Inspection on 01/12/08 for Maesknoll

This inspection was carried out on 1st December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Maesknoll 18/12/07

Maesknoll 30/07/07

Maesknoll 03/08/06

Maesknoll 14/01/06

Maesknoll 21/07/05

Maesknoll 28/03/05

Maesknoll 05/10/04

Maesknoll 25/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Maesknoll 101 Bamfield Whitchurch Bristol BS14 0SA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sandra Garrett     Date: 0 2 1 2 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 34 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 34 Information about the care home Name of care home: Address: Maesknoll 101 Bamfield Whitchurch Bristol BS14 0SA 01173772690 01173772691 maesknoll@bristol-city.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Bristol City Council care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: May accommodate one named service user aged 58 years of age. Home will revert when named person leaves. Date of last inspection Brief description of the care home Maesknoll is registered with the Commission for Social Care Inspection (the Commission) to give accommodation and personal care to forty people aged 65 years and over. The home is owned and run by Bristol City Council Adult Community Care and situated in the residential area of Whitchurch. Maesknoll is laid out over two floors and has a lift. There is a small patio and large areas of lawn surrounding the outside of the home. The fee for living at the home, in common with all other City Council care homes (excluding those for people with dementia) is 460 pounds per week. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk Care Homes for Older People Page 4 of 34 Over 65 40 0 Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before the visit, all information the Commission for Social Care Inspection (the Commission) has received about the service since the last inspection was looked at. We then drew up an inspection record in preparation for the visit. This record is used to focus on and plan all inspections so that we concentrate on checking the most important areas. We used information gained from the homes Annual Quality Assurance Assessment (AQAA) which is a self-assessment of progress and what they feel they need to improve on. We also looked at the homes own independent quality assurance survey together with comments from our own Have Your Say survey that we did just before this visit. We spoke to six people living at the home, five staff including the manager and looked at a wide range of care,staff, health and safety and associated records. Care Homes for Older People Page 6 of 34 Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Whilst the quality of care, respect for people and atmosphere of the home has improved out of all recognition over the last year, some work is still needed to make sure people living there have a good quality of life based on their own wishes, choices and feelings. Further they need to be kept safe from risk of harm and continue to be treated as valuable individuals in their own right. Two requirements and seven good practice recommendations were therefore made. These included: - The Statement of Purpose and service user guide should be made more accessible and available to people with dementia and/or sight difficulties. - Continuing work on making care plans more person-centred and making sure they are formally looked at with the person concerned at least yearly. - More and better background information about people would help staff make sure care is given from the persons own perspective, i.e. taking into account their past and personalities.Further, collating information about peoples leisure interests would help staff provide activities, hobbies and trips that people want. - Greater attention should be given to making sure people are treated with respect and Care Homes for Older People Page 8 of 34 their records kept confidential. -The communal areas within the home must be kept uncluttered and safe for people. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 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 34 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 people benefit from being given clear information about the home when they come into it, information should be made as accessible as possible for people with sight difficulties and dementia. Better use of information gained about peoples backgrounds, personal histories and preferences would enable people to get more person-centred care. Evidence: We followed up a requirement made at the last visit about making sure equalities and diversity information is included in the Statement of Purpose. This has now been done and the Statement changed to make sure it remains up to date. Copies of the Statement together with the service user guide were seen in peoples files kept in their rooms. The Statement and guide havent yet been put into accessible formats for people with sight difficulties or for people with dementia. The AQAA sent in before the Care Homes for Older People Page 11 of 34 Evidence: inspection didnt mention this or whether it would be done. We did see that minutes of residents meetings were in large print and we recommend that the service user guide at least be printed in this way for people with sight difficulties. Further, a large print copy of the Statement of Purpose should be printed and displayed for people to look at if they wish. Further work to the service user guide e.g. putting into picture format should be considered so that people with dementia can also have similar access to it. We asked people in our Have Your Say surveys whether they had been given enough information about the home before they moved in. Comments included: Yes I got a little bit, I came and had a look around with my friend and her daughter,I can vividly remember. It was a good place back then, I came here straight from hospital, I did have a look around but I wasnt given a lot of information and: My daughter sorted everything out for me. We case tracked three people in depth. This means looking at all records associated with a small number of people and tracking their care by talking with both them and staff caring for them. Case tracking is a way of thoroughly checking how needs of people living at the home are met. This way we can assess whether the care given overall is adequate and meets peoples needs. We looked at peoples social work assessments that are sent to each home before a person moves in. Staff use the detail and actions outlined in the assessments to decide if they can meet a persons needs. We had been given information by the manager and team manager for the home about their concerns in meeting one persons needs. The person had behaviours that challenged staff and people living there. We had been kept informed of the issues and meetings had been held. The person was eventually moved to a more suitable setting. We also saw a social worker at the home doing a review following a recent admission. Such reviews are done to make sure the person is settling, staff can meet her/his needs and the outcomes for the person are positive. Overall, actions from the assessments and from the basic care plans attached to them, had been transferred into care plans done by staff at the home. In the assessments, details of background and personal history were seen. However, some of this hadnt been transferred into peoples care plans or used to help staff manage actions and behaviours. One person with dementia had a clear employment history that would have shed light on why s/he kept leaving the building. This hadnt been used positively that would have helped her/him. Assessments also include information on culture, lifestyles and religion. Some of this information had been used to develop care plans but some hadnt. People are looked after by a well trained and experienced staff group. We saw clear Care Homes for Older People Page 12 of 34 Evidence: evidence of how their specialist needs are met from looking at care plans and touring the building. The home is largely accessible for disabled people and visitors but more could be done to meet specialist needs, particularly of people with dementia. Personal profiles werent seen in care files. Putting in place clear personal profiles with as much detail about past lives, interests, relationships and likes and dislikes would help staff give more individual and specialised care to this group of people. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The way care plans are written doesnt make sure staff people using the service are cared for in a person-centred way. Irregular review means that not all care needs will be picked up and met. People living at the home are looked after well in respect of their healthcare and medication needs. Whilst peoples privacy and dignity is respected, thoughtless use of photographs could take someones dignity away from them. Thoughtful ways of caring for people from other cultures or whose first language isnt English, makes sure their needs and wishes are respected. Evidence: We looked at three peoples care plans in depth. We also looked at assessments to see if actions in plans matched with information provided. We followed up a requirement Care Homes for Older People Page 14 of 34 Evidence: made at the last visit about making sure that peoples needs are picked up and actions taken to meet those needs are clearly recorded. The requirement was partly met. The manager had sent us information before the visit that showed care plans are moving to becoming more person-centred. However, on looking at them closely our view is that more needs to be done to make them truly person-centred. Care plans we saw do record the need from the persons own viewpoint. Actions went on to be recorded in the same way but were more hit and miss e.g. moving from the persons view to what staff should do. Sometimes actions were recorded in directive ways i.e. preventing someone from leaving the home, pushing fluids and telling staff to make sure someone has a wash. The overall result or outcome for people wasnt therefore, clearly for their benefit. We discussed all we found with the manager and gave advice on how to make care plans more reflective of the care actually given. The manager said she believed everyone living at the home gets good outcomes and is looked after well by staff. She did also say however that some staff were still finding person-centred care difficult to grasp and she was working to help them. Staff have been doing person-centred care training recently but until a year ago had been used to working in more institutional ways. Care plans were being looked at monthly and recorded in peoples files. It wasnt clear if a full review was being done six monthly or yearly however. Review sheets were seen but didnt give enough detail to show that people were being consulted or involved and their wishes recorded. However since the draft report was issued the manager has sent us information and evidence that shows reviews had been done. Reviews showed that people living at the home and their relatives had been involved in the reviews and comments recorded that showed peoples satisfaction with the care they get. Therefore the requirement has been met. An issue about signatures showed that one person may not have actually signed either her/his contract, care plan or review, therefore not knowing what her/his rights were. The manager said she would take this up with staff involved. Daily records gave better information and were written more regularly than before. This was required at the last inspection. Records clearly showed how peoples needs were being met and the good relationships staff have with them. Moving and handling risk assessments were in place for each person that were properly recorded and rated to make sure people are kept safe. Other risk assessments had been done for specific issues such as use of oxygen, falls, and self-medication, which had also been required at the last visit. People are looked after well when they are ill or have healthcare needs and their Care Homes for Older People Page 15 of 34 Evidence: health is regularly checked. Records of GP, district nurse and chiropody visits were seen written in daily records. One healthcare professional had written in a persons daily records when s/he visited. One person was having difficulty using healthcare equipment and lots of records were seen about this including training for staff from district nurses. Accident records sent to us and discussed with management staff showed prompt actions taken when people had accidents or became ill. This had made sure people were kept as safe as possible and free from pain. We asked people if they get the medical support they need. Comments included: I do if I need it and: I had a really bad ankle when I first came here but thanks to the staff here looking after me its much better now. We checked medication. A requirement made at the last visit was met. All medication administration records (MAR) were regularly signed with no gaps. Risk assessments for people that look after their own medication had been put in place. People having eyedrops, eardrops, creams or lotions applied had their MAR sheets kept in their bedrooms that were signed when the relevant medication was applied. We checked supplies of medication kept for people that is controlled by law (Controlled drugs). A book is kept for the purpose of recording these. They were stored securely and two staff had signed for each time of giving for each person. Quantities being kept were all correct. The medications fridge has an internal digital thermometer that shows the temperature its kept at. This was within normal range. Unopened medications such as eye drops were stored in the fridge to make sure theyre kept at the proper temperature for them. Photographs of each person living at the home were seen at the front of their MAR sheets (photos are also kept in peoples care files). One persons photograph was undignified as it was taken when the person had had a severe facial injury. People have a right not to have injuries photographed (unless its needed for legal purposes), so that their dignity can be respected. We spent time around the home and observed and heard staff interactions with people. These were respectful and people were treated with dignity. We didnt hear people being patronised or spoken with in any tone but friendly and caring. We asked people in our survey: Do you think youre treated with respect by staff members? Comments were mixed about this and included: Yes theyre all very nice, Yes I think so, Most of the staff members do but there are a few that dont, Yes I do very much so, Oh yes definitely they are all very nice, Yes I really do and: Yes I do definitely. The manager told us that a person from another culture that spoke no English had recently stayed at the home for respite. Staff had got key phrases from the persons relatives and had them translated into English so that some communication could be Care Homes for Older People Page 16 of 34 Evidence: used. Interpreters were also used where necessary. The manager said that the period of respite hadnt led to any difficulties that couldnt be met and the person had given positive feedback when s/he left the home. Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to activities recordkeeping shows that peoples needs for stimulating and enjoyable social and leisure pursuits are met. Encouragement of contact with the community helps people stay in touch with whats happening outside the home. Meals at the home are well managed and provide daily variation, good nutrition and social contact for people. Evidence: We asked people whether they felt there are enough activities going on at the home. Comments were mixed and included: Sometimes, but I dont like that sort of thing anyway, There is some but at the moment Im not interested, There are a lot of activities and some outings now and again, Yes. They do bingo once a week and sit watching old films, that type of thing, I dont do the activities by choice but everyone here makes me feel socially accepted, There are a few bits to do but weve all got to muck in otherwise we would just sit back, Sometimes but I think we could do with something more to do really and: Theres nothing going on. I wish there was, it would Care Homes for Older People Page 18 of 34 Evidence: make things a lot better. We all get bored to tears sometimes. We followed up a good practice recommendation made at the last visit about planning activities based on peoples wishes and putting in place a wider range of them. We looked at activities records. This showed a slightly wider range than last time we visited. From the residents meeting minutes that we saw, activities are chosen very much from what people say they want. The manager had engaged the services of an activities provider known as Everyday Miracles that comes into the home to do entertainment with music and movement, using equipment and musical instruments. The manager said its very jolly and upbeat and people like it. Other entertainers are very popular: one in particular - Shakin Mikey makes each person feel special. A Christmas fete was being arranged at the time we visited to be held on the 6 December. The manager said that staff had worked very hard to make this a success and had done nearly all the work for it themselves. We saw Santas grotto that had been made from an empty bedroom. It looked very realistic and cosy with lots of decorations. Activities records were well written and gave information about how people enjoy the particular event. These included: Staff reading to people from newspapers, bingo and sherry evenings, outside entertainers with singing and dancing, games of dominoes, skittles and Connect 4 and Snakes and Ladders. These were all accessible for older or disabled people, being larger than average and with raised textures so that people can feel them easily. A Chinese takeaway evening had also been held with people contributing a small amount of money and the rest subsidised from the homes amenities fund. Twenty-one people had enjoyed the meal and many commented on how lovely it was. The film unit had visited and people had watched films such as: Night at the Museum, Titanic and Billy Elliott and enjoyed them all. Quizzes with prizes had also been held and people were pleased when they won. Plans were in place for future trips and a large number of people, their relatives and staff were looking forward to a trip out to a local pub for a Christmas lunch in the week following our visit. From minutes of residents meetings that we saw, people had talked about what further activities they would like. More trips, pub lunches, shopping trips and exercises were the choice of those that attended the meetings. Since the last inspection people had been asked about their previous leisure interests and what they would like to do now by means of a leisure interests checklist. Use of the checklist is to be commended. We saw copies of the finished ones in peoples files but were unsure what is being done with the information gained so that events and activities can more nearly match what people like to do. People were able to state if they were interested in particular things such as sports, countryside and wildlife, horse racing, gardening, sewing, knitting and cooking to name just a few. Where people said Care Homes for Older People Page 19 of 34 Evidence: they were interested there was no overall collation of the checklists to show future plans for starting up certain activities or doing more e.g. gardening or cooking. We discussed this with the manager and advised that the checklists give valuable information about peoples past likes and dislikes, hobbies and current interests that could be put to good use in giving person-centred care. Use of accessible games for people with sight difficulties or mild dementia helps them join in with activities. One person had said that s/he wanted more accessible bingo as s/he is blind and had to keep the called numbers in her/his head. This had been remedied by getting advice from Royal National Institute for the Blind (RNIB) that had helped with getting accessible equipment. The home has a games room with a snooker table and dartboard. Unfortunately this room was being used to store furniture and other things that made it inaccessible to people wanting to use it. Key time (one to one time with a person and their key care worker) was recorded in peoples records and people were more able to go out to local shops or into the city to shop. All records of activities and key time were positive and showed good relationships between people and staff. There is very little contact from the local community coming into the home. A nonreligious community choir is coming to the home to sing carols closer to Christmas. People are asked about their religious and cultural needs when they come to the home. However no ministers of any religion currently visit the home as no one has expressed a wish for this. Neither have they expressed a wish for more local involvement. However people are taken out to a nearby supermarket that has a coffee shop, during key time if they want. We followed up a recommendation about meal temperatures as the last time we visited meals were only warm. This time when we sampled lunch with people on the first day, the meal (of spaghetti bolognese), was hot and very tasty. Menus have been re-done on the basis of what people say they want. Minutes of residents meetings showed meals are regularly talked about and people are clear about what they want and the temperature of food and drink. A complaint had been made at one of the meetings that tea and coffee taken round on trolleys during the day quickly got cold. The manager had said she would take immediate action to rectify this. People are very clear about the food and choices of meals they want and told us they felt the meals had improved greatly since we last visited. Having sampled a meal we would agree. The manager had tried introducing serving dishes on each table to make the meal more person-centred (by giving people more choice and being able to serve themselves with portions they want rather than having the meal plated up). However this had met with mixed responses. Some people like the serving dishes but some dont. When discussed at the residents meeting it was agreed that both choices would Care Homes for Older People Page 20 of 34 Evidence: be respected. From the AQAA and residents meetings we saw that people are given a more immediate choice of meals each day. A staff member asks each person what they want on that day rather than the day before. Menus for the day were seen displayed on each table so that people can check whats available. One person had asked if s/he could have a cup of tea whenever s/he felt like it and everyone was told to ask staff for a drink whenever they want one. We asked people in our survey what they thought of the meals at the home. Comments included: Yes shes a marvellous cook, the food has really improved, its gradually getting better, the food is reasonable, the food here really is marvellous. Ive never left a crumb since being here, the food is very nice (two similar comments), I really like the food and: theres nothing wrong with the food whatsoever. People we spoke to at the visit told us that the food has improved. One person said: the food is wonderful now and weve been included in choosing the menu. The menus are better now than theyve ever been. People we observed at lunchtime (who chose the option of sausages, mash and baked beans) showed that they enjoyed it. Care Homes for Older People Page 21 of 34 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. People living at the home have the necessary information and feel confident about being able to raise concerns or complain about their care if they need to. Proper management of abuse issues keeps people protected from risk of harm or abuse happening to them. Evidence: In our survey we asked people if they knew what to do if they werent happy and whether they knew how to make a complaint. Comments included: Id talk to my daughter first, Ive got my own key worker who I feel very comfortable talking to, No I dont but Im so happy here I probably wouldnt need to anyway,No I dont know, Yes Ive made one before. I went straight down to the office and it was all sorted out, No but I know I would never need to make one, I would go to one of the officers, and: Id speak to someone down in the office. Copies of the complaints procedure were seen in individual peoples files kept in their rooms. This has been made into a picture format for people with dementia to understand more easily. We looked at the complaints log. There were a large number of letters of thanks and compliments although many of these went back several years. We suggest that they should be filed away and only the most recent years batch kept in the file. No complaints had been made since the last visit in November 2007 and Care Homes for Older People Page 22 of 34 Evidence: none had been reported directly to us either. Staff have done safeguarding adults from abuse training and certificates for this were seen in individual training records. Incidents of alleged abuse have been dealt with quickly and actions taken to make sure people are kept safe. Where abuse had taken place because of a persons challenging behaviour, mental health professionals had been called in and meetings held to discuss a more suitable placement elsewhere. We had been sent copies of meetings and the team manager had kept us informed of the outcome. The person involved had been swiftly moved to a more suitable home. Care Homes for Older People Page 23 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people benefit from living in a comfortable, clean, safe environment that is well decorated, looked after, physically accessible and meets their needs, more work on access for people with dementia and sight difficulties would help them find their way around more easily. Storing furniture in communal areas denies people access and may not keep them safe. Better attention to smokers needs would keep them and others safer. Evidence: From the AQAA we noted that a number of rooms have been redecorated and recarpeted since our last visit. We spoke to one person whose room had just been done that looked fresh and homely. The person said she had chosen the wallpaper herself and was about to have a new carpet. Other work had also been to done to improve the fabric of the home and make it more accessible. This included: a new patio area at the front of the home with a small enclosed garden, purchase of new patio furniture, painting the toilet doors a bright red to make them more accessible to people with sight difficulties or dementia, painting the grab rails throughout the corridors a bright shade of yellow with red at the ends to help people use them, and making grab rails in bathrooms easier to see by putting bright red flurescent strips around them. An access audit that was a recommendation from the last visit had been done. Together with the Care Homes for Older People Page 24 of 34 Evidence: above work more had been done to make sure door plates showed not just the name of the room but its function also. The plates that were of good size have symbols to show if they are bedrooms, lounges, toilets or bathrooms. They also have a pocket for a name or a picture to be slotted in to help people find their own rooms. Unfortunately for one person, her/his name was wrong in the pocket but right on a notice below it! We advised the manager to make sure this was corrected as the person has dementia and may be more confused by the wrong name. We had previously commented on people not being able to find their way to lounges or find light switches in toilets. Whilst this had been dealt with at the time by putting dayglo pink labels and signs showing people, a more permanent way of making them accessible hadnt been put in place. Therefore the label on light switches was looking tired and institutional as were the signs alerting people to where the smoking lounge is. We therefore recommend that attention is given to making better, more accessible and permanent signs e.g. by painting around light switches in a primary colour and by proper use of arrow signs for people with dementia to see and understand. Further as we went around the premises we found several lounges and the activity room had furniture stored in them. In one lounge a mattress was seen and in another the base of a divan bed. We have already commented above on the furniture stored in the activity room. These rooms must be cleared to make sure people have full access to them and are not at risk. People were seen watching TV in their rooms or in the lounges. We visited the smoking lounge and found the atmosphere thick with smoke as the fan wasnt on. There were several glass ashtrays, some filled with cigarette butts and one metal waste bin half full of butts. At first we thought that a cigarette was still alight in the bin as the smoke was so dense. However this wasnt the case. We discussed the matter with the deputy manager and strongly recommend that proper, free standing metal ashbins are used to keep people safe. All other areas of the home were fresh and clean at this visit and staff were seen cleaning rooms. No unpleasant odours were noticed except in one lounge and this could have come from the furniture. We advise that wiping down of all chairs is added to the regular cleaning rota to make sure the whole home remains fresh, clean and hygienic. Care Homes for Older People Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Low numbers of permanent staff and reliance on agency staff may affect the quality of life for people living in the home. However, they benefit from a well trained and qualified staff group that are able to meet their needs. Evidence: We asked people if they felt they get the care and support they need. Comments included: Yes very well indeed. Its a lovely place, Yes theyve really been all right, Some staff are very nice and some are not but youll get that wherever you go and: I get the care I need but I dont really need much, Im pretty independent. We also asked if staff listen and act on what people say. Comments included: Some of them do, I get on very well with most of them, Yes they do most of the time and: In the main staff are pretty reasonable. We asked people: Are the staff available when you need them? Comments were mixed about this: Im very independent so I dont need them very much, Sometimes theyre a bit short of staff but most of the time its ok, I think they could do with a few more staff sometimes, I think it can be very under staffed sometimes, I think the staff here are beautiful and: I think they could do with a few more staff. Care Homes for Older People Page 26 of 34 Evidence: We talked with the manager about the continuing high use of agency staff. Recruitment drives have been held but havent resulted in new staff being taken on. This was because of potential staff wanting to work hours that the home cant offer. Also, where the home is situated has an effect as its away from main areas and suitable transport links. Wherever possible regular agency staff are used that get to know the home and people living there. However, some of these have now found other work which adds to the problem. The AQAA showed that the manager agrees staffing could be better and plans for improvement include offering more fixed term posts. From rotas seen however, suitable numbers of staff are on duty each day to meet peoples needs. Progress with NVQ training (the national vocational training as set out in the National Minimum Standards) continues, with eight out of sixteen care staff having achieved Level 2 or above and four staff working towards it. Staff also get essential training in a range of subjects including moving and handling, medication, food hygiene and fire and health and safety (including first aid). New staff get a formal programme of induction that includes basic training and shadowing experienced staff. All Adult Community Care staff have yearly reviews of their work that assesses progress, future development and training needs. A requirement made at the last visit about training in caring for people with behaviours that are challenging was met. The manager had sent information to us when we asked for it, that showed all night staff had done the training in 2007-8 as well as all care staff who did it in November 08. Cooks and kitchen staff had also done it but only one domestic staff member. Care Homes for Older People Page 27 of 34 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. Both people living at the home and the staff team continue to benefit from an experienced manager who encourages an open style of management. Various ways of making sure people can comment about life in the home helps them to be sure their views and opinions will be taken note of. Peoples cash is well managed that makes sure they are protected from financial abuse. People get the proper care they need from a staff team that have opportunities to regularly talk about their work practices and training needs. Better ways of keeping records about people living at the home would help keep them confidential and in good order. Good management of health and safety in the home makes sure people are kept safe. Care Homes for Older People Page 28 of 34 Evidence: The manager, Mrs Barbara Cairns has now been at the home over a year, having been transferred from another local authority home. During this time she has put in place new procedures and processes that give better outcomes and quality of life for people living there. Comments from people about the improvements show the effect her management has had. Mrs Cairns is fully trained and very experienced. She shows a strong commitment to person-centred care. She has an open-door policy for both people, their relatives and staff. She was welcoming and open to the inspection process and supplied us with information that showed how requirements made at the last visit had been met. All local authority care homes have a yearly quality assurance survey done by an independent organisation. This survey was done in July. The scores were lower this year than before. We discussed the report with the manager and also gave her a copy of our own survey findings. Checking of quality is also done by the team manager for the home who visits monthly and is aware of all issues affecting people and staff. Further checking is done at residents meetings where concerns can be raised and people are asked about what they want and the quality of the service offered. From all of these ways the manager is aware of what needs to be worked on and how the service can be improved and developed further. We did a sample check of peoples cash to make sure its being kept for them safely. All was in good order with receipts, balances and records of cash taken to buy things for people, all correctly recorded and attached. People can choose to keep their own cash and have lockable space in their rooms for this but the majority prefer it to be kept securely by the management team. We checked a sample of staff supervision records. Good progress has been made with this which is commended. All showed evidence of at least six sessions over the last year, as recommended in the National Minimum Standards. The sessions included a group supervision, one to one meetings every two/three months and a yearly review of performance. Records showed staff get opportunities to talk about their work and any training needs they have including NVQ qualifications. Having looked at peoples care records in detail we found that they werent always being kept in an orderly or indeed confidential manner. We found that one care plan had another persons name on it, one persons risk assessment referred to someone else and on the back of one persons daily records was a whole page of records about someone else. The overall effect was of staff cutting corners or not checking sufficiently whose records they were keeping. Records should be kept for each person in a confidential and orderly way that shows respect the person concerned. Care Homes for Older People Page 29 of 34 Evidence: Fire and health and safety records were looked at. A new fire safety risk assessment thats required under the new Regulatory Reform Order relating to fire safety had been done. A fire safety officer had visited and a copy of a letter with recommendations was seen. The recommendations had all now been adopted. Five fire drills have been done this year, either planned or because of the fire alarm sounding. Between six and thirteen staff attended the drills that lasted up to twenty minutes. Discussions had been held following the drills on the outcomes and procedures used. All were written up to show the learning for staff from each one. Records of night staff fire walkthrough drills were also seen in October and November 08. Records of fire safety training for both permanent and agency staff were also seen together with checks on fire safety equipment and health and safety matters. Care Homes for Older People Page 30 of 34 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 31 of 34 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 19 16 All areas used by people 30/01/2009 living at the home must be cleared of unnecessary furniture and other items and proper health and safety procedures observed. This will make sure people have access and ownership of the rooms and will be kept safe from risk of harm. 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 The Statement of Purpose and service users guide should be made more accessible to people with sight difficulties. This should include publishing the documents in large print and putting the service users guide into picture format for people with dementia. This will make sure people with specialist needs will have the same access to printed materials as others. Information about background, lifestyles and personal preferences should be used to develop staff understanding of the needs of people living at the home especially those with dementia. This will make sure peoples behaviours and needs will be Page 32 of 34 2 4 Care Homes for Older People properly managed by an informed staff team. 3 7 All care plans should be written entirely in person-centred ways and staff continue to be given advice and training in how to do so. This will make sure people are treated as valuable individuals with their rights and choices being respected. 4 10 Photographs should only be taken with peoples consent and if the person concerned is free from facial injury. This will make sure peoples dignity is respected. 5 12 The results of the leisure interests checklist should be collated and used to plan future activities and events for people. This will make sure people get a stimulating choice of activities based on their expressed wishes. 6 19 Work should continue to make certain areas of the home accessible for people with dementia and sight difficulties. This will make sure people can find their way around with greater ease. Records about individual people living at the home should be kept confidentially and in good order. This will make sure people will be treated with dignity and respect. 7 37 Care Homes for Older People Page 33 of 34 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). 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