Inspection on 11/08/09 for Rowanweald Nursing Home

This inspection was carried out on 11th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rowanweald Nursing Home 09/10/07

Rowanweald Nursing Home 06/07/06

Rowanweald Nursing Home 09/09/05

Rowanweald Nursing Home 20/04/05

Rowanweald Nursing Home 22/06/04

Rowanweald Nursing Home 19/05/04

Rowanweald Nursing Home 13/01/04

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 26/11/2009.

Key inspection report Care homes for older people Name: Address: Rowanweald Nursing Home 1 Weald Lane Harrow Weald Middx HA3 5EG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ram Sooriah     Date: 1 3 0 8 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 34 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. 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 Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Rowanweald Nursing Home 1 Weald Lane Harrow Weald Middx HA3 5EG 02084248811 02084248585 rob.adams@sanctuary-housing.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sanctuary Housing Association (trading as Sanctuary Care) care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 45 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 Date of last inspection Brief description of the care home Rowanweald Care Home is a part of Sanctuary Care, a subsidiary of Sanctuary Housing Association. The home was first registered in 1998 for 45 elderly frail residents requiring nursing. It is located in Harrow Weald. The back of the home faces the High Street and entrance to the home is through Weald Lane, a small road off High Street. The home is easily accessible by public transport and by car. It is close to some shops and local amenities. More extensive shopping can be found in Harrow Weald or Harrow on the Care Homes for Older People Page 4 of 34 Over 65 45 0 Brief description of the care home Hill. There is a large car park in the front of the home for more than ten cars. There are maintained garden areas in the front, the side and the back of the home. The building is three-storey high and was purpose built to be a care home. Rowanweald as registered with the Commission, provides accommodation for residents in forty-five single rooms with en-suite facilities (toilet and wash basin). There are three units of fifteen residents each. Pelena and Rheola units are found on the ground floor and the Arden unit is found on the second floor. The first floor of the building, which has two units of fifteen beds each, is leased to and run by Harrow PCT. The home has all the necessary support facilities such as laundry, kitchen and maintenance. It is run by Sandy Vigor, the manager and Denise Tolland the deputy manager with support from the Head Office of Sanctuary Care. The home charges weekly fees of around 750 pounds for private residents, depending on the needs of the residents. It also accepts residents who are publicly funded. They do not have to pay a top-up. At the time of the inspection there were 43 residents in the home. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 key unannounced inspection started at 10:25 on Tuesday 11th August 2009 and finished at 18:10. It continued on Thursday 13th August 2009 from 12:00-16:30. Our last key inspection took place in October 2007 when we rated the service as providing good outcomes for people who use the service. We carried out an Annual Service Review on the 26th September 2008 and monitored the home from notifications about significant events in the home and from feedback from the management of the home and social and healthcare professionals. During the course of this inspection we toured part of the premises and looked at a sample of records. We also talked to three visitors, five residents and four members of staff. When we finished the inspection we gave feedback to the manager of the home. An Annual Quality Assurance Assessment (AQAA) was also received from the service. Care Homes for Older People Page 6 of 34 This was on the whole completed appropriately and was used where possible in writing this report. We also carried out a satisfaction survey and received eleven satisfaction questionnaires from residents, two from social and healthcare professionals and four from members of staff. At the time of the inspection, there was major refurbishment in the home. The main kitchen floor was being replaced, which meant that the kitchen had to be cleared of all equipment and appliances, and a temporary kitchen installed in the staff room. The kitchenette on each unit was also being replaced. The work lasted about three-four days. The manager and staff were making every effort to run the home as normal as possible. We would like to thank all the people who contributed and supported us during the inspection. Care Homes for Older People Page 7 of 34 What the care home does well: The home received many positive comments from residents in our survey. There were three comments that the home does a very good job in caring and supporting the residents. One person said that the home is clean and neat. Two said that the food is good. One person who spoke to us told us that they are always made to feel welcome and that they knew that the home was right for their relative and friend when they first visited the home. The home has a comprehensive statement of purpose and a comprehensive service users guide (SUG). The SUG is offered to all residents or representatives to inform them about the services that the home provides so that they can decide if they would like to receive a service from the home. The preadmission assessment of the needs of residents is carried out to a good standard, to make sure that the home only accepts residents whose needs can be met in the home. As a result the home is quite comfortable in meeting the needs of the residents that live in the home. The home provides a generally homely, clean and warm environment for residents. Residents and their relatives are able to personalise their rooms to make them as homely as they want to. The enclosed garden provide a pleasant area for residents to enjoy. Visitors are made to feel welcome by the manager and her staff and are kept informed of changes in the condition of residents. There is a stable and consistent group of staff that are familiar with the needs of the residents. They receive training in mandatory and clinical areas to make sure that they are competent to do their work. There is regular supervision of nursing and care staff to make sure that they are appropriately supported in their job. The staff team is led by the manager and the deputy manager. The deputy manager provides the clinical leadership to ensure that residents receive a good standard of care. The home liaises and communicates well with other healthcare professionals in the community to make sure that the needs of the residents are being met. Staff say that the home is a friendly and pleasant place to work. The manager is approachable by staff, residents and visitors. She knows all the residents and visitors well, and maintains a good relation with them. Staff say that they are well supported by the homes management and that they all feel part of a team. Staff rate the the standard of training that they receive as high. The home has an effective quality assurance and quality control system in place, to measure the quality of the service and to ensure continuous improvement of the service. Health and safety issues are taken seriously and the home makes sure that relevant checks and maintenance of items of equipment are carried out to ensure the safety of all people who use the premises. The six requirements that were imposed during the last inspection have been met. Care Homes for Older People Page 8 of 34 What has improved since the last inspection? What they could do better: Our survey showed that there were few negative comments about the service. One resident who replied to our comment cards said that my relative cannot cut the foodbut does not need minced food. One person said that a few members of staff have a could not care less attitude. Another commentator said that staff could spend more time with my relative. During this inspection we found that the main area that requires improvement is the management of medicines. A number of issues were noted that could put residents at risk. The home should have systems in place to ensure that the management of medicines is robust enough to make sure that mistakes are not made and that residents safety is maintained at all times. We noted that the level of staffs interaction and engagement was not as good at it could have been. There seemed to be an over-reliance on the activities coordinator to address the area regarding stimulation and engagement. The provider should ensure either by training or otherwise that improvement occurs in this area. Three out of the four members of staff who responded to our questionnaires said that at times there are not enough staff to care for residents. Two said that they would have liked to have more time to spend with residents. They say that, as many residents require two members of staff to move since they need a hoist, and as the nurse is busy with medicines or other nursing tasks, they at times do not have the time to be in the lounge with residents and to interact and engage with them. The provision of meals is the area that scored least as compared to all other areas of the survey that we conducted. The second area that scored least is the provision of activities in the home. The management should consider these findings and look at ways of improving the service in these areas. We think that on the whole the home is clean and free from odours, but there are instances when there is an odour on the ground floor and on the Arden unit. The home should ensure that as far as possible there are no odours in the home. Care Homes for Older People Page 9 of 34 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. Care Homes for Older People Page 10 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has all the necessary information to offer to people who want to use its services, for them to make an informed decision about using the service. The needs of all prospective residents are assessed before they are offered a place in the home, to make sure that the home will be able to meet their needs. Evidence: The service users guide (SUG) and the statement of purpose were available in the reception area of the home and we noted that these documents have been kept updated. The manager stated that all residents are offered a copy of the SUG that they can refer to, to find information about the service that the home provides. Ten of the eleven residents who responded to our questionnaires said that they received enough information to help them decide if the home was the right place for them, before they moved in. Care Homes for Older People Page 12 of 34 Evidence: We found preadmission assessments of the needs of residents when we looked at the care records of two newly admitted residents. These were completed by the manager when she visited the residents. She said that the deputy manager and herself both go together to assess prospective residents needs to be absolutely sure that they will be able to meet the needs of the prospective residents. A healthcare professional commented in our survey that the preadmission assessment that the home carries out is useful for the proper preparation of the admission of the resident. The format of the preadmission assessments contained prompts to cover most of the needs of residents and were appropriately completed. The care plans of local authorities that placed residents in the home or discharge letters from hospital were also noted in residents care records. Residents that are admitted to the home are mostly referred to the home by local authorities. This is confirmed by the information in the AQAA that shows that the overwhelming majority are funded by a local authority. However, some people did confirm that they had the opportunity to choose the care home. Visitors of two residents that we spoke to, said that they were given a number of care homes to choose from, and that they visited a few care homes before deciding to accept Rowanweald. The manager stated that as far as possible all residents or their representatives are given a contract or statement of terms and conditions to inform them of their obligations and rights while a resident in the home. We checked the records of two newly admitted residents and noted that contracts were in place for both residents. All residents who responded to our survey stated that they had received written information about the homes terms and conditions. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans of residents are on the whole appropriately completed with the involvement of residents or their representatives to describe the action to take to meet the needs of the residents. Residents are appropriately supported with their healthcare needs to ensure their welfare. The management of medicines was not always carried out thoroughly to ensure the safety of residents. The end of life care of residents is appropriately addressed in the home although records were at times not that comprehensive. Evidence: We looked at the care records of six residents to find out whether residents receive the care and support that they require and whether the care plans accurately reflect the care that residents receive. The care records were kept in a small office that is present on each unit. We found that the assessment of the needs of residents generally describe the individual needs of residents in sufficient detail to identify the needs of the residents and areas where they need care and support. Care Homes for Older People Page 14 of 34 Evidence: Care plans were generally comprehensive and reflected the needs of residents and the action to take to meet these needs. We found that risk assessments such as nutritional, falls, pressure ulcer and manual handling were in place and that other more specific risk assessments were also in place when there were limitations on the freedom and rights of residents such as when bed rails were used. We noted that manual handling risk assessments often identified that a standing hoist should be used to move residents. We found it difficult to justify the use of standing hoists for some residents because it was not always clear in the assessments, whether residents could weight bear or whether the standing hoist could be used for residents who can partially weight bear. We recommend that the home always clarifies whether residents can weight bear on the manual handling risk assessment and whether the standing hoist can be used with residents who cannot or who can partially weight bear. The care plans and risk assessments are discussed and agreed with residents or with their representatives. The visitors who spoke to us during the inspection told us that members of staff discuss and agree the care of the residents with them and keep them informed of changes in residents condition. Residents generally presented as appropriately dressed and with a good standard of personal care, but at least one resident had a top that was not well ironed. The wardrobes of residents also contained many items of clothing that did not look ironed. The manager stated that she has tried to address this issue recently by reviewing the staff that work in the laundry. We looked at the care plan of a resident with pressure ulcers and noted that there were good records in place including a repositioning regime, information about the equipment in place, progress notes and pictures. There was also evidence that the person had been seen by the tissue viability nurse for advice on managing the pressure ulcers. The care records contained information about the outcomes of referrals to healthcare professionals such as the GP, dentist and optician. There was also evidence to show that referrals to other healthcare professionals such as speech therapists were made as required. Ten of the eleven residents said in the satisfaction questionnaires that staff in the home always ensure that they get the medical support that they need. Both healthcare professionals who sent us surveys confirmed that staff are vigilant and will take action when they have concerns about the care of the residents. Care Homes for Older People Page 15 of 34 Evidence: Residents who had short term care needs and those who were at risk of loosing weight had care plans in place to address these needs. This is good practice. During the last inspection we made a requirement that suction machines and other equipment be prepared and made readily available for an emergency. The home now has special trolleys on each unit with all the necessary equipment ready to be used in an emergency if required. The home is commended for this. The care records to some extent address the end of life care needs of residents. In two of the care records, the care plans simply mentioned the arrangement for funerals and did not elaborate on the cultural and spiritual aspects of the end of life care or about the fears and expectations of residents for the future. Knowing this information might help staff to better meet the needs of residents with regards to this aspect of care. There was also a few residents in the home with palliative care needs. While one resident had been referred to the palliative care service another with similar symptoms had not. We recommended at the time that the home consider referring the resident to the palliative care service. Notifications about the death of residents show that the end of life care is generally managed well in the home. We looked at the management of medicines on all three units. We noted that on the whole medicines were signed for when administered or a code was used when the medicines were not administered. The codes described the reasons for the medicines not being given. The temperature of the medicines fridges and of the clinical room was monitored and recorded. We noted that the fridge on the Rheola unit was often giving readings of a minimum of 7 degrees centigrade and actual of about 7-8 degrees centigrade. These readings were on the warm side and we recommend that the fridge be adjusted or repaired or replaced to ensure that the optimal fridge temperature is always between 3-5 degrees centigrade. We noted that the amount of at least four medicines did not balance (were more than what should have been in place) with what should have been in place, taking into consideration the number of occasions that these were administered and the amount that had been recorded as received in the home. Some of the medicines were essential to keep the condition of residents stable. This could be because at times, the amount of a few medicines was not carried forward from a previous cycle to provide a total amount at the beginning of a medicine cycle, but in at least one of the cases the medicine had not been administered as prescribed. Care Homes for Older People Page 16 of 34 Evidence: We looked at the management of controlled drugs (CD) in the home. We noted that these were generally managed well but we found an anomaly with the recording of a CD. The medicine was entered on two pages at about the same time and one of the entries made was not very clear. When we gave feedback to the manager, she stated that she would investigate this anomaly. We checked the amount of medicines in stock and noted that this balanced with the amount that should have been in stock. A resident that self-administered their medicines had a risk assessment and an area in their room for the safe storage of the medicines. That is good practice. We found that a resident who had swallowing difficulties and was on a pureed diet and thickened drinks, was being given tablets instead of liquid medicines. We suggested that this be checked with the relevant healthcare professional as this seems to be contradictory. Two residents were in the home on oxygen. We noted that the oxygen was not entered in the medicines chart and signed. Oxygen is treated as a medicine and is prescribed. It should therefore be entered on the medicines administration records charts. Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home seems to offer activities to suit the needs of residents, the level of interaction and engagement of staff with residents was not that good to make sure that residents live as fulfilling a lifestyle as possible. The home provides a variety of nutritious meals to residents while taking into consideration their choices. Evidence: The assessment of needs contains a section about the assessment of the social and recreational needs of residents. There is also a getting to know you form that contains information about the life history of the resident and provides a person centred perspective to the care records. We talked to the activities coordinator and she said that there have been a few outings, a garden party in July and visiting entertainers. There was a programme of activities in the home. With regards to what the home has done about activities the AQAA states We have a programme of favourite outings our service users have suggested. We have introduced coffee mornings where staff from all departments join residents for coffee and a chat. We have improved the ambience of both Pelenna and Rheola lounges by redecorating and replacing furniture. We have added to our Care Homes for Older People Page 18 of 34 Evidence: extensive range of films available for our service users. We however, saw limited interaction and engagement with residents on the first day of the inspection. Staff were mostly busy with checking and providing care to residents in their bedrooms and residents sat in the lounge either watching TV or listening to music. In one lounge the radio and the TV was playing at the same time. These should not be on at the same time as it could be difficult for people to hear particularly if they have an impaired hearing. Feedback from residents and other people suggests that that the interaction and engagement is generally left to the activities coordinator. As she was not in during the morning of the first day of the inspection, there was little in terms of interaction and engagement. There was supposed to have been a cinema session during that morning and staff did try to set up a film for residents to watch. The feedback from residents and visitors during the inspection also confirmed that there were some very good care staff and a minority that were not so good in terms of their attitudes and the quality of the care and support that they give to residents. The homes own satisfaction survey showed that activities and involvement is the section that scores lowest in terms of satisfaction. 46 of residents who responded to the homes survey strongly agree or agree that the home provides appropriate activities as compared to over 75 who strongly agree or agree that other sections of the survey such as the environment, meals and care and support, are good. Our satisfaction survey of residents showed that the provision of activities is the section that scored second least as compared to other sections of the survey. Six residents always like the activities that are provided in the home, three said usually and two did not respond to that section. We noted that the home has an open visiting policy and that visitors came into the home to see residents. Some visited residents in the communal areas and others visited residents in the bedrooms of the residents. The visitors who spoke to us told us that they are always made to feel welcome in the home. The home had a programme in place for representatives of the main church to visit residents. The kitchen was being refurbished during the inspection and there was a temporary menu as the kitchen could not be used to prepare meals. The temporary menu contained meals that could be easily prepared and frozen meals that needed reheating. There was still some choices for residents to have and we noted that the cultural needs of the residents had also been accounted even though there was a Care Homes for Older People Page 19 of 34 Evidence: temporary menu. We visited the staffroom, that have been cleared to accommodate the temporary kitchen. We noted that precautions were in place to ensure compliance with good food hygiene practices and to ensure the safety of people. In the past the provision of meals has been assessed as good and that residents have the opportunity to choose from a variety of nutritious meals. Copies of the menu that were kindly provided to us by the manager suggest that the home provides a variety of meals to residents. However, feedback from our survey shows that this is the area, where people were least satisfied with, when compared to other areas of the survey. The home regularly arranges residents and relatives meetings. The chef also attends these meetings to get feedback about the meals from residents and their relatives. Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home takes all complaints and allegations and suspicions of abuse seriously and will make sure that these are investigated properly. Evidence: A copy of the complaints procedure is available in the reception area of the home and in the service users guide that is offered to all residents. Each floor kept a record of complaints. We looked at the complaints folders for two units and noted that there has been a number of formal and informal complaints. All were appropriately recorded and evidence was kept to show that they had been investigated and responded to. Residents and visitors said to us that they would speak to the manager or the deputy manager if they had any concerns about the care of residents. Conversation with staff also showed that they would try and resolve minor informal issues but would contact the person in charge when people make formal complaints. Our survey has shown that most people know how to make a formal complaint and that they know who speak to if they have concerns. The AQAA showed that the home has had twenty-three complaints during the twelve months prior to the AQAA being completed. The home keeps records all informal and formal complaints by residents, visitors and stakeholders. The manager states in the AQAA We respond to complaints positively and promptly in Care Homes for Older People Page 21 of 34 Evidence: an honest and open manner. We operate zero tolerance to lack of dignity or respect, we act immediately to investigate any allegation of abuse. According to the manager there have not been any allegations of abuse in the home that were referred to the safeguarding adults team of the Local Borough. Staff that we spoke to were also aware that they have to report all allegations and suspicions of abuse to the person in charge. Our survey of staff that work in the home has also shown that staff knew what to do if someone raise concerns with them. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a programme of redecoration to ensure that the home continues to provide a quality environment for residents. Evidence: The home has a large parking area. This was maintained and the grounds in front of the home was also maintained. We noted that the gardeners were maintaining the grounds of the home on the day of the inspection. There is a small enclosed garden that was maintained and that was well liked by residents and their visitors. We observed a few residents sitting there with their visitors enjoying the peaceful surroundings. The exterior of the building was generally in good condition, but there was a large amount of rubbish to clear out as the kitchen and kitchenettes in the home were being refurbished during the inspection. On the second day of the inspection we indeed noted skips in place to take away the rubbish. The home was on the whole in an acceptable state of decoration. The home has a redecoration plan and the refurbishment of the kitchen and replacing the kitchenettes that was taking place was part of the plan. The manager told us that there are now plans to refurbish the nurses stations and the communal areas, replace divan beds Care Homes for Older People Page 23 of 34 Evidence: with adjustable beds and to purchase more pressure relieving equipment for the home. We noted a lot of items of furniture that were kept in the communal area that had been brought from the staff room and other areas of the basement as the floor of the kitchen was being replaced and the staff room was being used as a temporary kitchen. The manager stated that once all the work finishes in the basement, the communal lounges will revert to what they used to be. The bedrooms of residents were well decorated and personalised. There was evidence that there has been ongoing redecoration. Residents and their visitors were encouraged to bring personal items of the residents to decorate the rooms. A few visitors told us that they did bring personal items of the residents to personalise the bedrooms. Although there was major refurbishment work going on, the home was on the whole clean. We did note that the carpet in some communal areas was not as clean as it could have been and that there was a slight odour on the Arden unit. A visitor and two persons sending questionnaires said that there is at times an odour in the home particularly in the morning. There are sluicing disinfectors on each floor and there are systems in place to encourage hand washing and hand decontamination with antibacterial handrub. The training records showed that staff have had infection control training to ensure good infection control practices in the home. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides staffing levels that are appropriate to meet the needs of residents. The recruitment procedure is on the whole carried out appropriately to ensure that only suitable people are employed in the home. The standard of training that is provided is appropriate to ensure that members of staff are skilled and competent to care for residents. Evidence: There is one trained nurse and two carers on each unit during the day. At night there is one trained nurse and one carer for Arden (on the 2nd Floor) and one trained and three carers for the two units on the ground floor. In addition to these numbers there is a floater from 08:00-14:00 who works on all three units. The manager is fully supernumerary but the deputy manager is partly supernumerary and will work on the units to cover shifts if there is a shortage of staff. Our satisfaction questionnaires showed that seven out of eleven residents said that staff always act on what residents say and that staff are available when they need a member of staff and four said usually or sometimes. Only one of the four members of staff who responded to our survey think that there is always appropriate numbers of staff. Two said that said that they could have more Care Homes for Older People Page 25 of 34 Evidence: staff to spend quality time with residents. Feedback from residents and visitors were on the whole positive about the attitude of members of staff. They say that staff are attentive to their needs and listen to them. One person said that the care could not be better and that the nurses are more attentive than staff in the hospital. There was however one person who commented in the survey about staff attitude not being good. One visitor and two residents also told us about the negative attitude of staff, but this could be related to one member of staff rather than the whole team of staff. Three of the six comments made in our satisfaction questionnaires about what could be improved in the home was about staff. We looked at the personnel files of three members of staff who recently started work in the home. We noted that they all had appropriate records in place. The application forms were on the whole appropriately completed except for one member of staff, where the work history was not as fully completed as it could have been. There was evidence of CRB checks, references, proof of identity and eligibility to work in the country and interview notes were kept. Records show that newly employed members of staff undergo induction. New care staff also undergo the common induction standards as per Skills for Care. Members of staff who responded to comment cards said that the induction appropriately prepares them to work in the home. The manager kindly provided the training matrix of the home and a list of training that has been organised.We noted that most staff had an NVQ qualification in care or were in the process of studying for one. There was evidence of ongoing training in mandatory areas including fire training, manual handling training, health and safety and protection of vulnerable adults. There was evidence of training being provided to carers in clinical areas such as, training in nutrition and hydration and challenging behaviour. We however noted that few members of staff have had training in dementia and in managing continence. Three of the four members of staff who responded to our survey said that they were very satisfied with the standard of training that they receive in the home. The home keeps a programme to ensure that all members of staff receive supervision as required. Conversation with members of staff suggests that they are satisfied with the supervision that they receive in the home. Care Homes for Older People Page 26 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager runs the home in an inclusive and open manner to make sure that the aims and objectives of the service are being met. There is an effective quality management system to monitor the quality of the service that the home provides. The home has good systems in place to manage the personal money of residents to prevent financial abuse as far as possible. The provider ensures that appropriate health and safety checks are carried out and that items of equipment are maintained to ensure the safety of all people who use the premises. Evidence: The manager has now been in post for about four years. She is closely supported by her deputy. She is a trained nurse and has the Registered Managers Award. She has an open door policy and keeps an active presence on all the floors. She was able to discuss the issues in the home and the care of the residents with us in an informed manner. Care Homes for Older People Page 27 of 34 Evidence: There were minutes of staff meetings, residents meetings and relatives meetings. These are not always arranged every three months although the manager stated that she makes an effort to arrange these meetings regularly. The organisation has a quality assurance procedure and a quality management system. A copy of the report following the 2008 annual satisfaction survey that was conducted by the home, was given to us and we have used this to support the findings of this inspection where required. There are also annual audits that are carried out based on set standards that reflect the outcomes areas of the national minimum standards for older people. These audits are carried out by the Quality Assurance Department of Sanctuary Care Ltd. The last annual audit was carried out in May 2009 when the home scored an overall rating of Good. We looked at the management of residents money and noted that the safe has been tidied up and that all the content has been recorded to establish an audit trail. Each resident that has money with the home has a personal record of the money and an envelope to keep the money. Any money in excess of £100 is banked in a main account managed by the Head Office. When the home requires money for the resident then a request is made to the head office to draw some money. All the records were available on file and there was a breakdown of the residents account in terms of people who had money in that account. We looked at the management of the personal money of two residents and noted that the balance of money on the individual record sheet of the residents matched the amount of money in place. Records were in place for each expense that was made on behalf of the residents. During the last inspection we made a requirement for the home to have risk assessment to manage the risk associated with the hot water boilers in the Kitchenettes. These areas were being refurbished as previously written, and we noted that there were plans to place doors to the kitchenettes areas to restrict access to these areas. All health and safety checks were being carried out at the time of the inspection. There were records of weekly fire detector tests, emergency lights test and hot water temperature checks at water outlets to which residents have access to. Care Homes for Older People Page 28 of 34 Evidence: Certificates were in place to show items of equipments were checked and maintain to ensure the safety of people who require or who use the equipment. A fire risk assessment, fire emergency plan and a health and safety risk assessment were available for inspection. We noted that the home had a risk assessment about the work that was being undertaken at the time of the inspection: replacing the kitchen flooring and refurbishing the kitchenettes. This is good practice. We however noted that residents were transferred at times in a few wheelchairs that did not have foot plates. This could be putting residents at risk of injury. On the first day of the inspection we were able to enter the home and gained access to all three units without being challenged. Only one member of staff on one unit asked us who we were after we had been on that unit for a few minutes. The home should be vigilant about visitors to the home to ensure the safety of residents. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 All entries in the controlled 18/11/2009 drugs register must be made carefully to ensure that there are no duplication. To reduce the risk of making mistakes to a minimum. 2 9 13 The amount of all medicines that are carried forward must be recorded. To ensure a full audit trail. 18/11/2009 3 9 13 All medicines must be administered as prescribed, unless there are indications that they should not be administered. To make sure that residents receive the full benefit from their medicines regime. 18/11/2009 4 12 12 The home must review the level of interaction and engagement of staff with residents. 23/11/2009 Care Homes for Older People Page 31 of 34 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 To improve the quality of the social life for residents. 5 38 13 The provider must ensure 24/11/2009 that all wheelchairs that are used to move residents have foot rests unless there are appropriate risk assessments in place. To ensure the safety of residents 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 7 We recommend that the home always clarifies whether residents can weight bear on the manual handling risk assessment and whether the standing hoist can be used with residents who cannot or who can partially weight bear. Residents should always wear clothes that have been appropriately ironed to promote their dignity. Oxygen should be entered on medicines administration records charts as it is a prescribed medicine. It is recommended to check with the relevant healthcare professional whether it is safe for individual residents to take solid tablets when they already have swallowing difficulties and cannot manage solids. The temperature of all medicines fridges should ideally be between 3-5 degrees centigrade and not at the top part of the safe range 7-8 degrees centigrade. That the care plans of residents addressing end of life care contain information not only about funeral arrangements but also about their wishes and instructions about end of 2 3 4 8 9 9 5 9 6 11 Care Homes for Older People Page 32 of 34 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 life care as well as their fears and expectations for the future. 7 8 12 15 The radio and the TV should ideally not be on in the lounge at the same time. The home should continue getting feedback from residents about the meals that are provided in the home to ensure improvement in this area The home should as far as possible ensure that there are no odours in the home. That the work history of applicants to work in the home is completed as thoroughly as possible. The home should be vigilant about visitors to the home to ensure the safety of residents. 9 10 11 26 29 38 Care Homes for Older People Page 33 of 34 Helpline: 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). 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