Inspection on 14/05/09 for Somerset House

This inspection was carried out on 14th May 2009.

CQC found this care home to be providing an Adequate 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

Somerset House 29/08/07

Somerset House 17/11/06

Somerset House 03/01/06

Somerset House 30/06/05

Somerset House 21/12/04

Somerset House 03/08/04

Somerset House 26/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Somerset House 157 High Street Yatton North Somerset BS49 4DB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sandra Garrett     Date: 1 5 0 5 2 0 0 9 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. 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. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Somerset House 157 High Street Yatton North Somerset BS49 4DB 01934832114 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Wendy Rita Hiles care home 26 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 26 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Somerset House provides personal care for up to 26 people over 65 years of age. The home is a pleasant period property situated off the main road through Yatton, with walled gardens that are well kept. The property has been extensively improved and extended. A majority of rooms are situated on the ground floor. Rooms on the first floor are accessed by a stairlift. for people with mobility difficulties. The premises also have a small satellite home. This is suitable for people who wish to use the support Care Homes for Older People Page 4 of 35 Over 65 26 0 Brief description of the care home offered by the home, but desire a more private form of accommodation. The provider makes information available through a brochure and information pack. The information pack contains the Statement of Purpose and Service User guide and all relevant information about the home. Inspection reports are displayed in the entrance to the home and available for all to read. The fees range between 380 and 440 pounds a week with additional charges being made for hairdressing, chiropody, newspapers, and toiletries. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before the visit, all information the Care Quality Commission (the Commission) has received about the service since the last inspection was looked at. We then drew up an inspection record in preparation for the visit. This record is used to focus on and plan all inspections so that we concentrate on checking the most important areas. We spent one and a half days at the home and spoke with a number of people, manager, deputy manager and staff. We had visited the home before our visit to fill in our Have Your Say surveys with ten people. Their comments, as well as comments from four surveys filled in by staff and one from a healthcare professional, are included in the report. We looked at a wide range of records including: care plans, risk assessments, complaints, staff supervision and training records and health and safety records. The owner and registered provider of Somerset House was unavailable during this inspection. We therefore gave our findings to the manager at the end of our visit. Care Homes for Older People Page 6 of 35 What the care home does well: What has improved since the last inspection? What they could do better: We found from talking with people and staff that overall they get a good quality of care and life in the home and are happy there. However, the way records are kept needs to be improved to show this better and to make sure they are kept safe and protected. As above, only two out of eight good practice recommendations were partly met. The remainder hadnt been adopted. In particular much more work needs to be done to move towards adopting a person-centred approach to care. This means care that looks at a persons whole life, history and needs. It recognises and values them as individuals with rights and choices, rather than just focussing on doing basic physical care tasks. Some care plans were very brief and didnt include all the needs the person had. Risk assessments also need further work to make sure people are kept safe, particularly around mental health issues and self-medication. Yearly care reviews must be held so that people and their relatives can be sure the home remains the right place for them and their needs are met. Care Homes for Older People Page 7 of 35 Menus and the quality of meals needs improvement to make sure people get meals that they enjoy eating. Further, regular meetings with people that live at the home will help them exercise their rights, give them greater choice and help them to know that their wishes and comments are taken on board. Complaints recording needs to improve to show that all concerns and complaints are investigated and clear actions taken within reasonable timescales. Whilst staff were seen to treat people with respect, they need training in personcentred care so that they can better understand peoples rights and choices. Further, staff supervision must improve and regular staff meetings held so that they get opportunities to reflect on their work with people they care for. Checking quality of care and the service provided needs improvement. Survey reports must be published and made available to people and their relatives. Records of the owners visits to the home that are essential for making sure quality is checked regularly must be kept and sent to the Commission as requested. The inspection report should be displayed so that people and visitors are able to see for themselves how we check the service they get and our findings. Where peoples behaviour or health conditions put them at risk and actual events happen that could have a serious effect on them, notices must be sent to the Commission. This will make sure that we can check if needs are met and whether people are kept safe from harm. 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.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 8 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from being given clear information about the home when they come into it. Lack of detailed pre-admission assessments doesnt make sure that the home is the right place for everyone and that staff are able to meet their needs. Whilst people are generally looked after well by staff that are suitably trained and experienced, people with mental health problems or varying types of dementia may not get the same care as others. Evidence: We saw the homes Statement of Purpose. This clearly sets out how people can expect to be looked after at the home and the services on offer. It covers all the elements as laid down in the Care Homes Regulations. It also includes a statement about equality and diversity so that people with cultural, disability, age-related or other needs will Care Homes for Older People Page 10 of 35 Evidence: know that the home will try to meet their specialist needs. The Statement has information about terms and conditions. This includes the four-week trial period that helps people decide if they want to stay at the home and also gives staff information about whether they can meet needs. Information about fees is also set out in the Statement (although not the amount payable each year) and covers all that they include. This is helpful to people who will then know whats covered by the fee and what extras they will need to pay for. Fees from April 2009 are between £380 to £440. We asked people in our Have Your Say survey filled in with them before this visit whether they received enough information about the home before they moved in so that they could decide if it was the right place for them. Comments included: I came here to see it and really liked it so here I am, My family made the decision for me but it was definitely the right one, I did although I didnt really have a choice as my daughter lives miles away, As far as I can remember I came here on the doctors say so but I really cant be certain and: I came here to recover initially but came to realise that I couldnt manage my big house anymore. We case-tracked three peoples records. This means looking at all their paperwork, talking with both them and staff caring for them. This helps us to make sure people are being properly cared for. Case tracking starts with the pre-admission assessment. We looked at those done by social workers for people that are funded by social services. These showed care needs that had been transferred into care plans. They also included lots of information on background, personal history and equality and diversity needs. However for people that pay for their own care we didnt see any full needs assessments. A good practice recommendation had been made at the last inspection about making sure the assessment tool is reviewed to show a more person-centred approach to care. This hadnt been adopted. We did see an admission form that has a graded checklist of issues under different headings. These included medication, communication, social relations, co-operation, temperament,bathing, mobility, feeding among others. The manager said this was the assessment form used. However comments made were brief and didnt clearly show how needs were to be managed by staff. Further, it wasnt clear if all needs were picked up to transfer on to care plans. This meant that another good practice recommendation made at the last visit about making sure full and clear information is recorded to help with the care planning process, also hadnt been adopted. The form also showed judgements were made by the person filling in the form e.g. under temperament we saw seems a very pleasant, kind person. This isnt objective Care Homes for Older People Page 11 of 35 Evidence: or person-centred and doesnt show what needs the person may have for staff to meet. Further, from case tracking assessments and care plans we found that staff hadnt confirmed in writing that it could meet peoples needs. This could lead to difficulty with caring for people with mental health needs or dementia. The home caters for people that are largely independent and dont have lots of specialist needs. One person had specialist needs to do with mental health. Records showed that staff tried to meet her/his needs yet struggled to do so. Another person had memory problems that staff were aware of and had tried to make sure s/he could remain as independent as possible. Staff told us that they had recently done a halfday dementia awareness course that they found helpful. The home doesnt offer intermediate care for people that includes rehabilitation. It does however offer short-term respite care when needed. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Insufficient or inadequate documentation of care plans doesnt make sure staff are given the information they need to care for people. Lack of formal, regular review means that people may not be able to discuss their satisfaction with care given and any changes they want or need. People living at the home are looked after well in respect of their healthcare needs. However, failure to keep risk assessments where people are at serious risk of harm doesnt keep them safe. Whilst medication procedures and practice has improved, more needs to be done to make sure people are kept safe. Whilst being treated with dignity and respect benefits people living at the home, this must be continued in all aspects of their lives. Evidence: We looked at care plans in detail. The manager and deputy were open with us about Care Homes for Older People Page 13 of 35 Evidence: discussions they had been having about improving the plans and making them more person-centred. This had been a good practice recommendation made at the last inspection but had still not been adopted. The manager said she was unsure how to go about the process of updating plans. From those we looked at it was clear they need much more work. Some plans were brief and didnt show how needs were to be met. Care plans although detailed, were written in a basic way that didnt always show how peoples needs, choices, wishes and dignity would be met. Plans had a space for the persons name and keyworker name but werent filled in. They had clear headings that followed on from the admission form. One person had needs relating to her/his family but it wasnt clear how these were actually being managed to meet her/his choice and wishes. We looked at one plan and found it to be inadequate in showing how a persons mental health needs were being met despite clear and detailed pre-admission information from healthcare professionals. The plan didnt have clear detail of the persons needs nor actions to be taken to protect her/him from risk. Further, risk assessments werent in place for effects of the persons mental health and the fact that s/he had frequent falls. The care plan itself merged into a general risk assessment. The overall effect didnt show staff what clear actions needed to be taken to keep the person safe and to meet the needs s/he had said they had. Much of the information we saw about the meeting of this persons needs was written in the daily records. These showed a clear tracking of what happened to the person, effects of her/his mental health needs and the frequent falls. Daily records however didnt make clear that the GP was called promptly during an emergency situation nor what treatment had been prescribed to keep the person safe. The manager gave us more information about the cause of the persons mental health needs. However, this wasnt clearly recorded in the care plan. We spoke with staff about care plans and reviews. Care plans are kept in the managers office. Theyre checked monthly and any adjustments written on them. Staff have a general meeting with the manager or deputy each morning so that they know of any changes. They said that they read plans most days. However, staff said there was no formal review held at least once a year with the person, their relative, keyworker or senior staff member. This doesnt make sure people have ownership of their plan or opportunities to discuss whether it works or any changes they would like made to it. In general, daily records were factual and clear and a separate health visits sheet was also kept to record GP, district nurse, chiropody visits etc. One person had needs associated with a cognitive impairment (this means an undiagnosed condition that could affect their memory and reasoning skills). Records were detailed Care Homes for Older People Page 14 of 35 Evidence: about the persons confusion and behaviour and showed staff had managed one incident well. Apart from the issue about risk assessments above, we also didnt see a risk assessment for a person keeping their own medication. As the person has short-term memory difficulties and staff had had to remind her/him about taking medicines and keeping them safe, a risk assessment is necessary. From reading care plans and discussing them with the manager its clear that there is much work to be done to improve both the information recorded and the way its recorded, making sure theyre fully looked at with the person at least once a year and making them easier for staff to follow. We later sent the manager some examples of person-centred care plans to help her with this. We asked people if they get the care and support they need. Comments included: Yes I do. The staff here are excellent, The staff can be very busy at times but I know they would be there if I needed them especially if I was ill, Yes very well, Yes up to a point but they have a hell of a job here, Yes I do its lovely here they are all so kind its like a home from home and: Yes I do there are no problems there. One person we spoke to told us about her/his keyworker and said shes friendly and does her best. We also asked if people get the medical support they need. Again comments included: I would if I needed it but I am in charge of my own medication, Yes. The doctor comes to see me, Yes. I can see the doctor as and when I want, Yes they would get me a doctor if I needed one, Yes I do as and when I need it and the staff bring me my medication morning and night and: I can see the doctor or the nurse if I feel I need to. We received one survey from a district nurse. The survey was positive about the home and its ability to meet peoples healthcare needs with all boxes ticked as always being met. We followed up a good practice recommendation about medication. Improvements had been made. These were that a new locked medication trolley had been installed in the dining room and chained to the wall there. The administration of medicines is by blister packs supplied by the pharmacy that delivers all medicines to the home. A supplies sheet shows how much is delivered and staff are able to check how much stock is in the home. An issue had been picked up when a person didnt have a Care Homes for Older People Page 15 of 35 Evidence: prescribed medication for a fortnight. The manager had dealt with this as it had been a problem between the pharmacy and the prescribing GP. Two staff always do medication. Medicines were all recorded properly in administration records that showed no gaps. Medicines were stored in an orderly way in proper locked cupboards that are fit for the purpose. However we picked up other issues with medication. In particular the way medicines treated as controlled by law wasnt satisfactory. Records were kept in a diary and the medication itself kept in a locked box within a locked cupboard. Whilst records showed the time and name of person having the medicine, the actual time and only the persons first name were recorded. Further, there was no record of what had been given only the amount. We checked quantities remaining and found them to be right. Two staff had initialled when they had given the medicines although these werent easy to see. We advised the manager to get a proper controlled medicines book and record full names, name of medicine given, actual time and two full staff signatures. The manager later told us the pharmacy were going to supply a proper book. This issue will therefore be followed up at the next inspection. We also saw that the medication fridge didnt have a minimum/maximum thermometer and temperature checks werent being done each day. Again the manager immediately asked the pharmacy to supply this. We also saw that when medication is returned to the pharmacy the reason for it isnt recorded and advised the manager to make sure this is done. We observed staff interacting with people living at the home. People were treated with respect and dignity during our visit. However two people told us they are told off for being late for lunch. (Please see standards 12 - 15 below for more about this). We asked people if staff listen to them and act on what they say. They told us: Yes they do and act straight away, Yes they will and they do, Yes they do straight away, Yes they do. Thats not a problem at all and: They listen but I dont always get the answer that I want, but I have to rely on their judgement. However one person we spoke to told us that s/he is: generally treated well by staff but sometimes they get a bit uptight. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst activities happen, further consultation with people living at the home is needed to make sure theyre happy with the standard of social contact, activity and entertainment offered. Encouragement of contact with the local community helps people stay in touch with whats happening outside the home. Further, few restrictions placed on people living at the home gives them lots of choice in a relaxed atmosphere. Continuing issues with meals stops people from being fully satisfied with the standard of them. Evidence: People commented in our survey about activities: Yes there is usually something going on in the afternoon, They do quite a lot but I dont take part its not my thing, I know there is some but its not my call, I struggle because of my sight but I enjoy doing a bit of folding for the staff and enjoy going out in the garden, Yes there are but I cant wait until the warmer weather because there is a trip out every Monday. We have exercise on Tuesdays, church service on Wednesdays, music on Thursdays and bits and bobs on the other days. They certainly do their best, Yes there are but Care Homes for Older People Page 17 of 35 Evidence: its up to us really what we want to do, You can do what you want and: Theres quite a lot to do but Im quite content doing my own thing and I enjoy being out in the garden. I know a coach trip that runs every Monday in the summer. We also spoke to people we saw going out during our visit. One person likes to go out to the local shop and another likes to go out regularly and chat to people she knows in the community. We had seen a note in the managers message book that a Nativity play had been put on at Christmas and people had enjoyed it. People later told us that this had been held at a local school and they had gone to see it there. Also a local adult group had come to the home and put on a pantomime for people. There is no separate activities record kept to show whether people engage with or enjoy activities provided. Some comments were seen in individual daily records. However these are only recorded for people that take part in activities so dont show overall whether others get regular opportunities for good quality social contact or enjoyment of planned or unplanned social activities. People are free to come and go as long as staff know that they have gone out, for fire safety reasons. People have choice of where to sit in the home, when to get up, go to bed and what they want to do. However, staff that filled in our survey had a different view: More activities and encourage clients to join in more, Provide more social activities and: Would be nice to see more activities, especially in the afternoons i.e. card making, flower arranging and people coming from outside the home to give talks or slideshows etc. The surveys didnt however make it clear whether these activities were ones people had requested themselves. We asked both people living at the home and staff if residents meetings took place. Both groups told us that such meetings arent held at the home although they used to be. This doesnt give people an opportunity to discuss whether they would like different activities or how often. Residents meetings are also a way of checking on quality of the service provided and should be held regularly. We looked at menus and joined people for lunch on the second day of our visit. Menus are of plain, traditional English dishes. Although there is a choice of two main meals at lunchtime one of the choices is always salad. For dessert there is one cooked dish or yoghurt available. We had asked people in our survey about the quality of meals. Comments were mixed Care Homes for Older People Page 18 of 35 Evidence: and included: Yes the food is all right, Yes the meals are very nice, Yes 90 per cent of the meals are ok, its just the odd one I dont enjoy but youre always going to get that, No I dont. The problem is what they serve. They dont seem to take into consideration the residents that have bad teeth, Yes the food is very good, I think they could do with having more cake at suppertimes and they do seem fond of doing tomato on toast, which is better than nothing I suppose, Yes the food is really good and I enjoy it. There is also a lot of variety, Yes the food is very good and: Yes we get good home cooked meals with fresh fruit, vegetables and salad regularly. Whilst the comments reflected individual tastes we found that the meal we shared with people was of poor quality and matched some of the comments. The hot meal was meant to have been fishcake, chips and peas. What was served was fishcake, waffles and spaghetti hoops. None of these were home-made. Some people found the waffles hard to cut and eat and all commented on having spaghetti hoops rather than peas. People agreed that the meal was one more suitable for children.We asked what they thought a score out of ten for the meal would be and most said five. We chose ham salad from the menu, but the ham was re-formed, tinned ham that wasnt tasty or pleasant to eat. People said they always have tinned ham and dont like it much. This was unfortunately on the menu for the following day with bubble and squeak. We spoke to the manager and staff about the quality of the meal.The manager said it wasnt the usual cook on duty that day. Staff told us that there had been no cooked breakfast for the last four weeks. They also said that people are offered different choices, but when asked they usually ask for what they already get. All admitted there were issues with provision of good quality, home cooked meals that needed to be resolved. We suggest that if residents meetings were held regularly menus could be discussed and issues with meals quickly ironed out. Further, the menu should be looked at again to include more meaningful choice of both hot and cold dishes. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of proper attention to publicising the complaints policy or recording complaints, fails to meet peoples needs for action to be taken over them. Improvements in staff training on abuse issues keeps people protected from risk of harm or abuse happening to them. However, failure to make sure staff are aware of their rights to whistleblow may mean abuse isnt dealt with properly. Evidence: We asked people if they know who to speak to if theyre not happy and whether they know how to make a complaint. Comments about who to speak to included: Yes any of them. They are all good girls I cant grumble at anything really, Id speak to the manager or whoever is available, Yes whoever is in charge on the day, I dont really but Id mention it to one of the staff perhaps, I could talk to anyone really, Yes I think if I went to the manager shed sort me out, I would talk to any of the staff and: I would talk to the manager, or one of the other staff. About making a complaint: Id go to one of the girls in charge and ask for some advice, Yes Id talk to my daughter and go from there, Id speak to the one whose in charge of the staff, Yes, not that Id need to though and: Yes I do and I know it would be sorted out. We looked at a copy of the complaints leaflet. This was very out of date and gave Care Homes for Older People Page 20 of 35 Evidence: completely the wrong information about who deals with complaints, referring to us as the agency to contact. It therefore wasnt clear for people or their relatives who to complain to and who had responsibility for dealing with concerns. We discussed this with the manager who produced a new leaflet by the second day. No complaints had been recorded for some years. We saw complaints about the behaviour of a person living at the home recorded in 2005. However these werent made by other people living there and werent appropriate to keep in such detail. One person wanted to speak to us. S/he told us that s/he had been spoken to rudely by a staff member. S/he hadnt reported it to the manager but did tell another staff member. There was no record of the incident or action taken to deal with it. We followed up a good practice recommendation about staff having safeguarding adults from abuse training. Almost all staff have now done the training and those that have not are booked to do so. The home now employs a training co-ordinator who makes sure all essential training is provided. We saw records of the safeguarding adults training on a sheet and in individual staff files. However, the second part of the recommendation hadnt been adopted. This was to produce a whistleblowing policy and to make sure all staff are aware of it. We saw a policy on safeguarding adults that mentioned whistleblowing but not a policy on the issue itself. Staff we spoke to were unaware of what whistleblowing was until we explained it to them. They then said it was done as part of their NVQ training but hadnt seen a policy on it at the home. Staff we spoke to were however aware of what signs to look for that would alert them to the fact that someone might have been abused. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a comfortable, clean, safe environment thats well decorated and looked after and meets their needs. Improved bathroom facilities in individual rooms gives people greater privacy and choice. Good, proper cleaning and hygiene makes sure people are protected from risk of infection. Evidence: Somerset House is a Georgian, Grade 2 listed building. Many of its original features remain. However, a large extension of bedrooms has been added to the back of the house. The home has been greatly refurbished since the last inspection. Eight bedrooms now have ensuite facilities. Several include walk-in showers with toilets and washbasins and the rest have toilets and washbasins. All these were accessible with grab rails and shower seats etc. There are also toilets in the communal areas and an accessible bathroom. The manager told us she planned the refurbishment without losing valuable bedroom space. This is commended as it gives more people homely, good sized rooms with their own private facilities. The home has been decorated throughout that was of a good standard. We followed Care Homes for Older People Page 22 of 35 Evidence: up a requirement about improving the outside laundry room, from the last visit. The room, housed in an outbuilding, has been redecorated, with a new sink unit and washing machine installed. The room looked bright and fresh although we saw that the floor was covered in dust and fluff and the room itself was untidy. Staff said they have to go out in all weathers to take and bring back laundry as its not under cover. The manager told us the stone or concrete floor had been repainted but already this was chipping off. Because of the propertys listing there have been limitations on being able to make the home fully accessible for disabled people. A stairlift is in place that is frequently used by a number of people with upstairs bedrooms (although the majority of bedrooms and communal space are on the ground floor). The dining room is large and bright and leads to a conservatory overlooking the garden. This is used as extra dining space. The lounge is also of a good size although we only saw a couple of people using it while we were there. People like to spend time in their rooms and we met them there. Some people have sight difficulties or mild dementia or cognitive impairment (this could mean a problem with short term memory or behaviours). However there were no signs to help them find their way around. Bedrooms are furnished although people can bring in small items of furniture, pictures and ornaments etc to make their rooms feel more homely. Bedrooms include wardrobes, bedside lockers, armchair, small table and lighting suitable for peoples needs. We saw peoples bedrooms that looked homely, personal and cosy. One person that had not long moved in said she was waiting to have pictures and photos put up on the wall. We did notice that not every room had a lockable space for people to keep valuables or things like medication in. We discussed this with the manager who said some rooms have cash boxes. However she admitted that not every room did and we advised her to make sure each room has a lockable space for people. The home was very clean and smelled fresh. Staff were seen cleaning all areas. No cleaning materials that could be dangerous for people were seen left out. We asked people about the homes cleanliness. They commented: Its excellent. Ive got no complaints there, Yes its beautiful and clean, Yes its very clean, Yes it is, definitely and: Oh yes. You can see its nice and clean cant you?. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from sufficient numbers of care staff to meet their needs. However care staff that dont work as a team fail to meet peoples needs. Satisfactory progress with National Vocational Qualification in Care training makes sure people are looked after properly. Satisfactory recruitment processes make sure people living at the home are protected from risk. Lack of staff training in person-centred care could mean people arent treated as individuals and their rights, wishes and choices respected. Evidence: We asked people if staff were available when they need them. Comments included: Yes Im very comfortable, If they are short I certainly havent noticed, Not always because if two people are calling at the same time it can be chaos and its not fair on the staff really, Yes I think they are youve only got to ask and they will do anything if possible, Its difficult to say really as they have so many duties but yes, I do think so most of the time. You cant complain really, Yes I think they are, They usually are. They do have times when they are a bit short but 9 times out of 10 its fine and: Id say staffing is reasonably adequate and I know that it could be a lot worse. Care Homes for Older People Page 24 of 35 Evidence: From staff surveys we received, one staff member ticked always to the question are there enough staff to meet the individual needs of all the people who use the service? although three ticked usually. No individual comments were made about staffing levels however. On both days of our visit staff were seen in adequate numbers and people didnt have to wait long for call bells to be answered. From the AQAA the manager had written that the improvements made to the home and facilities has improved the staff morale and working conditions. We asked staff if they have staff meetings to discuss issues about their work, staffing levels, training etc. One staff member said she had been at the home for a couple of years but had never known a staff meeting to be held. Staff also indicated there were some issues around working together as a team and lots of unavoidable absences that they felt hadnt been resolved. National Vocational Qualification in Care at Level 2 is the recognised training for all care staff. We asked staff we spoke with if they had all done it and they confirmed that they had, but also said that two others are waiting to start the training. From the AQAA the manager had written: Almost all of our senior care staff both night and day have done or are doing their NVQ Level 2 training. One of our domestic staff has also done Level 2. However from the numbers given to us they showed that of nineteen staff eight actually have the qualification whilst eleven are working towards it. The manager went on to say Our staff are caring, understanding and sympathetic to the residents needs. They are also supportive to myself and the home. The staff work hard and well. We checked a sample of records of staff taken on to work at the home since the last inspection. All records were kept as required under regulation and checks had been done on peoples fitness to work at the home. These included Criminal Records Bureau checks, references, application forms showing employment histories and copies of signed induction records. All files we checked had photographs of each staff member. We followed up a requirement about staff training. This was to make sure all staff did essential training to keep people safe and protected. The manager had told us a training company had been appointed to make sure all staff had essential and relevant training. We saw copies of certificates for courses completed in individual staff files and a record of all sessions each staff member had attended. Courses included moving and handling, emergency aid and health and safety as well as safeguarding adults from abuse. Staff told us they had done some dementia care training although this wasnt seen in the records we looked at. We were later told that certificates for the Care Homes for Older People Page 25 of 35 Evidence: training had been received and are on staff files. They said they had also done infection control training. We asked staff about training in person-centred care. None of them had done it and were unsure about what it meant. We also asked staff if they were aware of the homes Statement of Purpose that sets out the aims,objectives and ethos of the home and how it should be run. Staff said they had seen the Statement but that it isnt regularly discussed in supervision. Care Homes for Older People Page 26 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of assertive, confident management and checking of quality doesnt show the home is run in the best interests of people living there. Peoples money is looked after well although balance checks should be tightened up to make sure they are protected from risk. Failure to give or receive supervision regularly doesnt make sure people are cared for by competent and confident staff. Failure to notify us of serious incidents that negatively affect people or carry out regular fire drills may not keep people protected from harm. Evidence: The manager Mrs Julie Jones, has worked at Somerset House for several years. She was formerly a member of care staff. She works closely with a deputy manager who also does care duties. One person had commented in our survey that: I know I can go Care Homes for Older People Page 27 of 35 Evidence: to Julie and she would deal with any complaint straight away there and then because thats what shes like. Mrs Jones has a qualification equivalent to NVQ Level 4 which is recommended for managers. She is therefore experienced in care management. We noted that staff when leaving messages for her in the book kept for the purpose were respectful and polite. We asked staff about management of the home. Comments included: We can go and see Julie at any time and discuss things and she listens and all staff find her approachable. However, staff went on to say that things arent always dealt with quickly. Overall staff views of the manager are that she lacks confidence and assertiveness and doesnt always challenge staff performance issues. Our findings also confirm that view. Mrs Jones was welcoming to us and open to the inspection. However, she did tell us she would like advice from us about different issues. We suggest that as registered manager of the home Mrs Jones should be confident about dealing with any issues, particularly if they relate to staff performance, person-centred care and good outcomes for people living at the home. We followed up a good practice recommendation about producing a quality assurance report to show how peoples comments are taken into the development and running of the service. We asked the manager about this. She told us that a survey is done to find out peoples views of living at the home. The completed surveys are then given to the registered provider to collate. This isnt independently analysed and no report is published for people and their relatives/representatives to see. However, the manager said any matters raised through the surveys are dealt with although we were unable to see evidence of this. We had also previously talked to the owner and registered provider, about her visits to the home to check for herself the quality of the service. We had asked in August 2008 for reports of her visits to be sent to us and had advised about the format to be used. None had been sent nor were any kept on file at the home. We asked staff if the provider visited the home. Staff confirmed that she pops in at least weekly, but doesnt speak in any depth with people living at the home or staff. We are concerned that the failure to: publish quality assurance reports, carry out and record provider visits, hold residents or staff meetings, record complaints and adopt good practice recommendations about care practice, doesnt make sure that the quality of peoples lives is treated as important or that the home is run in their best interests. We did a check of monies kept for people living at the home. The manager uses a Care Homes for Older People Page 28 of 35 Evidence: satisfactory system of dealing with it. We checked a sample of cash against balance sheets and all were correct. Receipts were attached and also reasons for staff taking money to buy things for people as they needed them. The manager said she does a complete balance check of all accounts kept, about seven or eight times a year. We recommend that she and one other staff member do this together and each sign to say its been done. This will protect both people living at the home and herself. We followed up a good practice recommendation from the last inspection about keeping supervision records up to date. It was disappointing to find this hadnt been adopted. We looked at records and spoke with staff. They said supervision doesnt happen often enough. From the sample of staff records we looked at, supervision is held at a maximum of four times a year (rather than six as recommended in the National Minimum Standards) but often only three sessions were recorded. No records of yearly reviews or appraisals were seen for any staff member, so that they can check their progress with training, care planning and what they need to improve on. The manager said that she finds it difficult to get staff to come in for supervision as they tell her they have nothing to say. We looked at fire safety records. Regular checks of the fire alarm, fire fighting equipment, emergency lighting and call bells etc are done and records kept. We looked at records of fire drills and saw that no drill had been held since March 2008. A fire risk assessment was in place that was detailed but didnt mention drills. The manager said at the last visit from the fire safety officer he had accepted discussion of fire safety in individual staff supervision sessions as adequate and drills need not be held. However as supervision isnt being done frequently enough and staff dont get opportunities to test out the procedure for keeping people safe, a full fire drill should be done twice yearly. We had previously discussed with the provider, notices staff have to send us that tell us about illness, injury, death, abuse or any event that has a negative outcome for people living at the home. We call them notifications. The provider had said that in her opinion this was due to the care and consideration given to people by her staff. We found when case-tracking however, that incidents had happened to people that we hadnt received notifications about. These included issues such as illness requiring hospitalization or GP contact and falls resulting in injury. In particular we were concerned to read about one incident that was life-threatening and extremely serious. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 A more person-centred and 07/09/2009 detailed method of assessing peoples needs must be put in place and used for people that fund their own care. Staff must sign care plans at the end of the assessment period confirming that the home can meet peoples needs. This will make sure that people are properly assessed so that the home is the right place for them and their needs will be met. 2 7 15 Care plans must be written 10/08/2009 in more detailed personcentred ways that show all needs to be met. Further, plans must be reviewed with the person concerned and/or their relatives/representatives at least once a year. This will make sure people Care Homes for Older People Page 31 of 35 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 have ownership of their plans that cover their wishes, needs, choices and dignity. 3 8 13 Risk assessments must be put in place where there are clearly identified risks to the health and safety of people living at the home. This will make sure people are kept protected from risk. 4 33 24 The registered provider 07/08/2009 must do regular visits to check quality care for people and keep records of the visits. These must be made available for inspection on request. This will make sure people are able to comment on the care they get, the overall quality of their lives at the home and be confident their views will be taken into account. 5 38 37 Notices about any incident 07/08/2009 adversely affecting people living at the home must be sent to the Commission in a timely manner. This will make sure we are kept informed of issues affecting the quality of care for people living at the home and we can be sure they are 10/08/2009 Care Homes for Older People Page 32 of 35 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 kept safe. 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 The manager and deputy should have training in personcentred care planning and cascade this to all care staff. This will make sure care plans are written from the perspective of the person they are about and all their needs and wishes will be included. Meetings with people living at the home should be started again and held regularly. Menus and issues of meal quality should be regularly discussed at meetings so that peoples wishes are fully taken into consideration. This will make sure peoples choices will be considered and met wherever possible. Any concern or complaint should be recorded with investigation, action taken, timescales and outcome. This will make sure people can be sure their concerns will be taken seriously and dealt with quickly. All care staff should have training in person-centred care. This will make sure people are cared for by staff that treat them as individuals with rights and choices and will respect their individual wishes and choices. Ways should be found to make sure peoples quality of life at the home is checked independently at least yearly. Results of surveys should be published and given to people, their relatives/representatives and be made available for inspection. An action plan should be made to show how any matters arising from the quality assurance survey report will be dealt with. A copy of the plan should be available for inspection or on request. This will make sure peoples views are acted upon and show the home is run in their best interests. 2 13 3 16 4 30 5 33 Care Homes for Older People Page 33 of 35 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 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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. 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