Inspection on 14/05/09 for Loganberry Lodge

This inspection was carried out on 14th May 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Loganberry Lodge 24/11/08

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Loganberry Lodge 79-81 New Farm Road Stanway Colchester Essex CO3 0PG     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: Diane Roberts     Date: 1 5 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Loganberry Lodge 79-81 New Farm Road Stanway Colchester Essex CO3 0PG 01206563791 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) : manager.loganberry@runwoodhomes.co.uk Runwood Homes Plc care home 108 Number of places (if applicable): Under 65 Over 65 0 108 dementia old age, not falling within any other category Additional conditions: 108 0 The maximum number of service users who can be accommodated is 108. The registered person may provide the followting 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: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Loganberry Lodge is a new purpose built home on the outskirts of Colchester in Stanway. The home has 108 beds, split into four units and care is provided to older people and older people with dementia. There are five lounges and two quiet rooms, one of which is used as a relaxation room, with specilaist equipment, for residents with sensory impairments or advanced dementia. All bedrooms are ensuite and some downstairs rooms have french doors leading onto patio areas. Other secure areas of garden are available. The home is near to bus routes and local shops and amenities. There is ample parking at the home. The home has a statement of pupose which Care Homes for Older People Page 4 of 32 2 5 1 1 2 0 0 8 Brief description of the care home outlines arrangements and services offered and a service users guide for residents giving day to day information on the home. The current fees range from £383.00 to £700.00. Additional charges are made foritems such as newspapers, chiropody and hairdressing. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 site visit was undertaken over a 12 hour period, over two days, as part of the routine key inspection. The Manager and members of the Senior Management team for Runwood were available during the inspection. Prior to the site visit, the manager was sent a variety of surveys to distribute and that asked questions that were relevant for each group, such as for people who use the service and relatives. Ten were received from residents and six were received from relatives. During the visit to the home, it was possible to speak to 5 residents and 5 staff in addition to the management team. It was also possible to speak to five relatives and two members of the district nursing team. A tour of the home was undertaken and a range of records relating to the home and the services offered were Care Homes for Older People Page 6 of 32 reviewed. A pharmacist inspector also examined practices and procedures for the safe handling, storage and recording of medication given to people. What the care home does well: What has improved since the last inspection? What they could do better: Whilst there have been many improvements made, there is still work to do and the improvements need to be sustained once all the external input, from health and social services is withdrawn. Work is needed on the development of the staff team to have a more person centered approach to the care they provide, especially for people with dementia. Training has been provided on caring for people with dementia, which is good, but management may need to look at further person centered training and putting the dementia training into practice. Improvements needs to be made around the promotion of continence and fluid intake for residents and staff need to be careful with weight monitoring. When medication is given in variable doses e.g. one or two drops or at times other than those printed on the medication record, the records made must be clearer and more accurate to demonstrate that people receive their medication as prescribed and in the correct dosage. The activities programme is in its infancy and needs developing to ensure that residents social needs are properly assessed and planned for, on an individual and group basis. Care Homes for Older People Page 8 of 32 Odour management in several parts of the home needs review to ensure that the route of the problem is addressed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate assessments are undertaken prior to admission to the home to help ensure that it can meet the needs of the resident and prospective residents have the information they need on which to base a decision about the home. Evidence: Since the last inspection the service users guide has been reviewed and a more pictorial format has been developed which is more suited to the residents group. Residents spoken to said that they had seen the guide. Two pre-admission assessments were reviewed and found to have been completed well, giving sufficient information on which to base a decision about suitable admission to the home. The information on one assessment was seen to identify the prospective residents strengths, which is positive and also detailed personal preferences, giving a more person centered approach to the assessment. The other assessment, whilst Care Homes for Older People Page 11 of 32 Evidence: informative, was not person centered. Where person centered information is noted, this needs to be carried through into the care planning process, as on cross checking, this was not used. Pre-admission assessments were backed up, where appropriate, by information from the referring social services department. It was not possible to speak to any newly admitted residents to the home about their experiences. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents experience different standards of care in the home making outcomes variable for them. Evidence: The manager has a care planning system in place. Four care plans were reviewed in detail and further care plans were used for cross referencing. Overall the assessment of needs and subsequent care plans that residents needed were seen to be in place and were sufficiently detailed to guide staff. The plans were up to date and and included improvements on care planning for residents medical needs including pain relief. Care plans relating to the management of residents continence were seen to need more detail in order to make them individual to the resident, especially when residents are on medication to aid continence. Care plans stated toilet regularly. More work is also needed on developing a more person centered approach to both care planning and subsequent delivery. Whilst the night care plans are good and quite person centered, more involvement is needed from the residents or their representatives regarding all their care plans so they contain their preferences Care Homes for Older People Page 13 of 32 Evidence: regarding their care and abilities, so that their independence and self worth is optomised/promoted as far as possible. Staff need to ensure that they are aware of the content of the care plans and that they are followed, for example, one resident should have had their legs elevated when sitting, but on observation over several shifts, this was not done. It was also noted that staff may need more guidance on interacting with residents who, with dementia, are sometimes reluctant with the care offered. Staff were seen to be persistent, making residents respond aggressively when at other times they responded positively to staff. One resident said to the staff member I will do what I want when I want it. This was further evident in the approach to care planning for residents with dementia. For example, one residents who often wanders during mealtimes would be managed by staff ensuring that they sit in the dining hall during every mealtime. This approach shows that staff need to be more open minded and creative about the individual management of such issues. Staff complete daily records that primarily relate to diet, fluid intake and toileting. These could be developed to relate more to the plans of care so that staff consider them more. Daily fluid charts show that residents are primarily being helped with their fluid intake at the standard offered times and not between drinks rounds. This is reiterated with the observation that residents are not routinely offered drinks between drinks rounds showing that there is not an individual approach or the awareness of all staff for the need for an adequate fluid intake. Relatives spoken to felt that the staff communicated with them well and contacted them at home when there were any issues. Residents spoken to said that the care at the home had improved and one said that with the help of the care staff at the home their mobility had improved significantly and that their independence meant a great deal to them and another said when the staff help me they know about me and how I like things done. Residents had a range of up to date risk assessments in place. Residents were being pro-actively assessed for the use of bed rails. Where risks have been identified, for example, in relation to the risk of pressure sores, the subsequent action taken needs to be detailed to help ensure that the correct management has been taken. Good risk assessments were in place for those residents who may exhibit challenging behavior and advice to staff was available on the triggers for the behavior with practical advice about the management. Records showed that residents were being weighed regularly but results showed that staff may not be using the equipment correctly and were having to reweigh residents. The management team were aware of this issue and were working with care team Care Homes for Older People Page 14 of 32 Evidence: managers to ensure that the weights are accurate and that therefore the correct action is taken for residents. The district nursing team confirmed that the weight monitoring and subsequent management of residents in the home had improved and agreed that staff needed to ensure they could use the weighing scales properly. Records showed that residents were being weighed regularly and referred appropriately. Records showed that some residents were still loosing weight but it is felt that this needs to be checked properly. It was noted that a lot of the residents are on supplementary drinks for their diet and this should be also be kept under review to ensure it is appropriate. Records showed that residents were seeing their GPs appropriately and generally in a timely manner and were also seeing other health care professionals such as physiotherapists and chiropodists. Staff recording shows that they are generally noticing health care needs with residents and referring, but a recent adult protection referral raises concerns that this is not always the case. Clear and detailed medicines handling procedures were available to care staff. The home has instituted a procedure for the regular checking of medication and medication records and this is good practice. The cupboards used to store medicines were secure for the protection of residents.The temperatures of the medicines storage areas are monitored and recorded regularly and are acceptable. This ensures the quality of medicines in use. But the records made of the fridge temperatures where medication is stored was only the current temperature not the maximum or minimum temperature that the fridge reached. It would be good practice to record the range of temperatures as a means to ensure the quality of medicines stored there. We looked at the medication and medication records for several people in all units of the home and, in general they were good with few discrepancies. Where people are given medication in variable doses, e.g. one or two tablets then the actual quantity given is not always recorded. This could result in people receiving too much or too little medication. Also when medication is given at different times to the time recorded on the medication record, this isnt clearly recorded and could result in people not receiving their medication at the right time. Medication is only given to residents by trained care staff and we watched medication being given to several people at breakfast time. This was done with regard to peoples dignity and personal choice. Some people look after and take their own medication and this is to be encouraged. The risks to themselves and other people had been assessed and documented in individual care plans. Requirements made about medication at the last key inspection have been met but it is not clear if these improvements have been made as a result of the recent changes in home management or the influence of the PCT practitioners who have been closely involved with the home. Nevertheless, these improvements must be sustained. Residents said that the medication systems in the home had improved since our last visit and now they generally get their medication on time. They also said that they Care Homes for Older People Page 15 of 32 Evidence: were now self medicating whereas before they did not have the opportunity to do this. Relatives commented that on admission their family members medication was reviewed by the GP at the request of the home and this has been very positive as they are much brighter in themselves now. Residents spoken to said that the care staff were polite and when helping them with their personal care, were respectful of their privacy and dignity. Some of the staff interaction seen with the residents was very good, respectful and caring. Other interactions demonstrated a need for more training, especially for those staff caring for people with dementia. Residents who commented on our surveys gave variable responses to whether staff listened to them and acted upon what they said. It is clear that residents experiences are different. Relatives who commented on surveys had concerns regarding the help given to residents regarding toileting both during the day and at night, saying that it was not often enough during the day so their relative was reluctant to drink and at night staff were not patient when being asked to help. This was confirmed in minutes of staff meetings where the manager had raised this with the care staff and was promoting an individual approach to this aspect of care. Relatives were also concerned that thier family members were not being optomised in relation to their continence as they had started to use pads quickly after admission where it was felt that tolieting was still an option. This needs to be reviewed. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be fully assured that their social needs would be fully met or that the routines of the day are always resident led. Residents can expect a satisfactory meals service. Evidence: Residents spoken to all said that they now had more choice about how they spent their time and that they were not being told when to go to bed anymore. However recent adult protection referrals indicate that residents choice and the development of person centered care still needs work. When speaking to staff about the routines of the day some were quite resident led and used such phrases as we see who has got up and offer to help them and its the residents choice if they lie in. Other comments were less person centered such as we have to get them up before 10 a.m and we toilet after meals and before lunch. Residents spoken to said that the night staff help me to wash and dress, they may as well if I am awake, if I was asleep they would leave me, the staffing of the home has improved, I dont have to wait to get into bed now and the night staff are more helpful than they were, On observation, it was noted that staff are still taking time to answer call bells in the home, up to five minutes. Residents spoken to said that if I use the buzzer they do come and are quite prompt Care Homes for Older People Page 17 of 32 Evidence: within reason, they may be busy. Staff were seeing to be helping residents with registering on the electoral register so they could vote in forthcoming elections. Some residents had family trees completed in their care plans which gives staff a good level of information about the resident as an individual and promotes their treatment as such. These were not in place for all residents, even for those with active family input at the home. This needs addressing. Staff spoken to knew the main care needs of residents but were generally not aware of residents social histories. Social care plans and an actual assessment of need also require more work as many did not identify the residents needs or strengths with regard to social care and how this could benefit the resident. They generally gave limited and basic information regarding social preferences. Some plans did identify some residents preferences but records then did not show that these needs were being met. Some residents were noted to be better with one to one activities but again records did not show that this was being offered or taking place. It is clear that recently more activities are being offered to residents but this is primarily group activities. Individual needs have not been fully assessed and whilst there are some good examples of one to one interactions, these needs are not being fully met. One residents who stays in their room said the activities ladies say hello to me but thats about it. Group activities included SONAS sessions, (Sensory based activities) basket weaving, arts and crafts, entertainers etc. Records showed that residents have a choice as to whether they took part or not. A new activities officer is in post and works 24 hrs a week and this is currently being supported by an activities officer from another home, who visits two to three times a week whilst they await recruitment of a further person. This would bring the activities hours up to 60 hrs per week. An activities programme is in place and it is used as a guide. More thought should be given to getting the activities programme out to all residents rather than pinned to a notice board. Residents spoken to said that they see the activities officer 2 or 3 times a week and whilst more could be done the activities offered were better now as she does things for us. In the past the activities were too childish and we were not interested. One resident said I do go out shopping occasionally with the staff. Some relatives who commented in our surveys said that they felt there were not enough activities. Notices indicate that external entertainers are coming into the home, usually monthly and residents confirmed that this was the case. Residents were seen to be enjoying taking part in SONAS sessions whereby music and exercise is mixed with other sensory activities to, for example, smells to promote memories. Care staff spoken to Care Homes for Older People Page 18 of 32 Evidence: confirmed that they also take part in the provision of activities and gave examples of helping residents with basic activities such as colouring and puzzles. The development of an assessment of social need and more detailed person centered care plan may help staff with the range of activities that they could offer. Records show that local churches people do visit the home and use the visitors room for services. Residents were observed having both breakfast and lunch on all four units. Breakfast tables were nicely laid in the morning and teapots, condiments etc. were on the table along with fresh fruit on the downstairs units, promoting residents independence. Consideration should be given to the promotion of independence during mealtimes for the residents with dementia, who do not have access to the same facilities. Hot breaks fasts are available on some mornings and residents spoken to were positive about this. Overall, apart from staff shortages in the morning, mealtimes were seen to be much improved with more support from staff and residents being served in a timely manner. Relatives confirmed that they had been able to come and eat with their family member for a small fee (£3.00). Residents spoken to said that the food provided at the home had improved recently but when the agency chef covers a shift the food is awful and two out of ten. Residents were seen to have drinks in their rooms but staff still need to work on ensuring that all residents have drinks available throughout the day and not just at designated rounds. Residents were seen to be offered choices with drinks by staff. On discussion with the chef, he confirmed that he has changed the menus following feedback from residents and could evidence this from a catering survey conducted in April 2009. Comments from that survey showed that overall residents said that they had choice at mealtimes although a few still said that they did not. Comments included on the whole the food is good, Im happy, our meals are not rushed, sometimes there is no salt and pepper and I am getting bored with mash. The manager said that once people were happy with the menus they would work on providing pictorial menus for use throughout the home. Comments made to us during the inspection included the food is not too bad, I have had worse, you get a choice more or less, they ask you the day before, the food is gradually improving, there is more choice now, the food is alright, I always find something that I like to eat and the food could improve, its a bit tasteless and more variety is needed. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be more assured that their concerns would be listened too and acted upon and that they would be protected by the adult protection procedures in place. Evidence: The complaints log was reviewed. Since the last inspection the new manager has worked on ensuring that all the previous and current concerns and complaints have been recorded properly and dealt with to everyones satisfaction, as far as possible. Since we were last at the home there have been 57 complaints logged and investigated. Records were quite good and showed that they had been responded to appropriately. The complaints were primarily regarding standards of care (29), then laundry services (13), miscellaneous issues (13), domestic standards (9) and then catering (4). The manager needs to ensure that she does not record a completed date on the complaints log until the matter has been completed. Residents spoken to confirmed that their concerns had reduced and overall the home had improved. It was evident though, from discussion, that residents were raising issues with staff and they were failing to pass them to management for possible further investigation. Overall, via our surveys, both residents and relatives said that they knew how to make a complaint and knew who they could talk to informally in the home if they wised to. Residents spoken to said I am unsure who I would raise any issues with, I would probably use my family to any views to the manager and I would Care Homes for Older People Page 20 of 32 Evidence: raise any concerns with my family and they would talk to the staff who are helpful. Staff spoken confirmed that they had attended training in adult protection but were unsure where to locate the staff guidance on this in the home. Records showed that the manager had raised adult protection referrals herself on behalf of residents who had experienced poor outcomes from hospital care. The training matrix showed that there was a good compliance level for staff attending training on this subject with only a few staff yet to complete it. Since the last inspection there have been 19 adult protection referrals made for residents in this home. These primarily relate to the poor standards of care that were being provided and a poor approach by care staff. The lack of consistent management in the home also contributed to this. Some of the adult referrals also related to thefts of personal items and small amounts of money from the home. Whilst the number of referrals has significantly reduced and standards in the home have improved, there is still work to do and this is reflected in the continued referral of adult protection matters to us and Social Services. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean, safe and well maintained home. Evidence: A tour of the home was undertaken without the manager. The bedrooms are of a good size with plenty of room for furniture and equipment if needed. All bedrooms are en suite and many have been personalised by the residents and/or their families. Overall the facilities in the home are very good. The garden areas could do with developing further to encourage residents to spend more time outside. Hand washing facilities around the home were seen to be satisfactory. Odour control in several parts of the home still needs work. It was noted that deodourisers had been installed in the area that had odour issues at the last inspection. Work may need to be done on the cause of the problem rather than using deodourisers. Overall the home was seen to be clean, tidy and well maintained and relatives who commented concurred with this. The floors in the dining rooms are sticky underfoot and a review of the cleaning times or products used is needed to address this issue, which was noted by us and also highlighted to us by residents and other visitors to the home. It was also noted that the lifting hoists require cleaning. More visual stimulation is needed around the home, primarily in the lounge diners. On Care Homes for Older People Page 22 of 32 Evidence: discussion with residents they were asking us what day it was and what month. There is no calender in the lounge. It was noted that the television in one lounge was broken and staff stated that this had not been available for three weeks. This needs addressing. Maintenance records were reviewed and showed that weekly and monthly checks and tests are carried out on systems and equipment in the home, including the hot water and nurse call system. This was seen to be done efficiently and any issues dealt with. The maintenance man was noted to interact well with the residents and was very helpful in trying to sort items out that they had raised with him. The laundry was visited as there had been complaints previously regarding the management of the laundry, primarily from relatives. The laundry was seen to be well organised and on randomly sampling clothes from the box system, items matched the named boxes that they were in. The manager confirmed that staffing of the laundry had been an issue which she hoped was now addressed and the complaints regarding the laundry should reduce. Staff spoken to confirmed that there were sometimes issues with clean items being short and occasionally given to the wrong resident. Records also confirmed that residents were sometimes without underwear because of the laundry system. Residents spoken to said that overall the laundry system was satisfactory but items such as belts off dresses etc. did go missing. Relatives who commented via our surveys said on what the home could do better was the laundry and comments included my relative has been put to bed in their underwear and was told that their nightwear was in the laundry. Ongoing monitoring is needed to ensure that this service within the home improves. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are benefiting from a steadily settling staff team who are being well trained. Evidence: Residents and relatives spoken to, all thought that the use of agency staff in the home had reduced and this was positive in relation to the care and services provided. Records of the last three weeks agency use demonstrated a significant drop every week with approximately 500 hrs of agency being the week before the inspection. Residents spoken to commented positively on the agency staff being used by the manager. Agency staff are still being used until new staff are recruited and there are ten care staff waiting to start once all documentation has been collated. Agency staff working at the home were seen to have profiles in place. Relatives commented in surveys that they felt their relatives care needs were met by permanent staff, who knew the plan of care, but not when the agency use is significant. Residents said that occasionally they are still short of staff but have been told by the manager that the home has enough staff. Staff also confirmed shortages occasionally and said that when they were short, say with 2 staff on a unit, it was difficult to manage or if the agency use was high this affected the standards of care given. Rotas showed that on the whole the current staffing levels were achieved with the occasional drop where cover had not be found at the last minute. Comments from residents on the staff team included by in large the staff are alright - there is the occasional bossy one who does Care Homes for Older People Page 24 of 32 Evidence: not seem to think you have sense because you are older, friendly and caring bunch of staff, polite and there is plenty of banter and the care staff are very nice and no-one has ever been rude to me. Care team managers were spoken to and those in post felt sufficiently supported by the companies management team and now felt more comfortable in their roles and with the responsibilities that they had. They confirmed that they were confident with the new manager at the home and that the support was also hands on when needed. Care staff also spoke positively about the new manager and and said the home had vastly improved and that they now had time to care for the residents and can do their nails, blow dry the ladies hair etc. Staff spoken to in the home confirmed that they had achieved NVQ qualifications or were currently taking them. Records showed that out of 47 care staff, only 13 currently had an NVQ qualification. It is hoped that once the term has more permanent staff this number will increase. Three staff files were reviewed to check the recruitment process in the home. The files were seen to be in good order with all the required checks and documentation in place. CRB checks were seen to be in place before staff commenced work and records available showed that they had been appropriately inducted to the home. Staff spoken to also confirmed that they had been inducted. Records show that after the home induction, staff are starting to complete the Skills for Care induction. The training matrix was reviewed and showed that there were good compliance levels with staff attendance at training for adult protection, first aid, moving and handling, health and safety, fire safety and infection control. Most of the care staff had also attended training in dementia and challenging behavior. Nearly half the staff have attended training on activity based care. As the staff team settles, management may need to look at staff putting training into practice in order to address some of the practice based shortfalls noted earlier in this report. Care team managers were also seen to have completed advanced medication training. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are starting to benefit from a home that is gradually being run in their best interests. Evidence: Since the last inspection a new manager started at the home and left and another manager started in March 2009. The new manager also has a new deputy manager and assistant deputy manager in post. The manager has previously run a large residnetial home and has been registered with the CQC. She has been in managerial posts for over 7 years. The manager has City and Guilds qualification and an NVQ level 4 in Management and plans to put in an application to be registered for this home. There is evidence from records that the manager has been meeting with care staff and discussing practice and procedures in the home and promoting good practice. Relatives spoken to during the inspection and via surveys, were positive about the new manager and the recent changes for the better in the home. Care Homes for Older People Page 26 of 32 Evidence: The providers completed a full audit of the home in February 2009 and gave us a copy of the audit. Records showed that the manager was pro-actively working through the action plan from this audit to ensure that all shortfalls were being addressed. The manager undertook a quality audit on the 12.5.09 and is spending a lot of the time out on the floor monitoring care practices and standards. The results of the audit were seen and showed that menus are to be changed to residents specification, that care plans were checked along with health and safety, activities and staff training. Minutes of residents and relatives meetings were available for review and showed that the manager was actively encouraging people to comment on the home and was giving information about forthcoming items and changes. It is also positive to see that the management of the home are holding multidisciplinary meetings that external health care professionals are attending, in order to address issues and improve care standard sin the home. Residents spoken to said that since the new manager was in post, standards in the home have improved they also said We would like more residents meetings so we can express our opinions and the manager does come around and sees us, but group opinions should be sort. Staff spoken to confirmed that they were receiving supervision on a regular basis. Ten records were sampled at random and showed that overall staff were receiving regular supervision now and that it was comprehensive. The supervision matrix confirmed that staff supervision had improved since the last inspection. Accidents records were reviewed and were completed well and noted whether changes to any risk assessments had been completed. There was also evidence of contact with relatives if a residents had suffered an accident and residents choice as to whether they wanted hospital intervention or not. Where appropriate, we had be notified under Regulation 37 of the Care Standards Act 2000 and the manager was seen to be signing off all accident forms. Discussion with the district nursing team confirmed that the incidence of residents with skin tears had reduced significantly but they were still occurring and required careful monitoring. Accident records showed that the skin tears were caused by a variety of reasons including, self inflicted, staff handling, unknown cause and falls. The manager is keeping a log of all skins tears in and effort to reduce the number and address any issues, where possible, through risk management. Relatives who commented in our surveys highlighted the incidence of skin tears that their relatives sustained as a cause for concern. There is evidence of a proactive approach by the manager to this issue from minutes of staff meetings where the issue has been discussed. Staff have also been offered further training in moving and handling. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 12 16 Following further 31/01/2009 consultation, develop the activities programme to meet the diverse needs of a range of residents living in the home. To ensure that residents social care needs are met as far as possible. 2 12 12 Routines of the day must 31/01/2009 take into account residents needs and, as far as possible their preferences. So that the routines of the day is residents rather than task led. 3 26 16 Keep the home free from offensive odours So that the home is a pleasant place to live in. 31/01/2009 Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Continue to develop the care 15/07/2009 plans to involve the residents and ensure that their is sufficient individual detail in all of them, for staff to follow So there is a more person centered and individual approach to care so residents get the care they want in a way that they would wish. 2 8 12 Ensure that where risk are identified the management of the risk is considered and recorded. To ensure that correct management of risks for residents 15/07/2009 3 9 13 Records made when 01/07/2009 medication is given to people must be accurate and complete. Care Homes for Older People Page 29 of 32 This will demonstrate people are given their medication as prescribed. 4 16 22 Care staff must ensure that 15/07/2009 the management team are made aware of any complaints raised with them. So that residents can be assured that the matter would be dealt with in line with procedure. 5 18 13 By means of staff training 15/07/2009 and monitoring practice prevent residents from suffering abuse or being at risk of suffering abuse in the home. So that residents are protected, as far as possible in the home. 6 26 16 Provide residents with a satisfactory laundry system. So that they had the clothes they need and their dignity is maintained. 15/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 7 Encourage staff to use the valuable information gained at the time of the assessment in the care planning process. Continue to develop a person centered approach to the delivery of care especially in relation to continence, fluid intake and the care of people with dementia. Management to have systems in place to ensure that the weight monitoring of residents is correct. Page 30 of 32 3 8 Care Homes for Older People 4 9 The temperature records of the fridges used to store medicines should be recorded as the current, maximim and minimum temperatures reached. Continue to develop and train staff to listen to residnets and undertsand the needs and behaviors of people with dementia. Care staff should consider residents dignity and individuality when providing care Ensure that, as far as possible, residents have their family trees/social histories completed and that staff are aware of the content. Continue to consult regularly with residents on the meal service at the home. Provide more visual stimulation around the home, for example clocks, calenders etc. Continue regular group consultation with residents as the home develops. Continue to monitor and reduce the incidence of skin tears in the home as much as possible. 5 10 6 7 10 12 8 9 10 11 15 19 33 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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