Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Longbridge Deverill House Church Street Longbridge Deverill Warminster Wiltshire BA12 7DJ The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Roy Gregory
Date: 0 2 1 0 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 31 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home
Name of care home: Address: Longbridge Deverill House Church Street Longbridge Deverill Warminster Wiltshire BA12 7DJ 01985214040 Telephone number: Fax number: Email address: Provider web address: penny.carroll@equality-care.co.uk Name of registered provider(s): Name of registered manager (if applicable) Jean Proctor Type of registration: Number of places registered: Equality Care Ltd care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category physical disability Additional conditions: No more than 2 service users aged 65 years and over with a learning disability may be accommodated at any one time No more than 3 service users aged 65 years and over with dementia may be accommodated at any one time Not more than 1 service user aged 65 years and over with a physical disability may be accommodated at any one time The maximum number of service users who may be accommodated in the home at any one time is 27 Date of last inspection Care Homes for Older People
Page 4 of 31 Over 65 3 2 27 1 0 0 0 0 Brief description of the care home Longbridge Deverill House is a private residential home offering accommodation and personal care to up to 27 people over the age of 65 who require care primarily through old age. The home is also registered to accommodate some people with additional needs related to dementia and learning disabilities. The home is an attractive listed building, which has been extended over the years. It is situated on the A350 south of Warminster, in the village of Longbridge Deverill, where there are limited local amenities. There is a railway station in Warminster and the A303 trunk road is about a ten minute drive to the south of the village. There is a bus stop immediately outside the entrance, and car parking is available at the home. Accommodation is in single rooms, located on two floors, which are connected by passenger lifts. All bedrooms bar one have en-suite facilities. Some rooms are notably large, and in respect of two rooms, arrangements could be made to facilitate sharing by two people who wished to do so. People have a choice of sitting rooms and other sitting spaces in the home. The main sitting room, and the dining room, look out over a traditional country house garden, to which residents have full access. Peoples pets can generally be accommodated. The baseline weekly fee is currently £490, with some larger rooms charged at a higher rate. The home is provided by Equality Care Limited. Care Homes for Older People Page 5 of 31 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited Longbridge Deverill House unannounced on Wednesday 1st October 2008 between 9:30 a.m. and 5:45 p.m. and returned the following day from 9:00 a.m. to 4:50 p.m. During the inspection there was direct contact with a number of residents, in the communal rooms and individual rooms, and by joining five residents for lunch in the dining room. This allowed for observation of the service of meals and administration of medications. We also had the opportunity to meet with the visiting relatives of four people; a visiting community nurse; and a massage therapist. Jean Proctor, the registered manager, was available during most of the inspection time. We spoke with various staff on duty: the head of care, carers, a housekeeper, the cook, laundress, handyman, training co-ordinator and administrator. Care Homes for Older People
Page 6 of 31 Records examined during the inspection included care plans and records of care, medication records, evidence of activities provided, incident records, how complaints had been handled, and records of staff training and supervision. It was also possible to look at results of the homes internal survey of residents and relatives opinions. Prior to the inspection visit, Jean Proctor had returned the homes Annual Quality Assurance Assessment, which gave some descriptive and numerical information. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visits to the home. They take into account the views and experiences of people who live there. What the care home does well: Assessments of people considering admission were very full. People and their relatives felt they had contributed to assessments. They were able to visit the home as much as they wished in order to help make decisions about taking up a place. Care plans included personal profiles, which gave a good overview of peoples diverse backgrounds. A dependency assessment allowed reviews to evaluate whether there had been significant changes. A resident talked about their involvement in determining their care needs, and some visitors spoke of discussions with the home about care planning for their relatives. Notes kept by staff showed attentiveness to health indicators and it was apparent there were good working relationships with GP surgeries. A visiting community nurse said she saw high standards of care in the home; calls to the community nursing service were always appropriate and arrangements were always made for people to receive treatment in private. The home also provided chiropody. One of the care staff had been able to develop a lead role in activity provision. The home aimed to provide a distinct activity opportunity each morning and afternoon. There was a mix of activities, variously incorporating movement, thinking, socialising, reflection and community access. There was a computer room for residents, equipped with games and email facilities. In one of the sitting rooms there was a Wii console to play sports’games through the television. Another sitting room was more of a quiet room. The main sitting room and dining room had good views over the gardens. There was good access to the garden. A chicken coop had been set up in a corner that people could see easily from inside the home and from the garden. Some people enjoyed hands on experience with the chickens. Some people were assisted to carry out gardening tasks if they wished, especially those who had small courtyard areas outside their rooms. The main meal of the day was served at lunchtime. This was always a three-course meal based on traditional choices. The menu of the day was displayed in the hallway, and showed that a range of alternatives could be requested in advance. We established that staff ensured people were aware of this facility daily. The staff group also had a good knowledge of individual likes and dislikes. All but one person we spoke to said they were very satisfied with meals served. With regard to the other person, it was clear that staff were aware of their perceptions and worked constructively to provide a good service. A complaints record was maintained. This showed matters raised were taken seriously and resolutions were sought. The home and gardens were kept secure by requiring visitors to sign in to the home and ensuring people’s whereabouts were known, because there was a busy road at the end of the drive. Staff received abuse awareness training. In some respects the environment is not ideal for older people, in that there are steps and slopes in various locations. However, this is offset by the homely nature of the building. There are interesting features such as fireplaces, and there is space for Care Homes for Older People Page 8 of 31 various objects to be displayed without constituting clutter. Visitors and people living in the home saw it as a building that could be related to, as its layout was in tune with a domestic house. All the individual rooms we saw were very personalised and people were very satisfied with their rooms, which had en suite facilities. We saw one bedroom transformed in readiness for a person to move in. People used varying amounts of their own furniture and effects. Furniture and soft furnishings provided by the home were of good quality. Two visitors spoke of their relatives rooms having been redecorated prior to moving in. We found high standards of cleanliness throughout the home, with no unpleasant odours. The home provided four members of care staff on duty in the mornings with three on in the afternoons and evenings. There were two waking night staff on duty at night together with a member of staff sleeping in, who could be called upon. A person told us their most important reason for living at the home was that there were always staff available to come in response to the call bell. Other residents, and visitors, considered there were sufficient staff around at all times. Care staff we spoke to thought staffing numbers were generally sufficient. They were appreciative of the amount of training available, and they confirmed receipt of sixweekly supervision. We saw a number of sensitive and kindly interactions by staff towards residents. Many residents and visitors commented on the quality of staff. The home benefited from a full time training co-ordinator. The company had arrangements for seeking regular feedback from residents and their supporters about the quality of service provided. The results of surveying were discussed in managers meetings and used to form action plans for improvement. We saw examples of changes made as a result of this process, including introducing afternoon high tea, installing a new hairdressing salon and changing the types of activities offered. What has improved since the last inspection? What they could do better: Care plans bore no evidence of peoples agreement to their contents. People or their Care Homes for Older People Page 9 of 31 supporters should be invited to sign agreement, to emphasise care as a shared task, based on consent. There were some shortfalls in care monitoring. For example, a persons care plan said they were to be weighed monthly, but the frequency of weighing was much less, with no explanation. We also found that manual handling assessments were neither dated nor signed, so we did not know how up to date they were. Waterlow skin condition assessments were done and were regularly reviewed. Although these were working well, it was recommended that an alternative assessment tool be used, to bring the home into line with practice in health settings in Wiltshire. With the development of a specialist activities role, there is scope to record more detail of peoples responses to activities, and of how individual interests and needs are developed on the basis of the life history and interests information in care plans. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 31 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 11 of 31 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. People are admitted only after an assessment that demonstrates the home can meet their needs. People and their supporters are able to visit the home at any time to help make a decision about admission. Evidence: We spoke separately to the relatives of three people who had been fairly recently admitted. All were very pleased with the nature of the assessment and admission processes. One person admitted had visited the home for tea. The head of care said the person had initially been visited at their own home to be assessed, but the visit had not gone well. The assessor had felt it was unfair to base the assessment on this one experience, hence a decision to approach the task differently. The visitor said the home not only met the needs of their relative, who had put on weight and benefited from social contact, but also were sensitive to their own needs, in terms of adapting to change. They felt the home worked in partnership with them through this period.
Care Homes for Older People Page 12 of 31 Evidence: Another visitor also spoke of support received from the home over the issue of their relative going into a care environment. They described a thorough assessment, in which they had been invited to provide a large amount of information. Several family members had visited the home at different times, and had been in agreement that Longbridge Deverill House would be the most appropriate placement for their relative. The third visitor had visited the home during the assessment period. They regretted that their relative was not able to leave hospital during that time in order to make a visit. However, they felt they and their relative were fully involved in the assessment, so they were confident in making their choice of home. We saw that the assessment tool developed by the home ensured a wide range of information was obtained. It included assessments of how people presented both wellbeing and ill being. At admission, checklists were used to make sure people were given necessary information, and able to make important choices. For example, it was established how people wanted certain decisions to be made. Care Homes for Older People Page 13 of 31 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs were met through care planning. People were treated with respect and their right to privacy was upheld. Residents were protected by the homes procedures for the safe handling of medicines. Evidence: Care plans were put in place for people soon after admission and were kept up to date by regular reviews. They included personal profiles, which gave a good overview of peoples diverse backgrounds. A dependency assessment allowed reviews to evaluate whether there had been significant changes. For example, for one person there was evidence of improved orientation to time and place. Care plans gave guidance on peoples needs in respect of sight, hearing and oral health. They guided staff on preferred care routines. There were stated objectives for each aspect of care provided. There was a nutritional screening assessment for each person. We saw that when this assessment showed a high risk, action was taken, for example a person had been referred for GP attention and they were in receipt of prescribed dietary supplement
Care Homes for Older People Page 14 of 31 Evidence: drinks. For the same person, a heightened risk of pressure area injury had also been identified and a related risk assessment was in place. The person was able to talk about their involvement in determining their care needs, and some visitors spoke of discussions with the home about care planning for their relatives. However, care plans bore no evidence of peoples agreement to their contents. People or their supporters should be invited to sign agreement, to emphasise care as a shared task, based on consent. It was clear that people were very much involved in annual reviews, which included consideration of whether the home could continue to meet needs. There were some shortfalls in care monitoring. For example, a persons care plan said they were to be weighed monthly, but the frequency of weighing was much less, with no explanation. We also found that manual handling assessments were neither dated nor signed, so we did not know how up to date they were. Waterlow skin condition assessments were done and were regularly reviewed. Although these were working well, it was recommended that an alternative assessment tool be used, to bring the home into line with practice in health settings in Wiltshire. All health appointments and referrals were tracked in peoples care records. Notes kept by staff showed attentiveness to health indicators and it was apparent there were good working relationships with GP surgeries. A visiting community nurse said she saw high standards of care in the home; calls to the community nursing service were always appropriate and arrangements were always made for people to receive treatment in private. We also spoke to a massage therapist whose weekly visits to the home are provided within the homes fees. She provided massage as people wanted, to legs, arms, hands or neck/shoulders. She said only one person declined to receive physical contact, but they still had private chatting time with her. People expressed appreciation of this service. The home also provided chiropody. Some people preferred to maintain their pre-admission arrangements for chiropody. Storage of medicines was orderly and good records were kept of receipt, administration and disposal of medicines. It was a part of the care workers tasks to administer medicines, which was undertaken in twos. Responsibility for overseeing medicines practice in the home was delegated to the head of care, who had received appropriate external training. She undertook in-house training of staff, including assessing competency. The administration task was undertaken methodically and safely. One person liked to have medication left with them at one time, to take later. This practice had been risk-assessed. No homely medicines were used: GPs were always asked to prescribe for additional temporary needs, such as cold relief. During the inspection, it was confirmed that the storage arrangements for controlled drugs met current legislation. Most medicines in use were supplied in a monitored dose system. The supplying pharmacy were introducing a new form of packaging. The head
Care Homes for Older People Page 15 of 31 Evidence: of care used staff shift handovers to introduce this to staff and to allow them the opportunity to practice opening the new packs under supervision. All care interactions seen were sensitive and kindly. People living in the home, and visitors, said this was always so. People could use door locks if they wished, subject to risk assessment. All personal and health care was given in the privacy of peoples rooms or bathrooms. People chose where in the home or garden they wished to spend their time. Staff did not enter personal rooms without the agreement of occupants. Care Homes for Older People Page 16 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was active in identifying and meeting peoples social, religious and recreational needs. People kept in contact with family and friends and went out into the community with support. People experienced a homely way of life, including how meals were served. They were able to exercise choices. Evidence: One of the care staff had been able to develop a lead role in activity provision, and was due to work solely as an activities co-ordinator commencing the week following our visit. She was able to demonstrate a wide-ranging view of activity and occupation, pitched at the needs of individuals and groups. She was interested in making links with activity co-ordinators in other services. The home was aiming to provide a distinct activity opportunity each morning and afternoon. There was a mix of activities, variously incorporating movement, thinking, socialising, reflection and community access. There was a residents computer room, which was equipped with games and email facilities. In one of the sitting rooms there was a Wii console to play sports games through the television. Another sitting room was more of a quiet room. Some people had been involved in painting pebbles. This had included looking at books for ideas and encouraging people to make choices. A person was completing a jigsaw on a
Care Homes for Older People Page 17 of 31 Evidence: table where it could be left. People were able to use taxi tokens to go on trips out of the home. Some people chose regular attendance at a day resource in Warminster. The main sitting room and dining room had good views over the gardens. There was good access to the garden. A chicken coop had been set up in a corner that people could see easily from inside the home and from the garden. Some people enjoyed hands on experience with the chickens. Some people were assisted to carry out gardening tasks if they wished, especially those who had small courtyard areas outside their rooms. There were two cats in the home, with a third due to arrive with a person about to move in. People could visit the homes vegetable plot. One person spent most of their days with the handyman, to the extent they had been provided with a toolkit. They were helping with some painting when we visited. Their relative saw the home as imaginative in how they had engaged the person in familiar activities. An activities diary showed what activities had taken place and who had participated. With the development of a specialist activities role, there is scope to record more detail of peoples responses, and of how individual interests and needs are developed on the basis of the life history and interests information in care plans. There was already evidence staff were sensitive to such issues. For example, it had been noted that a person rarely read the daily newspaper that they bought. Staff suggested to them that instead, they could buy a monthly magazine about their interest in railways, and this was implemented. A persons care record showed that when they had wished to telephone a relative, this had been facilitated promptly. We saw that people could arrange to have a telephone fitted in their room to keep in touch with family and friends. When we visited, there was a pre-arranged afternoon tea for relatives and friends, which was very well attended. People told us they were able to visit at any time. They always received a good welcome and could have as much privacy as they required. All people we spoke to in the home said they were free to arrange their days as they chose. Some people spent a lot of time in their rooms, by choice. When we visited, two people had breakfast in the quiet room at 11:00 a.m, as each had wanted a lie-in. Another persons care plan noted, he likes to come down to breakfast in his dressing gown. Staff said most people preferred to come to breakfast in the dining room, but timing was flexible and delivery to bedrooms was also an option. The main meal of the day was served at lunchtime. This was always a three-course meal based on traditional choices. The menu of the day was displayed in the hallway, and showed that a range of alternatives could be requested in advance. We established that staff ensured people were aware of this facility daily. The staff group
Care Homes for Older People Page 18 of 31 Evidence: also had a good knowledge of individual likes and dislikes. Some people chose always to eat in their rooms and others did so sometimes. Trays to rooms were delivered before service started in the dining room. This meant people received hot meals, served to their individual taste, for example in terms of portion size. One person had an arrangement that they would ring their call bell when they were ready to receive their sweet, demonstrating choice and control. Another spoke of having breakfast in bed, lunch in company in the dining room, and tea in their bedroom. They described this routine as just like home. The dining room offered a pleasant atmosphere. Sherry was available to those that wanted it. Vegetables were provided in dishes for people to serve themselves. Service by care staff was attentive but non-intrusive. When people needed some assistance, this was given discretely and in an unhurried way. Second helpings were offered. Yoghurts, fruit and ice cream were readily available to anyone not liking the sweet on the menu. The cook said there was an emphasis on making fresh fruit and vegetables available as a matter of course. All soups and cakes were homemade. For their birthdays, residents chose the menu for the day, including what kind of birthday cake they would like. Sometimes people had the opportunity to decorate cakes as an activity, and some residents made use of the kitchen to get drinks or to wash up cups. The cook had daily direct contact with residents. She said there were few requests for alternatives to the menu; more frequently, changes would be offered because someone was unwell. There were no people currently on diabetic or vegetarian diets but one person was on a reducing diet. So they did not feel left out, they were offered fruit at afternoon tea time, when cakes were served to others. All but one person we spoke to said they were very satisfied with meals served. With regard to the other person, it was clear that staff were aware of their perceptions and worked constructively to provide a good service. Care Homes for Older People Page 19 of 31 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is provision for receipt of and response to complaints. Staff and management understand and exercise responsibilities in respect of keeping residents safe. Evidence: A notice in the entrance hall informed people that the provider welcomed complaints as a means of improving service, and gave guidance to using the complaints procedure. A person living in the home said that relationships between management, staff and residents were such that there would be no problem raising any issues. Another person said they were dissatisfied with provision of a new piece of furniture in their room, but they had voiced this and arrangements were in hand to revert to the original provision. A persons relative said they had no doubts about how to complain, formally or informally. They were confident that the openness they encountered in the home would mean any issue would be discussed and resolved. A complaints record was maintained. This showed matters raised were taken seriously and resolutions were sought. Most complaints were about food. Records showed people were reminded of how to request alternative meals, and also showed staff were reminded of the importance of offering choices automatically. The complaints form was a well-designed document but its usefulness was reduced because all sections were not always completed. Care Homes for Older People Page 20 of 31 Evidence: Incidents arising in the home were documented. They showed that consultations with external professionals and family members took place, to ensure people were informed and able to influence strategies for managing identified situations or risks. In one case, we saw that consideration of capacity had been followed through in steps, in accordance with Mental Capacity Act guidance. The management also made it clear that a working solution to a problem that had arisen was preferred to any consideration of seeking an alternative placement for the person concerned. Alongside the incident recording system, we saw an incident book that was used intermittently. This was confusing, as it was not clear what were the criteria for using this book. New staff employed received abuse awareness training as part of their induction programme. Staff also covered abuse training when completing the National Vocational Qualification. Staff were issued with the No Secrets brief guidance to local inter-agency safeguarding procedures. The home and gardens were kept secure by requiring visitors to sign in to the home and ensuring peoples whereabouts were known, because there was a busy road at the end of the drive. There was a procedure to follow in the event of a person going missing. The manager and head of care maintained on-call availability to staff. Department of Health guidelines concerning the use of bed rails were displayed in the care office, although currently none were in use in the home. Care Homes for Older People Page 21 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, well-maintained and homely environment. Communal and private areas are kept clean and hygienic to a high standard. Evidence: In some respects the environment is not ideal for older people, in that there are steps and slopes in various locations. However, this is offset by the homely nature of the building. There are interesting features such as fireplaces, and there is space for various objects to be displayed without constituting clutter. Items such as a sewing machine, books and baby cradles give attractive reference points for people, complemented by pictures on the walls of interest to the age group accommodated. Some rooms have French windows to courtyard areas. A persons visitor said the family had been given free reign over how to use such an area for the person’s enjoyment. Visitors and people living in the home saw it as a building that could be related to, as its layout was in tune with a domestic house. There were passenger lifts to two separate upstairs areas, so people did not have to negotiate stairs. All the individual rooms we saw were very personalised and people were very satisfied with their rooms, which had en suite facilities. We saw one bedroom transformed in readiness for a person to move in. People used varying amounts of their own furniture and effects. Furniture and soft furnishings provided by the home were of good quality.
Care Homes for Older People Page 22 of 31 Evidence: Two visitors spoke of their relatives rooms having been redecorated prior to moving in. We found high standards of cleanliness throughout the home, with no unpleasant odours. A housekeeper conveyed a strong commitment to achieving high standards, as did the person employed in the laundry. The kitchen had been awarded five stars in the Environmental Health scores on doors initiative. The laundry worker followed a daily cleaning schedule within the laundry. Completions of cleaning tasks were recorded and monitored. Some cleaning tasks were carried out at night. We saw the dining room receiving a thorough clean between meals. Sluice rooms were well kept. The home had experienced an outbreak of diarrhoea and vomiting earlier in the year. This had been traced to a person discharged from a stay in hospital. Since then, the home had instituted a policy that staff do not wear uniforms outside the home. We saw that the head of care changed before and after making an assessment visit to a prospective resident. The handyman confirmed that he attended all staff meetings and had a close working relationship with housekeepers in particular. He said he was made aware quickly of any maintenance needs. He oversaw the operation of maintenance and servicing contracts. He toured the building every month with a proprietor in order to identify and prioritise tasks. The handyman would be well placed to undertake a systematic survey of all hard-to-see areas, such as around waste traps and mobility aids, that pose possible risks to infection control in toilets, sluices and bathrooms. This would enable problems such as rusting and scaling to be seen and rectified at an early stage. We noted that the lighting in one of the residents toilets was too dim for comfort and safety. The handymans audit process could consider such issues, along with placement of facilities such as soap and towel dispensers. Care Homes for Older People Page 23 of 31 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. People have support from competent staff who are provided in sufficient numbers. People are protected by sound recruitment practices that ensure nobody works at the home until checks on their background are complete. The provider invests in the development of staff, to maintain a trained and mainly qualified team. Evidence: The home provided four members of care staff on duty in the mornings with three on in the afternoons and evenings. There were two waking night staff on duty at night together with a member of staff sleeping in, who could be called upon. A person told us their most important reason for living at the home was that there were always staff available to co me in response to the call bell. Other residents, and visitors, considered there were sufficient staff around at all times. One member of staff was appointed as Head of Care and was not counted in care shift numbers. Two carers were to be developed as senior carers. Care staff we spoke to thought staffing numbers were generally sufficient. There had been pressure in the late afternoons because of getting teas served, but this was resolved by appointing a supper cook. Staff were appreciative of the amount of training available, and they confirmed receipt of six-weekly supervision (see next section). They felt the staff group was cohesive, and committed to providing good
Care Homes for Older People Page 24 of 31 Evidence: quality care. We saw a number of sensitive and kindly interactions by staff towards residents. Many residents and visitors commented on the quality of staff. There was little turnover of staff, so there was a core staff group who had achieved National Vocational Qualifications (NVQ) in care to level 2 or 3. Two staff were currently working towards NVQ level 3 and the head of care had achieved NVQ level 4. The home benefited from a full time training co-ordinator. She had a strong link with the county co-ordinator for Skills for Care, which oversees training needs and provision for care services. The home offered an induction to new staff in line with Skills for Care expectations. This could last up to a year, as the co-ordinator said it was important to tailor to individual needs. There was a training plan for all staff. Individual training records kept for each member of staff showed evidence of completion of written exercises, and of certificates gained. Training provision included an in-house package about caring for people with dementia. The training co-ordinator sometimes worked alongside staff on shift in the home, so she was in a good position to observe care practices, whilst being perceived by staff as in touch with all aspects of the care task. We looked at records that showed how the three most recent members of staff had been recruited, and the progress of an application currently under consideration. In all cases there was an application form and a record of interview, and at least two references had been obtained. People had completed medical questionnaires. In all cases, a new Criminal Records Bureau (CRB) disclosure was in place before commencement of duties. We had made a requirement at the previous inspection to ensure this was done, as we had found people had started duties on the strength of CRB disclosures obtained with previous employers. Care Homes for Older People Page 25 of 31 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. The home benefits from an effective chain of management. The views of people living in the home are sought and acted on to ensure the home is run in their best interests. The support people receive is enhanced by regular supervision of the care workers. People are safeguarded by the arrangements made for handling their finances. The environment is safe for residents and staff because of sound health and safety policies and practices. Evidence: Jean Proctor, the registered manager, is a Registered General Nurse as well as holding NVQ level 4 in care and the registered managers award. She upholds her registration with the Nursing and Midwifery Council by ongoing professional development. We saw that she shared useful information from nursing journals with the whole staff group. She was supported in the home by the head of care, and in the company by weekly visits from her line manager, which included a weekly managers meeting. The home employed an administrator.
Care Homes for Older People Page 26 of 31 Evidence: The company had arrangements for seeking regular feedback from residents and their supporters about the quality of service provided. The results of surveying were discussed in managers meetings and used to form action plans for improvement. We saw examples of changes made as a result of this process, including introducing afternoon high tea, installing a new hairdressing salon and changing the types of activities offered. It was apparent from talking with residents and visitors that people were informed about possible future plans for development of the home. The administrator was working on a newsletter for residents and supporters. This could provide a further avenue through which to invite written or informal feedback. Most people had chosen to make use of safe keeping arrangements for holding personal monies. Families or advocates were informed when a person was in need of some replenishment. It was a key worker responsibility to undertake shopping for people if they wished, for example for toiletries or clothes. When this occurred the receipt was attached to the financial record sheet. The administrator checked balances before entering details of any new transaction. There was evidence of regular audit by the manager and visiting managers. All entries were double-signed. It was said that accounting errors identified at the previous inspection were related to poor practice by a former member of staff. Within activities, people were given opportunities to handle and maintain familiarity with money. At the previous inspection we recommended that the frequency of individual supervision for care staff should be increased, as it fell short of the National Minimum Standard. A chart in the care office showed that staff were now benefiting from sixweekly individual supervision from either the manager or training co-ordinator. This exceeds the standard. The head of care gave supervision to night staff, within their working hours. All ancillary staff received individual supervision. Good records of supervision were kept. For care staff, records suggested that supervision could reflect more consistently on how they felt their key work responsibilities benefited individual residents. There was a proactive approach to maintaining the health and safety of residents and staff. All staff received training in fire precautions and actions, first aid and food hygiene as priorities on induction. Fire procedures were revisited at every staff meeting. There had been a small fire in the laundry since the previous inspection. The handyman spoke of the lessons learnt, which were underlined by appropriate signage in the laundry and directions given to staff through staff meetings. The Fire Service had been consulted. Accident and incident sheets were appropriately completed, and could be cross-referred to individual care records. Care Homes for Older People Page 27 of 31 Care Homes for Older People Page 28 of 31 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 29 of 31 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations
These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 7 7 Care plans should show evidence of consultation with residents, or their supporters. Advice should be sought concerning how best to assess risk of pressure area injury, in line with practice in health settings in Wiltshire. Moving and handling assessments should show when they were completed, and by whom. Recording of activities should be sufficient to allow them to be evaluated, to ensure that the identified and changing activity and social needs of all residents are addressed. The complaints form should always be completed in full, to give a full audit trail. The use of the incident book should be clarified. Carry out periodically an audit of hidden areas that could pose infection control risks if not maintained to be free of accumulated rust, limescale etc. Individual supervision of care staff should always consider the effectiveness of their work with people to whom they are key worker. 3 12 4 5 6 16 18 24 7 36 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
