually having different things. They are. We also looked at the variety of meals provided over a period of two or three days. There is reasonable balance. The dishes include things like lamb chops, creamed mushroom and potato bake, cod in dill sauce and fish and chips. Nurses and care workers say that people can have drinks and snacks throughout the night. This is important. Otherwise, it can be a long time for some people between Care Homes for Older People Page 20 of 36 Evidence: the late evening milky drink and breakfast the next day. Care Homes for Older People Page 21 of 36 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. Standards 16 and 18. There is a complaints procedure. There are arrangements to make sure that complaints are dealt with properly. There are arrangements in place to safeguard people from being bullied or taken advantage of. Evidence: We asked several people about making complaints. They say and show by their relaxed manner they would feel quite okay about raising a complaint should they need to. In our questionnaire for people who live in the Service we ask, do you know how to make a complaint? Eight people say yes they do know how to make a complaint and two people say no they dont. One of the latter people says that their relative knows what to do on their behalf. The Registered Providers questionnaire asks relatives about this. It says, are you aware of the complaints procedure? Seven replies say yes and nine people say no. The latter people dont say anything more about their answers. Theres another question that asks, are your views and comments listened to and acted upon. Fourteen people say that yes they are, no one says no, one person says sometimes and no one says never. The person who says sometimes doesnt give us anything more to go on. The summary of the responses to the Registered Providers questionnaire for people who live in the Service says, both answered (that) they knew of the complaints process. Care Homes for Older People Page 22 of 36 Evidence: There is a written complaints procedure. This explains how to go about making a complaint or raising a concern about something. Its very important that people are confident that theyre safe from being taken advantage of. For example, that they need to know that theyre not going to be bullied or pushed around. The Assessment commits the Registered Provider to guarding against this. We asked some nurses and care workers about this matter. They know what to look out for. None of them have any concerns about how things are going. Since our last inspection, the Registered Provider has worked with the local authority to look into two separate concerns. One of them involved a person who lived in the Service being unhappy about some of the support they received at night. They were also not satisfied with some of the service they received the next morning. The records show that the Manager and the Area Manager promptly looked into this matter. Between them they spoke with the person concerned, interviewed the members of staff concerned and looked at relevant records. At the end of the process, the letter from the local authority says that the Registered Provider sent it a very thorough report. The local authority did not require that any further action be taken. This was the also the conclusion for the second complaint. This involved a person who was using the Service saying that a member of staff had been unkind to them. The member of staff denied the allegation and in the end it couldnt be proved one way or the other. While the matter was being looked into the member of staff was asked not to come to work, just in case the allegation turned out to be true. The letter from the local authority concluding the matter acknowledges the swift and open response from the Registered Provider. The people who live in the Service say and show us that they feel safe in Homeleigh. Care Homes for Older People Page 23 of 36 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. Standards 19, 22, 25 and 26. The accommodation is comfortable and pleasant. There is a modern fire safety system. The kitchen is well equipped. There is a suitable laundry. Evidence: The building is well maintained on the outside. For such a big building there is only a very small garden at the back. However, there is a summer house at the end of the garden and there is a level path there to get to it. On the inside, the accommodation is well decorated and furnished. The place has a homely, lived-in feeling to it. In our questionnaire we ask people who live in the Service, is the home fresh and clean? Seven people say that it always is, one person says usually and one says sometimes. No one says never. The last two groups dont say anymore about the reason for their replies. The summary of the Registered Providers questionnaire for people who live in the Service says that, both (are) happy with (their) surroundings. We had a look around and we noticed two things that now need attention. In one of the bedrooms, two of the double glazed windows have misted up inside. The look unsightly and theyll need to be replaced. When we spoke with one person who is cared for in bed, we saw that the mattress is quite badly stained and has a stale smell Care Homes for Older People Page 24 of 36 Evidence: to it. This too will need to be replaced. The building is fitted with an automatic fire detection system. This provides a high level of fire safety protection. We understand that the fire brigade people say that the system in general meets the national standard. However, when they last called in 2006 they said that various checks needed to be made about the external fire escape. After our visit, the Director of Operations told us that this work has been done. She also told us that the Registered Provider employs an experienced fire safety consultant who regularly examines the fire safety system in the Service. He does this to make sure that everything is still working in the right way so that the people who live in the Service have the protection they need. The people from the local Department of Environmental Health called to look at the kitchen in 2007. We looked at their report. It says that there are quite a lot of improvements that need to be made in the kitchen. These include the standards of cleanliness, the way various checks and records are kept and things such as food storage. All in all its a disappointing report. However, were pleased to tell you that the Registered Provider acted quickly to put things right. We looked in the kitchen. We checked two of the things that were raised by the environmental health people which the Registered Provider said had been sorted out. Things are okay. The kitchen is well equipped, clean and well organised. The chef does sensible things to ensure good food hygiene. He makes sure that the fridges and freezers are cold enough to store food safely. He also makes sure that hot foods are cooked through thoroughly. Theres a stock management system. However, at the moment this doesnt include having clear arrangement to date mark foods when they are opened. This needs to be done so that they dont hang around for too long. The Manager is going to sort this out by 1 March 2009. People who need it are helped to get about. There are four baths with hoists. They have a seat that goes up and down. This means that you can sit on the seat outside the bath, then it can be raised to go over the side of the bath before its lowered once youre over the bath. There are also two walk in showers. There are two mobile hoists that can be used in the bedrooms. They might be needed if someone cant manage at all to get out of bed. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. There are frames near to the toilets. People find these very helpful when they are getting down and getting back up again. There are other less obvious things to help people get about. For example, there are special belts that can be used to give people that extra bit of help they might need Care Homes for Older People Page 25 of 36 Evidence: when getting up from a chair. Also, there are special sheets that can be used to help people change position in bed. When someone moves into the Service, the Manager makes a note of what assistance they need to get about. She looks at things such as the help someone needs in the bedroom and in the bathroom. We asked nurses and care workers about this. They know what theyre doing. We saw one person being helped into their wheelchair by two members of staff who were using one of the mobile hoists. They werent rushing the person and they were using the hoist in the right way. Once the person was seated in the wheelchair, one of the members of staff helped them get comfortable before wheeling the person off to the bathroom. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. When we arrived in the Service the central heating was on and it was on when we left. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. The hot water taps that are used by the people who live in the Service are temperature controlled. This means that they wont get hot enough to scald someone. We tested a few taps and the temperature seems alright to us. The laundry has three commercial grade washing machines. These have an extra cycle for items that need an especially hot wash. There is a large dryer. We looked in the laundry and its well organised and clean. New rules have been introduced to help make sure that used water doesnt leak back from things like washing machines into the drinking water supply. It looks like the Service already meets these rules. However, just to be on the safe side the Manager is going to contact the local water supply company to find out. Shes going to do this by 1 April 2009. The Manager says that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. We asked people about this. They say that they do nearly always get their own clothes back from the laundry. We had the opportunity to check this out for three garments. We found each of them to be marked with the name of the owner. Care Homes for Older People Page 26 of 36 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. Standards 27, 28, 29 and 30. There are enough nurses and care workers around. Nurses and care workers know what theyre doing. Evidence: There is always a qualified nurse on duty. During the morning there are also five care workers on duty and for the afternoon and evening there are four care workers. Again, there is a qualified nurse on duty at night and there are also three care workers. There are special security arrangements in place for the night time hours. During the day, there are other members of staff on duty who work in the kitchen, in the laundry and who do most of the housekeeping. In our questionnaire we ask people who live in the Service, are the staff available when you need them? Five people say always , three say usually and one person says sometimes. This latter person adds that members of staff are, not always available. In our questionnaire for members of staff we ask, are there enough staff to meet the individual needs of all the people who use the Service? No one replies that there always are enough staff. Everyone says that theyre usually are. That means that no one says that there sometimes or never are enough. One person adds to their reply saying, to be honest everybody knows that there are so many and different needs for each resident that you never have enough Care Homes for Older People Page 27 of 36 Evidence: staff to do it. When we were in the Service we kept a look out for things that might give us a clue about how well the place is being staffed. We noticed that two people who asked to be helped to use the toilet were assisted straight away. Another thing we looked at was the time taken to answer the call bells. In their reply to the Registered Provider one relative says, (I) would like call bells answered more promptly but (I) appreciate staff are busy sometimes. This isnt our experience. We looked at two occasions when it went off. On both times it was answered in less than half a minute. Thats pretty good. The Manager says that all of the shifts are being reliably filled. We looked at the written roster for a recent week in general and for two days in particular. We wanted to check out for you that what the Manager says is true. Things seem to be okay. Its very important that only honest and trustworthy people are employed as nurses and care workers. With this in mind, the Registered Provider completes a number of security checks on new nurses and care workers. These include things such as confirming their identity, taking up references and doing a police check. We looked at the records for two care workers who have been appointed since our last inspection. The various checks that we need to see have been done. The Manager says that new nurses and care workers have introductory training before they work on their own. In our questionnaire we ask about this. We say to members of staff, did your introductory training cover everything you needed to know to do the job when you started? Five people answer very well and two people say mostly. This means that no one says partly or not at all. One of the people saying mostly says, I marked mostly because (you) need time to do all the training you need and also it takes time for every beginner to understand, cope with and practice all ( of your) new knowledge and skills. There is a checklist of the subjects that new nurses and care workers are told about. We looked at one of these checklists that has recently been completed for a care worker. It shows that important things are being covered. For example, they are told about the individual nursing and support plans that we spoke about earlier. They are also shown how to help people get about safely. The Manager says that this initial training is just to get nurses and care workers started. Theres a lot for care workers in particular to learn after that. The Manager says that all care workers are expected to do initial and then regular refresher training in important subjects. For example, in how to safely support people move about, in basic first aid, in food hygiene, in keeping people safe and in infection control. There Care Homes for Older People Page 28 of 36 Evidence: are other one off courses that care workers are expected to do. These include how to support people who have difficulty understanding things and in saying what they want. Another is in health and safety. The Manager says that most of this training is done by trainers coming to the Service on a regular basis. We looked at the records of who has done what courses so far. We did this so that we can give you a clear picture of how things are going. When we first looked at the records we thought that there were quite a few gaps where individual nurses and care workers had not done particular courses. Afterwards, the Director of Operations told us that we have misunderstood the records and that all members of staff have completed the training that they need. We have accepted this assurance. However, when were next in the Service well double check this matter to make sure that everything is alright. In our questionnaire we ask members of staff, are you being given training that is relevant to your role and that keeps you up to date with new ways of working? Six people say yes they are and one person says no. The latter person doesnt say anymore. One of the former people says that plenty of training is offered to all grades. Theres a total of 14 care workers employed in the Service. Of this number, ten have completed a National Vocational Qualification (NVQ) at Level 2 or 3 in health and personal care. One more person has almost completed it. This qualification is a very good idea. This is because it helps care workers to deliver high quality residential care services. The Manager says that all new care workers will be encouraged to study for the award. We spoke with two care workers to find out what they know about particular bits of the support they will need to give people. As we have said earlier in this Report, they know a lot about how each of the people who live in the Service likes to be supported. More generally, they know about helping people to express themselves. They also know about how to respectfully help people who need assistance to manage their continence. Care Homes for Older People Page 29 of 36 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. Standards 31, 33, 35 and 38. In general things are well managed. People are asked what they think, but this needs to be a bit more organised. People are helped to buy what they want. There are sensible health and safety things. Evidence: The Manager has a good general knowledge of how things are going. She is a qualified nurse. Also, she also holds a particular management qualification. This qualification is important. This is because its designed to help managers ensure that high quality support is reliably provided. The nurses and the care workers say that there is good team work between them. There are handover meetings at the beginning and end of each shift. These are held so that nurses and care workers can be kept up to date with developments. In our Care Homes for Older People Page 30 of 36 Evidence: questionnaire for members of staff we ask, are you given up to date information about the needs of the people you support or care for? Everyone answers always. One person adds that, (at) each handover we get up to date information about new residents needs or about any changes in other residents conditions as soon as its happened. There are team meetings every couple of months or so. We looked at the records of the sorts of things that are being discussed. Theyre practical and relevant. For example, care workers have recently talked about some new training material that the Registered Provider has developed. They can ask to use this if they want to. In our questionnaires we ask members of staff, do the ways you pass information about people who use the Service between staff (including the manager) work well? No one says that they always do, five people say usually and one person says sometimes. No one answers never. One of the people who answers usually is quite positive in their comments. They say, yes, because (the Manager) is available most of the time to give us support if we ask and shes got solid knowledge. Its really important that the people who live in the Service have a direct say on how things are going. After all, theyre the experts because they live there. The Assessment says that people who live in the Service are regularly asked what they think about their home as part of everyday life. As we have already noted, each year the Registered Provider also asks the people who live in the Service and their relatives to fill in the questionnaires that we have quoted from. In general, we think that this is a very useful thing to do. However, there are some further improvements that can be made. Its disappointing to note that only two people who live in the Service chose to fill out a questionnaire. Everyone needs to have a chance to have their say. Therefore, in future we think that a different approach might be needed for people who dont want to fill in a questionnaire. For example, they might like it to be a more user friendly thing, or they might prefer to discuss what they think on a one to one basis. We also think that members of staff should be asked their views. After all they work in the Service and theyre bound to have lots of useful things to say. Another thing that needs more work is how to tell people who live in the Service what has been said and what is going to be done to introduce any suggested improvements. The Registered Provider needs to attend to all of these points in time for us to be told about them when we get its next Assessment in 2009. The Area Manager calls to the Service about once a week to see how things are going. We looked at the records of her most recent visit. These show that shes talking with service users and with members of staff to find out things. Also, she looks at key records and documents. The Registered Provider helps most of the people who live in the Service to manage Care Homes for Older People Page 31 of 36 Evidence: their personal spending money. This is done so that everyone has enough funds to pay for things that they want. For example, people need to buy toiletries and they need to pay for seeing the hairdresser and chiropodist. The Service holds small amount of cash for two people. We looked at the records of the money received into the Service and what its being spent on. Things are okay. The sums add up and there are receipts to support the purchases that have been made. For other people there is a different system. This involves the Service paying for things for people and then sending a bill to their families about once a quarter. The Manager says that each of the people concerned and their relatives have agreed to this in advance. We looked at the records for one person. We wanted to see if the amounts claimed to have been spent are reasonable. They are. We also wanted to see if the purchases are supported by a receipt to prove that the money in question has been spent. Again, they are. The Manager says that regular checks are completed to ensure that the Services fire safety equipment remains in good working order. We looked at the records. These show that the fire alarm bells are being tested each week. However, what should be the monthly checks of the emergency lights and fire extinguishers are considerably overdue. The Manager says that the maintenance man will put this right from the date of our inspection. More detailed checks of the fire safety equipment are completed every now and then by an outside contractor. At the moment, theres no programme of unannounced fire drills. These are important because they check out that members of staff know what to do under emergency conditions. The Manager is going to have unannounced fire drills regularly in the future. The first one will be held by 1 March 2009. There is a system to double check that each member of staff knows how to follow the Services fire safety procedure. The plan is for the training about this to be done twice a year. Its more detailed than the things that are done in the fire drills. We looked at the records of the last two training sessions. We checked the records for four people in detail. Three were present at both sessions. However, one person only attended the first one. After our visit, the Area Manager told us that this person has in fact received the necessary training at another of the Registered providers local services. Its very important that people dont go overdue on this training. This is because the level of fire safety protection in the Service largely depends on members of staff doing the right thing at the right time. Given this, the Manager is now going to double check that everyone is up to date with this training. This will be done by 1 March 2009. There are up to date reports from engineers about the gas appliances, the mobile hoists and the stair-lifts. They say that everything is in good working order. However, there is no record of an electrician having checked out the safety of the electrical Care Homes for Older People Page 32 of 36 Evidence: wiring. This now needs to be done by 1 June 2009. We looked at the record of accidents that have occurred in the Service over the past month or so. There hasnt been that many. Most have been minor bumps and bruises. The Manager keeps an eye on who has had an accident and what has happened. This is done so that she can do something if there is a particular problem that is causing the accidents. We dont think that theres anything obvious that needs to be sorted out at the moment. The Manager says that she and other members of staff regularly check the accommodation. They do this to make sure that nothing is broken. Also, they want to see that there are no hazards that might cause someone to have an accident. If there is something this is then written in the handymans book for him to attend to. We looked at this record. They show that relevant things are being raised. For example, quite recently a member of staff noticed that some roof slates were on the ground. The next day the handyman checked this out and decided that there was no need to take any immediate further action. When theyre checking the building members of staff dont really have a set list of things to look at. Since our visit, the Director of Operations has told us that she plans to address this by introducing a new list of things that will help members of staff when checking the building. We kept our eyes open when we were walking around. We didnt notice any particular hazards. We were looking for things such as frayed carpet seams and trailing wires that might cause someone to trip over. We were also on the look out for anything sharp that might catch someone walking by. We checked to see that cleaning products like bleach are stored safely when they are not being used. We found things to be in order. Care Homes for Older People Page 33 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 34 of 36 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 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 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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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