Inspection on 03/12/08 for Nayland House Care Home

This inspection was carried out on 3rd December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nayland House Care Home 05/12/07

Nayland House Care Home 10/01/07

Nayland House Care Home 14/08/06

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Nayland House Care Home Nayland House Off Bear Street Nayland Colchester Essex CO6 4LA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Deborah Kerr     Date: 0 3 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: Nayland House Care Home Off Bear Street Nayland House Nayland Colchester Essex CO6 4LA 01206263199 01206264019 naylandhouse@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ashbourne (Eton) Limited Type of registration: Number of places registered: care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Nayland House is owned by Southern Cross Healthcare and is registered to provide care for 54 older people who may also have a diagnosis of dementia. The home provides respite care as well as 24-hour long-term care. The home has been decorated and furnished throughout to a high standard. All bedrooms are for single occupancy, with en-suite toilet facilities. All areas of the home and surrounding gardens can be accessed via passenger lift, stairwells and ramps. The gardens and courtyards have been landscaped and planted to create places of interest throughout the year. The home has a Statement of Purpose, Service Users Guide and a Southern Cross Healthcare brochure providing information for prospective service users, these are Care Homes for Older People Page 4 of 35 Over 65 0 54 54 0 Brief description of the care home available on request. The current fee to reside in the home ranges from £577.38 to £608.00 per week. Additional charges which are not covered by the fees include hairdressing, chiropody, manicures, toiletries, magazines and papers. This was the information provided at the time of this key inspection. People considering moving to this home may wish to obtain more up to date information from the care home. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced and took place over ten and a half hours on a weekday. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection, including a selection of residents, relatives and health professionals Have Your Say surveys and the Annual Quality Assurance Assessment (AQQA). A number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. During a tour of the home time was spent talking with nine residents, four staff and four relatives. The manager was available and fully contributed to the inspection process. The responsible individual Care Homes for Older People Page 6 of 35 was also present at the home to receive feedback at the end of the inspection. An Expert by Experience, Peter Godden Kent, joined us on the inspection. Experts by Experience is used to describe people whose knowledge about social care service comes directly from using them. Their comments and observations are included in this report. What the care home does well: What has improved since the last inspection? Seven requirements were made following the last inspection. These related to updating the statement of purpose, making sure care plans were up to date to reflect and monitor peoples current needs, the quality of food being provided, making sure complaints were fully investigated and feedback provided to the complainant, to ensure there is a continuous program of cleaning and maintenance of the home and to review staffing levels. The home has taken action to address all of these requirements. The statement of purpose has been amended and provides accurate information about what the service provides. Entries in the complaints log identified three complaints have been made about the service, since the last inspection. These have been fully investigated and a detailed response provided to the complainant, with satisfactory outcomes. New care plans are being introduced with improved documentation which reflect peoples current needs in a person centered way. There have been improvements to the recording and monitoring of peoples health. Improvements have been made to the internal decoration of the home, including refurbishment of bedrooms and new flooring laid in the dining areas. However a relatives Have Your Say survey and people spoken with during the inspection commented, improvements are being made to the interior decor, but I would like to see improvements to the gardens, these seem a little neglected. A previous requirement was made for a review of staffing levels to ensure there are adequate staff rostered to ensure call bells are answered within acceptable time limits and to meet the needs of the people using the service. Nurse calls were monitored during the inspection, these were responded to promptly. Residents, relatives and staff provided mixed information about staffing levels in the home. The manager confirmed staffing levels are being increased to eight staff during the waking hours and four staff at night, which will include a senior member of staff. New care staff are in the process of being recruited, in the mean time the home will be using bank staff and agency to cover shifts. Care Homes for Older People Page 8 of 35 At the previous inspection in December 2007, people using the service and their relatives told us they were concerned about the lack of a permanent manager and a general deterioration in the service regarding cleanliness, maintenance of the environment and the quality of the food. Discussion with people using the service and their relatives provided positive feedback about the manager, comments included, the atmosphere in the home has improved, it is certainly better and good to see a consistent managers presence and the manager responds well to concerns, they have regular relatives meetings and surgeries, I feel kept informed. Other comments included, the manager is very helpful, they answered all my questions, when I visited for my initial visit, they seemed very professional and organised, which gave me confidence in the running of the home and the staff are exceptional, my relative feels secure and happy, which is very important for them, as they have dementia. They are treated with great respect, which is wonderful for us both. They could not be cared for better, I think Nayland House is a wonderful care home and the manager is very approachable and extremely good, I have no complaints at all. A previous recommendation was made for 50 of staff to be trained at National Vocational Qualification (NVQ) level 2 and should complete the induction training in line with Skills for Care, Common Induction Standards. Information provided in the AQAA and verified at the inspection confirmed that Southern Cross have developed their own induction training program, which meets the requirements of the Skills for Care Induction Standards. Information in staff files confirmed that new employees had completed their induction training within the first six weeks of their employment. Additionally staff have been encouraged to complete an NVQ. In total the home employs twenty three care staff, twelve staff have completed NVQ level 2 or above, with thirteen staff staff currently working towards completion of the award. These figures reflect there has been in improvement in the number of staff qualified, which meets the National Minimum Standard (NMS). Nayland House has become a member of the National Association for Providers of Activities for Older People (NAPPA). The association offer advice on activities, which promote mental and physical stimulation, choice and independence for people living in residential care. The activities co-ordinator has incorporated some of their suggestions into their activities schedule. What they could do better: The administration of medication is generally well managed within the home, however, closer monitoring of medications, such as eye drops needs to be undertaken to ensure these are used and discarded in line with the pharmacies instructions. The home is generally well equipped with aids and equipment to maximise peoples independence, however more consideration needs to be given to environmental factors relating to the size of rooms available and compatibility with peoples wheelchairs and the positioning of fixed hoists. This will ensure people have enough space to move around their room independently. An assessment needs to be completed by a suitably qualified person, such an Occupational Therapist to ensure the environment is suitable to meet the individuals needs of people who have moved rooms. Care Homes for Older People Page 9 of 35 During the inspection radiators in rooms 11 and 15 were identified as not working. An immediate requirement was made for these to be repaired within 24 hours. The manager contacted us confirming repairs had been completed to room 11, however the radiator in room 15 needed further attention. The occupant of this room in agreement with them and their relative has moved to an alternative room until the radiator can be repaired. The manager must ensure radiators are checked periodically to ensure they are in good working order to provide adequate heating for the people living in the home. The manager must confirm in writing that the necessary repairs to room 15 have been completed. The grounds and exterior of the home should be kept well maintained, tidy, safe and attractive. 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 who may use this service and their representative are provided with information and an opportunity to visit the service to help them decide if the home will meet their needs. Evidence: The homes statement of purpose has been updated to provide potential and current service users with information specific to Nayland House. This information informs people clearly about the service they can expect, quality of accommodation, qualifications and experience of staff and how to make a complaint. People moving to the service are also provided with a home pack, which includes the homes brochure, service users guide and the terms and conditions of residence. Three people living in the home were tracked as part of the inspection process. Their care plans and personal files confirmed each person had had an assessment completed Care Homes for Older People Page 12 of 35 Evidence: prior to moving in to the home, to ensure the home is able to meet their assessed needs. Files also contained proof that each person had been issued with a contract between them and Southern Cross, which included their fee, the role responsibility of the provider and the rights and obligations of the individual. People spoken with confirmed they or their relative had been provided with the opportunity to visit the home before making a decision if the home was right place for them. They told us, our relative looked around the home for us, we are very happy with the service so far, the staff are very good, they are lovely and helpful. The home does not provide intermediate care. They do however provide a respite service. People spoken with using this service told us, I am very happy with the service, If I need to move permanently into residential care I will be happy to move back to Nayalnd House and the staff are lovely and the food is good, I am very happy here. 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. The health and personal care people receive is based on their individual needs. Evidence: The care plans of the three people were examined. Each contained detailed information setting out the action required by care staff to ensure that all aspects of the individuals health, personal and social care needs are met. Previous requirements were made for care plans to be kept under review, to reflect where peoples needs changed and to monitor their health and well being. A review of care plans is ongoing, new paperwork is being introduced to further develop these, with the aim of providing a more person centered approach. These are being written from the residents point of view describing their needs and preferences and how they wish these to be met. Training is being provided to staff to coincide with the development of the plans to ensure they are familiar with person centered approach and how to use the care plan documentation. To ensure people receive appropriate health care, including specialist health care, Care Homes for Older People Page 14 of 35 Evidence: where required and to meet their dietary requirements, relevant assessments and health monitoring charts were being completed, these are being reviewed on a regular basis. Daily records are well written and provide a good overview of how each individual has spent their day, they also document the care provided and give an indication of the individuals health and well being. Staff spoken with were able to give a verbal account of the needs and preferences of individual residents, they were also clear about their responsibilities to ensue people are treated with dignity and respect at all times. The interactions between residents, relatives and staff were observed to be friendly and appropriate. People in the home are able to access health care services. Dates and details and outcomes of appointments had been clearly recorded in peoples care plans. For residents unable to leave the home, the local General Practitioner (GP) and district nurses make regular visits to the home. Information in care plans and a tour of the home confirmed, people had been provided with pressure relieving equipment, where required. The home has an efficient and comprehensive medication policy in place with detailed procedures for staff to follow when ordering, storing and administering medication. The practice of administering medication is generally well managed. Medication Administration Records (MAR) were inspected and found to be completed correctly, with no gaps. Staff had made good use of the reverse of the MAR chart to reflect if medication had not been administered and the reason why. Photographs of residents had been attached to the front of their MAR chart to avoid mistakes with the persons identity. Medication is stored in a purpose built medication room. The room and the medication fridge temperatures are being checked and recorded daily. Medications that need to be stored in the fridge, such as eye drops were checked. One box of eye drops which had been opened on the 10th October, stated these needed to be discarded after four weeks of opening, however these were still in use. No person living in the home is currently prescribed controlled drugs. The Controlled drugs cupboard was checked, no medication was being stored within, however the controlled drugs book reflected a balance of controlled drugs for three people. The returns book however reflected these had been returned to the pharmacy. A recommendation was made at the previous inspection for the palliative care and end of life needs of residents needed to be further discussed to establish peoples wishes at the time of death and dying. Evidence was seen in care plans that there has been some discussion around this issue. Care Homes for Older People Page 15 of 35 Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines of daily life and activities offered provide people who use this service with a lifestyle that meets their expectations and which meets their social, cultural and recreational interests. Evidence: Nayland House has become a member of the National Association for Providers of Activities for Older People (NAPPA). The association offer advice on activities, which promote mental and physical stimulation, choice and independence for people living in residential care. The activities co-ordinator has incorporated some of their suggestions into their activities schedule. This was confirmed in the schedule for November, which included, coffee mornings, a Body Shop party, join us for tea and toast, knitting club, remember 5th Nov with fine dining of bangers and mash , sherry and quiz, cake making and decorating. The schedule also shows entertainment brought into the home, such as a company called, Clear Productions, who put on a show featuring songs from hit musicals from the 1920s-1950s and sing a long sessions. In addition, Money Spinners a clothes shop visits the home, and regular sessions of games, word puzzles and films take place. A notice board outside the conservatory advertised a list of festivities leading up to Christmas, which included a supper party, mince pies and Care Homes for Older People Page 17 of 35 Evidence: mulled wine, a Christmas quiz, hand bells, an evening of carols performed by the Leavenheath Beavers and a cheese and wine evening. People spoken with confirmed they had attended the, Beavers carol singing and had enjoyed the evening. A relatives and residents notice board, in the entrance hall advertises events and information. These include Church of England Communion held weekly, and services such as the hairdresser, manicures and chiropody. People shared their experiences of living in the home and what it was like for them. They told us, I get everything I need, I have known many of the staff for years, they are nice and friendly, and are respectful of my privacy and dignity when supporting me with personal care and the food is very nice, the chef is helping me to monitor my diet. Other people told us, I sold my home when I moved here, I am very happy, there a lot of helpers, I am very comfortable and the staff are very kind. and the food is good, I have what I like, we always have a choice, I do enjoy the food and I cannot moan about the food, we are offered choices and we can always have more. A relative commented, we are very happy with the service, I am able to visit my relative every day, the carers are very nice and the food is very good. Relatives Have Your say surveys told us I feel confident if any thing happens I will be contacted straight away and staff are very considerate of my relatives needs, very understanding, without being condescending, they listened to them and provide the support and reassurance they need, my overall impression is that staff meet peoples different needs. Other comments included, staff at the home create a caring and happy environment for elderly people and especially people with dementia. When I visit I never see anybody unhappy or under stress. There is a good atmosphere in the home, one of concern yet enabling people to be as independent as they possibly can be. The lunchtime and evening meal was observed. Sherry was offered to all people living in the home prior to lunch. Mealtimes are a social affair, people were observed engaged in conversation and visitors were seen to join their relative at mealtimes. Meals looked appetising, with choices offered. The expert by experience spent time with people in The Cottage having lunch. People told them, the food was nice, but can sometimes be unimaginative, particularly the evening meal, which is normally, sandwiches and soup, but is food always served hot and food is very good, with good sized portions and we can always have seconds. The evening meal was observed and people could choose to have a jacket potato, or sandwiches or soup, with cake to follow. The majority of residents chose roast pork and vegetables, followed by jam sponge and custard for the mid day meal. The mealtime was very conversational, none of the residents appeared to require assistance with their meal and were allowed time Care Homes for Older People Page 18 of 35 Evidence: to eat their meal at their own pace. They were only offered the next course when they were ready. Staff were observed talking with people and were aware of their individual preferences. People told the expert by experience they were happy withe the service they received , some people commented about the garden being neglected. They were very complimentary about the staff, commenting staff are very caring and thoughtful. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service can be confident that complaints will be listened to and acted on and are protected from abuse. Evidence: Southern Cross have detailed policies and procedures in place for dealing with complaints, whistle blowing and safeguarding adults. The complaints procedure is displayed around the home and is incorporated into the Service Users Guide. The Safeguarding Adults Protocol includes an Easy Read Guide Say No To Abuse produced by Suffolk County Council and directs people to Social Services, Customer First, if they have concerns about the safety and welfare of an individual. Information provided in the AQAA and verified at the inspection confirmed the manager has an open door policy and that relatives and residents are encourgaed to raise their concerns, issues or worries. The manager continues to hold weekly surgeries for residents and relatives to raise any concerns they may have. Relativies Have Your say surveys told us I feel confident if any thing happens I will be contacted straight away and staff are very considerate of my relatives needs, very understanding, without being condescending, they listened to them and provide the support and reassurance they need, my overall impression is that staff meet peoples different needs. Other comments included, if I have any concerns, I would raise these with the manager, whenever I have raised issues these have been dealt with. Care Homes for Older People Page 20 of 35 Evidence: A previous requirement was made for complaints to be fully investigated within the given timescales to ensure that complaints are dealt with promptly and effectively. Examination of the complaints log identified since the last inspection there has been three complaints made about the service. The log book showed these have been fully investigated and a detailed response provided to the complainant, with satisfactory outcomes. As well as logging complaints, the home has received eleven letters and cards complimenting the staff for their care, support and kindness. We also received a letter from a relative of an individual living in the home informing us about the exceptional care of their parent at Nayland House. Robust recruitment procedures are in place, including police checks to ensure people working in the home are suitable to be working with vulnerable people. Additionally, staff receive regular safeguarding training to ensure they are aware of the policies and procedures for safeguarding adults. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Nayland House provides the people who live there with a safe, homely and comfortable environment, however an Occupational Therapist assessment needs to be completed of peoples individual rooms, to ensure they have the space and facilities they need for them to be as independent, as they can be. Evidence: Information provided in the AQAA and verified at the inspection confirmed there have been improvements made to the internal decoration of the home, providing the people who live there with a safe, comfortable and homely environment, however a relatives Have Your Say survey commented, improvements are being made to the interior decor, but I would like to see improvements to the gardens, these seem a little neglected. The home is divided into two units, the main house and The Cottage. The Cottage provides accommodation, care and support to people diagnosed with dementia. Work has been completed to extend The Cottage to incorporate a further ten beds, making a total of twenty three single bedrooms, each with en-suite toilet and washing facilities. Communal rooms consist of a dining room and two lounges. There is also an enclosed garden accessible from the corridors, which form a square around the garden. There are two additional bathrooms, one which has a walk in shower and an additional toilet Care Homes for Older People Page 22 of 35 Evidence: for communal use. The main part of the house has accommodation for thirty one older people, these are all single rooms with en-suite toilet and washing facilities. The main house has its own dining room, lounge and a conservatory. Additionally there are five large communal bathrooms, with showers for both assisted and unassisted bathing. All peoples bedrooms are nicely furnished with personal effects, which reflect their individual personalities and interests. The home is nicely furnished, with domestic style furniture, with fixtures and fittings that are of good quality. The home is generally equipped with aids and equipment to maximise peoples independence, including grab rails and other aids, which are available in corridors, bathrooms, toilets and where required, in residents own rooms. These are in the main capable of meeting peoples individual needs, however, to accommodate the extra dementia beds, some residents have moved rooms. One person who had previously occupied a ground floor room, has moved to a room on the first floor. Environmental factors relating to the size of the individuals room, size of their wheelchair, size of the lift between floors and the positioning of the overhead hoist and bed, have caused problems for the individual to move independently around their room and the home. An assessment needs to be completed by a suitably qualified person, such an Occupational Therapist to ensure the environment is suitable to meet the individuals needs. Records were available to demonstrate that checks were carried out on equipment to ensure that it was maintained in good working order. To ensure the safety of people living in the home, all radiators are guarded with purpose built radiator covers, or have low temperature surfaces, which minimises the risk of people falling against them and sustaining burns. Discussion with one relative raised concerns that the radiator in their relatives room did not work and that they had asked on three separate occasions for a heating engineer to be called to repair it. Their relative had been provided with a free standing radiator, however this does not provide a constant temperature and with the winter weather, their relatives room felt very cold. A tour of the premises confirmed the radiators in rooms 11 and 15 were not working, both rooms are currently occupied and although both had been provided with free standing radiators, the one in room 11 had not been switched on. The weather had turned very cold and both rooms did not have sufficient heating to ensure the occupants would be kept warm. The manager was left an immediate requirement to address this issue. The manager notified us on 5th December, that the heating in room 11 had been fixed, however contractors were unable to fix the radiator in room 15. In the interim the manager has discussed and agreed with the resident and relative to relocate to an alternative room until the radiator can be fixed. Maintenance records confirmed hot water temperatures are being maintained with the safe recorded temperatures of 41 degrees centigrade for showers and 44 degrees for Care Homes for Older People Page 23 of 35 Evidence: baths, which minimises the risk of people living in the home being scolded when taking a bath or shower. The premises on the day of the inspection were clean, tidy and free from offensive odours. Appropriate hand washing facilities of liquid soap and paper towels are provided in all en-suite and toilet facilities where staff may be required to provide assistance with personal care. The laundry facilities are clean and tidy with appropriate equipment to launder soiled linen, clothing and bedding. Care Homes for Older People Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The revised staffing ratio will mean their are sufficient numbers of staff available, who are trained and have the skills and experience to support the people living in the home. Evidence: A previous requirement was made for a review of staffing levels to ensure there are adequate staff rostered to ensure call bells are answered within acceptable time limits and to meet the needs of the people using the service. Nurse calls were monitored during the inspection, these were responded to promptly. However, discussion with staff, residents and their relatives provided mixed feedback about staffing levels. The roster showed the average staffing ratio has remained the same, since the previous inspection, with a senior and six staff split between the two units during the day, with three staff at night. An activities co-ordinator is employed in addition to these numbers. The roster showed that due to staff sickness, there were a number of occasions where these numbers fell to five staff on duty. This was confirmed in discussion with staff who told us, staff sickness causes a lot of problems, there are a regular people who report in sick, which puts pressure on the other staff. Additionally, the number of people in the dementia unit has increased, but the staffing ratio has not. Care Homes for Older People Page 25 of 35 Evidence: Observation and discussion with staff confirmed that care staff are still assisting people with their personal care and to get up as late as 11:30am. This is a particular issue in the dementia unit, where staff often have to double up to meet peoples manual handling needs, leaving one person to support the remaining twenty two clients. People using the service and their relatives told us, staff sickness still causes some issues, it would be helpful to have pool staff to fall back on and sometimes appear short staffed, the staff work very hard, especially in the dementia unit, the dementia unit has expanded but the staff team has not. Other comments included, staff listen to what I say, they are very nice, I think there are enough staff and staff are lovely, staffing levels are alright, nice to see consistency, previously the home used a lot of agency staff. This was confirmed by information provided in the AQAA states the home has not used agency staff and are in the process of recruiting more staff. Staffing levels were discussed with the homes manager and responsible individual, they were asked to put in writing what they were doing to address staffing levels in the home. We received notification on the 8th December that new care staff have been recruited and are currently waiting for confirmation of their references and Criminal Records Bureau (CRB) checks. In the mean time the home will be using bank staff and agency to cover shifts. As of the 6th December, with full occupancy staffing levels will be increased to eight staff in the mornings and four staff at night, which will include a senior member of staff. Discussion with staff confirmed they had been recruited fairly and that they received good training and support to ensure they have the skills and knowledge to do their jobs and to meet the different needs of the people living in the home. Most recent training has included care planning, food hygiene, fire safety, moving and handling, safeguarding adults, and health and safety. More specific training to meet the needs of the people using the service has included, dementia, managing challenging behavior, nutrition, equality and diversity and pressure area care. Staff files examined confirmed, all relevant documents and recruitment checks, required by regulations, to determine the fitness of the worker had been obtained prior to them commencing employment. A previous recommendation was made for 50 of staff to be trained at National Vocational Qualification (NVQ) level 2 and should complete the induction training in line with Skills for Care, Common Induction Standards. Information provided in the AQAA and verified at the inspection confirmed that Southern Cross have developed their own induction training program, which meets the requirements of the Skills for Care Induction Standards. Information in staff files confirmed that new employees had Care Homes for Older People Page 26 of 35 Evidence: completed their induction training within the first six weeks of their employment. Additionally staff have been encouraged to complete an NVQ. In total the home employs twenty three care staff, twelve staff have completed NVQ level 2 or above, with thirteen staff staff currently working towards completion of the award. These figures reflect there has been in improvement in the number of staff qualified, which meets the National Minimum Standard (NMS). Care Homes for Older People Page 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service can be assured that they live in a home, which is run in their best interests, by a competent and qualified manager, which is tested by an effective quality assurance process. Evidence: At the previous inspection in December 2007, people using the service and their relatives told us they were concerned about the lack of a permanent manager and a general deterioration in the service regarding cleanliness, maintenance of the environment and the quality of the food. The current manager has been in post for a year. They have the skills and experience to run the home with twenty one years experience in the care sector. They have completed the Registered Managers Award (RMA). Discussion with people using the service and their relatives provided positive feedback about the manager, comments included, the atmosphere in the home has improved, Care Homes for Older People Page 28 of 35 Evidence: it is certainly better and good to see a consistent managers presence and the manager responds well to concerns, they have regular relatives meetings and surgeries, I feel kept informed. Other comments included, the manager is very helpful, they answered all my questions, when I visited for my initial visit, they seemed very professional and organised, which gave me confidence in the running of the home and the staff are exceptional, my relative feels secure and happy, which is very important for them, as they have dementia. They are treated with great respect, which is wonderful for us both. They could not be cared for better, I think Nayland House is a wonderful care home and the manager is very approachable and extremely good, I have no complaints at all. Information received in a health professionals Have Your say survey, was complimentary about the staff and running of the home, they commented, this service supports individuals to live the life they choose, the staff are very good and respond well to the different needs of the people living in the home and the service offers a high quality, flexible, and personal service, and has a good working relationship with other agencies, over all this is a good residential home, I would recommend it highly. The manager continues to inform us of things that have happened in the home since the last inspection, and has shown they manage situations well. They notified us of problems with the water supply to the home. They had contacted the Local Water Authority and were awaiting for them to undertake the necessary remedial works. Babergh District Council, Senior Food and Safety Officer visited the home on 13th October 2008. They notified us following their visit of matters the home needed to address to meet safety standards. These included, improvements required to the water supply and to ensure that hot water was provided, in the kitchen for staff to wash their hands and to wash equipment. They also raised concerns about the cleanliness of the kitchen and the procedure for cooking and reheating meat for the Sunday lunch. Examination of records and inspection of the premises confirmed the problems with the water supply have now been resolved, a deep clean of the kitchen has taken place and the joint of meat is now being cooked from fresh on the Sunday, for lunch and not being reheated. During the inspection the home had a power cut. The manager was seen to deal with the situation well, they were observed giving clear instructions to staff of what they needed to do to support the residents. Additionally, they arranged for a generator to be brought into the home, and arranged for additional staff to provide additional support for residents through the night, however these additional resources were not required as the power was restored within an hour. The home operates an effective quality assurance monitoring process. The operations manager visits monthly to review the service. Residents and relatives are invited to Care Homes for Older People Page 29 of 35 Evidence: attend regular meetings, as well as having the opportunity to discuss concerns at the weekly surgeries. Customer surveys are issued to residents and relatives, to obtain their views about the service. The outcome of the the surveys was positive, with a few minor issues about the external appearance of the home and the garden. People said they were happy living in the home, were satisfied with their surroundings, were able to personalise their rooms, felt safe, had the privacy respected and were able to receive visitors in private when they wanted. Some people commented that they did not always receive their laundry back and sometimes had to wait when they required assistance, but overall they commented they were extremely happy with the service. Relatives commented, our family are very grateful and impressed by the staff and for the care and facilities provided, which makes Nayland house such a warm and welcoming homely place to be and the general care is excellent, my relative is very happy, I very much appreciate all that is done for them and the staff are first class, caring and thoughtful. Other comments included, at this moment we feel positive about everything and my relative is treated well. The home has policies and procedures in place, which safeguard peoples financial interests. The home does not act as appointee for any person living in the home, residents either manage their own finances or are supported by their relatives or have assistance from a power of attorney. Small amounts of money are held by the administrator on behalf of residents who choose to do so, for their convenience. A record of all transactions are kept. Staff files had records to confirm that regular supervision takes place, this was also confirmed in discussion with staff. The documentation reflects that these sessions include discussion of general work objectives, performance and development and identify training needs. Records examined and information provided in the AQAA confirms the home takes steps to safeguard the health, safety and welfare of people living and working in the home. Risk assessments are carried out for all safe working practices with significant findings recorded and the action taken to minimise risks occurring. The most recent Gas and Electrical Safety certificates, including Portable Appliance Testing (PAT) were seen and records showed that all equipment is regularly checked and serviced. The fire logbook showed that the fire alarm, emergency lighting and fire fighting equipment is regularly serviced. Emergency lighting and the fire alarm system are tested weekly and regular fire training and drills take place. Care Homes for Older People Page 30 of 35 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 1 24 23 The registered person must 05/12/2008 ensure radiators in rooms 11 and 15 are in good working order to provide adequate heating for the people occupying these rooms. This will ensure people occupying these rooms will be warm and their health and well being is maintained. 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 The registered person shall 30/01/2009 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This includes using and discarding of medications in line with the pharmaceutical guidelines. This will ensure people using the service, receive their medication, as prescribed by their GP and in line with the pharmacies instructions. 2 22 23 An assessment needs to be completed by a suitably 31/01/2009 Care Homes for Older People Page 33 of 35 qualified person, such an Occupational Therapist to ensure the size and layout of peoples rooms are suitable for their needs. This will ensure people are able to move freely about in their room and access the other parts of the home independently. 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 19 The grounds and exterior of the home should be kept well maintained, tidy, safe and attractive. 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!