Inspection on 04/12/08 for Marple Dale Hall Nursing Home

This inspection was carried out on 4th 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

Marple Dale Hall Nursing Home 06/10/09

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Marple Dale Hall Nursing Home Dale Road Marple Stockport Cheshire SK6 6NN     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: Fiona Bryan     Date: 0 5 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 35 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 35 Information about the care home Name of care home: Address: Marple Dale Hall Nursing Home Dale Road Marple Stockport Cheshire SK6 6NN 01614490771 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Joshua Henley-Adams Type of registration: Number of places registered: Barchester Healthcare Homes Ltd care home 86 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability old age, not falling within any other category physical disability Additional conditions: A minimum of four registered nurses must be provided between 8:00am and 10:00pm each day including weekends when 69 service users or more who require care are accommodated. A minimum of three Registered Nurses must be provided between 10:00pm and 8:00am when 69 service users or more who require nursing care are accommodated. A minimum of two Registered Nurses must be provided between 10:00pm and 8:00am each day. Ensure that three separate units for YPD each containing ten beds (30 in total) in line with National Minimum Standards are provided by May 2006. Ensure that two separate units for residential and nursing care each containing 45 beds (90 in total) in line with National Minimum Standards are provided by May 2006. Care Homes for Older People Page 4 of 35 Over 65 0 67 0 2 0 25 No more than 71 service users may be admitted into the establishment who require nursing care. Date of last inspection Brief description of the care home Marple Dale Hall Nursing Home is a care home that provides 24 hour nursing care and accommodation to 86 people. The home is split into three separate units, the Main Hall, the Balmoral Unit and Clarence House. Marple Dale Hall nursing home is owned by Barchester Healthcare Homes Limited and they also own another home on the same site called The New Windsor nursing home. The two homes have the same manager and the policies, procedures and organisational records and paperwork within the two homes are the same. Clarence House offers a specialised service to three residents with a history of brain injury. The Main Hall and Balmoral units offer nursing care and personal care for people. Marple Dale Hall is situated on Dale Road, a quiet leafy residential road approximately half a mile from Rose Hill railway station in Marple. Local bus services and shops are also available fairly close by.A long driveway leads to a car park and the different entrances to each of the suites can be accessed from here. The home has accessible garden areas and patios, which are bordered by woodlands and open countryside. Assisted bathing facilities are available throughout the home.There are a selection of lounges and dining rooms. The current weekly fees range from 321- 650 pounds depending on the package of care required. Further details regarding fees are available from the manager. Additional charges may also be made for hairdressing, chiropody and other personal requirements. Care Homes for Older People Page 5 of 35 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: This key unannounced inspection, which included a site visit, took place over 2 days on Wednesday 4th and Friday 5th December 2008. The staff at the home did not know that this visit was going to take place. This was the first inspection for this service since it was registered as being owned by Barchester in June 2008. All the key inspection standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with people who live at the home, the manager, visitors and other members of the staff team. Four people were looked at in detail, looking at their experience of the home from their Care Homes for Older People Page 6 of 35 admission to the present day. A selection of staff and care records was examined, including care files, staff personnel files and staff duty rotas. A pharmacy inspector assessed the arrangements the home had in place for dealing with medicines. Before the inspection, we asked for surveys to be sent out to people living at the home and staff, asking what they thought about the care at the home. Six people who lived at the home and one staff member returned their surveys. Comments from these questionnaires are included in the report. We also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. We feel this was completed quite well and the manager was able to tell us what plans he had in place to continue developing the service. What the care home does well: People were assessed before they came into the home to make sure staff would be able to meet their needs and care plans were developed to address the needs identified during the assessment process. Care plans were well written and contained detailed information about the abilities and care needs for each person. Since Barchester took over the running of the home they have introduced a new format for the care plans, which were easy to read and extract information from. People in general said they liked the staff and thought they worked hard, although a couple of people said that they found it hard to understand some staff due to language difficulties. Comments included, The staff are cheerful, friendly and work well as a team. They take good care of my mother. They work hard, are often under pressure, their attitude and manner are good , They are very prepared to listen and understand the varied needs of the resident, I have come across staff dealing with anxious bewildered confused residents and have noted great patience, tact and gentleness in staffs approach to the situation. They are prepared to take plenty of time to help residents in distress. The staff are caring towards me (as a relative), which I appreciate, (staff are) pretty good to me - they do the job for me and I cant grumble. Three social life organisers work between Marple Dale home and The New Windsor home, which is on the same site. People that we spoke to all knew who the organisers were and said they did a good job in arranging social events and recreational activities that they could get involved in. A minibus had been bought, which people were looking forward to going out in - some people had been on a canal trip, which they had enjoyed. A weekly events sheet with information about the different activities that had been arranged for that week was produced and given to everyone living at the home so they could decide if they wanted to join in or not. Comments about activities included Canal trips are very good, there is lots on offer, Quiz and discussion groups are very good, I liked the disco at Halloween and I appreciate very much the visits of the resident chaplain who is very caring. The internal and external appearance of the home is of a high standard and provides a pleasant, comfortable environment for people to live in. Since Barchester took over the running of the home a lot of investment has been made to ensure that the environment meets Health and Safety requirements, for example window restrictors and radiator covers have been fitted and fire doors have been repaired or replaced. All 6 people who returned surveys said the home was always or usually clean and fresh, as it was when we visited. Recruitment procedures were thorough and ensured that the staff that were employed were suitable to work in a care home. The manager has just been registered by us after demonstrating that he had the skills, knowledge and experience to manage the home. Care Homes for Older People Page 8 of 35 A team of maintenance staff work between Marple Dale and The New Windsor homes. Good systems were in place to ensure that the home was well maintained and conformed with requirements in relation to Health and Safety. Staff were seen to be working using safe working practices. What has improved since the last inspection? What they could do better: Although care plans were very detailed, from the feedback we got from some visitors and from other records in the care files we could not always see if care had been given as it was stated in the care plans, for example it was not clear how often some people were helped to have baths or showers. Managers need to make sure that staff are properly following the care stated as being needed in the care plans. Overall suitable arrangements were in place for handling medication but these were not consistently followed throughout the home. These inconsistencies need to be addressed minimise the risk of mistakes being made. On the first day of our visit we ate the lunchtime meal with other people who lived at the home. Although the meal was tasty and enjoyable, we had to wait a long time to be served and people told us it was unusual that the meal was hot when it was served, as it was normally cold. The tablecloth and table mat were dirty and there were no condiments or sauces on the table to accompany the meal so the dining experience was not as good as it could have been. There was a very limited choice of menu and from feedback we received from some people living at the home the meals did not always meet their expectations. The manager acknowledged there had been some difficulties with the catering arrangements and told us about the plans in place to improve this area of the service. Although from looking at the staff duty rotas it was clear that good staffing levels were seen as a priority, the perception of many people living at the home and visitors to the home was that there were not enough staff to meet the peoples needs. When Barchester took over the running of the home there was a high staff turnover due to agreements made by the previous owner. Consequently the manager has had to work very hard to recruit suitable new staff. Although many of the staff team are now permanent staff they are relatively inexperienced and need a lot of training, support and supervision. Barchester has appointed a management team and a home trainer. Members of the management team need to make sure they work closely with the senior staff on the units to ensure staff are brought up to speed as quickly as possible. Since Barchester took over the running of the home a number of complaints had been made. From the records of these complaints we saw that some people felt that their complaints had not always been fully addressed. There had been some resident/relative meetings but the general manager had not attended and people felt the unit managers did not always have the information to be able to fully answer their Care Homes for Older People Page 9 of 35 queries and concerns. Further consideration is needed as to how changes and improvements to the service are communicated and made known to people living there and the manager should continue to promote and develop the complaints procedure so people have confidence that their concerns are being listened to and acted on. 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 35 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 35 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 were fully assessed before they came to live at the home so staff could determine if their needs could be met. Evidence: We looked the care provided to four people in detail, looking at the information obtained before they came into the home and how that was used to develop a plan of care for each person. Assessments had been undertaken for all of the people before they came into the home and the assessments were detailed and covered all the different aspects of their care needs. The information obtained had been used in each case to create individual care plans, to tell staff what help each person needed and what their abilities were. Six people returned surveys to us. Most of them were unsure as to whether they had a Care Homes for Older People Page 12 of 35 Evidence: contract as their families dealt with any administrative tasks. One person who responded on behalf of his relative who lived at the home wrote, I was not given all the information I needed. This establishment has 2 versions of its terms and conditions - one for people who are self funded and one for local authority funded residents. The 2 versions are not clearly labelled and I was given the wrong one. Consequently only when the invoice for the first month reached me did I discover there is an administration charge for self funded new residents only. (A one off charge to cover such things as setting up the care plan). It is recommended that people are made fully aware in writing, of the terms and conditions of their stay before they make the decision to live at the home. Care Homes for Older People Page 13 of 35 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. In general peoples health care needs were met although there were some inconsistencies in staff practice in respect of personal care and the management of medicines which put them at potential risk of their needs not being met. Evidence: The care for four people living at the home was looked at in detail. Care plans were in place for all of them that had been written to address their needs, as identified when they were assessed before and on admission to the home. Recent care reviews had taken place for two people, which had involved either the person themselves or their family and staff from the home, to make sure that the care that was planned was meeting their needs. The care plans for all four people were well written and contained information about individual routines and preferences. Risk assessments had been undertaken to assess the risk to each person regarding falls, nutrition, pressure areas and moving and Care Homes for Older People Page 14 of 35 Evidence: handling. Additional risk assessments had been carried out for specific risks to individuals related to the environment or their abilities. Where people were identified at high risk care plans had been written to reduce the risk as much as possible and monitor the persons condition. Records showed that people living at the home had seen their GPs,chiropodists, opticians and dentists. From the records we could not always be certain that the care stated as being needed, particularly in respect of personal care was what was delivered to each person in practice. For example the care plan for one person said they wanted to have a bath or shower twice a week. However, from the records it was only documented that this person had had baths three times since August 2008 (on 25/8/08, 7/9/08 and 13/11/08). Two visitors that we spoke to during our inspection expressed concerns about the levels of hygiene being provided to their relatives. One person told us their relative had not had a bath for ages and another felt that the care was not as smooth running as it had been previously. This person said that there had previously been a good system where people were routinely offered help to go to the toilet before and/or after meals but now staff seemed to wait until they were asked for help. This person was concerned about this as their relative would not be able to request help and they therefore could not be sure that they were clean and comfortable. They had been to visit recently and found their relative still sat at the dining table at 2.15pm and in a distressing state of hygiene. Six people living at the home returned surveys to us that we had sent out before the inspection. From these, 3 people said that they always or usually received the care and support they needed and 3 said they sometimes or never did. Comments about the care provided included Its sufficient, carers always seem too busy - not enough people and The staff are cheerful, friendly and work well as a team. They take good care of my mother. They work hard, are often under pressure, their attitude and manner are good. One person thought staff made any excuse not to help. In answer to the question Do staff listen and act on what you say? three people responded yes and 2 responded no (1 person did not answer). Additional comments were made such as Some do if time allows, They are hard to understand! I dont understand what they are saying, More or less, Depends on staff, When available, hard to understand some staff, I get frustrated when they dont know what I want because they dont know the language and They are very prepared to listen and understand the varied needs of the resident. Feedback from residents and Care Homes for Older People Page 15 of 35 Evidence: relatives is welcome. Matters I have drawn to attention of staff have been dealt with courteously and promptly. Four people said they always or usually got the medical support they needed and 1 said they sometimes did (1 did not answer). Comments included Sometimes but mostly not, if I dont ask for things I dont get it, I have asked for a walk in the fresh air but carers too busy and they say no staff and The medical support is prompt and good. Overall suitable arrangements were in place for handling medication at the home. Medicines policies provided clear guidance to staff in the handling of medicines at the home. Medicines were administered by qualified nurses or by suitably trained staff (for personal care residents). Part of the teatime medicines round was observed in Balmoral. Care was taken to complete the medication records immediately after administration to help ensure they are accurately maintained, reducing the risk of mistakes. However, medicine administration did not begin for some people (medicines in second trolley) until 7pm. This is quite late and may have a knock-on affect for example if another dose of the same medicine is needed at bedtime. The times that medicines are given should be monitored to try and ensure they are given at both the right and best times. Throughout the home most medicines were administered by staff, but people choosing to self-administer medication were supported to do so safely. The home has arrangements in place so that non-prescribed medicines for the treatment of minor ailments can be given. This benefits people at the service as they can receive treatment for conditions such as minor pain without delay and without the need to see the doctor. We looked at medicines record keeping. Records showing the administration of medication were generally up-to-date but there was some inconsistency across the home. This needs to be addressed to help ensure the completeness and clarity of these records across the service. For example in Balmoral we saw examples where there were several gaps in the medicines records where administration or the reason for non-administration was not recorded. Most administration records were pre-printed by the pharmacist but where handwritten entries were made these were not always signed and countersigned. This is recommended to help reduce the risk of errors. In the Main Hall we saw one handwritten entry that mistakenly recorded the wrong medicine name. Similarly, we found that records of communication with healthcare professionals such as G.Ps were generally clearly made, but some were missing, particularly in the Main Hall. This meant it was not always possible to track changes to peoples medicines. It is important that records are always made to ensure changes are promptly made and where needed, followed-up. Care Homes for Older People Page 16 of 35 Evidence: We found that external preparations (e.g. creams) were not always well managed. In Balmoral we saw examples where they had not been used because staff could not find them. There was not always sufficient written information for staff about when creams may be needed or where they should be applied. We looked at medicines storage and found that medicines including controlled drugs were safely stored, helping to reduce the risk of mishandling or misuse. Staff explained that they had recently started to order medicines on-line and there had been some teething problems. This had resulted in some people missing doses of medicines because none came with the monthly delivery. Staff have had meetings with the supplying pharmacy and have a printed record of the medicines ordered to try and addresses this concern for future deliveries. Managers explained that regular written medicines audits were planned across the service. This will help to help ensure medicines are safely and consistently well managed and ensure that, should any weaknesses arise, they will be identified and quickly addressed. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inadequate kitchen facilities made it difficult for staff to produce meals that met peoples expectations in terms of choice and presentation. Evidence: In the AQAA the manager said that the provision of opportunities for people to engage in social events and activities was an area he felt the home did well. A weekly activities programme was distributed to everyone each week and was also displayed in prominent areas around the home. Most people spoken to were aware of who the Social Life Organisers were and felt they did a good job. There were 3 social life organisers that worked between Marple Dale Nursing Home and The New Windsor. Of the six people living at the home that returned surveys 5 said that there were always or usually activities going on that they could take part in if they chose to. Comments included The canal trips are very good, there is lots on offer, Quiz and discussion groups are very good, liked the disco at halloween. I like the singers and bingo and I am aware of all the activities and also get a weekly diary sheet but I am a loner, I prefer my TV but I enjoy a chat with the social team. Care Homes for Older People Page 18 of 35 Evidence: Most people we spoke to were aware that Barchester had bought a new mini bus but a lot of them had not yet been out in it. However, staff told us that people living at Clarence House did use the bus on a frequent basis to go out for tea and trips out. Some people on other units said they would like to go out more. Of the six people that returned surveys 2 said they usually liked the food whilst 3 said they only sometimes liked the food and 1 said they never liked it and would rather eat a sandwich. Other comments were Too fancy - would like simple old fashioned food steak and kidney pie, more roasts, sausage and mash, stew and dumplings, real apple pie, Not what I would cook! and Its OK. We heard different opinions about the food during our inspection. One person said, The food is good really - its presented in a nice sort of way, lovely food and the food is very,very good. There are some things I dont like such as curry and they give me sandwiches instead. One person who could only eat a soft diet said there was no variety and we looked at what they were given for lunch, which the carers said was meat and gravy, mashed potatoes, sprouts and carrots, and thought that the presentation did look a bit uninspiring. People said there was no real choice especially at lunchtime and if people did not want the hot meal on offer there was no other hot option available, or meal of the same calorific content. We had lunch with some of the people living at the home, in the dining room on the Balmoral unit. We were told that lunch was served at 12.30pm but we were waiting half an hour before the first course was served and another 20 minutes between the first course and the main meal. A visitor commented that people often sat a long time waiting to be served and that tea was also a long process. The tablecloth and table mat were dirty and the apple juice had already been poured so we didnt drink it as we did not know how long it had been sat on the table. There were no napkins or condiments on the tables. One of the carers was sent to the kitchen to get some napkins but people told us there had been no napkins up to that point for several days. Staff told us what would be served for each course but did not offer any choice. When the meal came no one was offered condiments or accompanying sauces. We looked for some salt but only found one pot in a side cupboard, which was actually a pepper pot but had salt in it. When the meal was served the plate was cold but the meal was hot. People were quite Care Homes for Older People Page 19 of 35 Evidence: surprised at this and thought the meal must have been microwaved, as they said the meal was normally cold before it was served. Lunch was cauliflower soup followed by braised beef, mashed potatoes, mushrooms and carrots and the meal was tasty and enjoyable. We tried a spoonful of the Eves pudding served for dessert and found that somewhat stodgy but quite edible. The manager did acknowledge that there had been problems with the provision of food. The kitchen in the New Windsor currently produces all the meals for both the New Windsor and Marple Dale Homes and is not large enough to cope with the workload. The manager was confident that the plans Barchester had in place to upgrade the kitchen facilities would provide a better dining experience and improved quality of food and choice once the work had been carried out. We were told that initially plans had been made to upgrade the kitchens before Christmas but the work had been put back to the second week in January because the work will create some disruption for the people living at both homes. Care Homes for Older People Page 20 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people were able to make complaints they did not always feel they were fully addressed and they did not have the confidence that changes would be made that would improve the service. Evidence: The complaints procedure is displayed in the reception areas of the home and is also provided in the homes service user guide. However, of the 6 people that returned surveys 5 said they did not know how to make a complaint, although 1 said they did and that the procedure was clearly displayed. Other comments were I am never informed. I wanted to complain but had no help to do it, If I did I would worry about doing it and not told. One person wrote that they had Always been satisfied with the treatment given. In answer to the question Do you know who to speak to if you are unhappy? responses were The care staff dont listen and not aware of any person who can be spoken to. In the AQAA the manager said that since Barchester took over the running of the home residents and relatives had felt able to complain and that their complaint would be dealt with. From the complaints log it was clear that at least some people knew how to make complaints as there were a number of complaints recorded. However, we saw from the minutes of meetings and from letters sent to the manager Care Homes for Older People Page 21 of 35 Evidence: that a number of complaints had been made, where the complainants did not feel their concerns had been fully addressed and it had not been acknowledged clearly enough that the issue they raised was valid. The manager and senior managers of Barchester did seem to be aware of the main issues people were not happy about and felt they had plans in place to improve in these areas, but some of the complaints have been repeated for a number of months and people wanted to see positive changes now and not some time in the future. Although some major work was planned to address certain issues, small things had still not been adequately addressed. For example we saw from the minutes of one resident/relative meeting held in July 2008 that most people had said they wanted to be helped to use the toilet before meals so they would be comfortable whilst eating, and would like suitable condiments and sauces served with meals. We did not see either of these things happening. The day before this inspection some staff had attended training in safe guarding adults and the manager said there was ongoing training for all staff in this topic. Staff that we spoke to were aware of the signs to watch for that someone may be being abused and knew what action to take if they suspected abuse. Care Homes for Older People Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and comfortable home where ongoing refurbishment is being carried out. Evidence: In the AQAA the manager said that since Barchester took over the running of the home all of the top floor of the Main Hall had been refurbished, wide screen televisions had been installed in the lounge areas in all the units and a wide range of new equipment and soft furnishings had been bought such as hoists, profiling beds, crockery, linen and towels. We carried out a partial tour of the home. Most areas were clean, tidy and comfortable for people to enjoy relaxing in. The home was nicely decorated for Christmas and looked festive and cheerful. Bedrooms in all the units were warm and cosy and people had been encouraged to personalise them. The Main Hall was very homely and each room had its own character. The top floor had been completely refurbished and all bedrooms had been redecorated and had new carpets, curtains, bed linen and furniture. One room on the ground floor did not have Care Homes for Older People Page 23 of 35 Evidence: curtains up at the window as the person living in the room tended to pull them down. The nurse in charge said they would be getting blinds put up in the room and this needs to be done as soon as possible to ensure the persons privacy. The two bathrooms had been upgraded and provided excellent bathing facilities for people. There were 2 lounges on the top floor but one was very small with room for 2 armchairs and the other was also quite small and the amount of usable floor space was further reduced due to the sloping ceiling which created low head room. This room was cluttered with too much furniture, some of which was inaccessible as other furniture was standing in front of it. On the second day of our inspection new dining tables, dining chairs and armchairs had arrived for the lounge/dining room on Balmoral. The satellite kitchen that staff use at the present time to serve meals from that are delivered from the kitchen in The New Windsor home, was dirty and untidy with wheelchairs, pressure cushions and boxes stored in it. We returned to the home on the first day of our inspection at 9.05 pm. We were concerned about the security of the building, as we walked in unchallenged through a side door on the Balmoral unit and were in the home for at least 10 minutes before we saw any staff. Some people were still up and sitting in the lounge at the far end of the building. Staff said they found it difficult in the evenings, until everyone was in bed, because due to the size of the building and the length of the hallways, when they were helping one person get ready and go to bed others were left unsupervised for some time. This problem was further exacerbated because the nurse call at one end of the building could not be heard by staff at the other end. We discussed this with the manager who said work was due to be carried out to rectify this so all the nurse call bells would be audible in any part of the building. Clarence House was well maintained, clean and cosy. New armchairs had been provided for people living there, and as with all other units a new wide screen television had been bought. All the 6 people that returned surveys said the home was always or usually fresh and clean. Comments included Usually sufficient, very clean, very nice, Excellent, super job and good standard maintained and accidents are dealt with promptly. Three full time maintenance people and one full time and one part time gardener are Care Homes for Older People Page 24 of 35 Evidence: employed that work between Marple Dale Hall and The New Windsor. Care Homes for Older People Page 25 of 35 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. Some care staff were not yet sufficiently well trained and their inexperience and need for support and supervision led to a risk that peoples needs were not always met. Evidence: Before we did this inspection several relatives had telephoned us with concerns about the staffing levels in the home. The complaints log also contained a number of letters from relatives with concerns about the perceived shortage of staff and the impact this had on the care delivered to people living at the home and the maintenance of their personal and health care. Whilst we were at the home we received the following comments: When I want to go to the toilet Im waiting hours. I am left waiting and waiting. I do a lot of sitting and waiting. Staff dont come when the bells are rung. They are short staffed - kindness itself but so busy sometimes I feel sorry for them. They are so short staffed there is never anyone coming up to see if you are alright - you have to wait until you send for them. Of the 6 people that returned surveys 2 said staff were usually available when they needed them, whilst 3 said they sometimes were and 1 said they never were. Comments included Too busy but always promise to come back but never do, 8.30Care Homes for Older People Page 26 of 35 Evidence: 9pm not able to get hold of them - too busy and no one will come, not sufficient, takes too long to arrive they say no staff available and absent only in times of crisis - calamity/sudden illness just occasionally means a little wait is unavoidable before non-urgent needs are met. Examination of the staff duty rotas for the weeks commencing 17/11/08 and 24/11/08 showed that in principle all three units in the home (Balmoral, Main Hall and Clarence House) were sufficiently staffed. However it is recommended that the manager takes other factors into account when deciding how many staff are needed on each unit, for example the layout of the building in Balmoral means that staff have to walk long distances between one end of the home and the other. Also as the nurse call system can not be heard by staff in all parts of the building additional staff may be necessary to ensure people are appropriately supervised and checked on. Certain times of the day such as meal times also present challenges to staff in serving meals and helping people to eat them in a timely way. One staff member returning a survey said mealtimes could be difficult. The skill mix and experience of staff should be also be taken into account. Since Barchester took over the running of the home a lot of staff have left due to contractual arrangements made by the previous owners. Barchester have had to address this and have been proactive in recruiting new staff but this has taken time. It was recognised that a lot of the staff are relatively inexperienced and a home trainer had been appointed who is in the process of creating training files for each staff member. Training is seen as a priority by the organisation, and the home trainer said she intended to work with individual staff showing them basic practical skills. The new management structure also incorporates an Assistant General Manager and a Clinical Services Manager and if they work closely with staff on the units as well, staff will be trained to a level that meets peoples needs as quickly as possible. It was acknowledged that training records were not yet up to date as records had been incomplete when Barchester took over the running of the home and training was being arranged and was being delivered on an ongoing basis. Two staff personnel files were examined. Both contained the documents and evidence necessary to ensure that people recruited were suitable to work in a care home. It was reported that out of 50 care staff 20 (40 ) have successfully completed NVQ training. New staff should be encouraged and supported to undertake National Vocational Qualifications so they have the skills and background knowledge to deliver good care. Care Homes for Older People Page 27 of 35 Care Homes for Older People Page 28 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good systems were in place to ensure the health and safety of people living and working at the home. People living at the home and their relatives did not always feel that communication from the management of the home was sufficient to inform them and reassure them that changes were being made to improve and develop the service. Evidence: The manager has just been registered by us after demonstrating that he had the skills, knowledge and experience to manage the home. A couple of people said they saw the manager around the home occasionally but many of the people we spoke to said they did not know who the manager was. Minutes from a recent residents/relatives meeting showed that people were quite annoyed that none of the senior managers of the home had attended the meeting. Although most people knew who the unit managers were and felt they were trying to answer their questions and concerns, they felt that the unit managers could not answer a lot of their queries Care Homes for Older People Page 29 of 35 Evidence: as they did not have the authority to speak on behalf of Barchester and were unable to give them all the information they needed about when changes and improvements would be made. As stated in the section about Complaints and Protection some people expressed dissatisfaction that previous complaints and issues had not been dealt with and sorted out. This was also evident from the minutes of residents/relatives meetings, for example at a meeting on 23/7/08 most people said they wanted to go to toilet before their meals to ensure comfort when eating. They also said they would like suitable condiments and sauces with meals. One visitor told us her relative was still not helped to go to the toilet before meals and when we had a meal on Balmoral on the first day of our inspection we were offered no condiments or sauces and none were provided on the dining tables. This was discussed with the manager, assistant manager and the deputy operations director for Barchester. Following the last residents/ relatives meeting a newsletter had been produced to give people updates on some of the progress made since Barchester took over the home and we were told about other ideas that were being put in place to make sure people knew about changes happening in the home. We did acknowledge that as the manager also manages The New Windsor Nursing Home, which is in the same grounds, the site was a big area to get round and ensure everyone had the opportunity to meet with him. Barchester has systems in place to review the quality of the service delivered to people. In the AQAA we were told that monthly internal audits (checks) were made and that Barchester had recently appointed a compliance officer to undertake audits in line with the National Minimum Standards and Care Homes Regulations. We were told that Barchester carry out satisfaction surveys annually but we did not see any feedback from these as responses are sent back to an independent company to analyse and report on and the report was not yet available. Small amounts of money were held in the home for some residents. It was reported that receipts were kept for all transactions but we did not examine these in detail at this inspection. Systems were in place to ensure Health and Safety policies and procedures were maintained. A Health and Safety Committee met regularly and various personnel had been delegated responsibility, for example to deliver training and to analyse accidents and determine if risk factors could be reduced. Since Barchester took over the running of the home a lot of work has been done on the environment to ensure it meets Health Care Homes for Older People Page 30 of 35 Evidence: and Safety requirements, for example radiator covers and window restrictors have been fitted, fire doors repaired or replaced and electrical remedial work has been completed. Staff were seen using safe working practices and said they had enough equipment to carry out their jobs safely. A team of maintenance personnel work between The New Windsor and Marple Dale nursing homes and ensure that the buildings and equipment are serviced and maintained to a high standard. Records of checks made in respect of fire and health and safety were available and up to date. The manager returned the AQAA to us on time and it contained detailed information about the improvements that have been made since Barchester took over the running of the home. Although we felt small parts of the AQAA were aspirational in that they reflected the service as the manager is aiming for it to be rather than how it actually is at the present time, the manager had recognised most of the areas that still needed development and had indicated how he was going to make improvements. Care Homes for Older People Page 31 of 35 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 32 of 35 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 9 13 Complete, clear and accurate records of medication administration must be maintained. This will support the safe administration of medication. 22/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 Staff should make sure that peoples personal care needs are carried out according to their care plan and that the care delivered is properly recorded so it can be reviewed accurately. Handwritten entries should be signed and countersigned to reduce the risk of errors. The times that medicines are administered should be monitored to help ensure they are administered at both the right and best times. Consideration should be given to the day that medicines deliveries are made to the home, to ensure there is enough time to address any discrepancies before the medicines are 2 9 Care Homes for Older People Page 33 of 35 actually needed. 3 15 Further consideration should be given as to how the choice and quality of meals provided to people living at the home can be improved to meet with their expectations and wishes. The manager should continue to promote and develop the complaints procedure and be very clear in all responses to complaints, where action has been taken, the expected timescales for any action and how this will improve the service. This will give people confidence that their concerns are being listened to and acted on. The security of the home should be reviewed to ensure that staff are aware of all visitors entering the buildings. The nurse call system should be upgraded to ensure that on each unit it is audible to staff in all parts of that unit. Staff rotas should be written to take into account the skill mix of staff and to ensure that less experienced staff are appropriately supported and supervised until they have received sufficient training to enable them to carry out their jobs competently and effectively. The manager should continue to encourage and support staff to undertake National Vocational Qualifications so they develop skills and have a good knowledge of how to provide care to a high standard. 4 16 5 6 7 19 22 27 8 28 Care Homes for Older People Page 34 of 35 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. 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