Inspection on 01/10/08 for Primrose House Nursing Home

This inspection was carried out on 1st October 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

Primrose House Nursing Home 02/10/07

Primrose House Nursing Home 27/04/06

Primrose House Nursing Home 13/10/05

Primrose House Nursing Home 20/04/05

Primrose House Nursing Home 03/12/04

Primrose House Nursing Home 06/05/04

Primrose House Nursing Home 15/05/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Primrose House Nursing Home 765-767 Kenton Lane Harrow Weald Middx HA3 6AH     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: Judith Brindle     Date: 0 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 36 Information about the care home Name of care home: Address: Primrose House Nursing Home 765-767 Kenton Lane Harrow Weald Middx HA3 6AH 02089544442 02089545376 hassam.cader@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Hassam Cader Type of registration: Number of places registered: Mrs Raziya Banu Cader,Hassam Cader care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 23 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Primrose House Nursing Home provides nursing care for up to 23 elderly persons, some of whom have dementia care needs. Mr and Mrs Cader own the care home. Mr Cader is also the registered manager. The home is a large detached house close to Harrow Weald. It has three floors, with lift access. There are 17 single rooms, and 3 shared rooms. There are bedrooms on each floor. Four bedrooms have either an Care Homes for Older People Page 4 of 36 Over 65 0 23 23 0 Brief description of the care home ensuite toilet or an ensuite toilet and bath. Communal rooms are located on the ground floor. The care home has a large, accessible, well maintained garden. There is parking for several cars on the forecourt of the home. Information and documentation about the service, and the fees are available from the care home. Care Homes for Older People Page 5 of 36 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 unannounced key inspection took place throughout a day in October 2008. There were two vacancies at the time of the inspection. An expert by experience was invited to take part in the inspection process, and accompanied us during the visit to the care home. An expert by experience is a person who has a shared experience of using services, and can help an inspector get a better picture of what it is like to live in a care home. Key parts of the report written by the expert by experience following this inspection, will be used as evidence to support judgements made in regard to the service provided to residents by the care home. The inspection focused on spending a significant period of time with people living in the care home, and observing interaction between residents and staff. We were pleased to Care Homes for Older People Page 6 of 36 speak to several residents, visitors and staff. A number of the people using the service, have significant communication needs. Some were unable to respond to questions other than to a limited degree, so observation was a significant tool used in this inspection. Documents inspected included residents care plans, risk assessments, staff training records, and some policies and procedures. Staff were very helpful during the inspection, and supplied all documentation, and information requested. The inspection included a tour of the premises, carried out with the expert by experience,and the care home manager. Prior to this inspection, the registered manager supplied the Commission for Social Care inspection with a completed Annual Quality Assurance Assessment (AQAA) document. This includes required information about the quality of the care home, and of plans to improve, and develop the service. All sections of this document were comprehensively completed. reference to some aspects of this AQAA will be recorded in this report. A number of feedback surveys were supplied to the care home prior to this inspection. These requested feedback from people using the service, health and social care professionals, and staff. At the time of writing this report, we had received 14 completed surveys from people using the service, 8 surveys from staff, and one from a health professional. Information from these surveys will be included in this report. Other information received by the Commission for Social Care Inspection (CSCI) about the service since the previous inspection was also looked at. This included what the service has told us about things that have happened in the service, these are called notifications, and are a legal requirement. The registered manager was present for most of the inspection. The inspector thanks all the people living in the care home, visitors, and staff for their assistance in the inspection process. What the care home does well: What has improved since the last inspection? Inspection requirements from the previous inspection have been met. The garden area continues to improve. A variety of plants have been added to the area, and a gazebo with a seating area, has been constructed. The home has continued to make efforts to improve the signage in the home, taking in account of residents varied needs. The dementia care needs of people using the service were judged to be more understood and better met since the previous inspection. Resident’s care plans, particularly the care plans of people who have dementia care needs, have continued to be further developed and improved. People living in the care home are given more opportunities to be involved in meaningful daytime activities of their own choice, and according to their individual interests and capability. The care home has employed an activity co-coordinator. The numbers of staff achieving appropriate NVQ (National Vocational Qualification) training has continued to increase, which ensures that staff have the opportunity to gain knowledge and skills that enable them to provide the care and support that people using the service require. The management of resident’s monies has been reviewed, to ensure that there are transparent and safe systems in place. Care Homes for Older People Page 8 of 36 There have been some development made to the premises. This includes the redecoration of several bedrooms, some new carpets laid, and some improvements made to the kitchen. The home has employed an administrator/management staff member, who within the short time he has been employed has instigated a number of significant developments, which have improved the quality of care provided to people using the service. He and the manager/owner are aware of further developments to the service that can be made, and have plans to put these in place. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 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 the service and their representatives have the information needed to decide whether the home will meet their needs. The format of this information could be developed to improve its accessibility to residents. People using the service have their needs assessed prior to moving into the care home, which makes certain that the home knows about the person, and the support that they need. Some equality and diversity aspects of this assessment could be further developed. Evidence: The care home has a service user guide, which provides information about the service provided for residents by the care home. The format of this information should be further developed to improve its accessibility to people using the service, particularly those who have difficulty in reading or whose understanding of English is limited. Care Homes for Older People Page 11 of 36 Evidence: We saw copies of the service user guide documentation in the bedrooms of people using the service. A care plan of the most recent person admitted to the care home was looked at in detail. The manager/owner told us of the process of admitting a person. He informed us that following receipt of a referral (generally from the Local Authority primary care team), he carries out an initial assessment of the prospective resident. He told us that the care plan information about meeting the immediate needs of new residents is recorded and verbally communicated to staff, and that a comprehensive care plan is developed within approximately two days. A nurse also spoke of the process of admitting residents to the care home. Staff feedback informed us that they received up to date information about the needs of people that they support. AQAA (Annual Quality Assurance Assessment) told us that the pre-admission assessment includes new references to the Mental Capacity Act legislation, with regard to consent and capacity. The AQAA told us that the home ensures that it is able to meet the needs of the prospective resident. The care plan file of the newly admitted resident contained initial pre admission assessment information carried out by the home and assessment/discharge information from the hospital. It was evident that the assessment information (including a dependency assessment) was comprehensive, but there could be more information about the equality and diversity (spiritual, gender, age, sexual orientation, race and disability) needs of the prospective resident. This was discussed with the manager and administrator. The four care plans inspected, were very detailed, and included assessment with regard to the health, personal care, emotional, social and cultural needs of the people using the service. There was evidence from these care plans that residents and/or family members/significant others had been involved in this assessment process. The administrator told us that involving relatives/significant others (with the residents agreement) in regard to gaining knowledge and understanding of the persons needs was very important, particularly when a resident has significant communication needs. A relative of a resident told us that they had participated in the process of initial assessment of a family member. Care Homes for Older People Page 12 of 36 Care Homes for Older People Page 13 of 36 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. Each person using the service has a plan of care, which set out the health, personal care , emotional, and social needs of residents. People using the service are respected and their right to privacy upheld. People using the service are protected by the home’s policies and procedures for managing and administrating medication to people using the service. Evidence: The care plans of four people using the service were looked at. There was evidence that since the previous key inspection there have been improvements (particularly with regard to the care plans of the residents who have dementia care needs) made to these documents. AQAA (Annual Quality assurance Assessment ) documentation told us that the home has made some improvements in ensuring that the equality and diversity needs of Care Homes for Older People Page 14 of 36 Evidence: residents are met. These include improving our disabled access to the home, and having created two books with pictures and translated words for our ethnic non English speaking residents. We were told that there were plans to make further developments including developing signage in the home in a variety of languages. The manager and administrator spoke of plans to continue to develop the care plans. The format of some of the care plan documentation could be developed to improve the accessibility of information to residents who have difficulty in reading. It was also evident that care plans had been reorganised since the previous inspection (October 2007) so that the information is more easily accessible to staff. The care plan files recorded moving and handling, and pressure area needs, nutrition, falls, swallowing difficulties, oral health care, continence, behaviour, financial, cultural assessment and other dependency level assessments. There was also individual strength based care plans for those residents who have dementia care needs. Generally, comprehensive staff guidance to ensure that these assessed needs are met, was documented in the care plans that were looked at. There were records of visits made by the GP, chiropodist, optician, dentist, tissue viability nurse and care manager. We were told that due to their medical needs, two residents were being ‘barrier’ nursed. The expert by experience noted that ‘there was clear signage to this effect on their bedroom doors’. The home’s pre-assessment information also detailed whether someone had been admitted to the care home with pressure sores. Individual body maps and a record of any treatment administered to residents were documented. The manager spoke of providing appropriate pressure relieving equipment for residents. He told us that he had ordered eleven pressure relieving mattresses for the home. The manager informed us that the home provides specialist beds for residents, which ensures that it is safer for staff and residents when people using the service are assisted in and out of bed. The home has three hoists, (used for transferring residents with mobility needs), which we, were told are serviced every 6 months. The manager notified us that a new ‘hoist’ had recently been purchased. A hoist was observed to be stored in a resident’s bedroom. This practise should cease. Records confirmed that resident’s care plans, and risk assessments are reviewed regularly. Residents weight is monitored closely, and individual nutritional assessments are recorded. Care Homes for Older People Page 15 of 36 Evidence: The care plans are reviewed monthly. It could be more evident that the residents participate in the review of their care plan. Day and night records are completed by staff in regard to the progress of each person living in the care home. A relative told us that the ethnic and diversity needs of his family member were being met by the care home. The administrator spoke of being in the process of making accessible to staff some information/words in a number of languages; to improve and meet the various communication needs between residents and staff. This is positive. We observed that staff interacted with residents in a sensitive manner and with respect to their privacy. Staff were observed to knock on doors prior to entering bedrooms, but during the tour of the premises we noticed that the manager did not always knock on the bedroom doors. We were sure that he may have known the residents were in the lounge, but there should still be an awareness of privacy in case a resident had chosen to go to their room. A call bell was tested and found to be in working order. Call bells were answered fairly promptly during the inspection. The manager told us that there was an intercom system combined with the call bell system, which enabled staff to communicate with each other when working on different floors of the care home. The medication storage and administration systems were inspected. Medication is stored securely, and the care home has a medication policy/procedure. We were told that the care home had recently changed it’s pharmacist, and that the majority of medication was now administered via a ‘Monitored Dosage System in which single dosages of medication for each resident is dispensed by the pharmacist. A nurse told us that this system was working well. She spoke of the robust checks that are carried out with regard to ensuring that the medication storage and administration systems are safe. Registered nurses administer the medication to residents. We were told of the recent medication training that the trained nurses had received. Records of medication received into the home and disposed off were seen. We were told of the process of ensuring that all residents newly admitted to the home receive all their prescribed medication. Appropriate and required systems are in place for the administration of ‘Controlled’ medication. The care plans inspected recorded death and dying needs. We were told that the home was in the process of ensuring that these needs would be recorded for all the people using the service. Care Homes for Older People Page 16 of 36 Care Homes for Older People Page 17 of 36 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. People have the opportunity to take part in a variety of preferred activities. The visiting arrangements are flexible and meet the needs of visitors and residents, so as to ensure that residents have the opportunity to develop and maintain important relationships. People using the service are supported to make choices. Meals provided are varied, nutritious, and wholesome, and meet the cultural preferences of people using the service. Evidence: There is an activities programme. Records and talking to staff informed us that there has been significant development with regard to ensuring that people have more opportunity to participate in activities of their choice. The administrator spoke of the on going development in improving opportunities for people using the service to access community based facilities including local shops. He gave us examples of residents recently being accompanied by staff to go to local shops. This is positive. Care Homes for Older People Page 18 of 36 Evidence: There was better evidence of individual activity/leisure needs being identified in the care plans inspected. We were told by the administrator and AQAA information that an activity’s cocoordinator was now employed, and that this staff member, and care worker had recently undertaken training entitled ‘memories are made of this’, which was a ‘reminiscence’ training course. We were informed that individual/personal ‘memory’ bags had been produced for residents. These included items and pictures from the person’s life. Personal photographs have been laminated for residents, so that they could easily handle them whenever they wished. These memory bags were accessible to the residents. The administrator spoke of the progress made in ensuring that residents could participate in varied preferred activities. We were shown photographs of residents enjoying celebrating a variety of occasions, including religious festivals. During the inspection residents were observed to have the opportunity to receive ‘pastoral care’ from representatives of the Roman Catholic Church. We were told that the home had made arrangements for residents to receive visits from a Church of England vicar. Records told us that resident’s have the opportunity to discuss preferred activities during resident’s meetings. We were informed that the hairdresser visits the home every two weeks. A resident told me that she had recently had her ‘hair done’, which she said made her ‘feel better’. There a two large televisions in the communal sitting room. It was noticeable that the televisions were not on all the time, and that music was listened to at various times of the day. Residents were observed to enjoy the music, and one resident danced to some of the tunes. The activity coordinator was not on duty during the inspection. Care staff were seen to spend some ‘one to one time’ with residents during the inspection. Residents were seen to be supported in taking short walks, and to spend some time looking at books. A resident spoke of enjoying reading his daily newspaper. A resident and staff told us that a library service regularly visits the home. There were a number of people who were in their rooms. Those spoken too, said they preferred to stay in their bedrooms. One person said he liked watching television in his Care Homes for Older People Page 19 of 36 Evidence: bedroom, and preferred not to go into the communal sitting room. Staff were observed to interact with residents who chose to stay in their bedroom. Some feedback received following the inspection informed us that a person felt that staff could be more ‘chatty’, and their general attitude better, when they provided care and support to people who chose to remain in their bedrooms. The manager should examine ways of ensuring that all staff develop their understanding of the social staff/resident interaction needs of the people who choose to remain in their room rather than spend time in the communal sitting room. The expert by experience spent time talking to people in their own rooms, and in the communal area. Comments from talking to the residents included a person saying that they were ‘quite happy at the home’, and another resident commented that he/she was ‘well fed and looked after’. A resident showed her his own personal telephone, which he said made him feel ‘more at home’. Another resident said that she was ‘very happy’, and ‘loved the staff’ who were ‘very kind’. The visitor’s record book confirmed that there were frequent visitors to the care home. A visitor spoke of visiting the care home at different times of the day. We spoke to four visitors during the inspection. They all made generally positive comments about the care that their friend and or family member received in the care home. A visitor told the expert by experience and I that he was ‘happy’ with the care that his relative was being given. Another visitor said that ‘things have really improved over the last six months’, and that he/she felt that their friend/relative was ‘quite well cared for’. Feedback from a visitor told us that they felt that the home could be more proactive in contacting family members/significant others about the progress of their friend or relative, particularly if they were unable to visit regularly. A visitor commented that the last Christmas party could have been better as the ‘entertainment was ‘not always the right type’. We discussed this with the administrator who told us of the developments, and improvements that had been made with regard to the celebration of a variety of events and occasions including spiritual/religious festivities. We were shown photographs of residents enjoying recent parties and celebrations. Residents kindly spoke of the visitors that they received. Work experience students visited the home during the inspection and spent time with people using the service. Residents have access to a telephone. Staff were observed to offer a variety of choices to residents during the inspection. It was evident that since the previous inspection the cook has continued to make improvements with regard to the variety of meals provided to residents. There is a pictorial display of the meals provided each day. Care Homes for Older People Page 20 of 36 Evidence: It was evident that people using the service have more opportunity to be involved in choosing their preferred meals. The cook was observed to ask each resident what he or she wanted to eat on the day of the inspection. The cook spoke with us about her role and of how she had recently involved residents in the recent review of the menu. She was knowledgeable about meeting the resident’s cultural, and religious needs with regard to their meals. The cook spoke of how she ensures that all residents receive fresh vegetables and fruit. There is a daily record of the residents’ meal choices, and food eaten by them. The cook told us that she has built up a portfolio of photographs of meals and foods to use as a tool, when she talks to the residents about their meal choices. The cook spoke of the importance of involving relatives and others in finding out the particular food preferences of residents, who because of their needs might have difficulty in communicating this information to her. She told us that she had close liaison with the relatives/visitors of residents and frequently cook recipes of meals that met their cultural needs, and preferences. A relative spoke to the cook during the inspection about her relative’s cultural nutritional needs, and food preferences. This visitor was very positive about the care that his/her relative received and commented that the ‘home is like her/his own home’, and that their relative was ‘very happy’. The visitor confirmed that the cook will ‘happily prepare dishes from her/his (relative’s) home country’. The cook spoke of teaching herself to cook a variety of dishes from various countries so as to meet the needs of residents, and she spoke of baking cakes regularly. The cook confirmed that that there are food items with which the residents can have snacks. She was knowledgeable of the particular dietary needs (including diabetic needs, and any food allergies) of residents. The kitchen was seen to be very clean, and has had some improvements made to the work surfaces and cupboards. Care Homes for Older People Page 21 of 36 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 the service and others are confident that their complaints will be listened to, looked into and action taken to put things right, but there could be development in the recording of ‘comments/concerns’. Residents are protected from abuse, neglect and self-harm, and the care home takes action to follow up any allegations. Evidence: The care home has a complaints procedure. This is documented in the service user guide. AQAA (Annual Quality Assurance Assessment) information recorded that the complaints procedure has been recently revised. The format of the complaints procedure could be better developed to improve its accessibility to people using the service. This was a previous recommendation. There was one complaint, which was judged to have been generally responded to appropriately, but there could be better recorded information with regard to whether the complainant was satisfied with the action taken by the care home, and with the result of any investigation. There should be more evidence that the registered person supports and encourages residents and others to communicate any ‘concerns’ that they might have. This was Care Homes for Older People Page 22 of 36 Evidence: discussed with the registered person/manager and administrator. Staff told us that they knew the procedure for responding to complaints from people using the service and from visitors/significant others. Feedback surveys from people using the service told us that they know who to talk to if they are not happy. The care home has a suggestion box located near the front door of the home. Several compliments from relatives/significant others about the care received by their friend or relative were recorded. The care home has a safeguarding adults procedure, and a whistle blowing policy. Records and staff told us that staff receive safeguarding adult’s training, and that they had knowledge and understanding of how to respond appropriately to any suspicion or allegation of abuse. Incidents and accidents are recorded. Care Homes for Older People Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment of the home is safe, homely, clean and comfortable. The premises are suitable for the care home’s stated purpose, resident’s bedrooms are individually personalised, and meet their individual needs, but there are some rooms where redecoration needs completing. Evidence: The front external walls of the home are well maintained. There are several hanging baskets with attractive plants and flowers located at the entrance of the home. There is parking for seven or more vehicles on the forecourt of the home. AQAA information, the manager and observation told us that there had been significant improvements and developments made to the environment. We carried out a tour of the premises with the registered manager. We noticed that there was a lot of signage around the home for the benefit of those who have dementia care needs, and that the home has been decorated in colours that had been advised from the Alzheimer’s Society. The home was clean, tidy and free from odours. There was a domestic member of staff working throughout the day of the inspection. Care Homes for Older People Page 24 of 36 Evidence: The garden continues to be well maintained. We were told that a gazebo with seating had been recently erected. A variety of attractive plants, a water feature, and seating areas were seen in the garden. The garden is accessible by residents who use a wheelchair. We were told by staff, and visitors that people using the service spend time in the garden during sunny weather. The expert by experience noted that ‘bird feeders had been placed in strategic areas which could be seen from the lounge’. Since the previous inspection the conservatory/dining area has had curtain/blinds put up to prevent that area becoming too hot. The curtains of this dining/seating area have been organised to ensure that the residents can have a good view of the garden if they so wish. The resident’s bedrooms that we looked at were generally personalised with photos, ornaments and some had their own furniture. The manager told us that residents can choose to bring a piece of furniture with them into the care home. The expert by experience and I were told that several bedrooms had recently had new carpets fitted. There were some bedrooms that had only partially been redecorated. We were told that this redecoration would be completed shortly. Action needs to be taken to complete this task promptly. The manager told us that an application to the Local Authority with regard to plans to extend and totally refurbish the kitchen had been made. During the tour of the premises we found that there were three radiator covers, which were not secure, and could be of risk to health and safety. We were told by the administrator following the inspection that these had now been secured to the wall. There bathroom area of the top floor felt ‘chilly’ during the tour of the premises. The windows of the bathroom had been left wide open. We were told that this was to ‘air’ the room, and that this bathroom was rarely if ever used. If this bathroom facility is used, the home should ensure that there is a facility for heating it. Later in the inspection the inspector noted that the bathroom window had been closed and that this area was warm. Most rooms in the care home have a thermometer secured to the wall to monitor the temperature of all areas of the care home. In the 2nd floor bathroom there was a specialist bath. This bathroom had a large window with net curtains. Whilst it could not be overlooked by anyone, we felt that a Care Homes for Older People Page 25 of 36 Evidence: blind could be fitted to the window. The expert by experience commented that this ‘would give a more secure/safe feeling to the person having a bath’. The laundry facilities are located away from food storage and food preparation areas. We were told that some articles of clothing are hand washed by staff, and that all garments are marked with the resident’s name. Soap and paper hand towels are accessible, and staff were observed to wear protective clothing such as disposable gloves, when required. The home has an air freshener system. AQAA (Annual Quality Assurance Assessment) information confirmed that staff had received infection control training. Feedback from resident surveys told us that they thought that the home was clean. Care Homes for Older People Page 26 of 36 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. Staff receive appropriate training, and support from their manager to ensure that they have the skills and knowledge to carry out their roles and responsibilities in meeting the varied care and support needs of people using the service. There could be a further review of evening/night staffing needs. People using the service are supported and protected by the care home’s recruitment policy and procedure. Evidence: The staff rota was inspected. This record confirmed that there are generally four care staff, a registered nurse, the cook and the domestic staff member on duty during the day. On the day of the inspection these numbers and skills of staff were on duty, plus the manager, and administrator. The current night staffing continues to be one nurse and one care staff for up to 23 people. We were told during the previous inspection that there was also a care staff member on duty until 9pm, but that this shift had ceased. The manager informed us that several residents go to bed early (between 18.00 and 19.00 hrs). It needs to be evident from records that there are enough staff to ensure that people using the service choose when to go to bed, and that their dependency needs are met. Care Homes for Older People Page 27 of 36 Evidence: Comments from staff feedback surveys included ‘there are instances where you have limited staff on shift’. Other comments told us that staff felt that there were enough staff on duty to meet the needs of people using the service. Staff were observed to interact with residents in a sensitive manner during the inspection. The expert by experience observed that staff in a ‘very calm, caring manner’ managed a situation when two residents had an argument, and ‘thereby diffusing the situation effectively’. Feedback from staff told us that they had a good understanding of treating all residents with respect. Staff surveys confirmed that staff felt that there were good communication systems in the home, including regular staff meetings. Comments included ‘communication is very important and works well in the home’. Staff feedback told us that staff enjoying working in the care home and confirmed that teamwork among the staff was positive. Three staff recruitment files including a registered nurse and a newly appointed care staff member were looked at. All checks that are required to ensure people are protected from harm had been carried out. These included protection of vulnerable adult (POVA) first checks. These files were better organised than during the previous key inspection. Staff feedback told us that required recruitment checks are carried out before they commence employment within the care home. Records confirmed that staff (including the trained nurses) receive an induction. Care staff confirmed that they had received an comprehensive induction programme. We were told that staff sign once they have read key policies, such as safe guarding adults, complaints, health and safety etc. AQAA (Annual Quality Assurance Assessment) informed us that 14 out of 23 permanent staff have achieved an NVQ (National Vocational Qualification) level 2 care qualification, and that there were staff undergoing NVQ level 3 and 4 training. During this inspection staff and records confirmed that they received a variety of training to develop their skills and competency. This training includes infection control training, Health and Safety, fire, palliative care, nutrition, managing challenging behaviour, dementia care, and risk assessment training. Comments from staff surveys included ‘the company provides different training, for example moving and handling training, dementia care, first aid and so many other training (courses)’, and ‘we get training and lectures on a regular basis’. AQAA documentation told us that there were plans to ensure that staff complete equality and diversity training. There is a training plan, and individual training records for each staff member. Care Homes for Older People Page 28 of 36 Care Homes for Older People Page 29 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager/owner is qualified, competent and experienced to run the care home appropriately. Effective quality assurance, and quality-monitoring systems are in place to monitor, develop and improve the quality of the service provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected, and their financial interests are safeguarded. Evidence: The manager is a registered general nurse, and registered mental health nurse and has managed and run the care home for several years. He generally completes the staff ‘in house’ training, and has a management qualification. The AQAA documentation was completed comprehensively and within the timescales set by the Commission for Social Care Inspection. Care Homes for Older People Page 30 of 36 Evidence: The manager spoke of plans to appoint a senior nurse to assist in the management of the care home. Feedback from visitors and people using the service confirmed that the manager was approachable. Comments from staff feedback forms included ‘we have full support from the manager’, and ‘there is a good relationship between the staff and management’. Systems for monitoring the quality of the service are in place. This includes staff training, monthly medication audits, and accident monitoring, maintenance review, reviewing records, care plans and staff training needs. Staff meetings and resident meetings take place. The AQAA information told us that the care home’s policies and procedures have recently been reviewed. The manager and administrator confirmed that annual feedback surveys are supplied to stakeholders, and that action is taken by the home in response to the comments received. The administrator told us that senior staff regularly contact relatives/significant others about the progress of their friend/family members, and that relatives/significant others are invited to regular meetings at the care home. There was a meeting planned on the day of the unannounced inspection. The administrator and the manager confirmed that the care home carries out an annual business plan with regard to the service. The care home manages small sums of resident’s monies. The manager and the administrator informed us that resident’s financial affairs are generally managed by family members, or by care managers. A sample of resident’s records and monies held in the home were looked at. It was evident that the management of resident’s monies by the care home had been comprehensively reviewed since the previous inspection. Care plans inspected included individual resident’s financial risk assessments. There has been significant improvement with regard to the recording of monetary transactions of resident’s finances. We were told that resident’s toiletries are now bought individually, and that sometimes residents will go with their key worker to local shops to purchase their toiletries and other items. The care home has a supervision policy and staff sign a supervision contract. Care staff, and records confirmed that care staff and nurses received 1-1 staff supervision, and staff appraisals. Required checks of the electrical and gas systems, and other health and safety checks are carried out. Certificates and service records for appliances and equipment used in the home were noted to be in order and up to date. AQAA (Annual Quality Assurance Assessment) information informed us that staff complete health and safety training. Care Homes for Older People Page 31 of 36 Evidence: The care home has an up to date fire risk assessment. There was a detailed record of all fire safety and other checks carried out in the home on either a weekly or monthly basis. . Accidents and incidents are recorded. Fridge and freezer temperatures are documented. The employer’s liability insurance certificate was displayed and up to date. . Care Homes for Older People Page 32 of 36 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 33 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The redecoration of 01/12/2008 residents bedrooms that have been commenced need to be completed. This will ensure that residents bedrooms are an attractive environment for the people using the service. 2 27 18 The care home needs to 16/12/2008 review the evening/night staffing needs to ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of people using the service. It needs to be evident from records that there are enough staff to ensure that people using the service choose when to go to bed, and that their dependency needs are met Care Homes for Older People Page 34 of 36 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The format of the service user user guide should be further developed to improve its accessibility to people using the service, particularly those that have difficultly reading or whose understanding of English is limited. There could be more initial assessment information about the equality and diversity (spiritual, gender, age, sexual orientation, race and disability) needs of the prospective resident. The format of some of the care plan documentation could be developed to improve the accessibility of information to residents who have difficulty in reading. It could be more evident that the residents if they are able) participate in the review of their care plan. 2 3 3 7 4 10 The hoist stored in a residents bedroom should be stored elsewhere in the care home, to ensure that the resident is treated with respect and that their privacy needs are met. All staff should ensure that they knock on residents bedroom doors prior to opening the door, so it be evident that they are aware of and respect residents privacy needs. 5 12 The manager should examine ways of ensuring that staff develop their understanding of the social staff/resident interaction needs of the people who choose to remain in their room rather than spend time in the communal sitting room. The format of the complaints procedure could be better developed to improve its accessibility to people using the service. There should be more evidence that the registered person supports and encourages residents and others to communicate any ‘concerns’ that they might have. 6 16 Care Homes for Older People Page 35 of 36 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 © (2008) 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. 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