Inspection on 21/01/10 for St Winifreds

This inspection was carried out on 21st January 2010.

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

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

Other inspections for this house

St Winifreds 30/01/09

St Winifreds 11/01/07

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for older people Name: Address: St Winifreds 236 London Road Deal Kent CT14 9PP     The quality rating for this care home is:   one star adequate 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: Penny McMullan     Date: 2 1 0 1 2 0 1 0 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 33 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 33 Information about the care home Name of care home: Address: St Winifreds 236 London Road Deal Kent CT14 9PP 01304375758 01304370911 st.winifreds@nellsar.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Nellsar Ltd care home 59 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 59. The registered person may provide the following category/ies of service only: Care home only - (PC) 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 (OP) Dementia (DE). Date of last inspection Brief description of the care home St Winifreds is a large care home situated on the London Road in Deal. The property has been extended over a number of years to its current size, which provides accommodation for fifty nine service users. The home is located half a mile from the town centre of Deal and is on a local bus route. There is off street parking to the front and the side of the home. Accommodation comprises fifty one single and four double rooms, mainly situated on ground and first floors, with two rooms at second floor level. All areas are accessible Care Homes for Older People Page 4 of 33 3 0 0 1 2 0 0 9 59 0 Over 65 0 59 Brief description of the care home via the two shaft lifts, one at either end of the home. All bedrooms have a wash hand basin and a large proportion of the single bedrooms have en suite facilities. All rooms are provided with a telephone. The home has five lounge/dining areas and also a porch, which serves as an additional small sitting area. Kitchen facilities are provided for service users able to make themselves drinks and snacks. Service users also have the benefit of well maintained and accessible gardens in which to enjoy the sunshine and fresh air. The current fees for the service at the time of the visit range from £475 to £570. Information on the home`s services and the CQC reports for prospective service users should be detailed in the Statement of Purpose and Service User Guide. Care Homes for Older People Page 5 of 33 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: This key inspection was carried out over a period of time and concluded with a visit to the home on 21st January 2010, between 09.30am and 4.30pm. The last key inspection was carried out on 30th December 2008. This key unannounced inspection was brought forward due to the concerns raised through safeguarding issues. Two inspectors and an Expert by Experience completed this unannounced visit. The Expert by Experience is someone who has a special knowledge of the needs and issues, which are likely to be important to the people who live in the home. The Expert by Experience visited the people in both units in the home to discuss their daily lifestyle and views of the home. The first floor unit is for people with residential and dementia care needs and the ground floor is dedicated to people with dementia needs. The outcome of her findings is included throughout this report. Postal surveys were forwarded to the home to distribute to the people who use the Care Homes for Older People Page 6 of 33 service, staff and health care professionals. We sent ten surveys to the people who use the service, ten to the staff, fifteen to relatives and five to health care professionals. Eight surveys were received from the people who use the service, three from staff and four from social care professionals. The Registered Manager told us that she had sent out the fifteen surveys to the relatives, however none were returned to the Commission. Information from all of the surveys and any comments have been included in this report. The care of three people was tracked to help gain evidence as to what it is like to live in the home. A partial tour of the home was made and we also looked at care plans, risk assessments, training records, staff files, quality assurance and complaint records. Several members of staff were also involved in the inspection. The Annual Quality Assurance Assessment (AQAA) that was sent to us by the service was clear and comprehensive. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The home returned the Annual Quality Assurance Assessment (AQAA) within the required timescale. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: When asked what the home could do better the people living in the home told us the following: I would like to go out more. Stop the men from coming into your bedroom when you are asleep. A similar comment to the previous one was made in the quality assurance survey carried out by the home: I get fed up with other people coming in and out of my room we need to stop this. The Registered Manager told us that peoples movements are monitored and there are checks in place to minimise these incidents. We identified that some of the health needs identified at peoples assessments were not incorporated in to their plans. Some care plans have not been updated to reflect changing health and personal needs of people. This means that people may not be getting the appropriate and correct care and support. We looked at the staffing levels in the home and found that generally the levels are adequate. However we were told that, at times, one unit runs with only two care staff on duty in the afternoon. There are several people in the home who require more than one carer to support them and this level of staffing may result in their care needs not Care Homes for Older People Page 8 of 33 being fully met. The Registered Manager is aware of this shortfall and told us that she would review the staffing levels in the home. 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 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care needs assessments are in place to make sure that the home can meet the needs of the people before they decide to move into the home. There are no intermediate placements in this home. Evidence: We looked at the information provided to people before they decided to move into the home. Out of the six postal surveys received from the people who use the service, three said they did not receive sufficient information before moving into the home. We spoke to the people living at St Winifreds and they told us that they or their family were given information about the home before they moved in. The Statement of Purpose and Service User Guide are available in large print; however alternative formats such as using photographs to describe the home may benefit people who have dementia. There are also abbreviations used in the Care Homes for Older People Page 11 of 33 Evidence: Statement of Purpose for example there are two RMAs , this information needs to be clear so that people can understand what this means. RMA is a management qualification, and this means that two members of staff have achieved the Registered Managers Award. The home has a pre-admission assessment procedure. We looked at two assessments of the most recent people to move to the home and one of a person who has been at the home for some time. We saw that the registered manager visits prospective residents in their own home, in hospital, or in their existing placement to carry out a pre-admission assessment. This helps the service decide on whether they will be able to offer the person the support and care that they need. The registered manager told us they will not accept any resident unless they are confident that they can do this. The assessment looks at the prospective residents physical and mental health, personal care and social needs. It also looks at cultural and religious needs. The pre assessment tool is also supported by other assessments for nutrition, skin integrity and continence. Prospective residents and their families are involved in the process. Some of the assessments are done in conjunction with joint assessments done by care managers from the local social services team. There is also some information about peoples past lives and people that are important to them. Care Homes for Older People Page 12 of 33 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. People can be sure that their personal care needs are met but they cannot be sure all their health care needs will be identified and consistently monitored and met. People are treated with respect and dignity. People can be sure they will receive their medication safely and on time. Evidence: Each person at the home has a care plan. We looked at three of these in detail and at specific things in another three plans. Some plans were done to better standard than others. We found that plans did not follow through all the areas of need and support that had been identified during the assessment. Parts of the plans relating to personal care people do not tell staff about the support and care people need and who needs to do what and why. They did reflect what people can do for themselves and how the staff were to offer people choices about what they wear and how they want to be supported with their personal care. For Care Homes for Older People Page 13 of 33 Evidence: example they explained that a person could wash and get dressed independently but needed some direction and prompting from the staff to achieve this. One of plans said that a person, Is unable to anything for themselves because of their dementia, but then went on to give guidance to the staff about what the person could do and the support that was needed to achieve this as independently as possible. The person was encouraged to choose their own clothes and assist with washing. We did find shortfalls in meeting peoples health needs. Some of these were regarding health conditions people had before they came in to the home which were identified when they were assessed. We have made a requirement in the report (with time scales) about this and have asked the service to tell us how they are going to make sure this improves. We will re-visit the home to do compliance visit to make sure this requirement has been met. We did find that there was minimum information about how to support people with confusion and memory loss and how these needs are being supported and monitored for deterioration or improvement. We found that three of the plans identified people as being verbally aggressive and resistive to certain interventions. One of assessments said a person could be resistive when in a hoist but there was no direction or guidance in the care plan to tell staff how to best manage the situation in a consistent way that would best meet the needs of the person while keeping them as safe as possible. Some people had been prescribed medication for behaviours but there was no record in place to say that this was monitored and whether it was effective or not. We found that one person had diabetes and this was recognised when they were assessed but there was nothing in their care plan as to explain how this is managed. There was no guidance in place for staff to recognise if the persons blood sugars were too high or too low and the action the staff needed to take. This was made more concerning as the staff we spoke to had not received training in diabetes. Staff did know that the person had diabetes and that the district nurse visited to take their blood sugars and administer their insulin. They said if they were concerned they would contact the doctors surgery. We found mixed practice supporting personal and health care, and some areas of concern, described as follows, need to be improvement. Where a persons eating support needs had changed, the care plan did not reflect how to maintain the independence that was preserved. Recording was absent in respect of feedback following specialist, doctor or district nurse visits. In some instances, the advice given, for example, to maintain skin integrity a bathing regime was required, this had not been put in place. The care plans did not document the support being provided by the Care Homes for Older People Page 14 of 33 Evidence: District Nurse, such as leg ulcer dressings and how staff should support the individual. Eating and drinking records have been kept, but the individuals particular requirements have not been updated in the care plan to reflect their changing needs. We did see some good practise where people had use of airflow mattresses and cushions to help prevent pressure areas, and that where prescribed, creams were being applied. In some cases, these had been risk assessed, and there was evidence of assessment to prevent pressure ulcers forming. We found that peoples weight is closely monitored and if they are losing weight or not eating very well they get advise from doctors, nurses and the dietician There is also more in depth information kept about what they were eating and drinking but their care plan and risk assessments did not contain this information or had not been updated to reflect the changes. Some people had special mattresses on their beds and they were sat on cushions that help prevent the skin from breaking down. Some people had cream applied to their pressure areas. There was some information about this in the care plans and people had risk assessments if they were at risk of developing pressure areas. We found that in one area of the home care plans were not kept with the daily records this means that staff are not using them as a working tool and are not referring back to them to make sure people are receiving all the care that they need. Staff keep a daily record of what people do during the day. Some of these were individualised and gave information about how people spend their time, others were task orientated and not individualised. We looked at medication procedures in the home. Medication is stored in trolleys and locked cupboards. We found that drugs are kept securely and safely in each unit. One of the temperatures in one cupboard was consistently on or over the recommended temperature for storing medication. The registered manager said she would address this. A lot of the peoples medication is given by using blister packs which are made up at the pharmacy. This system reduces the risks of errors when giving out medication. All staff who administer medication have received training. We saw no evidence to show that their competencies are checked at regular intervals. We found on the day of the inspection one person had tablets missing from the blister pack that could not be accounted for. This meant staff could not trail if the person had received the medication or not. The manager told us she would investigate this to find out what had happened. Care Homes for Older People Page 15 of 33 Evidence: We found that all the remaining medication records we looked at indicated that people are receiving their medication safely and on time. Records for the administration of routine medication are well maintained. We did find that there was guidance and direction for staff on when to give medication on when required basis. This means that people can be sure they will receive their medication when they need it and they can be sure they will not be given extra medication. It also means the staff will be consistent in giving the medication. We did observe that when supplement drinks are given to people, staff make sure they are taken or record if they are not and why. This means people are receiving the nutrition they need to keep them as healthy as possible. We were concerned to find the pages of a controlled drugs book had been ripped out and filed somewhere else. We were told that this was because the staff wanted to use the book for a new batch of medication. The controlled drugs book is a legal document and should be kept intact at all times. Through observation and from talking to the residents and staff there was evidence to show that privacy and dignity is up-held. People were called by their preferred name and staff were observed knocking on peoples bedroom doors before they entered. Staff explained to people when they were going to give support and the reason why. We saw that people are well dressed in clothing appropriate for the season and appeared well kept. Some staff were observed assisting the residents in a caring and supportive manner and were seen treating them with respect and understanding. We spoke to residents and their relatives and they confirmed that all the staff are very good and kind. One relative said, They manage and look after my husband very well and that can be difficult at times. I feel confident that he is getting everything he needs. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported to make some choices about their lifestyle. The improvements being made to the activity programme will give all of the people the opportunity to participate in appropriate social activities of their choice. People enjoy the food and have a varied diet. Evidence: There were no activities being provided at the time of the visit due to the activities coordinator receiving training. The Expert by Experience talked to the people, relatives and staff in the home to find out what daily life was like in the home. Her findings are as follows: In the first floor lounge there were examples of arts and crafts which were attractive to look at and several residents pointed out there own particular work of which they were proud. There is an Activity Co-ordinator who uses the first floor lounge for activities. People Care Homes for Older People Page 17 of 33 Evidence: on the ground floor are encouraged to participate but most are reluctant to leave their own area. This has been considered and an Activities Co-ordinator has been appointed to post on 1st February. I spoke with the current co-ordinator who told me that the idea is for them to work together and support more integration of the two floors. There was not a copy of the activity list available to see but I was told that fortnightly sessions of a visiting musician took place, exercise with ball and quoits, bingo, reminiscence and arts and crafts took place. A hairdresser visited weekly and those residents who wanted to could be taken out. There was no indication throughout the home of activities on offer but I was told that co-ordinator talks to the residents daily and tells them what will take place that day. From observing her over a very short period it is apparent that residents have a good rapport with her and recognise that she has organised an activity for them. Activities take place afternoons only but can and do include Sundays. I spoke to a person who was taken weekly to a sculpture class which she spoke to me about very enthusiastically. There were many examples of artwork for me to see and the co-ordinator was full of ideas for extending this. She told me that within a reasonable budget she had no problems with financing this and was actively encouraged to come up with ideas by management. I spoke to some residents who told me they were taken out for a drive or to the shops by relatives on a regular basis. A relative told me she took her mother out weekly. I also spoke to another family member who told me her relative had recently moved in the home and had settled well and liked the staff. She also told me the staff were very kind and nothing was too much trouble. A church service is provided for people with different denominations. A member of staff told me that one service takes place in the lounge while others preferred to visit the people on a one to one basis carried out in the privacy of the individuals room. Residents and staff meetings occurred regularly and points of view were listened to and acted upon. A relative comments: Yes they do have activities, last year they even went to the local pantomime. Both floors had several lounges and areas set aside for dining. They were clean and tidy with some pictures on the walls and the lounge and dining area on the first floor Care Homes for Older People Page 18 of 33 Evidence: had bowls of fresh fruit in several areas for residents to take. The fruit was fresh and appetising and I observed three residents make use of this facility. Drinks were offered to residents, visitors and myself during my visit. Residents do not have keys to their rooms but are able to shut their doors if they wish. These can also be closed from the inside but opened with what looks like an Allan key by staff from the outside. Those residents who do wander are observed and encouraged to move around rather than go into rooms. I observed staff being aware of the movement of residents. Two residents did return to their rooms for a rest during my visit on the first floor. There were three dining tables on the first floor where residents did sit for lunch, which was served from a large heated trolley. However on the ground floor residents sat in the seat they had occupied during my visit with individual movable tables. Some residents ate in their rooms which I was told was their choice. I spoke to the cook and saw a four week menu plan which was also on notice boards on both floors. The menu was varied throughout the weeks and although no choice of main meal or dessert was offered, I was told that if something was refused an alternative would be offered. There was a list of individuals dislikes and I observed that portions were of a size suitable for the individuals appetite. A cake had been baked for that afternoons tea and I was given to understand that cakes were made every day. The introduction of a Food Book has proved effective for staff in that they record if an individual has had a poor appetite and if they have refused what was on offer. This is available for all staff to use and see and has cut down on administration time. A carer told me it gives me more time to chat to residents. Lunch was hot with reasonable sized portions taking into account individuals appetites. In the dining area on the first floor all residents sat at a table which encouraged social contact. On the ground floor lunch arrived in a hot cabinet, but with inadequate hot dinner plates. Cold plates were found but the lunch itself remained hot whilst being served. Most residents ate at their own individual table, which did not encourage either mobility or social contact. Support and assistance was offered where necessary. Staff were kind and attentive and spoke to all residents as individuals. The Expert by Experience completed her visit and left the home after lunch. Care Homes for Older People Page 19 of 33 Evidence: Each unit has a small kitchenette, with a kettle and microwave so that the people or staff in the home have facilities to make snacks or tea and coffee. People were seen moving around the home and choosing where to go and where to sit. On arrival there was a person entering someone elses bedroom. Although staff was asking him to come out of the room, they did not manage to do this and left him there. Improvements are required to make sure that peoples privacy is protected at all times. Care Homes for Older People Page 20 of 33 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. Improvements are required to make sure that people are aware and supported to raise any concerns or complaints. Staff are not fully aware of the prcoedures for dealing with safeguarding issues. Evidence: Two out of the six surveys received from the people who use the service indicate that they do not know how to complain. The complaints procedure is briefly mentioned in the Statement of Purpose and suggests to people to follow the company complaints procedure, which can be found in the Service User Guide or on display around the home. People living in the home, relatives or visitors do not have clear information of how to complain. Improvements are also required to make sure that people with dementia are supported to complain or have their views heard. There have been three complaints since the last inspection and manager was able to show us that these had been dealt with using their complaints procedure. There have been five safeguarding alerts raised since the last inspection. The home raised two alerts and the other three were raised by the Commission after receiving anonymous complaints from some of the staff. The home is working closely with Social Services and investigating the issues. The safeguarding alert at the home remains open. This means that social services are still monitoring the progress being made to Care Homes for Older People Page 21 of 33 Evidence: make sure people living at the home are safe. The majority of staff have received safeguarding training, however not all staff are aware of what the process is for referring safeguarding concerns. The Operations Director told us that all staff will receive additional training to make sure they are clear of what they should do if they have any concerns. The home already has one member of staff who is qualified to provide safeguarding training and it is their intention to train two other senior members of staff to this level. Care Homes for Older People Page 22 of 33 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 are living in a home which is homely, comfortable and generally clean. Evidence: The building provides a suitable range of facilities for the people who live there. The home employs a maintenance person to make sure that routine maintenance is carried out in the home. The home is currently working towards the shortfalls identified in the recent fire officer visit. They have already replaced twenty six bedroom doors and have purchased some fire door guards so that doors can be left open when required but still close should the fire alarm ring. It was noticed that the kitchen door on the first floor was being propped open by a waste bin. The Registered Manager told us that this door was on the list to be fitted with the new device. The local Fire and Rescue Service visited the home in November last year and they are working to a schedule to improve fire safety. The fire escape is also being replaced. The Fire Office will revisit the home in May to make sure the required action has been taken. The Expert by Experience visited some people who preferred to stay in their rooms. The rooms were clean and bright and had personal effects such as ornaments and photographs in them. Staff visited these rooms and spoke to the people during the visit. Cleaners knocked on doors before entering and also spoke to the people in a cheerful and kindly manner. Care Homes for Older People Page 23 of 33 Evidence: The home has purchased a new tumble drier which is waiting to be installed in the laundry room. The floor in the laundry requires attention to make sure that it is water resistant. There are no hand washing facilities in the laundry room however there is a sluice room near by. There are systems in place to reduce the risk of infection, including the safe handling of clinical waste. In general the people have the necessary aids and equipment to assist them in maximising their abilities and improving their comfort and health. However not all of the people had pressure relieving cushions in their armchairs in the lounge. Overall the home was clean, however there was an odour on the first floor corridor near the lounge. The Registered Manager told us that the domestics clean the carpets as and when any spillage occurs. Carpets have been replaced in two bedrooms and the home is hoping to replace all non impervious carpets throughout the home. Care Homes for Older People Page 24 of 33 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. The people who use the service can not be sure that their care needs will be fully met at all times. People are receiving care from trained staff and they are protected by the recruitment policies and procedures of the home. Evidence: At the time of the site visit the staffing levels were adequate to meet the needs of the people living in the home. There are seven staff vacancies. The home is currently advertising for a Deputy Manager, two senior night staff and care staff to cover in times of sickness and annual leave. The Registered Manager and Deputy were on duty at the time of the visit. The Deputy Manager was attending the training being held in the residents lounge. The cook, kitchen domestic, four other domestic staff and a laundry person were also duty. Currently there is one part time activity co-ordinator and in February there will be an additional activity co-ordinator to specifically cover the dementia unit. A part time maintenance person and gardener are also employed. Each unit in the home has one senior and two carers on duty during the day and there is five staff on duty during the night. Staff told us that, at times, the unit on the first floor manage with two members of staff on duty in the afternoons. The Registered Manager is aware of this shortfall. To make sure that there is enough staff on duty to meet the peoples needs, including Care Homes for Older People Page 25 of 33 Evidence: eighteen people living in the home who require more than one carer, a review of staffing levels is required. The Registered Manager told us that she is actively recruiting staff to address these shortfalls and is using agency staff to cover some night duties. At the time of the site visit training was taking place in the residents lounge in the dementia unit. Two members of the staff attending the training were also part of the rota to cover the care needs of the people living in the home. They had not been replaced on the rota. When the inspection started the Registered Manager arranged for an additional carer to come in early to cover for this shortfall. Although there is another area where people can sit, the people who live in the home are being restricted from using the lounge and not replacing rostered staff will result in their care needs not being fully met. As the Registered Manager is taking action to address these issues and agreed that no further training will take place in the lounge, we will not be making a requirement in this report. However we will revisit the home to make sure the requirements made in this report are met and staffing levels will be monitored at that time. Comments from the people who completed a quality assurance survey in November 2009 are as follows: Staff are not always around due to being busy. I am not happy as the home needs to improve, they need to stop night staff running along corridors in the early hours of the morning. The training records show that more than half of the staff have completed a relevant National Vocational Qualification (NVQ). Therefore this standard has been exceeded. Included in this number is seven members of staff who have NVQ in dementia care and two staff are in the process of completing the award. Staff files show that full checks are made prior to employment for all new recruits. This includes full and complete application forms, Criminal Record Checks (CRB), proof of identity and satisfactory written references. This makes sure that staff have been checked and are safe to provide care to the people living in the home. There were no recent staff photographs on file. The Registered Manager told us that this would be addressed as soon as possible. There is a full training programme in place and the majority of staff have received core training for example, health and safety, infection control, first aid awareness, food hygiene, fire and moving and handling. There is an in depth dementia training programme in place and other specialist training has also been provided, such as food Care Homes for Older People Page 26 of 33 Evidence: and malnutrition, activity and reminiscing, and communication and challenging behaviour. All staff have received Mental Capacity training and senior staff have completed a Deprivation of Liberty Training course. There are some people living in the home who have diabetes and the staff would benefit from receiving training in this subject. A revised induction training programme has been introduced and there is evidence that this is taking place. Care Homes for Older People Page 27 of 33 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. Improvements are required in the effective management of the home, including the quality assurance programme, to make sure the home is run in the best interests of the people who live there. Staff are not receiving regular supervision to make sure they are supported to do their job well. Peoples finances are protected and the health and safety of the people living in the home and staff is promoted and protected. Evidence: The Registered Manager has worked in the home for over fifteen years and is qualified and experienced. She has completed the Registered Managers Award and NVQ 4 in Care. Since the last inspection there has been a number of safeguarding issues which has resulted in the home working to an action plan provided by Social Services. Although some improvements have been made, there is still a lot of work to do to make sure the improvements continue and are then sustained. Following the concerns raised in the safeguarding alerts, we asked the Registered Provider to carry out an Care Homes for Older People Page 28 of 33 Evidence: investigation which is currently being completed. This will make sure that the home is being effectively managed and in the best interests of the people who live there. As part of the monitoring of the service the Quality Assurance Manager is carrying out weekly audits to make sure the home is continuing to improve the service. Some staff spoke positively of the manager saying that she works really hard, however others said that they did not always feel supported, as the manager and deputy rarely come out of the office to assist with care if they are running short staffed. Staff also confirmed that a recent staff meeting had been held and staffing levels were discussed at that time. A person living in the home comments: The staff are friendly and happy to help me when I need it. I am happy with how the home is run. The home has undertaken an annual quality assurance survey which was sent to people who live in the home and health care professionals in November 2009. Relatives were not included at this time. Staff supported the people who live in the home to complete the surveys. The results of the survey have not been summarised and there is no evidence to confirm what, if any action, was taken as a result of the comments made. Improvements are therefore required to make sure that the people living in the home, their relatives, visitors and health care professionals are included in the survey. The results of the survey are not made available to the people to make sure they are confident that their views are taken into account in the daily running of the home. The Registered Manager told us that the organisation is working on new surveys to send out to all of the people living and involved in the home. This will support and improve the quality assurance programme to highlight what the home could do better. Peoples financial interests are protected. The relatives of the people living in the home deal with their finances. The service continues to provide the staff with core and induction training. Information in the AQAA told us that all the relevant checks and inspection of equipment have been undertaken. The fire book was in good order with appropriate drills and tests in place. The Accident Book was in good order; however previous completed accident forms are not being filed in individual personal files and remain in the Accident Book. The Registered Manager told us that this would be addressed to make sure this confidential information is stored correctly. Care Homes for Older People Page 29 of 33 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 33 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 8 12 All health care needs of the 27/04/2010 residents must be identified, documented, support action agreed and those needs must be monitored closely for improvement or deterioration. To ensure that proper provision is made to meet the health and welfare needs of the residents. Regulation 12 of the Care Homes Regulations 2001 requires you promote and make proper provision for the health and welfare of service users. Failure to comply with this regulation is an offence. Care Homes for Older People Page 31 of 33 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 32 of 33 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). 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. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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