Inspection on 24/11/08 for Loganberry Lodge

This inspection was carried out on 24th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Loganberry Lodge 14/05/09

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 06/02/2009.

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:   zero star poor 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: 2 5 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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 © (2008) 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: Loganberry Lodge 79-81 New Farm Road Stanway Colchester Essex CO3 0PG 01206563791 Telephone number: Fax number: Email address: Provider web address: manager.loganberry@runwoodhomes.co.uk Name of registered provider(s): Name of registered manager (if applicable) Ethna Harbrow Type of registration: Number of places registered: Runwood Homes Plc care home 108 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 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 Care Homes for Older People Page 4 of 36 Over 65 0 108 108 0 Brief description of the care home 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 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 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: zero star poor 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 14 hour period, over two days, as part of the routine key inspection. Both the Acting Manager and the Quality manager were available during the inspection and it was possible to meet other members of Runwoods Senior Management Team on the second day. The previous manager had submitted an Annual Quality Assurance Assessment as required prior the site visit. This detailed their own assessment of what they do well, what could be done better and what needs improving. This information is considered as part of the inspection process and is usually reflected in the report. The AQAA has been referred to in this report but it is felt that on the whole, this reflects the previous managers assessment of the home and does not reflect the current situation. Care Homes for Older People Page 6 of 36 Therefore its use has been limited. 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, relatives and staff. One response was received from people who use the service, seven from relatives/carers and one from a member of staff. 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 reviewed. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Older People Page 8 of 36 240 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst residents can be assured of an appropriate assessment they may not have all the information they need on admission, which could affect outcomes for them. Evidence: The proprietors have a both a Statement of Purpose and Service Users Guide in place. These were reviewed and whilst the content was as required by regulation, the format was not user friendly for the two primary residents groups that would be living in the home and a review is required. The management of the home have a pre-admission assessment system in place. A member of the management team goes out and assesses residents prior to admission and an assessment form is completed. Two recent assessments were reviewed and were found to have been completed fully giving sufficient detail on the needs of the prospective residents to enable a decision to be made as to whether those needs could be met in Loganberry Lodge. The assessments contained some detailed person centered information and included needs around Care Homes for Older People Page 11 of 36 Evidence: mental wellbeing and pain management. Residents preferences regarding the provision of their care were also noted. The AQAA states that all residents have a full needs assessment before commencing their stay and that they are invited to visit, and the evidence would concur with this. It was noted that valuable information, gained at the time of assessment, for example, on an individuals wellbeing, had not been transfered into the subsequent care plan. New residents spoken to said that they came to see the home and they were showed around and that I was assessed when I came to visit and I was able to choose my room. Some new residents said that they had not seen the Service Users Guide and went onto confirm that they did not know, for example, about who to raise concerns with. With regard to to the actual admission, residents said that I was made to feel most welcome and its takes time to get use to the home as its a very different atmosphere. Another said there was a service users guide in my room - we settled ourselves in, the staff were busy. Relatives who commented said that initial information was good, information after my relative moved in deteriorated and is now poor, when my relative moved in the staff could not have been more helpful and most things we need to know we have to inquire about. A standard brochure is available outlining the registration of the home and the key services offered. Care Homes for Older People Page 12 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can not be assured that they will receive the care and support that they require. Evidence: The management of the home has a full care planning system in place. Three care plans were fully reviewed and four further plans were used to review specific information. Each resident has a full needs assessment in place with associated care plans, where a need has been identified. These are backed up with a range of risk assessments as appropriate. Needs assessments were seen to be up to date. The care plans were variable in quality with some giving sufficient detail to guide staff and others requiring more practical guidance. Some care plans also needed to be focused on what the actual need was, for example, not eating rather than diabetes. There were some good aspects of person centered care planning seen, but this does need to be developed further in order to reflect the individual, their abilities and their preferences and goals. There were some good behavioral care plans in place giving staff guidance on how to deal with some aspects of residents behavior. Occasionally some key Care Homes for Older People Page 13 of 36 Evidence: information, identified in the pre-admission assessment or subsequent needs assessment, had not been transfered to the care plan, which could potentially result in omissions by care staff. It was also noted that residents with recently diagnosed medical disorders did not have care plans in place and care plans in relation to pain management and communication also need to be put in place for several residents. Managment care planning audits for November 2008, identified that there were residents with identified care needs that did not have, in some cases, the required care plans in place. Residents were seen to have up to date risk assessments in place for manual handling, falls, the use of bed rails, management of medical conditions etc. Again these were variable with some giving a good account of the management of the risk and others requiring more practical details to guide care staff. Nutritional risk assessments are completed and these were seen to be up to date but records showed that staff had not followed their own plan, i.e refer on if resident looses weight again, as residents had continued to loose weight and steps had not been taken to address this. Staff had also recorded to weigh some residents weekly and subsequent records showed that this had not taken place. Overall the majority of residents were being weighed monthly. Falls risk assessments are completed and it was noted that staff had reviewed these and identified increasing risk of falls, with some residents being high risk, but had not then evidenced what, if any action had been taken to address the issue. Accident records showed that there was a pattern of residents being found on the floor, particularly at night and this needs to be reviewed so that where possible, risks can be reduced. Records showed that residents were being referred to their GP quite promptly for issues such as chest and general infections. District Nursing teams visiting the home raised concerns regarding the care management and delivery in the home. They were concerned that residents were not being washed properly, that staff did not know how to deal with residents, especially those with dementia and that residents had unexplained bruises and/or skin tears and accidents records were not always completed. Whilst the care planning system, although with some shortfalls, is in place there are many concerns regarding the actual delivery of care in the home. This is compounded by the current high use of agency staff which is adversely affecting the standard of care provided in the home. Residents and relatives made the following comments regarding the care provided: Residents said I am bothered about how long it takes for the buzzer to be answered when I need help to go to the toilet, I prefer a female carer, but its mixed, I dont get a choice, I would like to put my own laundry away, so I know where it is, I dont get the choice, I have not seen my care plan, I could take my own medication, they did not ask me if I wanted to do it, I feel as if I have to fight for everything here, caring is sparse they need more help, they have not got Care Homes for Older People Page 14 of 36 Evidence: the care staff to help me on the hoist, nighttime is very bad, I have had to wait to go to bed and then I had to have a male carer which I did not want, but I accepted just so I could get to bed, my care plan is in my room, I read it with my relatives and we feel that it is not being carried out, like the way we were promised and I called the night staff using the buzzer and they did not come for a long time, they said they did not hear it - they cover two units. It was observed that calls bells did take time to be answered and one was timed at over 5 minutes. Relatives who commented said that My mother was bathed by a male carer and she was not given a choice, I wanted to talk to some-one about my relatives health but I could not find anyone, my relative always looks well groomed and they contacted us promptly when there was accident recently, the level of care and support that was indicated would be the norm has not materialised, e.g social interaction, bathing etc., agency staff do not always understand the needs of the residents, some of the staff rush through their duties with apparently little regard for the needs of my relative, I am more than satisfied with the care they give my relative, the quality of care can be inconsistent mainly due to the fact there are far too many agency staff, my relative fell and we were informed within 30 minutes, my relative saw the doctor promptly when he was chesty, I dont feel that I am kept informed of my relatives condition unless I keep asking, It once took me ten days to get the staff to bathe my relative, I was given excuses, due to staff shortages my relative often has to wait for help and this can be embarrassing, Both residents and staff spoke positively regarding the skills of and care provided by the permanent members of staff at the home. They felt that this was marred by the excessive agency use and the levels of stress felt by these staff in trying to work in the home. Staffing is discussed in more detail under Section 6 of this report. Some residents who needed support with shaving were noted to have not been shaved for at least two days. Management reported to the inspector that this was the case as the residents needed a specific carer to do this job, who had not been available. Medication procedures at the home were observed and medication systems reviewed. It was noted on both days of the inspection that the 08:00 hrs medication round was still taking place late into the morning, for example 10:45 a.m. Management were aware of this issue. This needs to be addressed to ensure that residents are having sufficient time between each medication. Staff and residents both reported that this round often started late. It was also observed that senior care staff were helping to dish out meals, leaving the medicines trolley unlocked, with the medication round not Care Homes for Older People Page 15 of 36 Evidence: started. Residents who commented on this said that my tablets are often late and they overrun and the medication is late, along with breakfast and because of my medication, I am not going out until later now. One relative commented that medication times are erratic and so pain relief is often too close together and my relative refuses medication if this is the case. Records show that medication is properly checked in and administered, apart from the delays. There are some issues around medication supplies and this relates to delayed prescriptions as these cannot be done until new patients have had their standard check from their new GP. Staff report that they are trying to get these done as soon as possible. Staff need to ensure that they bring urgent matters to the attention of managers where need be. Medication records charts showed a large amount of residents are refusing their medication, especially on the units where people have dementia. After one refusal staff then destroy the medication. Staff need to adopt a more person centered approach with regard to residents with dementia taking medication. Medication does also not need to be destroyed if a resident is not taking them because they are in hospital. On discussion with residents it was evident that there are people in the home who would be able to maintain some independence by self medicating. On discussion with the residents they said I could take my own medication, they did not ask me if I wanted to do it. I am only here a short while and I was told I had to move to another GP surgery and I signed the form before it was too late. It caused some problems but my relative has sorted it out for me now and I am quite capable of taking my own medication but I have never been asked. No residents in the home are self medicating. Care Homes for Older People Page 16 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be assured that their needs will be met in relation to their daily lives and sometimes social activities. Evidence: From observation and discussion with residents and staff, it is clear that at the current time the routines of the day are not resident led. A high number of agency staff are working at the home and they regularly outnumber the permanent staff on shift. Discussion with agency staff demonstrates that they are task led and know little detail about residents individual needs and them as a person. Permanent staff are more resident led but the current pressures, relating to staffing the home, are detrimental to what they are trying to achieve. Permanent staff commented that the quality of staff on duty affects the quality of individual care given to the residents. Residents spoken to commented that the actual home staff are quite good but agency staff waste time talking to each other rather than helping out, you can go to bed when you want but my friend was once told by an agency worker to go to bed at 9p.m , my friend was told to leave my room one evening when we were talking, staff came into my room in the night, I was asleep, to remove my wheelchair for cleaning and woke me up and then they woke me again when they brought it back, sometimes they have not got Care Homes for Older People Page 17 of 36 Evidence: the staff to help me and I have to wait and I have had a lot of problems with my diabetes in here as I am having to wait for breakfast and other meals. Visitors confirmed that they are made welcome in the home and felt that the current management team were approachable. Two activities co-ordinators are employed at the home, for 60 hours and the manager plans to employ a third to make up vacant hours. Discussion with one of the coordinators showed that there is also cover at the weekends, which is good. From discussion and records it is evident that a satisfactory activities programme is beginning to develop in the home. The co-ordinator works with residents on a one to one basis and in small and large groups. This member of staff was very resident led and showed an understanding of supporting residents with dementia despite having no training in this area or in the provision of activities. The AQAA sates that one member of the activities team has undergone training in providing activities for people with dementia. Activities recorded included cake decorating, arts and crafts, reminiscence, topical news and reading newspapers, bingo, painting, exercise games with balls, board games, jigsaws, recognition games, music and outside entertainers. The co-ordinator has developed profiles for residents that identified their social, family and work history and what their social preferences would be. More work is still required with the activities programme in order to develop it further, for example, social care plans need to be in place that identify goals, promote social inclusion, independence, and self worth. More work also needs to be done on developing one to one time with residents who are reluctant to take part in group activities or with those who are more independent and/or have a sensory impairment. More consultation with these residents would be of benefit. A`weekly programme is printed and displayed around the home but consideration could be given to making this even more accessible. A snoozlem room is available in the home that provides sensory stimulation for residents with advanced dementia. Several residents with dementia were observed to be activity taking part in small group activities. Residents who commented on the activities said that there is nothing that currently appeals to me, I enjoy playing dominoes and cards with the activities co-ordinator and other residents, they just play about with balls and balloons, after tea in the evening its so quiet here you are better off in your room, we rely on x but she is upstairs a lot, she is good when she comes around but its not enough and there are sometimes activities to take part in. Care Homes for Older People Page 18 of 36 Evidence: Relatives who commented said that a lack of permanent staff means that there is not enough time for social interaction between staff and residents, they could improve by providing activities for non-dementia residents and those with sensory impairments, it would be nice for residents who cannot attend church to have a service in the home, more staff to encourage a wide variety of structured activities and no religious services of any faiths have been offered. The meals service in the home was observed, breakfasts in two units and lunchtime, in all four units. Records were reviewed and residents were spoken to regarding their experiences. The arrangements for residents to have a positive mealtime experience needs a significant amount of work in this home. Observations included: residents being fed by staff who were standing over them and rushing them, no condiments available in some dining rooms, although these were available in the unit kitchen, one member of staff was heard to interact well with a residents explaining the meal and checking that the resident was happy and some food was noted to be on the hot trolley whilst other hot dishes were not and these dishes felt cold. On the units where residents with dementia eat, it was noted that place mats are not used, there were no condiments and no drinks - despite clean glasses being easily available for staff to use on a nearby trolley. Residents were heard asking for drinks after their meal had finished. Condiments on one of the downstairs units were not clean. Staff were observed to be walking around the units with cutlery during the mealtime period to deal with shortfalls. Residents with dementia were observed to be asleep during the whole mealtime period and insufficient staff were available to support and prompt residents with eating. Drinks were not freely available between the drinks rounds and mealtimes in the lounge areas. One relative commented that my relative has a sensory impairment and I found that x was left with a meal in their room with no help. The menus seen are satisfactory and residents are choosing where possible and requesting alternatives but comments from residents indicate that they may not be getting their chosen preference. It is a concern that residents are not getting access to enough fluids as these are not routinely being offered by staff and are not freely available between the drinks round that do take place. Mealtimes, especially breakfast are often delayed and this could mean that some residents do not have a drink for approximately 16 hrs. The management team were aware that the evening drink had not been given at time and were under the impression that this matter had been sorted out when it had not. Residents who commented on the food and the meal service said that you dont get a cup of tea until you come down for breakfast, it could be 8.30 or later, it depends how many staff there are , the food is quite good, there is enough and its hot, staff dont Care Homes for Older People Page 19 of 36 Evidence: always put condiments out, the food is often cold, there is only one person to serve, the chef is quite good, we should have hot breakfasts 3 times a week, it started with eggs, bacon beans and its been cut down, no bacon and spaghetti instead of beans, Often the menu is different to what you get, care staff note down what our alternative choices are to the menu but when the food arrives our preferences have been ignored, they are short of place mats, knives and forks - staff have to go and find these and this wastes time, the food has deteriorated since we first came, After tea, which is about 5, there are often no hot drinks, its very hit and miss as to whether we get a drink or not, the food is alright, but not enough of it and the quality is inconsistent, the food is often cold, the food is good but its cold, there are delays in serving it and the food is adequate, the quality is variable - there is not much choice for deserts - especially if you are diabetic, as the food takes time to dish up, it is often cold and we use to get hot drinks in the evening but this has stopped, so you could have a drink at 5 p.m and then nothing until the morning and you have to wait for breakfast. The AQAA states that a varied diet is maintained and we cater for all the needs of our residents. The evidence obtained would not concur with this at the current time. Care Homes for Older People Page 20 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot not be assured that their concerns will be addressed or that they would be fully protected by current systems and staff training in the home. Evidence: The management team have a complaints procedure in place. Consideration should be given to making the format more user friendly. The procedure can be found in the service users guide and it is also displayed in the reception area of the home. It could be displayed in a more accessible place for residents. Some residents spoken to were clear how to make a complaint whilst others said that they did not know. Complaints received and logged by the management team were reviewed. On discussion with residents who had raised concerns with the home, it was evident that not all complaints, primarily from residents, were being logged and appropriately responded to. It was also evident from care staff communication records that residents had made complaints and these had not been passed to the management to deal with. Residents who commented on the handling of complaints said that I have seen and spoken to the directors and other people and they have not acted and I have told the managers of my concerns and nothing has happened. On the days of the inspection several residents were very keen to speak to the inspector to raise concerns with her regarding the standard of care and services in the home. Relatives who commented said that I have already had to make an official complaint regarding the care of my Care Homes for Older People Page 21 of 36 Evidence: relative and I was assured that the issue would not reoccur and it has happened again on three occasions, we have already voiced our concerns to one of the managers and also our social worker, so we are hoping to see improvements, mainly about the staffing, Some of my concerns have been raised verbally more than once and we have written a letter of complaint under the complaints procedure. All of the relatives spoken to and who commented, knew how to make a complaint. They knew where to find the procedure and had seen the management of the home at various opportunities, such as recent managers surgeries. Opportunities for formal consultation with residents were not evident and this could explain the reason the high levels of concerns raised with the inspecting officer. The manager stated that she plans to have a residents meeting, with the date to be set. The AQAA said that 3 complaints had been received and dealt with and all were substantiated. Records showed that by the time of the inspection that 11 complaints had been formally logged in total. It was evident that some of these had not been previously dealt with and responded to. The AQAA states that any complaint is logged and addressed within the time scale. Nearly all of the complaints were from relatives and related to standards of care, missing laundry, missing hospital appointments due to missing paperwork in the home, standards of personal grooming, standards of laundering, relatives being unnecessarily disturbed during the night, insufficient support at mealtimes, insufficient staff and poor mealtime arrangements. Records show that recently complaints have been appropriately responded to by the current management team and where appropriate, for example, with missing/ruined laundry, items have been replaced. Around the time of the inspection 3 further comprehensive complaints have been sent to the home from relatives and responses are awaited. Records also show that the District Nursing team also lodged a complaint regarding medication with the management team and a meeting was subsequently held to improve working practices. The management team have adult safeguarding policies and procedures in place, including local guidance. Permanent staff spoken to demonstrated an understanding of adult safeguarding matters but training records show that a significant amount of the care and ancillary staff team have not had training on this subject. Care Homes for Older People Page 22 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. Residents can expect to live in a safe, comfortable, clean and generally odour free environment. Evidence: A partial tour of the home was undertaken with one of the management team. The home is well appointed and resources are good. The home is split into 4 units with general residential beds primarily downstairs and specialist dementia beds upstairs. Each unit has two lounge areas and a dining room. One unit downstairs also has access to a conservatory. All bedrooms are large with en-suite toilets. Some of the downstairs bedrooms have french doors leading onto a patio area and bedrooms were seen to have been personalised by residents and/or their families. The bathrooms are large and well equipped and separate mechanical sluices are also available. The home has adequate storage space and there is a staff office to cover two units on each floor. There are areas of garden around the home with hard standing access for wheelchairs. Signage around the home to help residents find communal rooms and toilets etc is generally good but more individual work on signage needs to be done to help residents find their own room, should they need support. Overall the home was seen to be very clean but one of the upstairs units did have an unacceptable odour which remained throughout the day. Care Homes for Older People Page 23 of 36 Evidence: The management team have a full fire safety risk assessment in place which was up to date and records also showed that regular testing of the fire alarm and emergency lighting is undertaken. Records show that regular staff fire drills are also undertaken. Residents who commented on the home said that the home is always fresh and clean, toilet rolls are not replaced enough in the en suites and the other toilets and the bedrooms are lovely and large. Relatives who commented said that the actual home is beautiful, the rooms are lovely with very nice furnishings and it is kept nice and clean, the housekeeping side of the home is very efficient, the visitors room is used for meetings with staff and therefore can not be used by families and this was a selling point for the home, there is a odour in some parts of the home, and there is a clean, bright, spacious and safe environment. Care Homes for Older People Page 24 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of permanent, well trained, staff working in the home means that outcomes for residents are poor. Evidence: Staffing levels and deployment in the home were reviewed. At the current time the management team are using a significant amount of agency staff to cover the rotas at the home and this causes concern with the residents. The acting manager reported that they due to have 11 new permanent care staff start in the near future that are currently awaiting document checks and are having their training induction. Since the home opened 12 staff have left including the manager. Records show that the standard of permanent staff employed at the home is generally good with experienced staff being taken on, often with NVQ qualifications. Staff rotas from November 2008 showed that the number of staff covering Rose and Heather units on the ground floor, for 41 residents, were from 7 - 8 care staff during the day,including the care team manager. For Snowdrop and Lavender unit, primarily for people with dementia, the rota shows that 10 - 11 care staff including the care team manager were on duty for 38 residents. On the first day of the inspection only 16 staff were on duty for 76 residents. At night, the rotas show that 3 - 5 staff have been covering Lavender and Snowdrop units and, on average 5 -6 staff are covering Heather and Rose units. Care Homes for Older People Page 25 of 36 Evidence: Records show that the majority of staff are agency care workers, with sometimes only two of the homes own staff on duty. Efforts are being made to use consistent agency staff but this is not always possible. Residents who commented on the staff team at the home said some agency staff are quite good but they need more direction, the staff are hard workers, they have to be, some agency workers are very bossy, staff are friendly enough but overworked, this home got the residents in first and then the staff - the wrong way around, it always feels understaffed, it was OK when I came in and then the staff dropped away,the regular staff do work very very hard and X, a care team manager is marvellous and the care staff try to do a good job, caring is sparse, they need more help, Staff, including agency staff, who commented said that there are a lot of residents on the ground floor who require two care staff to help them and this causes problems, whilst the numbers of staff may be high, staff are often shadowing and cannot work fully and numbers dont always mean its fine and more people need to actually know the residents, there are never enough staff to meets the needs of the residents, organisation is an issue we spend a lot of time getting things we need and its a large home, it all takes time, I do like the home and the staff, a while back you could have a chat with a resident, not now, team managers are meant to help out on the floor but the reality of this is that it is difficult as there are other pressures on thier time and on the ground floor there are a lot of people that need two care staff and we are often called on to help upstairs. Relatives who commented said that due to such a large staff shortage, a large number of agency care satff have been used, which does not bring the continuity with carers, due to the staff shortage, the units upstairs seem to draw downstairs staff aware from these units and at times 1 member of staff has been left to deal with all calls from residents, more staff are needed on shifts, staff do seem to do their best, the home will be better when they are fully staffed, the permanant staff are very good and have high standards but some have already become disollusioned and have left, including the manager, the Runwood staff are great nothing is too much trouble for them and a more consistant staffing rota is needed so that residents relate better to staff and vice versa. Whilst it is acknowledged that the high use of agency staff affects the day to day running of the home, the managment need to keep staffing levels under regular review to help ensure that residents needs are met, based upon residents dependancy, the experience and quality of staff and the large footprint of the home. A review of shift organisation may also be of value. Care Homes for Older People Page 26 of 36 Evidence: It must also be noted that many of the care team managers are relatively new in post and because of changes in management, may have not had the support and guidance that they need to manage shifts and care staff, especially with the current staffing situation. More input needs to be given to these key staff, especially before the new staff begin work and this was discussed with the management team. At the current time 42 care staff are employed and out of these 12 have NVQ level 2 or above. The management team plan to encourage staff with NVQ training on an ongoing basis. Four staff files were checked in relation to recruitment and these were found to be in good order with all the required checks and documentation in place. All the required agency staff profiles, for those on duty on the first day of the inspection were checked and found to be in order and up to date. Training records show that there are good levels of compliance with manual handling and fire awareness training but shortfalls in relation to adult protection, first aid, health and safety, food hygiene and infection control. Whilst some staff have received training in dementia and challenging behavior there are still shortfalls that need to be addressed. Consideration should also be given to providing training in the future on care planning and diseases associated with old age. Staff who commented said that training is good, I have asked for more training on dementia. Staff induction was reviewed and discussed with staff and management. Staff reported that they had completed their induction. They also reported that they had completed their Skills for Care induction some time previously and had not received any feedback and other staff reported that they had been made to complete it over a very short timescale and this was of limited value. The management team appreciated that they needed to revisit some of these to ensure that they received an appropriate induction. Care Homes for Older People Page 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst he management team are making efforts to run the home in the best interests of residents, this has yet to be achieved. Evidence: The registered manager has recently left the employ of Runwood Homes. Two Senior managers from the company are covering the post and are spending a significant amount of time at the home. A new experienced manager has been employed and they hope that she will start work in early December 2008. The current management team have been holding meetings with staff and relatives but more consultation and feedback needs to be undertaken with and given to residents. Residents reported that directors of the company came to speak with them and they raised concerns and have heard nothing back. The current manager acknowledges the need for more consultation during this time. The acting manager has also appointed a qualified nurse to work in the home to provide a clinical/care input and at the current time he is focusing his work on the units for people with dementia. Care Homes for Older People Page 28 of 36 Evidence: Residents who commented said that the home is not running properly, the manager just disappeared and we dont know what happened but there is a nice lady running the home at the moment. The providers have a range of internal quality audits in place and this includes an annual general audits covering all aspects of the home. This has yet to be undertaken due to the relatively short time the home has been open. There was evidence that care plan auditing has been undertaken and at the current time the quality team fro the company have an active presence in the home. Annual satisfaction surveys are used for residents and relatives and a staff survey is also planned, carried out by an external company. The team at the home manage some monies for residents but these are only small amounts and the appropriate accounting and audit systems are in place. The AQAA states that any monies spent on behalf of the resident is logged and receipts maintained. The current management team have re planned the staff supervision programme and this is just underway and records evidence this. No physical health and safety issues were noted on spending time in the home. However it is recommended that a more formal, regular review of accidents and possible accident patterns are undertaken. Care Homes for Older People Page 29 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 30 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 1 7 12 Residents needs in relation to their personal care and wellbeing must be met and this should be done in a person centered way after consultation with them and in line with their care plan. To ensure that residents receive the care that they need with their wishes taken into account. 14/02/2009 2 8 12 Residents health care needs 31/01/2009 must be fully attended to in line with their care plans and risk assessments. To ensure residents health and wellbeing. 3 9 13 Residents medication must be given at the correct times. To ensure that medications are safe and administered correctly. 14/01/2009 Care Homes for Older People Page 31 of 36 4 10 12 Care must be provided to residents in a person centred way that promotes thier dignity. So that residents wishes are respected in relation to care delivery. 14/01/2009 5 12 16 Following further 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. 31/01/2009 6 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. 7 15 16 Provide residents with food and drink of a good quality at suitable times in a pleasant environemnt with adequate support. To ensure that residents have enough to eat and drink to maintain thier health and that mealtimes are a pleasant experience. 14/01/2009 8 16 22 All complaints must be dealt with in line with the proprietors procedures. 14/01/2009 Care Homes for Older People Page 32 of 36 So that residents and relatives can be confident that their concerns would be dealt with appropriately. 9 18 18 All staff must be trained in adult protection/safeguarding. To ensure that, as far as possible residents are protected by staff awareness and knowledge on this matter. 10 26 16 Keep the home free from offensive odours So that the home is a pleasant place to live in. 11 27 18 A competent care staff team of permanent employees, in sufficient numbers, needs to be working in the home. To ensure that residents receive a consistent approach to their care in the way that they wish, that their needs are met and that staff know them, in order to improve care standards and ultimately outcomes for residents. 12 30 18 Staff working in the home must receive the training they need to undertake the responsibilities that they have. So that residents are cared for by competent, well supported staff who know how to meet their needs. 14/02/2009 31/01/2009 31/01/2009 31/01/2009 Care Homes for Older People Page 33 of 36 13 33 24 More regular consultation is needed with residents, as part of the homes quality assurance systems. So that residents are aware of what is happening in the home and so that they have the opportunity to give thier views so that the home is run in thier best interests. 14/01/2009 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 1 Improve the actual admission experience for residents so they are helped to settle in and that they have all the information they require in the early part of their stay. Developing a short feedback questionnaire may aid this along with a review of the Service User Guide format. Continue to develop a more person centered approach to care planning that identifies individual preferences, goals etc and that promotes independence, choice and wellbeing. Residents independence should be promoted through the promotion of self medicating where it has been assessed as appropriate. More regular consultation is needed with residents regarding both food and activities. Complaints procedure should be in a user friendly format and be made more accessible to residents. Improve individual signage for residents to help them maintain their independence. The management team need to continue to encourage NVQ training with staff in order to achieve the desired 50 trained standard. Staff inductions should be reviewed to ensure that staff received an appropriate induction to their current role. Continue to develop the staff supervision programme and maintain records. Undertake regular reviews of accident records to check for 2 7 3 9 4 5 6 7 15 16 19 28 8 9 10 30 36 38 Care Homes for Older People Page 34 of 36 patterns and residents at particular risk. 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