Inspection on 22/09/09 for Overslade House

This inspection was carried out on 22nd September 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Overslade House 25/09/08

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Overslade House 12 Overslade Lane Rugby Warwickshire CV22 6DY Lead Inspector Sandra Wade Key Unannounced Inspection 22nd September 2009 08:00 DS0000072901.V376784.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Overslade House Address 12 Overslade Lane Rugby Warwickshire CV22 6DY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01788 522 577 01788 522 507 www.barchester.com Barchester Healthcare Homes Ltd Mrs Janet Hutchinson Care Home 89 Category(ies) of Dementia (44), Old age, not falling within any registration, with number other category (45) of places Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only:Care Home with Nursing To service users of the following gender: Both Whose primary needs on admission to the home are within the following categories: Dementia (DE) 44 Older Persons (OP) 45 The maximum number of service users to be accommodated is 89 2. Date of last inspection 25 September 2009 Brief Description of the Service: Overslade House is a large, detached, purpose built care home set amongst landscaped gardens approximately one mile from Rugby town centre. The home is set back off a busy road and close to local bus stops and schools. Car parking facilities are available near to the entrance of the building. Overslade House offers personal and nursing care to up to 89 people with physical frailty and dementia care needs. The home also admits people for ‘end of life’ care and is working with Macmillan Nurses to achieve the National Service Framework (NHS standards) Gold Standard for Palliative Care The home provides a total of 86 single accommodation rooms with en-suite facilities and includes 22 rooms in the recently built ‘new wing’. Three of the rooms are suitable for double occupancy if, for example, a married couple were to be admitted to the home. The dementia care unit is situated on the ground floor and comprises 43 rooms. The elderly frail unit is situated on the first floor and comprises 43 rooms. There is a passenger lift to enable people to access the upper floors and corridors are sufficiently wide enough to accommodate wheelchair users. There is a large communal lounge incorporating a dining area in each unit as well as another small lounge and dining room in the ‘new wing’ of each unit. Communal bathrooms are located near to lounge and dining areas and these Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 5 have assisted bathing facilities to support people with limited mobility. Written information about the scale of charges was not available on the day of the inspection visit but this information can be obtained by contacting the service direct. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star; this means that people using the service experience adequate outcomes. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place between 8.00am and 7.20pm. Two people who were staying at the home were ‘case tracked’. The case tracking process involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. A completed Annual Quality Assurance Assessment (AQAA) was received from the service prior to the inspection detailing information about the care and services provided. Information contained within this document has been included within this report where appropriate. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, complaint records, maintenance records and medication records. Because people with dementia are not always able to tell us about their experiences, a period of time was spent in one of the lounges to observe what it may be like for people living in the home. Both breakfast and lunchtimes were also observed. A tour of the home was undertaken to view specific areas and establish the layout and décor of the building. What the service does well: People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. One person commented “my daughter found the home and I was given a choice of two or three rooms, staff told me what I could bring in”. Staff were observed to be kind, caring and attentive towards people living in the home. People spoken to were positive about the staff. We were told Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 7 “Mostly there is a caring ethos between staff and residents, some nursing staff are particularly caring”. People living in the home were positive about the care they receive. People told us, “staff help me to get washed and dressed and I can go into the dining room or stay in my room”. “I am very happy here”. “We are well looked after”. A good range of social activities are provided for people to enjoy. We were told, “The activities staff work very well and try to stimulate the patients and it is much appreciated”. “I am being looked after well; I enjoy the trips they take me on” People benefit from a good choice of meals which they enjoy. People stated “quite nice variety”, “they will provide something different if asked, very good that way”. People are provided with, attractive, well-furnished and comfortable surroundings to live in and enjoy. People told us, “the home is generally clean with only occasional smells” and “nice bright, fresh and attractive decoration indoors”. People are safeguarded by robust recruitment procedures. People told us, “Nurses are always most helpful and co-operative and I know I can go to them with any concerns that I might have”. What has improved since the last inspection? What they could do better: Reporting and recording of challenging behaviour incidents needs to improve to ensure this is being identified and managed appropriately to safeguard people in the home. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 8 Where people raise concerns about aspects of their care, these need to be recorded in a complaints or concerns register so that it is clear what actions have been taken to address them. Records relating to the management of medication need to be improved so that it is clear people are receiving their medicines as prescribed by the GP to maintain their health. The systems for recording accidents and incidents need to be improved so that it is clear how many accidents each person has sustained, when and what actions are being taken by the home to address these. Staff induction training needs to be based on the “Skills for Care Common Induction Standards” so that it is clear staff have built up their competencies in caring for people safety and effectively. The are currently less than 50 of the care staff with a National Vocational Qualification (NVQ) II in Care. Action will need to be taken to ensure there are sufficient numbers of staff completing this training to ensure at least 50 of care staff achieve this National Minimum standard. The lighting in the dementia care lounge needs to be improved so that it is sufficiently bright to maintain the health and safety of people who use this lounge. Quality monitoring should be undertaken on an annual basis where the views of people who use the service and their representatives are sought. This is to help ensure the home continues to provide a service which people are happy with. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 were assessed. People using the service experience good quality outcomes in this area. There is some information given to people about the home to help them make a decision to stay. Each person has their needs assessed so that the home can be sure their needs can be met prior to them coming to stay. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: An “Enquiry Pack” is given to people who are interested in staying at the home. The AQAA completed by the manager states “brochure pack is informative, costs are explained”. We found this contained some information about the organisation, care and service provided but there was no information on the range of fees charged by the home. The home should provide a Service User Guide to people who may be interested in living in the home. This should contain a summary of our Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 11 inspection report, Terms and Conditions of Service and a standard form of contract for the provision of services and facilities. Although a Service User Guide was available, we were told this is only issued to people who decide to live at the home. We also found this did not contain all of the required information. The manager said it was usual practice for either herself, the deputy manager or one of the senior staff to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. She explained that trial visits can be accommodated to help the person make a decision. The manager explained that one lady had come to stay for a one month trial before deciding to stay. People spoken to said they had received help from their family to find the home. One person explained they had only been in the home for a short time but they had not had any problems with settling in. Another person said “my daughter found the home and I was given a choice of two or three rooms, staff told me what I could bring in”. They said that the routines of the home were explained to them by staff as they went along. This person indicated they were happy in the home. Another person explained they had come to stay on a respite basis some time before their recent admission. They explained that this short stay allowed them to see what the home was like and they had chosen to stay. They could not remember how they got to know about what went on in the home and the daily routines, they said they “just found out”. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 were assessed. People using the service experience good quality outcomes in this area. People living in the home are treated respectfully and each person has a care plan in place detailing their needs. Some information is not always clear to make sure people living in the home can be confident their health and personal care needs will be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People living in the home looked well cared for. People were wearing clean clothes, their hair was combed and their nails were trimmed and clean. Those people spoken to were positive in their comments about the home. One person said “staff help me to get washed and dressed and I can go into the dining room or stay in my room” and “I am very happy here”. Another person said “we are well looked after”. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 13 Comment cards received from seven people showed that five people felt they “usually” received the care and support they needed from staff and two people felt they “always” did. People told us, “residents physically well cared for, nicely dressed”. “Most staff are focused on the needs of the residents”. “Good care plans showing resident’s needs”. “I am or would like to feel I am very involved in X’s care”. The AQAA completed by the manager states “people living in the home are treated respectfully, care plans identify the needs of residents and staff recognise changes in health and respond accordingly”. We looked at the care files of people identified for case tracking. Care files were standardised and well organised making it easy to identify the needs of people and how these were to be met by staff. Each person had a care plan as well as daily records and monitoring records. Care plans were based on information secured during the pre admission assessment of people and had been supplemented by further assessment on the day of admission. The majority of the information in care files was clearly recorded. One person had developed a pressure sore. Care records confirmed a specialist mattress had been obtained and staff were to observe the sore daily to identify any progress or deterioration of the wound. There were also specific instructions that the person was to lie on their side and a repositioning chart was to be completed every two to four hours. Staff said they were completing ‘turn charts’ indicating which side they were assisting the person to lie on so that staff were clear which position to change them to the next time. A treatment plan was in place for the wound showing what dressings were to be used and how often they should be changed. This stated every three days but discussions with the person and staff confirmed that actually the dressings were being changed daily. A risk assessment had been completed identifying that the person was at risk of skin damage. A nutritional care plan had been devised as part of the actions required to ensure the person had a suitable intake of food and fluids to help promote the healing process. Risk assessments had also been completed for falls and the use of bed rails and bumpers. In one case a person had chosen not to have the bumpers in place (these provide padding against the rails to protect the person from injury). Records showed that staff had discussed this matter with the person and had made them aware of the risks of not having them in place. The person had accepted these risks and staff therefore had respected the person’s wishes by not putting them on the bedrails. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 14 Care records for a second person who had dementia showed they needed some assistance with most of their daily living tasks such as personal care and continence. Care plans showed the staff assistance required and the frequency that the person should be supported. Tasks that the person could do for themselves such as shaving were also indicated so that staff knew to let them independently do this. It was clear from speaking to staff and reading the daily records that this person was not sleeping well during the night and was sleepy during the day. It was also established that the person could display both aggressive and inappropriate behaviour towards staff. The ‘sleeping’ care plan in place did not acknowledge that this person was reluctant to go to bed or the challenging behaviour that could follow due to them being tired. There was no specific record seen for recording any challenging or inappropriate behaviour and staff spoken to confirmed they had not been told to record or report this. It is important that records are kept of any challenging behaviour so that staff can adopt a consistent approach to managing this and prevent other people from being placed at risk of harm. There were clear records in place for a person who had diabetes. The care plan indicated the person’s usual blood sugar readings and gave detailed information on the symptoms of both low and high blood sugar levels. There was also information on actions staff should take if these symptoms should arise so that staff could manage this person’s diabetes effectively. Care records indicated that people had been asked questions about gender preferences for female or male staff. One person spoken to during the inspection had indicated a preference for male support when receiving personal care. It was evident on talking with staff that they knew this and were respecting this wish. Each person’s care file contained a record of contact with or visits by Health Care Professionals. These included the GP, optician, tissue viability nurse specialist and hospital consultants. One person was asked if they are able to see a doctor if they ask for one, they stated “if I need the doctor they will come”. We looked at the systems for management of medicines in the elderly frail unit and dementia care unit. Each unit has its own medication trolley and staff within each unit administer the medicines for people in that unit. A monitored dosage (‘blister packed’) system is used and medication is stored in locked trolleys which are kept in locked clinical rooms. The facility for storing controlled drugs (CD) was satisfactory and a suitable controlled drugs register was in place to record how this medication was being Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 15 managed. Controlled drug medicines for two people were checked and medicines in the controlled drug cabinet corresponded with the quantities recorded in the controlled drug registers. We audited the medicines of two people involved in case tracking by comparing the quantity in stock against the signatures on the medicine administration records (MAR). Although the majority of medicines were being managed well, there were some areas where this was not evident. Where tablets had been prescribed “one or two to be given as required”, it was not clear if staff had given one or two. It was therefore not clear how many tablets the person had received. This is important particularly when administering pain relief medication which can be limited to a specific amount over a 24hour period. On checking the amount of tablets received, given and remaining for one person, there was one tablet short. This could mean that on one occasion they received more tablets than they should have. Medication received was not always clearly recorded on the MAR. This made it difficult to audit that the amount of medication received, given and remaining was correct. A comment card received by us states that something the home could do better is “staff presence until prescribed medication is taken by patients (not just left beside them)”. One person observed had been given their medication in a pot by the nurse and was not taking it. Soon after another member of staff came along to assist and encourage the person to take it. As medication records must only be signed when the person has been observed to take their medicine, the nurse should wait until they have taken it before moving on to the next person. It was evident that staff were ensuring those people experiencing pain were given pain relief. During the inspection one person with dementia complained of head pain. Staff promptly arranged for them to receive pain relieving medicine. Another person given pain relief medicine said this was effectively managing their pain. People living in the home were observed to be treated with respect and their dignity maintained; for example, personal care was provided in private and people were spoken to respectfully. Those people assisted with the hoist were managed safely and respectfully making sure they were appropriately covered when being moved. Staff were very knowledgeable about the people they care for and were observed to be kind, caring and supportive towards them. A comment card received by us states “residents are on the whole treated with dignity and not patronised”. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 were assessed. People using the service experience good quality outcomes in this area. There is a planned programme of social activities led by a team of dedicated staff so that people can maintain some of their interests and wellbeing. People benefit from a varied diet with a good menu choice so that they can enjoy the meals provided. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA states “we are trialling more varied activities that have involved the choices of residents and their families”. We identified that there is a varied range of social activities being provided. The home employs a team of four people to provide social activities. Notice boards around the home detail activities planned as well as outside entertainers and organised trips. For example in one part of the home activities advertised included, Art and Crafts, Musical Bingo, Pamper session, Church Service, McMillan Coffee Morning and Garden lounge Wii Session. Outside entertainers included, Creative mobility every Thursday Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 17 A Pianist Singer, Armchair line dancing and PAT Dogs every Friday. The manager confirmed that church services are held in the home and other requests for religious support are considered. She advised that a Priest visits certain people who have requested this and a nun visits the Catholic people living in the home. We were told that birthdays are celebrated with a cake and if requested small parties for family and friends can be accommodated in one of the lounges if required. The manager provided us with a list of trips that had been arranged and explained that outside trips usually took place each Wednesday. Trips recorded included garden centres, a boat trip twice a year, tea dances in the Town Hall, pub lunches, shopping trips, theatre trips, Walsall lights, safari parks, Coombe Abbey, museums, coffee mornings, Sea Life Centre, Dracote Water, Ryton pools, Botanical gardens, Coventry cathedral, Twycross Zoo and many more. It was evident from speaking to people that they had attended some of these activities and trips. Case files examined documented the life histories of people living in the home and included details of their hobbies, interests and relationships. This is so that staff can use this information when planning a programme of activities that reflects the interests of the people living in the home. The records for one person stated they liked watching sport on the television, and joining in activities where they can. This person confirmed that they did watch the sport and said they had enjoyed a recent canal boat trip. The records of another person who was limited in what they could do due to a health condition stated they liked reading, TV and puzzles. On speaking with them they confirmed they enjoyed visiting the hairdresser twice a week, musical bingo and quizzes. They also said “staff want me to do activities but I do not really, we go out on the bus sometimes but they can only take so many so have to take it in turns”. This person said they had been on a bus trip to Coventry. Comment cards received from seven people showed that four people felt there were “always” activities they could take part in. One person said there were “sometimes” one person said “usually” and one person said “never”. Some of the comments made to us include: “The activities staff work very well and try to stimulate the patients and it is much appreciated” Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 18 “I am being looked after well I enjoy the trips they take me on” One person has suggested that staff should spend more time with people who are unable to join in activities due to their poor health but who still need some social stimulation. On the day of inspection musical bingo took place in one part of the home and a coffee morning was evidenced in another which people seemed to enjoy. We identified that talking books were not in use and there was no hearing loop available in the home to assist people with hearing aids to hear more easily. These issues were discussed with the manager so that they could be addressed accordingly. At breakfast time we observed people in the elderly frail unit and at lunchtime people in the main dementia care unit to see what the dining experience was like. Staff advised that breakfast is usually served at 9am. People had cereal, toast and juice but staff confirmed they could have a cooked breakfast if they wanted one. One person spoken to said “at breakfast there is quite a selection including cornflakes and toast and some have a full breakfast”. A nurse said that they usually ordered a cooked breakfast for those that had one regularly but people had the option each day to choose what they wanted. Staff explained that if people are up really early then they can use the kitchenette areas in each of the lounges to prepare bowls of cereal or drinks for people prior to breakfast being served at 9am. Some people had their meals in their rooms and others in the dining room. Meals were provided to the units in a heated trolley to ensure the meals remained hot when served. At 1pm the main meals arrived and people were given the choice of pork and leek pie or haddock in a mushroom sauce with mixed vegetables, cauliflower and potatoes. Choices were offered by actually taking the two plated meals around to people for them to look at and decide. This made it easy for people to make a choice of what they wanted. The meals looked appetising and suitable sized portions were served. One person who was asked if they liked the food said “quite nice variety” “they will provide something different if asked, very good that way”. Other people also commented that they liked the food. Staff were available to assist people as required. Staff cut up the food for one person and prompted another who periodically was falling asleep. One person was asked “are you ready for your lunch” the carer then went on to explain what was on the plate and started to assist the person to eat. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 19 One person who was shown the meals said “that looks lovely smashing, that’s a lovely one that is” but they would not eat the meal they had chosen despite encouragement and support from staff. Staff asked the chef to cook some scrambled eggs for this person and when this was provided the person ate it without any help from staff. The atmosphere was quiet and calm in the lounge dining room with relaxing music playing in the background. Some people sat in their chairs with small tables to eat and others sat at the dining room table. Comment cards received from seven people show mixed comments about the food. Two people have stated they “always” like the meals, three people have stated they “sometimes” do and two people have stated they “usually” do. One person said they found the food “stodgy” but liked the fish, another has stated “meals good quality and plentiful”. The chef said that menus are printed each day but if anyone wanted something different he would do this. Menus were seen on display in the reception area of the home. It was not evident that staff are recording the meals that people have chosen each day to show that a varied and nutritious diet is being provided consistently. The manager agreed to address this. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. People using the service experience adequate quality outcomes in this area. People living in the home can be confident that their concerns will be listened to and acted upon but records need to demonstrate this so that it is clear a consistent and appropriate response is being taken to safeguard people. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a formal complaints policy which encourages people to raise any concerns with the staff on duty. People were observed to be familiar with senior staff and appeared at ease to make requests of them. This suggests people would be confident in raising concerns with staff. There was no information in the policy on how to make contact with the Local Authority who can investigate complaints if a person does not wish to raise their concerns with the home. The policy also did not contain our up-to-date contact address as required. One person spoken to said they had raised a concern about their care with the manager and she had taken action to address their concern with the member of staff concerned. The person explained they had not had any further problems and they had received an apology. It was not evident from complaints records viewed that their concern had been documented. This is Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 21 important to show that the home are identifying complaints and concerns and are actioning them appropriately to safeguard people in the home. Six out of seven people who completed comment cards for us state that they know someone in the home they can speak to informally if they are not happy. One person states they are unable to do this due to poor health. One person has commented they do not know how to make a formal complaint. Comments from people and their relatives about the way the home manages concerns or complaints include: “it would be nice for residents to have a link care worker who would be able to speak to relatives to discuss resident’s needs …… concerns as sometimes you can speak to many care workers and at times no one knows what you are asking”. Another comment suggests their concerns are not taken seriously and are “brushed to one side”. These comments suggest that a central record where concerns and comments from people and their relatives can be recorded would be helpful. These can then be identified by the manager or senior staff and followed up accordingly to ensure concerns are addressed. Since the last inspection we have received a concern about injuries a person received as a result of a challenging behaviour incident in the home. Records confirmed this had been investigated and actions had been taken to help prevent this happening again. The inspection identified that one person who displayed challenging behaviour did not have a specific care plan in place and these behaviours were not being monitored. The manager has stated in the AQAA that something they could do better is “monitor behaviour more on the dementia care unit”. Action will need to be taken by the home to ensure this now happens so people can be assured they are living in a safe environment. Four complaints had been received by the home, these related to a missed appointment, the management of care for person on respite, inappropriate language by a member of staff and a person in the home being disruptive to other people in the home. These issues had been investigated and actions had been taken to resolve them. The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidences of abuse. Staff training records were seen to demonstrate that most of the staff had received training in recognising and responding to signs of abuse. Staff spoken to knew they needed to report any allegations or observations of abuse to the person in charge. Staff also knew that they should make sure the person affected was made safe. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 22 Since the last inspection the manager has attended training in safeguarding people to make sure any allegations of abuse are managed appropriately and people are not placed at risk. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,22 and 26 were assessed. People using the service experience good quality outcomes in this area. People are provided with clean, attractive, well-furnished and comfortable surroundings to live in and enjoy. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The Service User Guide states that there are 86 single bedrooms, two shared rooms and six lounge/dining rooms. This was confirmed during the inspection. The home is divided into three areas. There is a dementia care unit on the ground floor which is secured by a coded keypad lock and an elderly frail unit upstairs which is not locked. There is also a ‘new wing’ which accommodates eleven frail elderly people upstairs and eleven people with dementia care needs downstairs. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 24 Comments received from seven people about the home’s environment include, “the home is generally clean with only occasional smells”. “Nice bright, fresh and attractive decoration indoors”. “General cleaning of resident’s rooms could be better”. Comment cards received by us show two people feel the home is “always” fresh and clean and five people feel that it “usually” is. It was evident that a lot of time had been spent developing reminiscence areas around the home and in particular in the dementia care units. Areas of reminiscence included a ‘Singer’ sewing machine, soft toys, an old fashioned wedding dress, an ‘Oscar’ area – which has a large Oscar ornament, Hollywood Boulevard area with pictures of Hollywood stars, a baby corner with dolls and baby clothes, a gardening corner with silk flowers and baskets and a sailing area with sailing memorabilia. Some areas of the dementia unit had also been decorated and the manager states in her AQAA that people were asked what colour doors they would like to their rooms. The dedicated reminiscence areas allow people to have lots of areas of interest to look at and to stimulate memories if they should choose to walk around the home. People also have access to a ‘Sensory’ room which can be used for relaxation or as a ‘quiet’ area. This contains a mirrored ball hanging from the ceiling, music system and a picture viewer where pictures can be projected onto a blank wall. There are large communal lounges in the elderly frail unit and the dementia care unit which also accommodate a dining area. In some areas these are small and homely but in others large and spacious making it difficult to achieve a cosy or homely feel. The smaller lounges help people to more easily interact with each other and staff. Although most lounges were bright, clean and decorated to an acceptable level, the lighting in one of the dementia care lounges was reduced and almost gave a ‘dimmed’ effect. This could present a health and safety risk to those with reduced vision as well as make it difficult for people to read their newspapers. The bedrooms of the people case tracked as well as some others were visited. Rooms viewed included both single and double room accommodation. All had en-suite toilet and hand-wash basins and some of the new en-suites also had accessible showers fitted. The rooms were each decorated in a similar way with pale coloured paint and co-ordinating borders, bedding and curtains. Rooms contained nursing beds which could be adjusted to variable heights and some also had specialist mattresses to help in the prevention of pressure sores. Most people had taken the opportunity to personalise their rooms with photographs or small items of soft furnishings to make them more homely. There is a large and attractive hairdressing salon which has pale lilac walls, large mirrors with lights around the outside, a hairdressing sink, hair driers Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 25 and extra chairs. People spoken to said they enjoyed visiting the salon and the opportunity to speak to other people. Gardens seen were secure and had seating areas for people to use in finer weather. Some had raised flower beds so that people can reach them if they choose to do some gardening. The home was clean and fresh throughout. The Environmental Health Officer awarded a Gold rating for Food Hygiene in March 2008, indicating a good standard has been achieved. Systems were in place to manage the control of infection. Staff wore protective clothing when attending to people’s personal hygiene and dealing with soiled laundry. Different coloured aprons were used during food service. The home has a modern, well-organised laundry room with dedicated laundry staff. Separate baskets were in place for clean and dirty laundry although these had not been labelled to ensure the right baskets were always used. Staff agreed to make sure these were appropriately labelled. There were disposable gloves and aprons available as well as a hand-wash sink to allow staff to practice good infection control procedures within the home. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, and 30 were assessed. People using the service experience adequate quality outcomes in this area. There are suitable numbers of staff on duty to support people in the home and staff training is being addressed to demonstrate that staff employed are deemed competent to care for people safely. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: On the day of inspection there were 80 people living in the home. The manager explained that she aims to provide one nurse and six care assistants during the day from 7am to 2.30pm to each of the large dementia and elderly frail units and one nurse and five carer assistants in the afternoon up to 8pm. In the third unit where there are eleven people in the elderly frail and eleven people in the dementia care units staffing arrangements are for two care assistants on each floor plus one nurse during the day. At night they aim to provide two nurses and seven care staff or three nurses and six care staff to cover the whole home. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 27 Duty rotas viewed over a three week period confirmed that these staffing numbers are mostly being achieved with the odd shortfall if staff have been off sick. Of the seven comment cards we received from people, two felt staff were “always” available when they needed them, three stated they “usually” are and two stated they “sometimes” are. Comments included: “Nurses are always most helpful and co-operative and I know I can go to them with any concerns that I might have”. “Mostly there is a caring ethos between staff and residents, some nursing staff are particularly caring”. “This home is very short staffed” “add more staff”. “Better staff to resident ratio so that resident’s who take time to be fed or given fluids are given enough time to do so”. A person who was asked if they could access staff support when needed stated “yes alright at the moment, feel well supported yes”. Another said that staff were “gentle and very kind people”. On the day of inspection there appeared to be sufficient numbers of staff in the areas observed to support people during lunch and breakfast. There were times during the day when there were less staff around than others but this was found to be due to staff assisting people in their rooms. There are dedicated staff to provide ancillary services such as catering, laundry and cleaning. The manager advised that these staff work set shifts seven days per week. Duty rotas had not been routinely completed demonstrating this which the manager agreed to address. The manager also agreed to ensure all staff working in the home are detailed on the duty rota such as the Activity Organisers, the ‘Handyman’ and any other support staff. The AQAA states “all staff receive induction and up to date training” and “our current NVQ qualifications are below the minimum standard but new staff have applied to undertake their NVQ in level II in care”. The manager confirmed there are 50 care staff employed by the home. The National Minimum Standard stipulates that 50 of care staff should have a National Vocational Qualification (NVQ) II in Care. The AQAA shows that five staff have an NVQ II in care and two of the Enrolled Nurses are working as carers. This falls below the minimum standard and means the home cannot demonstrate people are being cared for by suitably competent staff. The manager has stated in the AQAA that there are other staff employed as carers who have achieved an overseas nursing qualification but this training is not Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 28 considered to be equivalent to achieving an NVQ II in care. The manager acknowledges that more staff need to complete this training and training records seen show that there are eight staff who have applied to do this. We looked at the personnel files of two recently recruited staff to confirm that recruitment practices are suitably robust to protect people living in the home. Each file contained evidence that satisfactory pre-employment checks had been carried out before people started to work in the home. This included Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) checks and two written references. Staff training records demonstrated that staff complete an induction programme and receive mandatory training in food hygiene, fire safety, Abuse awareness, infection control and moving and handling. Induction booklets completed by two new staff did not demonstrate they had completed training in line with the “Skills for Care Common Induction Standards” as required. This training allows staff to build up their competences over a number of weeks so they can care for people safely and appropriately. A comment card received by us states “Some of the more …. younger carers need better training about how to speak to residents”. Staff spoken to confirmed they had completed training in various areas since they had started working in the home. One stated they felt confident to work with people because of the training they had done before they started at this home. The home employs several overseas staff. Several people commented about difficulties in communicating with staff that do not speak English as a first language. These comments included: “Patients who are not able to speak very well because of their illness have a hard time being understood and difficulty understanding foreign languages” “As a relative I have difficulty with some of the foreign helpers so it is even more difficult for the patients” Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,37 and 38 were assessed. People using the service experience good quality outcomes in this area. The manager has organisational support to ensure the service is run in the best interests of people living in the home although establishing people’s views of the service has not taken place to demonstrate people are happy with the care and services being provided. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager has been in post for approximately thirteen years and is registered with us. She is a registered general and mental health nurse and has attained the Registered Manager’s Award (NVQ Level 4). She also is an NVQ Assessor and Verifier. Since the last inspection the manager has Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 30 completed further training to update her skills. This includes attending a pilot project to update her leadership skills, safeguarding people and heath and safety training. There are clear lines of accountability in the home with each of the three units having an identified ‘head of unit’ who reports to the home manager. Residents and relatives told us: “Communication between relatives and staff is good in general”. “don’t know if I will be staying here for good it’s expensive but at the moment its ok” “the manager is very good we see her usually once a week” One person said the home was “a good choice” and another stated “I am very happy here”. The manager said that no quality monitoring surveys had been done since the last inspection to gain the views of people, their relatives and staff. She explained that a relative meeting had taken place and there had also been opportunities for relatives to attend social evenings. The notes of the last relative meeting showed that items for discussion included social activities, the laundry system and weight loss of some people. Relatives were informed of plans to improve the range of activities and ways to prevent items being lost in the laundry and systems the home had implemented to help prevent the weight loss of some people on soft diets. Staff meeting notes showed they had discussed, personal care, social activities, hoisting, wheelchairs, nutrition of people, duty rotas and one to one care of a person in the home. Action areas had been identified for each of these areas to ensure the quality of care and services were maintained. It was evident that regular visits are made by the registered provider to assess the quality of care and services provided. A copy of these reports had been provided to the manager with any action points as appropriate. Audits of the service are also undertaken and a nutritional audit was viewed. This identified those people in the home that had lost weight although there were no actions were identified on the audit sheets. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 31 The manager explained that staff are given a copy of this audit and are told to observe people and implement a short term care plan to address concerns. This may include the person being weighed on a two weekly basis to monitor their weight and ensure their food intake is sufficient. She also had spoken to the chef and asked him to get more calories into smaller portions of food. This was confirmed with the chef who advised that one of the changes made was to introduce ‘gold top’ milk as this contained had more calories. The gold top milk was seen in the fridges when viewing the kitchen. The service does not hold personal monies or valuables for people for safe keeping so standard 35 could not be fully assessed. People are invoiced for additional costs such as hairdressing or chiropody. We asked to see records of accidents and incidents that had occurred in the home for those people that had been case tracked. Due to new computerised systems that have been introduced it was not possible for this information to be provided to us. This was due to the system in place not being able to select and extract this specific information. We were also not able to view all accidents and incidents that had occurred since the last inspection to confirm the home were reporting these to us as required. This meant we could not be sure that serious accidents and incidents had been managed appropriately. This was discussed with the manager who agreed to discuss this with the provider. The AQAA showed that all health and safety checks had been completed in 2009. A random check was made to confirm this and checks relating to fire, electrical portable appliances, gas and electrical wiring had all been completed as appropriate. Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X 2 X X 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 3 Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12 Requirement Timescale for action 30/11/09 2. OP9 13 The service must ensure that people who display challenging behaviours are monitored and appropriate actions are taken to address any behaviour that could place people at risk. This is to ensure people living in the home can be sure they will be cared for in a safe environment. 30/11/09 Records must clearly demonstrate how medication has been managed. This includes the number of tablets/capsules that have been administered. This is so that records show medication has been given as prescribed and people who use the service can be confident that their health needs are being met. A risk assessment must be carried out in the large lounge located on the ground to ensue there is sufficient light available to prevent the risk of possible falls and to ensure the environment is suited to the needs of the people who use the service. DS0000072901.V376784.R01.S.doc 3. OP25 23 31/10/09 Overslade House Version 5.2 Page 34 4. OP37 37 This is to ensure the health, safety and well being of people living in the home is promoted and maintained. Effective systems must be in 31/12/09 place for monitoring and recording accidents and incidents which impact on the health and welfare of people who use the service. This is so that people can be confident that any action needed to promote and maintain their health is responded to appropriately. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Medicine Administration Records need to clearly identify how much medication has been received or carried forward. This is so that medication audits can be effectively carried out to confirm people have received their medication as prescribed. Staff management of medication should be audited to ensure medication records are not signed until the person has actually taken their medicine. Records should be maintained of meals that people have had to demonstrate a varied and nutritious diet is being provided consistently. Actions should be taken to identify why people may not always like the food and what can be done to make this a more positive experience for people. The complaints policy should be reviewed to include Local Authority details and our updated address. This is so that people have all the information they need should they wish to have their complaint investigated outside of the home. DS0000072901.V376784.R01.S.doc Version 5.2 Page 35 2. OP9 3. OP15 4. OP15 5. OP16 Overslade House 6. OP16 Clear recording systems should be in place to allow staff to record any concerns or complaints raised by people living in the home. This is so any complaints can be easily identified and the home can demonstrate appropriate action has been taken to safeguard people. A hearing loop system should be available to support people who use a hearing aid so that people have access to the equipment they need to enhance communication and promote their well being. Laundry baskets should be suitably labelled to indicate which are for dirty and clean washing to ensure good infection control practices are maintained. A duty rota which holds a record of all the staff working in the home, including their designation and the number of hours actually worked should be available. So that people who use the service can be confident sufficient numbers of designated staff are available to meet their needs. The service should be able to demonstrate that 50 of care staff have a National Vocational Qualification in Care at level 2 or equivalent. This includes overseas nurses whose qualifications may not be equivalent to the NVQ 2. New staff need to complete induction training based on the Skills for Care Common Induction Standards. This is to help ensure they reach a suitable level of competency to care for people safely and appropriately. Due to the ongoing comments regarding the language barriers between overseas staff and people living in the home. Suitable actions need to be taken to ensure this does not impact on the quality of care and services people receive. 7. OP22 8. OP26 9. OP27 10. OP28 11. OP30 12. OP33 Overslade House DS0000072901.V376784.R01.S.doc Version 5.2 Page 36 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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